Affluent Seniors Drive Home Care Market

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Gerie Cote of Manchester turned 95 last week.

On most days, she sits by a window in the home that her father built in 1912.

She raised her two children there.

Cote likes to listen to classical music.

And she loves to solve word puzzles.
But jokes about having to use a magnifying glass.

She feels lucky that she receives good care and can live in her own home.

But she says that being old is just plain frustrating.

“That’s what I say. I’m a fortunate old lady and I’m very dissatisfied with myself. Well, I can’t walk. I can’t see. What else?”

Cote uses a walker to get around.

Her television, radio, and drawer filled with CDs and puzzle books are all within reach from that chair by the window.

Cote’s personal caregiver, Sherry Ricard, stops by to help her with daily tasks.

And Cote’s eyes brighten when Ricard arrives to take her to a medical appointment.

AMBI of Ricard arriving

“She picks up and keeps the house in good condition. She talks to me and not afraid to say what she things. And that’s a big help.”
“I don’t know where she comes from. Sent from Heaven. Ha ha ha.”

Ambi with two talking about the word puzzle

Cote was a nurse. Her late husband was a dentist.

And they traveled the world together.

“Went to Spain Paris London and Hawaii couple times. We went to Alaska. That was our life and it was very pleasant. We traveled a lot. ”
Cote rents out a small apartment in her home to another senior.

That helps pay for Ricard, who works for Home Instead – one of the largest companies in the non-medical home healthcare industry.

Home Instead makes over $350 million a year in revenue. The company has spun off over 700 franchise operations in a decade.
Three of those found home in New Hampshire within the last year.

And over 30 competing companies and franchises have established themselves in the state since 2005.

It’s a booming industry valued at over $1.9 billion for the top nine companies in the nation.

And franchise expansion rates for some have been as high as 145%.

Susan Young is the executive director of the Home Care Association of New Hampshire.

She says that such industry growth is a good thing – for some.

“That is some good news…It looks like there will be availability of services for people who can pay.”

But Young warns that there is a labor shortage in the industry – and also a lack of funding for home care services for lower-income seniors.

Attracting and keeping quality staff is a nationwide challenge in the industry.

But the problems are bigger for some of the non-profit agencies that have traditionally served seniors who rely on Medicaid.

Young says that when costs rise, the for-profits are better positioned to handle it.

“They can raise prices if they have to raise wages to attract and keep good workers and they can pass that on to their customers.”

Rochester’s Your VNA is one of those non-profit agencies.

Your VNA has been providing home-based personal and medical care since 1913.

It was one of the original Visiting Nurse agencies.

Like Home Instead, Your VNA provides unskilled caregivers.

But it can also send skilled nurses and other medical staff to client’s homes.
So labor costs are higher.

And it’s been losing money on clients who rely on the state’s Medicaid program.

Julie Reynolds is clinical director at Your VNA.

She said her agency had to drop some clients that rely on the state.

“At this point we had to transition 40 patients to other agencies. They are able to provide the service less expensively than we can because we do provide skilled care and we are a medical model and some others are a social model.”

Reynolds adds that her agency also provides the staff with health insurance and competitive pay.

She says they lost hundreds of thousands of dollars a year on the Medicaid-funded patients before closing the door on them.

“Medicaid and HCBC, the home and community based care, only pay 50 cents on the dollar to take care of those patients. So we received not enough revenue to provide the care.”

One of the seniors dropped from Your VNA’s roster is 76-year-old Flora Nadeau.

Nadeau lives in a mobile home park in Rochester.

“I’m here because my son offered me to come live with him cuz I had to sell my house and couldn’t afford it on social security. “You have to pay your mortgage. The taxes were high the mortgage was high and the oil and food and then each one of the kids got married and the foster kids got married.”

Nadeau raised four foster children and four of her own.

She can’t walk.
And last summer, she lost use of both arms temporarily.

That’s when Your VNA dispatched nurses to her home.

“When the visiting nurses came they were very good and I liked the homemakers we got along good and I got the woman who helps me with the shower she was very good and when they told me they were going to stop, I had a hole in my stomach.”

Crotched Mountain Community Care became Nadeau’s case manager after Your VNA let her go.

It can be a challenge to find new services for Medicaid clients, say Crotched staff.

Some firms are willing to take the Medicaid clients – but they don’t always have staff to send out.

And if a client lives in a remote area – it’s even harder because caregivers are often paid only for the hours spent in the home.

Not for travel time.

Nadeau admits that she didn’t feel comfortable at first with the new services, but she’s happy now.

“They’re friendly. We laugh a lot. We joke a lot. And they make me feel good.”

Robert Butler, a professor of geriatrics at Mount Sinai School of Medicine in New York, established the International Longevity Center.

His organization is working to establish professional standards for non-medical caregivers.

“We know there is a terrific turnover rate. Very hard to retain even the best of the paid caregivers because frequently they can make as much money flipping hamburgers as they can for the arduous work of lifting patients and being very responsible for patients with respect to handling medications and so forth. It’s not an easy job. And home health aids are really not well taken care of. They have no health benefits themselves. The agency, including the nonprofit agencies, may get $19 or $20 an hour and the aid will get $7, $8 or $9 an hour.”

But Nadeau and Cote say they couldn’t do without those caregivers.

And Young, from the Homecare Association, warns that seniors in Nadeau’s position are vulnerable to losing their services.

She says that it appears the state may agree to reimburse providers at rates based on real cost data – which is required under state law.

But she warns that the agreement will be meaningless unless the governor’s budget includes enough funding to do so.

For NHPR News, I’m Dianne Finch