IME,Inc.
211 Beaumont
Traverse City,
Michigan MI 49684
Tel: (800)
968-4637
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ATTENDANT CARE SERVICES By:
Victoria D. Small RN WHAT
IS “FAIR WAGE” WHEN PROVIDED BY FAMILY OR FRIEND Over the past 3 years I have frequently been asked by claims
representatives, attorneys and family members for my opinion on a
”fair wage” for family members or friends being reimbursed for
“Attendant Care Services.” As a registered nurse for almost 20
years, with 15 of those years as a case manager, I have had a
great deal of experience in hiring the agencies that provide these
services. Prior to becoming a nurse, I was a Certified Nurses Aide
for 10 years, so I have first hand knowledge of what the job
entails. It has only been in recent years that this question has
gained so much interest. I am sure there are many reasons for
this, including increased costs in health care, and hospitals
focusing more on early discharge to the home. If the physician has
established there is a need, it is understandable that a client
would rather be cared for or assisted by a family member rather
than an unfamiliar person from an agency. In most cases there is
not a problem with a family member providing the care; however, I
always evaluate this carefully since there are instances when it
is inappropriate, and I advise against it. For example, if there
is evidence the caregiver is an abusive partner, has health issues
of their own, has many other responsibilities, or is not
comfortable with the tasks involved, I would tend to advise
against it. Once it is established the family member is capable
and willing to care for the patient, the issue of reimbursement
can be addressed with the insurance company paying for the
service. Few family members or friends understand the difference in an
agency providing this service and usually anticipate the same
amount of pay that an agency charges for the job. For this reason,
I felt it was important to clarify why there is a difference and
what is “fair” when all things are considered. My calculations and formulas are based upon my experience and
research with home health care agencies, as well as industry
standards. My determination of a fair hourly wage for the services
of a family member or friend providing the services of home health
aide/attendant care provider is outlined below. There is no dispute that as of 2004, an agency providing
these services would charge $15 to $20 per hour. There are many
costs incorporated in this fee. Home health care agencies have
overhead to cover, such as liability insurance, taxes, the
employee’s wage, benefits, supervisory, training, etc.,
accounting for higher costs. There is also a higher rate on
employee turnover with this profession resulting in additional
costs for advertising and training. In addition, services provided
by an agency would be done according to industry standards. Most
insurance companies, including Medicare, Medicaid, Blue Cross Blue
Shield, etc., outline the qualities of care requirements. Joint
Commission on Accreditation of Healthcare Organizations (JCAHO) or
Community Health Accreditation Program (CHAP) also accredit three
of the four agencies contacted. These accreditation programs
require the facility to maintain a set of guidelines and outline a
higher standard of care than a family member would be required to
adhere to. This higher standard includes the need for the home
health aide to obtain certification through the State of Michigan.
The state-sanctioned program requires 75 hours of instruction and
then the ability to pass both a written and practical exam. It is
then necessary for the aide to show proof of ongoing education in
the form of Continuing Educational Units (CEU’s) in order to
maintain their certification. The higher wages in this study reflect those of higher
skilled care providers who are usually certified and are
considered semi-skilled. Unskilled/uncertified individuals, such
as personal care aides or companions, make a wage slightly less.
Although a family member or friend can be trained to do specific
tasks on a daily basis, that caregiver would not be able to use
those skills in other settings; i.e. a hospital, rehabilitation
facility, long-term care facility, etc., without further training
or credentialing. Internet research revealed multiple sites where occupational
wages can be readily accessed. My key words were ‘home health
aides’. My research reflects the mean wage obtained from each
site. I found the average wage of the home health aide/attendant
care provider working for an agency in the industry to be $9.23
per hour. Based on that research, I feel a family member providing
the same service as an agency CENA/nurse’s aide/attendant, would
be compensated fairly at a wage between $9.00 and $10.00 per hour.
As case managers, we are in the position of having to
evaluate and consider all factors concerned. I feel it is
important to educate the client and caregiver so they are not
misled into believing they should be compensated at a higher rate
than a professional providing the same care. The research provided in this study was updated in October
2004 and I would like to thank the agencies listed for allowing me
to use their data for comparison. *
* * Victoria
D. Small RN is a certified medical case manager.
She has over 15 years experience in private rehabilitation.
Vickie and a co-worker started their own company, Selective
Case Management, Inc., in 1996.
In October 2003, Victoria decided to pursue her desire to
be an independent contractor under the name of Quality Case
Management. She
continues to provide medical case management for Selective Case
Management and conducts in-services on attendant care. HOME HEALTH AIDE WAGE
STUDY COMPLETED ON MICHIGAN AGENCIES IN THE
TRI-CITY AND FLINT AREAS AND
ON THE INTERNET OCTOBER
2004
INTERNET RESULTS
The
fees and wages used in this report reflect the highest fee charged
by an agency and the highest wage paid. These fees and wages would
usually reflect a case needing higher skills and experience. All
information was updated on October 2004. Based on the above
research, I calculated the average wage of a home health aide at
$9.53 per hour.
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