Guest Column
Private duty using the registry way
Clients, caregivers both gain
By Marc Catalano
President
Catalano’s Nurses Registry
Hialeah, FL
Nursing registries are a great option for Medicare-certified home health agencies that want to diversify into private duty. Over the past six months, I’ve received numerous calls from people who are interested in doing just that.
I admit that I’m biased about nurses registries. Operating one has just about been a lifelong endeavor for me. My parents founded Catalano’s Nurses Registry in 1964, and I’ve been involved in the business since I was 14. I have been actively steering the company since I was in my twenties.
But look at what registries have to offer: They give clients greater control over who provides care to them in their homes. They are an extremely cost-effective choice for those who need to stretch health care dollars. They allow caregivers more flexibility in selecting assignments and determining their schedules. And they put more after-tax money in caregivers’ pockets than any other form of home care.
Despite all these benefits, nursing registries are under-appreciated and misunderstood. Some believe that they lead to poor care quality and expose clients to theft and abuse. People also get the impression that registries just make referrals and aren’t there as a resource if either clients or caregivers experience problems. None of those perceptions are real.
Debunking the myths
Nurse registries are like commercial matchmakers. On one side, we recruit and screen self-employed caregivers. We verify that their credentials and work history show that they are capable of doing the work they report they’re qualified for. We also do criminal background and abuse registry checks.
On the other side, we get requests from individuals who want a certain level and amount of care in their homes.
We communicate those needs only to the caregivers we represent who have the skills necessary to meet the client’s needs. We then individually refer the ones who express an interest in the engagement to the client. Although it is important that caregivers have the right skills, we also attempt to match for personality and compatibility. Clients make the decision about the caregivers they want in their homes.
Some of our clients work with independent case managers. It is not unusual, especially for live-in care, for the client, family members, and case manager to interview prospective caregivers.
In some instances, we don’t have much involvement after the client selects a caregiver. But we are available 24 hours, seven days a week for both clients and caregivers.
At Catalano’s, we help clients in a wide range, including high-tech and personal care needs. Our registry represents RNs with and without high-tech skills, LPNs, and certified nursing assistants. In exchange for our services, we receive a 10% commission from both the client and caregiver.
This system promotes caregiver accountability and client satisfaction.
The higher after-tax pay and freedom in setting their own schedules help attract the best caregivers to start with. To keep working through a registry, however, they are only as good as their last referral. If they don’t satisfy their last customer, they won’t get another referral. Their livelihood depends on good outcomes.
Maintaining a market for their services is sufficient for most caregivers to do the very best job they can. Those with licenses are also bound by their state’s professional practice act, that not only establishes the boundaries of that profession, but also requires continuing education. And in Florida, the state will repeal the certification of certified nursing assistants who don’t provide good care.
RNs from the Florida Agency for Health Care Administration audit the company records of registries and reserve the right to conduct periodic home visits of nursing registry patients. Florida law also requires monthly RN visits on personal care cases staffed through registries. A record of these collaborative visits remains on file at each registry, subject to state audit.
Both professionals and paraprofessionals can obtain low-cost liability insurance in the event of any negative outcomes. In Florida, for instance, $1 million in coverage for RNs costs $75 annually; for certified nursing assistants, $61. Catalano’s also carries $1 million per occurrence/$3 million in aggregate coverage.
Primary nurse maintains schedule, care
On cases that involve more than one caregiver, there’s usually a primary nurse who coordinates the care and schedule. Those working on the case collaborate as professionals to staff it and provide the highest level of care. We also maintain a staffing schedule on all cases. This is helps us provide better backup in the event that staff have difficulty covering a shift or if someone makes a last-minute cancellation.
Caregivers have the freedom to work as much as they want, but they also have the responsibility to pace themselves so that they don’t burn out. For those who don’t recognize that they have overextended themselves, clients are in a position to call the registry at any time if they feel the caregiver isn’t as sharp as she should be.
The same thing goes with maintaining professional boundaries. On the one hand, there’s an opportunity to have a good, positive relationship between caregivers and clients. But if the family feels there is any issue, it just takes a phone call to say, "Get this person out of here."
Clients have a high degree of satisfaction with registries, not only because it is so cost-effective, but because they are very involved in their own care. They have total say over who will provide them care. And because they are in direct contact with their caregiver(s), they also have the opportunity to easily modify and fine-tune the times, locations, and nature of the services performed. The registry is available to mediate if there are any problems.
The limited involvement in day-to-day care doesn’t make registries any easier to operate. It requires a different mentality than a home health agency. If you don’t understand the nuances of private duty, you won’t succeed.
A registry is essentially a customer service business. We view both the people receiving and giving care as our customers. When people call a registry, they expect a certain amount of legwork, including all screenings and verifications. You really have to service them properly, have quality caregivers available, and be there when they need you — whether it’s two in the afternoon or four in the morning.
Caregivers count on having enough work when and where they want it. They also expect to be treated professionally at all times.
Successfully operating a registry also requires a good understanding of your state’s workers compensation and unemployment laws. Federal tax laws also come into play. A registry’s relationship as an agent for, rather than employer of, the caregivers hinges on common law right of control factors. The Internal Revenue Service currently considers 20 factors in determining the right of control. (See related article, right.)
I think a lot of factors will spur the growth of registries. The aging population is now demanding more and more service, but not all the elderly have open checkbooks. Medicaid and other state programs also have limited funds. Long-term care insurance is rapidly growing, but those who have it want to stretch their benefits as long as possible. Registries can save as much as 30% off home health agencies without skimping on service, making it an unbeatable choice for some people.
Registries aren’t for everyone. Some people don’t want to have as much direct involvement in their care or they have resources and are willing to pay more. But for those who want more control over their care and stretch health care dollars, registries are a great alternative over directly recruiting and contracting caregivers.
They are also a great choice for providers who either want to expand into private duty or offer even more private duty choices.
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