Home Health Care

There's a green garland strung between two IV poles, a lighted angel and some taped-up Christmas cards. But there is no Christmas cheer in Sara Granda's room at the rehabilitation hospital. All she wants for Christmas is to be home with her family. But because her home health care agency has dropped her, citing a shortage of nurses, that's the one wish that can't be granted.

They are the mothers who maintain loose-leaf notebooks so jammed with precise notations on drug dosages, monitor readings and feedings that they resemble hospital charts. The counter tops in their cramped kitchens bristle with medication vials, miniature syringes and special infant formulas. Their refrigerators are papered with instructions for performing cardiopulmonary resuscitation and lists of emergency telephone numbers. Green and silver oxygen tanks stand at the ready in the dining room.

Helen Kenny, 81, died well. Not perfectly, for such an end presumes a lot in these days of managed care and scarce resources. But a pretty good death is increasingly possible, and here's what one looks like. First the economic reality: Helen and James Kenny were forced to sell their Bay Area home of 46 years.

Standard & Poor's said Monday that it revised its outlook on Apria Healthcare Group Inc. to stable from negative, a reflection of how the Costa Mesa-based provider of home health care services has improved its operating performance. The rating was the latest of several favorable assessments in recent months for the company, which has posted profits for the last two quarters after sustaining more than a year of losses.

Apria Healthcare Group Inc., one of the biggest U.S. home health-care providers, said federal prosecutors have closed a criminal probe of its billing practices without filing charges. Apria said a year ago that the U.S. attorney's office in Sacramento had served the company with six subpoenas for information on its billing practices. The U.S. attorney's office later served it with two more subpoenas. The Costa Mesa-based company is still dealing with other legal challenges, though.

Apria Healthcare Group Inc., one of the biggest U.S. home health-care providers, said Thursday that federal prosecutors have closed a criminal investigation of its billing practices without filing charges. Apria said a year ago that the U.S. attorney's office in Sacramento had served the company with six subpoenas for information related to its billing practices. Apria said then that it had no reason to believe it had done anything wrong. The U.S.

Apria Healthcare Group Inc.'s chief executive said he is comfortable with analysts' expectations for the second quarter and dismissed as "ridiculous" accusations of accounting irregularities raised by short-sellers. In an interview, Philip Carter said there is no truth to the market talk that Apria Healthcare, a Costa Mesa home health care company, is improperly adjusting its accounts-receivable figure. The rumors apparently helped trigger an 11% drop in the company's shares Wednesday.

Re: "Home-Care Homecoming," May 1. The implication that the defunct Visiting Nurses Assn. was the end of the line for top-quality home health care for Los Angeles residents, including the poor and uninsured, is patently false. For the past 56 years, Verdugo Hills Visiting Nurse Assn., now VNACare, has continued to serve an ever-broadening population regardless of ability to pay. In fact, several former VNA of L.A. staff members have joined VNACare. As recently as 1997, there were 11 VNAs in Southern California.

It's a lot harder these days to get Medicare to pay your home care bills. This was the fastest-growing part of the giant federal health care system. A nurse would visit a diabetic's home to give her a daily insulin injection. A stroke victim would have visits at his apartment from a speech therapist, and a homemaker aide would help him bathe. Congress hit the brakes hard in 1997, concerned about soaring costs and widespread reports of industry fraud.

Leaving the security of a six-figure salary plus options at the publicly held SRS Labs Inc., Janet Biski last week said she will be co-founding a health care staffing start-up in Dana Point. Her new company, AccentCare, already has received more than $5 million in venture capital financing from three firms, Biski said.