Elder care referral agencies are in the news again. Due in part to the Seattle Times exposé “The Bed Brokers” as part of the paper’s “Seniors for Sale” series, the first attempts to regulate referral agencies are being made.

Representative Jim Moller of the Washington State House of Representatives has recently introduced HB 1494 “Concerning Elder Placement Referrals.” Among other provisions, referral agencies would be required to keep accurate records, make full disclosures to consumers including fees they are paid, and to make sure a qualified professional conducts an assessment. Referral agencies who do not currently conduct assessments are naturally alarmed at this provision which would severely limit their ability to collect huge fees from care facilities with a minimal amount of oversight.

Although HB 1494 is primarily aimed at the abuses in placing vulnerable adults in adult family homes, the bill would also affect assisted living and retirement communities and home care agencies. Home care agencies will be minimally impacted however. Unlike care facilities, home care agencies do not receive a large share of new clients from referral agencies.

If reasonable guidelines can be agreed upon, the net outcome is likely to be positive.  Consumers will have some greater assurance that the heavily advertised firm they have contacted for assistance will be working in their interest.

Another group to be affected by HB 1494 are Geriatric Care Managers. Currently, anyone can call themselves a “care manager” and charge fees for placement and referral. Most reputable care managers belong to the National Association of Professional Geriatric Care Managers (NAPGCM) and have Care Manager Certified (CMC) designation. The impact on these care managers will be minimal as they already make the required disclosers and do the assessments.

But for referral agencies who simply do a “free” telephone consultation, make a referral, and collect a huge fee from a care facility, things could be changing.

Washington State Initiative 1029, passed by the voters two years ago, will go into effect in a little over 6 weeks. But given the desperate state of the coming biennial state budget, how long the initiative will remain in effect is still a big question mark.

I-1029 would mandate 75 hours of training for long-term care workers generally employed by home care agencies, boarding homes, and adult family homes. It would also require each worker to pass a test and receive certification. The Washington Private Duty Association (WAPDA) along with associations representing boarding homes, adult family homes, and Medicare certified home care have long opposed the initiative as a draconian solution to a problem that doesn’t exist. But one of the good things (and perhaps the only good thing) to come out of the current state fiscal crisis is the likely delay of the initiative.

The state Department of Health (DOH) and Department of Health and Social Services (DSHS) have no authority to delay implementation on their own. Given their very constrained budgets, they might like to, but only the state legislature has the power to overturn or modify an initiative. Legislators we have talked to and information coming from the governor’s office seems to indicate that when the legislature meets, the odds are very good that the initiative will be delayed until 2013 or 2014. But since the initiative goes into effect on January 1 and the legislature doesn’t meet until January 10, the soonest that delay legislation could be passed in the regular session and signed by the governor is early February. But it could be May or June. Or given the sometimes inexplicable political atmosphere in Olympia, never. The state fiscal crisis was made worse by the results of the November election, most notably the repeal of the candy/soda tax, the passage of the 2/3 requirement to raise taxes, and the failure of the proposed state income tax on high earners. For that reason, there is a remote possibility that the governor could call a special session in December. But delay legislation is not expected in the event of a special session.

What are private duty home care agencies, adult family homes, and boarding homes going to do given the tremendous implementation costs of time and money coupled with the likelihood of a 2 – 3 year delay? Most private duty home care agencies are comfortable with using only exempt home care aids for the first several months of 2011 and waiting to see what happens with delay legislation.  At the very minimum it’s a good idea to get your own agency, facility and instructors lined up for the mandated orientation and safety training. See the DSHS 1029 website for forms and information. And stay tuned. The first few months of 2011 could be very interesting, and nerve wracking as well.

When seniors and their families look for home care services, most do what any of us would do – research. They ask trusted advisors, friends and neighbors. They call prospective service providers and interview them, compare important features and costs, and ultimately come to a decision that will prove to be the right choice.

There are many resources seniors and their families have when it comes to finding services. Every county has a Senior Information and Assistance which keeps resource lists. A geriatric care manager who subscribes to the standards of practice of the National Association for Professional Geriatric Care Managers can also be a knowledgeable and impartial advisor.  For Washington State non-medical private duty home care agencies, the Washington Private Duty Association (WAPDA) at www.wapda.org has an excellent website with a complete listing of members.

However, in the past few years a number of for-profit senior care referral service companies have sprung up that blur the line between information and ethics. You may have seen their advertising or listened to their sales pitch – “No cost to families” is always included. These companies present themselves as impartial 3^rd parties connecting seniors and their families with home care agencies. But left out of the sales pitch is the fact that these referral services will only refer to a home care agency if that agency agrees in advance to pay a stiff and sometimes exorbitant fee to the referral service company which most home care agencies refuse to pay. The unknowing consumer is thus left with fewer and often inferior choices.

