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Home Health Care on a Limited Budget

September 16, 1993

I am responding to your feature article entitled "The House Call Makes a Comeback" (Glendale Section, Aug. 12).

Your comments about the Verdugo Hills Visiting Nurses Assn. were commendable, however your facts about home health care, especially in regard to the private sector, were not entirely correct.

The Verdugo VNA provides skilled nursing services such as intravenous monitoring, wound care and hospice care. These nursing visits are covered by Medi-Cal and Medicare systems and are therefore reimbursable by the state and federal government and some supplemental insurance carriers, however, there is a limit as to how many visits can be made.

Most people recently discharged from the hospital and seniors trying to stay in their own home do not want to relocate to a convalescent hospital or retirement home, however, they are in need of non-skilled services, called "custodial care."

Custodial care services include assistance with everyday living needs, bathing, dressing, meal planning, shopping, food preparation, light housekeeping, laundry and transportation.

At present, Medi-Cal and Medicare do not reimburse for "custodial care" needs. In order to keep home health services affordable, private pay home health care agencies operate on a very narrow profit margin. There is one program, In Home Support Services, which allows some funding for this type of care. The criteria is very stringent with regards to physical and financial eligibility. When approved for benefits they (patients) are given a certain amount of hours a month and the money amount to pay minimum wage. Patients are left on their own to find a care-giver willing and able to take on the responsibility with minor reimbursement for the needed delicate, personal, caring services.

I am appalled to realize that we pay millions of dollars to a few good men who "sometimes" can hit, most times not, a ball "out of the park," while our elderly and infirm living at home must find some means to get a bath at $4.25 per hour, if they are eligible, pay for it themselves if they have some savings or for the most part do without.

Most private home health care agencies, such as our agency, LTC Home Health Care, work very closely with the VNA filling the "gaps" for care at home. We are the people that follow through with orders and instructions left by the visiting nurse and therapist. LTC coordinates care with and for the best interest of the patient. Most skilled nursing through the VNA is done on a short-term basis. Private agencies such as ours provide long-term care, an alternative to convalescent and retirement facilities.

At one time, our executive director worked for the VNA and saw the need to provide this type of service to the local community.

LTC has been in operation since January, 1981, and our profit margin is not high, especially with the escalating costs for small businesses, i.e.: liability, malpractice and workers' compensation insurance. However, we pride ourselves in providing a service that is definitely needed in our community.

We never turn a patient away, we strive to meet their needs and if unable we refer and assist them to the appropriate source. We put the quality of love in our care.

MARGARET NYLAND

Administrative Director,

LTC Home Health Care Services

Eagle Rock

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