Where the jobs are . . . and aren’t
Are there any jobs in home health care?
To hear people talk, the health care field is running neck and neck with technology when it comes to employment opportunities — that field is expected to increase by 30% (or 3.1 million jobs) by 2006. But does that apply to the home health care sector as well? (See graph, p. 39.)
An article in The Arizona Republic (Oct. 13, 1998) listed home health aide as a "hot job title." To see if this still holds true, Hospital Home Health spoke with home health agency administrators around the country to determine whether, in light of the interim payment system (IPS) and a spate of agency closures, employment opportunities still exist. Here’s what they had to say:
Carolyn Marr, RN, BSN, CNA, director of home health and hospice for Bradley County Memorial Hospital in Cleveland, TN."I don’t think you’ll find a shortage of nurses in home health care because visits have decreased with the Balanced Budget Act of 1997 [BBA]. So as far as a surplus of nurses in the area, I don’t know that it’s happened. We’ve lost four nurses in the last year — a couple to retirement, one to the hospital, and one who changed jobs, but we’ve not had any losses through layoffs. . . . And through attrition we’ve just not replaced employees after they’ve left. Our [number of] CNAs [certified nursing assistants] has lowered through attrition but there are still positions available for CNAs in the nursing home.
"Being hospital-based has been an asset to us because [hospital] employees can move to our home health setting and back or, if they’re a therapist, to the outpatient setting. Therapists aren’t always employees of freestanding agencies, they’re often contracted, and cutting therapy services is one of the ways to save money without letting employees go.
"Historically, I can’t find occupational therapists, but I have had a few looking for jobs this year. If there is a surplus of anyone it’s physical therapists. Usually I’m begging for [them], and this year I had 20 applications to fill one spot. I was quite surprised by the number of applications I received. I think I received so many because of the BBA and because of the caps placed on rehab facilities.
"All those people [applying] weren’t out of work, but they were concerned that their agencies may not be able to keep patient contracts and therefore were looking for something a little more secure.
"I haven’t had any calls from anyone looking for management jobs."
Terrie Hellman, president of VirtualNet in Carmel, IN."We’re a statewide network of hospital-based, home health infusion services. We have managed care contracts and call on providers to service them.
"Around this area, there have been a lot of layoffs, and I know the big rumors are that hospitals are getting out of the home health business. I think management is going to be the hardest hit no matter what because that’s where the costs are. Management isn’t a revenue producer.
"It used to be that physical therapists and occupational therapists were hard positions to fill, but now with PPS [prospective payment system] hitting the nursing home side that will probably change."
Warren Hebert, RN, CEO for the HomeCare Association of Louisiana in New Iberia."[Home care] has been significantly affected by the IPS. We’re seeing a significant reduction in the amount of home care that’s being provided across the country . . . a 38% reduction in payments made to home care from FY97 to FY98.
"There are estimates that as many as 2,700 home health agencies across the country have closed. Those include agencies that have merged with different providers and those that have closed. So from the employment standpoint, we’re seeing a reduction in the amount of care being provided, the number of agencies that are employing, and because of consolidation, a reduction in the number of management positions.
"I think a correct statement is that home care and health care as a whole will continue to be up and coming, but that the current shift we’re seeing in home care is a pendulum that will eventually swing back in the other direction. To say that health care is a good place to be is an accurate statement, but the security one would have is, shall we say, less than stable.
Therapy services also affected
"We’re seeing some reduction in employment across the spectrum. Obviously, the consolidations mean a reduction in the number of management personnel.
"The number of nurses and aides is being reduced so we’re seeing a similar decline in employment in each of those areas. Therapy services that have historically been provided for are now difficult to provide because of per-beneficiary limits. Here in Louisiana, 95% of all agencies provide therapy services on a contract basis so the therapy employment is not impacted as significantly, but services are reduced."
Joie Glenn, RN, MBA, executive director for the New Mexico Association for Home Care in Albuquerque."We have lost 50 agencies, and we didn’t have that many to lose in the first place. We only had about 145 on the books, and I speak in terms of agencies being parent and branches as one. In some communities, nurses and aides are looking for jobs because there has been such significant downsizing.
"In Albuquerque, I don’t know of that many folks looking, but in rural communities, especially where they’ve been hit, there are people out of work. We have home health nurses on welfare.
"People want to be at home in the rural communities, which in turn have been hit the hardest. There are some cities that have been hit, but in rural communities already there are problems with economic development. In one aspect, they [have a hard time] recruiting professionals, and then when they do something like [PPS], it really hits hard. It’s a Catch-22. You can’t recruit people. Then, when you do, the system changes. What do you do?
"In the articles you read a couple of years ago, home health aide was the fastest growing job in the country. Home health was exploding. All this has changed with the BBA and the IPS, very definitely.
