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Ankota: Ushering in the Next Generation of Homecare Blog

Home Care Dilemma: Why I'm Glad I'm Not Bill Dombi

Posted by Ken Accardi on Jan 11, 2012 9:05:00 PM

Today, there are labor law exceptions that allow home care agencies not to pay overtime to home care caregivers who work more than 40 hours in a week, and there's legislation under review that would change this.  The premise is that it's more fair to pay overtime than it is to have the exception.  On the surface it sounds simple, but it's not...

The home care lawyer, Elizabeth Hogue, Esq. shared a thorough rundown of the legislation that you can read here.

Proposed Changes to Exemptions for Minimum Wage and Overtime Pay Elizabeth Hogue

What makes this tricky is the following:

  • Home care doesn't pay well.  An average pay rate is $12/hour
  • The price of care is generally something like $19/hour
  • At one level, $19/hour doesn't sound like a lot, but it's much more than most people can afford (e.g., if 24 hour care is required at this rate, it adds up to $166,440 per year).
  • As such, it's difficult to charge the client overtime on a regular basis (most agencies I'm aware of charge extra for holidays, but for week-by-week care, they're going to do everything in their power to avoid having to pay overtime)
  • So if a caregiver is now working a 60 hour week and getting paid $720, this legislation is likely to result in their employer cutting them back to 40 hours and cutting their revenue for the week to $480.  So the caregiver takes a big hit.
  • The patient/client takes a hit too, because they have to work with more caregivers and this is difficult for clients with memory impairment.
  • So in the end, legislation to get fair pay for caregivers will actually result in caregiveres losing pay (unless they sign-on with another agency to get the additional hours) and they might have to work back to back shifts.
  • It's not pretty!

Bill Dombi, from the National Association of Home Care and Hospice (NAHC, which isBill Dombi pronounced like "nack") is the person who needs to try to lobby congress to explain that this legislation is more likely to lower the pay for a caregiver than to increase it.  But it's one of those "losing battles" because on the surface it seems like it will make it better for the caregivers. I'm glad not to be Bill Dombi...

NAHC Home Care

Does this legislation impact your agency (either positively or negatively)?  Please comment!

Ankota provides software to improve the delivery of care outside the hospital. Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care. To learn more, please visit www.ankota.com or contact Ankota

Topics: Home Care Industry, Elderly Care, Home Care, NAHC

Mobile Health App Market to grow 70%+ in 5 years

Posted by Will Hicklen on Jan 10, 2012 12:30:00 PM

Healthcare will continue its acceleration towards a highly mobile model, particularly as Accountable Care models force more and more care outside of the hospitals. More effective and less expensive care can be delivered earlier, with more proactive models mitigating the risk of patients being admitted to hospitals in the first place. Mobile healthcare models can be employed to help transition patients from hospital to home, helping them to recover more quickly and successfully. This requires many differerent types of providers, and providers of all types must coordinate to work together efficiently and effectively. Putting technology and information in the hands of the mobile health worker means that mobile health applications are already booming, and we're just seeing the tip of the iceberg. 

FierceMobile health logo 

Here is some terrific information on the explosive growth of mHealth apps from FierceHealth, on their Fierce Mobile Health site. The article appears in its entirety below, or  you can read it here on the FierceMobile Healthcare web site

The mobile health app market will grow to $392 million over the next five years, a 70 percent increase, according to new data from research firm Frost & Sullivan. And it might be quite a bit more than that, as the market has "consistently outpaced forecast growth and revenue," over the past two years, according to Frost senior industry analyst Zachary Bujnoch.

"MHealth apps will continue on a steep growth curve as increasingly sophisticated mobile technologies and relationship-management tools disrupt the market," he said in a statement. "Despite the hype, mobile apps are the single-biggest digital channel since the '90s and the Web."

Healthcare apps, which have developed a reputation for being easily bought--and easily dumped--may be getting more sticky. Frost researchers predict that not only will new users buy health apps, but also that existing customers will continue to buy and use more mHealth apps.

Calling 2011 the "tip of the iceberg," researchers say that low barriers to market entry will continue to lure new vendors, although they note that U.S. Food and Drug Administration oversight and security concerns mean it won't be a hassle-free endeavor for new startups.

"Consumer awareness is mixed, with privacy and security concerns ever present in the mHealth market," Bujnoch said in a statement. "Also, while still overall a good thing, increases in FDA regulation and oversight may dampen innovation."

Note: A releated Frost report, covered by our sibling publication FierceHealthIT, also forecasts growth in the remote patient monitoring market, with a strong mobile component. Frost projects revenues will more than double to $295 million in 2016, up from $127 million in 2010. Interestingly, the report predicts that remote patient monitoring technology will move in a more consumer-facing direction, driving much of that growth.

Even with double-digit growth rate for the past decade, Frost researchers say the market hasn't reached its "billion-dollar potential" because of scalability problems and limited business models.

