Let’s travel to the private duty marketplace

As in ancient Greece, this Agora is both a marketplace and a forum for the free exchange of ideas

(Editor’s note: When this column began last September, Private Duty Homecare opened a dialogue on the need to creating nationwide standards of care for the private duty home care industry. Since then, many of our readers have written, e-mailed, and even called in their thoughts on this topic. It now seems clear there is a wide base of support for supportive care licensure. At this point, this newsletter relinquishes this dialogue to Judith B. Clinco, RN, PDH’s consulting editor. She has offered to continue organizing the effort to create and obtain uniform standards for private duty home care workers. Names and contact information for those of you who contacted PDH are being forwarded to her. Others who want to join the movement for uniform standards should contact her. Names and contact information of everyone who has contacted PDH about working on uniform standards have already been forwarded.)

Before passing the torch for Agora, we’d like to share the thoughts of Chloe Lansdale, RN, president of HomeNurse Inc., of Wayne, PA. Lansdale is also president of the Pennsylvania Association of Home Health Agencies. She wrote:

"I am responding to the Agora column in the February 2000, issue of Private Duty Homecare. In Pennsylvania, there is no licensure for supportive care services, regardless of payer source. There is also no licensure for skilled, continuous care services except those things covered in the nursing practice act (i.e., what procedures RN’s and LPN’s are permitted to do).

"PA home care licensure is only for intermittent services and that only when a skilled services is required. The law is essentially a clone of the original Medicare law. It has not been updated to reflect later revisions of the Conditions of Participation. Quite naturally, this lack of regulation leads to enormous variation in private duty home care services in the state. Many of us in Pennsylvania find this difficult and dangerous.

"Many insurance carriers for long-term care insurance require licensure as a condition of payment. In order to conform, you need to handle such cases as a part of your Medicare licensed agency and meet the Conditions of Participation. For a private duty case needing only supportive care services this is very burdensome. In addition, the huge growth of the home care market combined with the total lack of oversight and standards for private duty is a real recipe for disaster. The Pennsylvania Association of Home Health Agencies has as one of its goals to achieve appropriate licensure and standards for private duty home care. Clients assume that agencies sending supportive care nursing personnel into the home must meet some minimum standards. In Pennsylvania it is not so. I find the standards you printed very appropriate. I would be interested in knowing what the purpose of the Pro-posed Standards and of U.S. Care Inc. would be in Pennsylvania. Is this a prototype of a law or a new accrediting body?"

To regulate or not

Ginny Pinkerton, RN, sent us the following e-mail: "Thank you for raising this very big issue — one near and dear to my heart! In California, our definition of private duty is home care aide services (vs. licensed companies that provide home care aide and Medi-Cal/Medicaid services). As is true in many states, there is currently no regulation or licensure available here for companies providing home care aide services. I have been very active here in helping to develop and promote voluntary standards for the industry in California. I am chair of our state home care association and have also chaired a statewide workgroup that developed minimum voluntary standards for home care aides (uniform job titles, training, and supervision requirements), and an accreditation standard specific to the home care aide industry. I have been an owner of a home care aide company in San Diego and am currently part of a larger, statewide company that hopes to influence the direction of our industry here in California by promoting and implementing those standards. I would be very interested in your nationwide initiative to raise and unify private duty home care standards."

And Kathleen Bailey, RN, our featured interviewee for the past three months, recently reiterated her support by writing, "I offered my services to work toward national standards for private pay services. My offer still stands."

Thanks to all who care deeply about this issue, and best wishes to all who choose to engage in this very important work.