Agora: The private duty marketplace
October 1, 1999 4 minutes read
Agora: The private duty marketplace
Susan Siegal, president of Gentle Homecare Inc. in Highland Park, IL, was the first of our readers to contact us following last month’s debut of Agora. "There are so many of us in private duty facing the same issues," she says, "and I love the idea of coming together and exchanging ideas. I think it’s great we have a forum through Private Duty Homecare. There’s a good deal of interest in private duty now, but our states’ nurses’ associations have only become active in private duty concerns within this past year."
Siegal also believes a set of voluntary standards would be helpful. "Where I live, you need nothing to start a private duty home care agency except a phone number. In a sense, our competition is people who provide independent contractors at very low cost. The disadvantage to agencies like Gentle Homecare is the rate of pay. We cannot compete with those people on fees. We don’t feel particularly threatened by them because what we’re selling is a different product. The public may not know that, but we do."
Siegal’s company does a very thorough background check on applicants. "We will only hire someone if we can verify all the references, not only validate dates," Siegal says. "If we can’t talk to someone who has used an applicant in the past, we won’t hire them. We do criminal background checks, work and personal references. Because some of our competition doesn’t have standards, it really becomes a caveat emptor for the buyer, who often has a very hard time understanding why our fees are so much higher. We’re employers — we have to contribute to Social Security, workers’ compensation, all those things. They don’t deal with that. It’s just direct pay to the independent contractor and they collect their placement fee."
Siegal says if she were writing a set of standards, the first three things she would write would be complete background checks, complete background checks and complete background checks.
"The more thorough I am, the better I’m going to sleep at night, knowing I’ve done my best to send a good person into homes where they are taking care of others who are at their most vulnerable. We owe it to our clients to be as thorough and as vigilant as we can. We had an applicant who came in with a written reference that was absolutely glowing. It was really beautiful. I think a lot of agencies might just have accepted that. We called and checked it out, and the woman who wrote the reference said, I wrote that reference for him three years ago because I was a little in fear of him. But I made up my mind that if anybody ever called me, I would tell them the truth. Yours is the first agency that’s ever called.’ As it turned out, the applicant had a serious drinking problem. We would not have known that unless we called," Siegal says. "A criminal background check wouldn’t have revealed this. People don’t usually have someone arrested. They just say, Go away and don’t ever come back.’"
Attorney John C. Gilliland II sees a probable value to the home care industry in having some standards or seals of approval to tell the public that participating agencies care about the quality of service they provide. "If there are standards and you have met them, they give you a marketing advantage," he says. "If standards are written properly, they are realistic and good agencies want to meet them. But they can be a two-edged sword because standards could be introduced as evidence as a standard of care in malpractice cases. It’s good in the sense that you know what the standard is, bad in that if you don’t need it, you could be in trouble in a malpractice case. So don’t do it unless you’re willing to do it."
Gilliland observes that accreditation through the Joint Commission of Accreditation of Health Care Organizations (JCAHO) or the Community Health Accreditation Project (CHAP) can be an expensive project.
"What would be the advantage of a new organization for private duty home care vs. the private duty agency on its own getting JCAHO or CHAP accreditation?" he asks. "A private accreditation — a body that would have these standards, that you would invite in to look at your agency and give you the seal of approval, which you then could put on your letterhead, use in your marketing — could be much less bureaucratic than JCAHO, more tailored to private duty, and perhaps more flexible in acknowledging that there’s more than one way of doing things. Private duty is more a matter of efficiency, business orientation, and entrepreneurial spirit. An accrediting body that’s set up from scratch that understands private duty might be a very good option."
So, readers — what do you think about this? Write to us, e-mail or snail mail.
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