George lives by himself. And he likes living by himself.
But this man, who is in his 80s, was recently admitted to a rehab center because he had problems with his feet due to diabetes caused in part by his inability to properly care for himself.
Kevin McClarren is helping to make sure that doesn't happen again.
McClarren, the owner of a Home Care Assistance franchise, has set him up with home health care aides who will:
McClarren doesn't have a medical license — but he is part of a growth industry that figures to be on the forefront of medical care moving forward.
Call it the in-home nursing home.
Or better yet, call it an opportunity for new businesses to meet the demand from baby boomers who want to grow old in their own homes.
It's a business embraced by both hospitals (who are eager to lower their costly re-admittance rate) and health care reformers (who see it as a less costly alternative to nursing homes).
"We set up a care plan and make sure there are no missing pieces," McClarren said.
His company provides aides to help with the activities of daily living — bathing, dressing, medication reminders, meals, errands. He can provide an aide to a senior who needs a few hours help each day to get around — or he might provide a live-in aide for an Alzheimer's patient.
At any one time, McClarren may employ 50 aides serving 35 patients, some of whom require more than one aide to span the entire day.
And his company is not the only one doing it.
Peter Ross, president of the Home Care Association, said a study commissioned in 2013 estimated the number of private-pay home care agencies has doubled since 2007.
The state Division of Consumer affairs licenses and regulates the state's more than 58,000 "certified homemaker home health aides" and the 969 firms that employ them.
The division does not have figures from past years that might indicate how much the sector is growing, but employment in this occupation is forecast to grow about 3.6 percent a year through 2020, according to the state Department of Labor and Workforce Development.
Ross said not every agency is successful, and he puts the rate at which firms exit the business at less than five percent.
"This is a very busy business; you have to manage a lot of caregiver employees," Ross said.
"You have to work well with people: This is a people business, not a put-your-head-down-in-your-cubicle business. You are providing services 24/7, and you are working with families, clients and employees."
Right from the time patients leave a facility, McClarren has two nurses on staff who work with the hospital, rehab facility or nursing home before the patient is discharged.
Medicare has started to penalize hospitals financially if they readmit too many patients within 30 days of their discharge, and there's been a trend toward shorter hospital stays.
"So when they leave the hospital, they have to be ready (to go home), and the home has to be ready," McClarren said.
Then there's the issue of cost — and billing.
The home care sector includes both nonprofit and for-profit agencies (including some hospitals and visiting nurses services).
Some agencies are licensed to accept Medicare and Medicaid reimbursements and others, such as McClarren's, are private-pay home care providers.
McClarren said he charges between $23 and $25 for in-home services and a live-in rate of $220 per day.
"It is expensive; there is no question about it," McClarren said.
McClarren, however, said between 15 and 20 percent of his patients have long-term care insurance, and some have veterans' home care benefits; in the case of an auto accident, vehicle insurance may cover some expenses.
The business is growing.
McClarren's office is in Warren, and he's considering opening a second office in the Morristown area to better serve Morris County.
"Clearly we are growing, the need has not gone away, and we will continue to grow," he said.
He's been careful not to expand too fast but realizes an office in Morris County would enable him to recruit local aides who wouldn't have to drive too far to serve the geographically spread-out county.
"I am at this point where I am at a decent size, and to sustain that growth, I need to add another location," he said.
And while it's easy to get caught up in the bottom line, McClarren is quick to point out this is not your typical business.
McClarren, who purchased his franchise eight years ago covering Somerset, Morris, Union, Essex and Hunterdon counties, said he's learned dealing with the emotional needs of families is a huge part of the job.
"If you get into this as a business owner because you would like to make a profit, this might not be the best business for you," he said.
"You need to be physically and emotionally involved in this," he added. "If profitability is one of the key drivers, then I think people are going to have a hard time. They are going to be very surprised because this is a tough business."
McClarren has worked with families with a terminally ill patient who is getting hospice care at home.
"(For the adult children,) this might be their last four weeks with their parents, and now they are reconnecting," he said. "And we're part of those last four weeks, helping bridge the emotional gaps."
While home care is a business, it is personal.
"My personal view is that I'm a social worker, and I'm not doing social work for the money," he said.
Families come to him in crisis, he said.
"All of a sudden mom's Alzheimer's has accelerated. What do we do?" he said. "Getting a good match and managing through that is so critical, and that is the piece I love. I can have an emotional investment into their families. I want to treat them like it's my mom or dad."
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