Home healthcare industry experiencing rapid growth

Baby boom generation wants to stay in home

Adam Wesley/The Gazette

Wilda Ralston (left) shows Rose Hesford what needs to be cleaned in her apartment in Cedar Rapi
Adam Wesley/The Gazette Wilda Ralston (left) shows Rose Hesford what needs to be cleaned in her apartment in Cedar Rapids. Hesford works for Right at Home, a Cedar Rapids company providing in-home services for seniors are capable of living at home but require assistance for certain specific tasks, such as cleaning.

Until trigeminal neuralgia from a bout of shingles cost her strength in her right side, Wilda Ralston was fairly self-sufficient in her Cedar Rapids apartment,

When Ralston, 78, needs assistance getting to the grocery store, pharmacy or doctor’s office, she turns to Therapy Solutions of Cedar Rapids, which provides her a caregiver three times a week.

For other tasks, such as washing her apartment’s windows and Venetian blinds, Ralston called Right at Home, a Cedar Rapids in-home senior care agency that provides non-medical homemaking, hygiene and physical assistance as well as companionship.

“I can’t run my vacuum cleaner and I can’t get down to clean my bathroom or kitchen floor,” Ralston said. “When I take a shower, I can get real dizzy. I have to have somebody there to make sure I don’t fall and hurt myself.”

With 10,000 baby boomers turning age 65 every day, according to the U.S. Census Bureau, Ralston is typical of today’s seniors who want to continue living in their homes rather than moving to assisted living facilities or nursing homes.

The number of seniors who own their own home is over 81 percent, compared with 68 percent for the rest of the population. Seniors typically live with either their spouse or alone as the era of living with extended family has pretty much disappeared in much of the nation.

The number of Americans requiring help with daily living at home is expected to more than double from the current 12 million to 27 million by 2050. The U.S. Bureau of Labor Statistics has projected job growth of 70 percent by 2020 for home health and personal care aides, compared with a growth rate of 14 percent for the U.S. job market at large.

There were more than 17,000 providers of home health care to 7.6 million people. Home care services fall into two categories — skilled home health care and non-medical home care.

Home health care is provided by licensed medical professionals, such as registered nurses, social workers and therapists. Non-medical home care, such as personal care, homemaker or companionship services, is provided by professional caregivers.

“When Home Instead Senior Care was started 20 years ago in Omaha, there was nothing like it. The only thing available was a registered nurse for in-home care,” said Karen Huber, owner of the Home Instead franchise in Cedar Rapids.

“We have clients who say ‘I will never go into a nursing home.’ They have prepared financially to pay for in-home care until the end of their life.”

Home Instead Senior Care is an example of the burgeoning growth of senior in-home care. The company has more than 900 franchise offices in the United States and Canada, as well as in Ireland, the United Kingdom, Portugal, Switzerland and Japan, Among other countries.

Home health care and non-medical home care providers charge by the hour, whereas assisted-living facilities and nursing homes typically charge by the day or month. Depending on how many hours are needed per week, home health care and non-medical home care usually are cost effective alternatives to assisted living or nursing home care.

Seniors who have relatives able to assist them, such as Mimi Satterly of Cedar Rapids, receive additional help from home care agencies. A Home Instead caregiver visits Satterly, 101, three times each week for two hours to help her with breakfast preparation, exercises and other daily tasks.

Designed for nursing home care

Medicare has been the largest single source of revenue to pay for in home health care services, accounting for 37 percent of the total. The rest is private long-term care insurance and out of pocket costs (22 percent), Medicaid (19 percent) and local governments (20 percent).

While some seniors have purchased long-term care insurance to pay for home care, policies vary in terms of what they cover and how long. Some policies written in the early days of the industry were primarily designed for nursing home care.

Medicare will pay for skilled nursing services and home health services provided up to seven days a week for no more than eight hours per day and 28 hours per week. Medicare pays in full for certain medical supplies provided by the Medicare-certified home health agency, such as wound dressings and catheters needed for care.

Medicare also pays 80 percent of its approved amount for certain pieces of medical equipment, such as a wheelchair or walker. The remaining 20 percent is the co-payment that must be paid by the consumer.

Medicaid pays for certain services under Home and Community-Based Services waiver programs, but only if providers are certified by Medicaid.

“Our clients are primarily private pay, but we are in the process of being certified for Medicaid payment,” said Renee Riffey, owner of Right at Home Cedar Rapids,

The relatively new local franchise is backed by Omaha-based Right at Home with 19 years of experience and 300 locations in the United States, Canada, Brazil, China, Ireland and the United Kingdom.

The Department of Veterans Affairs reimburses U.S. armed service veterans on a case-by-case basis. Huber said some veterans who did not serve on active duty outside the United States fail to realize that they qualify for home care benefits.

Comfort Care in Cedar Rapids has about 265 employees providing skilled home health care and non-medical home care in 21 Eastern Iowa counties. The agency is certified by Medicare and its home health care providers are certified.

Julie Knake Tow, a registered nurse who founded the locally owned and operated Comfort Care in 1996, said UnityPoint Health-St. Luke’s Hospital, Mercy Medical Center and another agency offered skilled home health care at that time. Tow said the need for home care assistance after hospitalization has become a major concern.

“The Centers for Medicare and Medicare, the VA, hospitals and doctors want patients to have assistance when they go home from the hospital,” Tow said. “It’s a lot less expensive for all of us when they don’t have to be readmitted.”

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