Subscribe: http://www.fiercemobilehealthcare.com/signup?sourceform=Viral-Tynt-FierceMobileHealthcare-FierceMobileHealthcare


Topics: Recommended Reading, HME Delivery Operations, HME Delivery Software, Home Care Best Practices, Health Care Reform, Care Coordination, transitional care, Home Healthcare Delivery Management, Home Care Mobile Solutions, Will Hicklen, Home Care Scheduling Software

Can Your Home Care Agency Help Prevent Delirium?

Posted by Ken Accardi on Jan 9, 2012 10:41:00 AM

Delirium is likely to be the most costly and debilitating disease afflicting the elderly that youThe New York Times never heard of.  We focus lots of attention on dementia, alzheimers and fall-related issues, and we should, but at the same time delirium is hurting the quality of life for elderly people and costing Medicare over $143 Billion per year according to a study this year in The Journal of American Geriatric Society.  The November 2, 2011 New York Times article "Another Hospital Hazard for the Elderly" by Susan Seliger tells a chilling story about the onset of delirium and just how common it is:

Hours before she fell and broke her hip, my mother, 85, lucid and whip-smart, was doing what she always did in the morning: drinking an entire pot of coffee and digesting both The New York Times and The Baltimore Sun.

The next day she came out of the hip surgery just fine. But within 24 hours, a totally different woman seemed to have taken over her capable mind and body.

She was disoriented. “This isn’t a very nice hotel,” she told us in the hospital room. “They haven’t even served cocktails. Let’s go.” My father, sister and I laughed, thinking it was just grogginess from the anesthesia. But then she developed trouble breathing, and the nurses clapped on an oxygen mask and whisked her off to another ward for more intensive monitoring.

Things quickly spiraled out of control. She tried to rip off her oxygen mask and IV tubes. She frantically tugged at the sheets and her skimpy hospital gown. Like the aged Lady Macbeth, she kept saying: “We have to clean this up! Clean this mess!”

They tied her hands to the bed. The medications to calm her down didn’t work. The doctors upped the sedation. Later, the physical therapist could barely rouse her to do the critical rehab on her brand-new hip.

What my family didn’t know at the time, because the doctors did not tell us, was that this frightening transformation was a classic case of hospital delirium — a brain dysfunction characterized by sudden confusion and inattention. It’s one of the most common, dangerous and costly complications of hospital stays for the elderly.

New Old Age Blog in New York Times

This two part story in the New York times continues by teaching us the signs of delirium and how it can be prevented.  The following items in particular caught my attention:

  1. Once delirium occurs, the patient has a 62% chance of dying in the next year
  2. Delirium can be prevented in 30 - 40% of cases
  3. The best people to detect and counteract delirium are caregivers who know the person well and are able to detect when they're not normal
  4. Home Care Caregivers can greatly assist in the prevention and recovery from Delirium with steps as simple as getting the person up to walk a little bit each day

This topic is too important to stop here, so here are the next steps:

Can your agency put an awareness and education program in place to help prevent and recover from delirium?  Can you offer hospital companion services with caregivers who can advocate for your clients, alert hospital staff when something's not right, and make sure that the hospital is doing the right things?


Ankota provides software to improve the delivery of care outside the hospital. Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care. To learn more, please visit www.ankota.com or contact Ankota


Topics: Home Care Entrepreneurship, Recommended Reading, Alzheimer's, Elderly Care, Home Care Blogs

Geriatric Care Management: Improving Hospital Discharge

Posted by Will Hicklen on Jan 4, 2012 6:34:00 PM

NAPGM logo

Sometimes we at Ankota come across good articles on the websites of other organizations and we like to share them with our readers. Today's post is such a piece posted last week by Horizon Care Services on their web site, which I read on the National Association of Professional Geriatric Care Managers' LinkedIn Group. The article is How Seniors Survive Medicare Hospital Discharge. For those who do not know this Horizon, they are a well regarded organization in Florida providing home healthcare, private duty and, pointedly, Geriatric Care Management (GCM) services in beautiful Miami-Dade, Palm Beach and surrounding areas. 

Horizon Home Care Svcs FL logo

The article points out that a recent Harvard study shows avoidable readmissions account for more than $12 BILLION of Medicare spending annually. Other studies peg this number as high at $17 BILLION spent by Medicare on hospital readmissions that should have been avoided. Whichever number tickles you best, it's a whole lot of money spent wastefully. Moreover, these readmissions needlessly cause stress and heartache on patients and their families.