Mergers eliminate jobs
"Mergers probably have eliminated jobs because very often they end up with two offices in the same city and won’t need all the people. It’s by no means a wipeout, but I do believe they need to be efficient. I would guess management is affected the most because the patients are still being seen and the new company acquires these extra patients. I suspect the big cuts are at the management level.
"Now I would caution those entering field and tell them that they must be specialists in order to participate in home health. . . . If you’re good and know home health, you can find a job, and that goes for nurses as well as management. With things like OASIS, it’s a new kind of requirement and one that’s complicated. Some of the best nurses are kicking and screaming while some are seeing it as a good thing.
"If you know what you’re doing, I sense there’s a demand and a place for you. Too many people really don’t know or understand all the regulatory aspects, and that’s something that’s hard to teach in an orientation program. If you know that and have practiced home health and learned the business over the course of time, and have the skill, you will have a job.
"Still, lucrative is not in the home health vocabulary. You’ll earn a decent living, but you’re not going to earn a lot of money. If you want that, go work for Bill Gates. When you enter the health care field, it’s not legislated but it’s an unwritten rule — you aren’t entitled to earn a lot.
"Most people perceive health care as something you do and that you’re not in it for gain or profit. If you’re good and want a fair wage, then it’s the place to be, and if you’re really good, you can earn a better living than someone who’s not — but don’t think about getting rich. In fact, I think everyone in home health has been asked to take a pay cut."
H. Carol Saul, JD, executive director of the Georgia Staffing & Home Care Association Atlanta."One area that’s growing and is an unrecognized opportunity is that of corporate compliance officers for home health companies. . . . [The position] was featured in an article last year about how these officers are the new job description and that there are so few people with any experience in this area.
"Larger companies are rolling out the red carpet and offering high salaries. Any company of any size needs to have a corporate compliance officer. It’s a role you can grow into but it’s not one without risk. I wouldn’t take it unless I really felt the board was truly committed and I had a direct relationship with the board."
Gregory P. Solecki, vice president of Henry Ford Home Health Care in Detroit."From what we’re seeing, I think the nursing shortage is back with a vengeance. In the past, whereas home care was seen as an exciting new opportunity for nurses, at this point in time, most have become aware that home health care is like working in the ICU but with more paperwork and travel.
"When you look at why nurses leave home care and where they go, we’re not losing them to other home health agencies but to other spots in the continuum. We’re seeing some cases where agencies are closing and nurses are coming here to apply.
"But for the most part, as agencies close, the nurses are going to a hospital or a number of other places where they’re being recruited. I can only speak for our marketplace, but we definitely have a shortage. And I think it’s happening in other parts of the country as well, although some areas with more desirable locations may have a waiting list of nurses.
Higher skills for less money?
"We’re asking for a higher caliber of nurse that is specialized or even subspecialized, but then we’re saying, we’ll pay you less than a hospital because of the BBA.’ So there are two problems: How do you find these specialized nurses, and then how do you get them to come and work for less? How do we compete for experienced people when we can’t compete with salaries?
"It’s as hard, if not harder, to find qualified supervisors than it is to find qualified nurses. Supervisors and managers in the home health field are more difficult to recruit and identify, I think, because of the intelligence of that pool. Most don’t want to get into supervisory positions in home health because it’s a no-win situation.
"It’s become so over-regulated as an industry, and the regs are so esoterically egregious, that it’s difficult for someone to step in from outside the industry and take a leadership role. It puts them at a disadvantage."
Sources
• Joie Glenn, RN, MBA, Executive Director, New Mexico Association for Home Care, 3200 Carlisle Blvd. N.E., Albuquerque, NM 87110. Telephone: (505) 889-4556.
• Warren Hebert, RN, CEO, HomeCare Association of Louisiana, 223-A E. Main St., New Iberia, LA 70560. Telephone: (318) 560-9610.
• Terrie Hellman, President, VirtualNet, 701 Congressional Blvd., Suite 300, Carmel, IN 46032. Telephone: (317) 581-7900.
• Carolyn Marr, RN, BSN, CNA, Director of Home Health and Hospice, Bradley County Memorial Hospital, 175 24th St. N.W., Cleveland, TN 37311-3826. Telephone: (423) 559-6092.
• H. Carol Saul, JD, Executive Director, Georgia Staffing & Home Care Association; c/o Long Aldridge & Norman, One Peachtree Center, 303 Peachtree St., Suite 5300, Atlanta, GA 30308. Telephone: (404) 527-4000.
• Gregory P. Solecki, Vice President, Henry Ford Home Health Care, 1 Ford Place, No. 4C, Detroit, MI 48202. Telephone: (313) 874-6500
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