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Health Horizons : Bringing Home a New Level of Care : The fast-growing field of home health care is expected to reap $26 billion in revenue this year. By one estimate, the industry employs more than 650,000 nurses, therapists and others.


Emma Quinones is a little girl who choked on a hot dog.

That event three years ago left Emma profoundly brain-damaged and changed her family's life forever.

Today 5-year-old Emma requires constant care. From 6 a.m. to 10 p.m., she is fed a liquid formula every four hours via a tube to her stomach. At midnight she gets water. Around the clock, her trachea tube must be monitored and suctioned.

Emma lives at home, and the burden of all these ministrations falls on her mother, also named Emma. But once or twice a week, a nurse from ColbyCare Nurses Inc. visits the tidy Hawthorne duplex so that Emma the elder can take a break--maybe go to the grocery store, do some gardening or take a nap.

"Sometimes I feel that no one can take care of my baby as well as I can," Quinones said matter-of-factly in Spanish as she hovered over the small wheelchair, braiding and unbraiding her daughter's long black hair. "Sometimes I have to go out and do some shopping, but I come back without finishing."

Nurse Victoria Bringier does what she can for her small patient, and the two have established a visible bond. Emma used to cry when Bringier arrived, but now she is " muy tranquila ," her mother said.

"I do anything the mother needs me to do," said Bringier, a foster mother to three. "I've always worked with kids. I like the kids."

This delicate world of suffering is the lifeblood of the fast-growing industry of home health care, projected to produce more than $26 billion in revenue this year.

About 15,000 home care agencies nationwide provide care for more than 7 million people who are sick or disabled, according to the National Assn. of Home Care, a Washington-based trade group. The industry provides work for more than 650,000 nurses, physical therapists, home care aides and others, the group estimates.

"I think people in general prefer to be at home," said Carolyn Colby, president of Culver City-based ColbyCare Nurses, a mid-size independent agency. "Your home is your castle. You have your things about you. . . . In the end, it's much better for the patients."

The home care industry provides exactly what its name implies: health care and medical products for patients in their homes.

Technological advances and the medical industry's quest for lower costs have brought to the home a variety of health services and products to treat conditions that were once the exclusive territory of hospitals and clinics.

You won't see heart surgery on the kitchen table or routine house calls by your doctor to treat junior's pesky ear infection. But home care has moved to encompass increasingly sophisticated treatments and procedures.

The industry employs all kinds of health professionals, from relatively low-skilled home care aides to highly skilled nurses providing intravenous treatments. Physical therapists, social workers, speech therapists and others--yes, even doctors--draw a paycheck from home care companies.

At ColbyCare, about 40% of the company's 250 employees are licensed vocational nurses, about 25% are registered nurses and nearly all the rest are home care aides, Colby said. Most work part time, she said.

Nationwide, nearly 45% of home care employees are nurses. The National Assn. of Health Care estimates that home care workers put in an average of 27.8 hours per week, and the nurses see an average of five patients per day.

Average salaries ranged from $18,721 for home care aides to $50,495 for physical therapists, according to a survey conducted by the group in 1993. Registered nurses working in home care earned an average of $38,723, and licensed practical nurses (called licensed vocational nurses in California) were paid an average of $27,040. (The compensation figures do not include fringe benefits.)

Bringier, a licensed vocational nurse, has been with ColbyCare for five years, taking care of children. She said she works part time, usually visiting three or four regular clients two or more times a week.

"A lot of our kids have feeding problems. A lot of them need oxygen," Bringier said. When she is with Emma, her duties include feeding the girl, suctioning her trachea tube and massaging her arms and legs to keep her muscles stimulated.

Her work is demanding and requires sensitivity to stressful situations in other people's homes. But Bringier said she enjoys establishing relationships with a continuing group of patients and likes the part-time arrangement.

"This job gives me more flexibility" than a hospital or clinic would, she said.

Home health care agencies continue to hire while hospitals lay off employees, said Tom Dorsey, ColbyCare's director of client services and a registered nurse. But the transition to the demanding field isn't always easy, he said.

"I've seen the home health area really, really change" in the last decade, Dorsey said. "It's a lot more high-tech. The patients are coming out of the hospital a lot sicker. The skills that are demanded out of the nurses are always escalating.

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