Seniors are particualrly vulnerable when being discharged from the hospital. Numerous studies show that general alertness and ability to stay attentive is diminished after being discharged from the hospital and typically requires months to recover from, regardless of the original reason they were admitted to the hospital. Clearly, assistance is required. It is well known that bringing an elderly parent home from the hospital can make family members anxious and few are trained or equipped to handle the task. It's not just an issue of lifting mom up from a wheelchair and into the bath, it extends to a complex maze of coordinating numerous services and multiple service providers, and even filling and monitoring medications. We can no longer leave the primary caregivers--the family members--alone to handle these transitions...it's costing the system at least $12 billion each year and undue stress to patients and their families.

There is a tremendous opportunity to help improve transitions from hospital to home, beginning with the process of planning for discharge. Discharge should pair the right resources to the right plan of care to assure that patients receive the care and follow up they need to help them recover well at home. Professional resources must be made available to help with transitions and assure that the right kind of medical care and personal support is available. Fortunately, products like Ankota's Care Coordination technology can assist with the planning and delivery cycles, assuring greater efficiencies, lower overall healthcare costs and healthier patients.

The home healthcare ecosystem-- the many tens of thousands of companies that provide home healthcare, private duty care, and other related services-- is especially well suited to be the delivery model for this type of care. The HME provider is needed to provide equipment and supplies, the pharmacy needs to fill medications, and nurses and aides must be coordinated with appropriate care plans. They all need technology and expertise to bring these providers into a well coordinated "network" that operates efficiently, coordinates services, and can deliver needed products and services in mobile healthcare models. 

The discipline of organizing and providing these services for the elderly is often called Geriatric Care Management. It's not just for care after discharge, it's also for helping to care for the elderly on an ongoing basis. These are experts that are well trained in the best practices of caring for the elderly, knowing what services they need, and bringing them together in a well coordinated and monitored, accountable plan.  

The providers in the home health care ecosystem that stop thinking of themselves solely as a "Private Duty agency," or an "HME delivery company" or a "Home Healthcare agency" or a "Rehab or Therapy agency" and start looking at their role--and value--in coordinated care and accountable care models WILL WIN. That's where the greatest opportunities and the highest rewards await them. Engage with Geriatric Care Managers, or in many cases, providers should employ Geriatric Care Managers to lead their involvement.

Ankota develops technology to help companies like these to coordinate care and operate more efficiently. Please let us know if we can help you make the transition to a better coordinated, more efficient business. 

Click me

Topics: Geriatric Care Management, Home Care Industry, Care Coordination, Aging in Place Technology, Home Care Mobile Solutions, Will Hicklen, Home Care Scheduling Software, National Association of Geriatric Care Managers

Home Care Can Create Jobs and Careers...

Posted by Ken Accardi on Jan 3, 2012 7:41:00 AM

In my previous blog article, I covered Home Care Predictions for 2012 based on some thoughts from Laurie Orlov.  One of Laurie's points was that caregiver jobs are being created, but they're not paying well enough for the caregivers to be off of food stamps and Medicaid.  I believe, however, that there is hope for caregiving to be the start of a career...

As we've discussed numerous times on this blog, we believe that home should become the location for much more of the care delivery provided by the US healthcare system.  This is especially true as it relates to the elderly for whom travel is difficult and who are more susceptible to get a cold or infection in a clinic or hospital.   So the future of care as we see it requires more care delivery in the home and the community.  This creates jobs and also creates cost, but the key is to more than offset those costs by reducing the cost of care.  We've seen that this is possible when focused inexpensive care is applied to expensive populations.  For more proof of this, read this article inspired by the research and writing of Atul Gawande.

Extrapolating from here, you can see how caregiving can become a first step towards a move to a comfortable middle class living.  Take a look at the diagram below:

Home Care Career Progression

In this rendering, a home care caregiving job becomes a first step in a progression and a big one, moving an individual from unemployed to having a job as a non-medical caregiver, providing companion, cleaning and assistance with activities of daily living.  This is not a high paying job but a caregiver can earn over $20K per year and possibly much more.

For caregivers with good reading and writing skills (or the ambition to develop them) and a good work ethic, they can move up to a higher skilled and higher paying job.  The diagram depicts a phlebotomist (a person trained at taking blood samples), but there are other potential roles as well, such as becoming a certified nurses assistant (CNA), a home care scheduler/supervisor, or a job monitoring telehealth results or working as a health coach in a call center.  These are the types of jobs that will be created as part of health care reform that will reduce overall health care costs.

Further progression can include a step up to a social worker role or a nursing role that requires a degree or specialized training.

All of this will require a better ability to coordinate the delivery of care, and this is what Ankota is focused on delivering.  If your organization has the ambition to improve care, create jobs and lower costs, but the technology to manage care coordination is a challenge, we'd love to help.

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Ankota provides software to improve the delivery of care outside the hospital. Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care. To learn more, please visit www.ankota.com or contact Ankota

Topics: Home Care Entrepreneurship, Home Care Industry, Elderly Care, Health Care Reform, Care Coordination, Aging in Place Technology, Home Care Technology, remote monitoring

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About Ankota

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Reeadmisison avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

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