Home healthcare system is in crisis

Feb 2011
16,908
6,050
Boise, ID
#11
Agreed except I don't see unions as a problem. Nurses generally want as many aides as they can get so they don't have to do personal care or housekeeping. Many of them don't treat the aides as peers, but that's not because of the union, it's just a snob thing.

Compared to nursing homes or hospitals, home health is a bargain. And by and large it's a better situation to have part time home health care for the elderly in coordination with families than a choice of one or the other. Having an aide come in for a short time daily or even once or twice a week gives the family a break and the client too. If the only option were for families to provide the care entirely on their own, they would opt for a nursing home. Sometimes just having part time help allows someone to stay at home rather than an institution.

Those who would see the workforce as skilled and unskilled, trained or untrained and pay them accordingly shouldn't be in charge of deciding what caregivers and aides are paid because we do the most work, put up with the most difficult behaviors imaginable and are constantly treated as disposable and lazy by the administrative end of the healthcare industrial complex.

We should be paid better. We're worth it.
Everyone thinks they should be paid more.

I'm not trying to single out unions as a problem in this particular case, or any other interest group as a problem while excluding any other. Whether unions were involved or not, every provider (and their representatives, if applicable) generally have the opposite incentives concerning cost of necessary care (whether per service unit or overall) as virtually every other party to this equation, which wants to keep the necessary care and assistance as affordable as possible (considering there is a huge wave of dying baby boomers crashing toward us). The patient population and their families want ample and exceptional care as long as they're not paying for it. The provider population wants the maximum amount of payment for their services possible.

The recipients themselves often either have plenty of wealth to afford as much of their own care as they could possibly ever need, or they have nowhere near enough to afford their own care. But we don't have a good way to aggressively tax senior wealth (and most of society's wealth is held as assets of a small fraction of senior citizens), and so we therefore just act as though the entire elderly population should be excused from having to pay significantly for their own retirement and end-of-life needs, and thus the burden defaults to the working age population.
 

Blueneck

Former Staff
Jun 2007
55,137
42,572
Ohio
#12
Everyone thinks they should be paid more.

I'm not trying to single out unions as a problem in this particular case, or any other interest group as a problem while excluding any other. Whether unions were involved or not, every provider (and their representatives, if applicable) generally have the opposite incentives concerning cost of necessary care (whether per service unit or overall) as virtually every other party to this equation, which wants to keep the necessary care and assistance as affordable as possible (considering there is a huge wave of dying baby boomers crashing toward us). The patient population and their families want ample and exceptional care as long as they're not paying for it. The provider population wants the maximum amount of payment for their services possible.

The recipients themselves often either have plenty of wealth to afford as much of their own care as they could possibly ever need, or they have nowhere near enough to afford their own care. But we don't have a good way to aggressively tax senior wealth (and most of society's wealth is held as assets of a small fraction of senior citizens), and so we therefore just act as though the entire elderly population should be excused from having to pay significantly for their own retirement and end-of-life needs, and thus the burden defaults to the working age population.
Isn't an economic rule that when labor is in short supply employers have to pay higher wages in order to secure workers? Isn't that the whole theory that concludes that wages will rise if illegal immigrants are kept out of the country and out of the workforce? Americans will go out and pick tomatoes if the money's good enough, right?
 
Jul 2013
40,382
26,474
On a happy trail
#13
Everyone thinks they should be paid more.

I'm not trying to single out unions as a problem in this particular case, or any other interest group as a problem while excluding any other. Whether unions were involved or not, every provider (and their representatives, if applicable) generally have the opposite incentives concerning cost of necessary care (whether per service unit or overall) as virtually every other party to this equation, which wants to keep the necessary care and assistance as affordable as possible (considering there is a huge wave of dying baby boomers crashing toward us). The patient population and their families want ample and exceptional care as long as they're not paying for it. The provider population wants the maximum amount of payment for their services possible.

The recipients themselves often either have plenty of wealth to afford as much of their own care as they could possibly ever need, or they have nowhere near enough to afford their own care. But we don't have a good way to aggressively tax senior wealth (and most of society's wealth is held as assets of a small fraction of senior citizens), and so we therefore just act as though the entire elderly population should be excused from having to pay significantly for their own retirement and end-of-life needs, and thus the burden defaults to the working age population.
Every businessperson thinks they should be able to charge more.
 
Mar 2012
57,981
39,546
New Hampshire
#15
Isn't an economic rule that when labor is in short supply employers have to pay higher wages in order to secure workers? Isn't that the whole theory that concludes that wages will rise if illegal immigrants are kept out of the country and out of the workforce? Americans will go out and pick tomatoes if the money's good enough, right?
I never thought that always applied unilaterally. Sure if the company is decent, they will pay more. But not always. Also there are some jobs that people dont always want to do. Although my son picked berries/apples in high school because the pay was 12 bucks an hour and he got to be outside all summer. However, I know first year teachers making $15 an hour who are pissed as hell that their contracts cant be renegotiated for 5 more years and they are making what McDonalds is paying now. Lifting tide doesnt lift all boats if the boat has a hole in it. We have massive structural economic issues that arent being looked at.
 
Feb 2010
34,667
24,618
between Moon and NYC
#16
Part of the problem is they're making it harder for independents. I could never work for an agency, they take almost half your money, offer no benefits quite often bounce you around from client to client to fill their needs, and it's really important as a caregiver to establish a relationship with the client (and their families) that includes trust and understanding what their priorities are.

For the last few years I'm seeing more and more the regulating agencies involved in hiring independent caregivers requiring redundant paperwork and proof that we're not billing for hours we didn't work, etc. More often than not I stay over what I bill for because of unexpected conversations so in my case at least, they're getting more than their money's worth.

But what I see a lot of also is caregivers who are older and suffering a lot of physical problems of their own. Like me, although with my new hip I should be able to do everything I did before and more with much less pain than I had before.

It's not any easy job for a million reasons, but it's better in a lot of ways than working at Walmart. I think a lot more people would be willing to do this work if it were treated as a more important service. Many see home health providers as personal servants, show them little respect or gratitude. That attitude really needs to be adjusted badly.
Spent a number of years overseeing home health care services for my mother. Agency was Integrity who provided us with good overall service. But the company did charge $20/per hour while only paying the attending caregiver $10/$11 dollars/hour.

For the last couple of years she needed someone with her 24 hours/day 7 days a week......and we experienced a wide spectrum of talent/compassion among the caregivers. Most were somewhere between good and wonderful (it is not a glamorous set of duties). While a subset were more to the lazy/couch potato end of the scale.

Agree that most of them were underpaid. But most of them did enjoy the flexibility and caring elements of the work. As noted above, some of the tasks are unpleasant and it does take a special soul to provide care for the elderly/infirm.







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Likes: Blueneck