Not all referral services are the same. There is at least one national company that charges home care agencies reasonable fees and which most home care agencies use. But that is the exception, not the rule.

We urge all professionals, including hospital and nursing home discharge planners making referrals to home care agencies, to develop their own trusted lists of agencies instead of using a referral service.

The problem has been around for ages, but more recently hoarding has come onto the radar of those who work with seniors.  There are the extreme cases we hear about in the news: an elderly person dies in a house fire when firefighter’s access to doors and windows is blocked by piles of newspapers and magazines; a frail senior who dies when a mountain of accumulated “treasure” falls and traps him in a corner of his living room with no available route to food or water.

The mental health world disagrees about what category hoarding falls into. Psychiatrist Frederick Schaerf says “hoarding is a behavior, and all behaviors have a mental state behind them. The problem with hoarding is that there is not just one mental state behind the symptoms.” When the hoarder is a younger person, it is generally considered to be an obsessive–compulsive disorder (OCD), like obsessive hand washing – only much messier. But generally, those with OCD related hoarding recognize that their behavior is extreme and try to resist their compulsion.

When an elderly person hoards, Alzheimer’s or dementia is often the cause. The senior may begin to save items because they feel confused and overwhelmed. They may fear that their memories will be lost without tangible evidence of the past. Accumulating more and more stuff can also feed a need for comfort. A senior with a history of anxiety, when faced with aging and the possibility of outliving their resources, may begin to save because they feel overwhelmed by what lies ahead.  As dementia patients lose track of the present these items become more and more important, and their home more and more cluttered.

Family members are often challenged to keep up with the daily needs of their own lives, let alone those of an aging loved one. But when that loved one also develops a hoarding problem, the situation can quickly spiral out of control.  Attempts to remove items from a hoarder’s home are typically met with resistance and fear. Most families will need to turn to mental health experts to address the problem and help the senior into a safer living situation. But there are also ways that families can avoid a small problem from growing quickly out of hand.

Hiring a trained homecare caregiver from a licensed homecare agency will provide families with regular monitoring of their loved one. If a hoarding problem exists or begins to develop, caregivers will help with such simple tasks as sorting through mail and newspapers, organizing photos and keeping the kitchen and bathrooms clean and organized.  A good caregiver is a simple preventative to a potentially dangerous problem.

Look in a any magazine that courts budding entrepreneurs as readers such as Entrepreneur, Franchise Times, or Inc. Among the advertisements selling franchises for sandwich shops, convenience stores, tax preparation, and cleaning services, are ads selling franchises for home care agencies.

Home care agencies have been around for decades and traditionally have been stand alone mom and pop operations. The idea of creating a home care franchise operation dates to the mid 1980s with a Pennsylvania company, Griswold Special Care. The tremendous growth of home care franchising came in the mid 1990s when most of today’s nationally recognized franchises started. According to Entrepreneur Magazine, there are currently 36 companies in the United States selling home care franchises.

Should a family needing senior home care for a loved one care if a potential home care agency is a franchise or not? Let’s look at the pros of a franchise home care operation.

First of all, here are the general reasons someone starting a business may consider a franchise.

1. Turnkey System. A new owner doesn’t have to create systems, figure out the business side of operations, or create a brand and marketing plan. It’s all done for them.
2. Support. Franchise owners may get support from the national company and other franchise holders in the area.
3. Brand name. Unlike “David’s Burger Barn,” people recognize the name “McDonalds” even when traveling far from home, and may stop at one because of familiarity.
4. Buying power. McDonalds can offer lower prices because it buys its hamburger patties and cups in huge quantities and gets substantial price reductions.

In home care, the franchise owners I’ve talked to cite numbers 1 and 2 above as the major reasons they bought a home care franchise. Number 4 doesn’t matter much at all because no home care agency gets a discount for hiring caregivers in bulk! There are advantages in purchasing advertising however.

From a family’s or referral point of view, what’s the advantage of hiring a home care agency that’s a franchise? For some, there may be comfort knowing that a home care agency has the support of a national or regional company with established and tested systems. Because national home care franchise operations can advertise more cost effectively than smaller independent agencies, they generally have better name recognition, which come consumers prefer.

I know most of the major home care franchise owners in Washington State and count many of them as friends. You can find the same amount of  honesty, integrity, hard work and excellent care at home care agencies that are franchises as home care agencies that are independent.

In part 2, the disadvantages of a home care franchise.