“Don’t shoot me, I’m only the messenger.” We are all familiar with the saying: Just because I am the one delivering bad news doesn’t mean I created it. Anyone who has ever explained that senior care of any type is not cheap can relate. And when it comes to being the one to share the news that ongoing care (assisted living or home care) is almost never covered by health insurance or Medicare, well, you better duck!
First, a large percentage of those suddenly thrust into the realm of finding care are not at all aware of the limits of Medicare and often do not realize Medicaid is only for the financially disadvantaged, so that’s the first shock. Then they start to consider options to keep costs low. Maybe start with a caregiver a couple of hours a day, sounds good, but then they explain what two hours they want: An hour in the morning (get mom up, fed, and dressed), a half hour check in visit midday, and then a half hour in the evening to say hi and drop off some dinner. Do you think you could set that up? And how much will it cost, maybe $40/day at $20/hour? If you are in the business you are probably laughing right now; if you are not you are probably thinking that sounds reasonable and wondering what’s so funny.
Put yourself in the shoes of the agency, explaining how $40 a day will get perhaps one of those visits assuming an agency will offer their services in 30 and 60-minute increments. Now explain that the caregiver is not a registered nurse but a non-technically trained companion or a home health aide. As I said above, you better duck!
Yes, senior service providers are familiar with “sticker shock.” Many people are unaware of the limitations of insurance. The first shock is the realization that it will have to come out of their own pocket. The second shock is the realization that you cannot buy an hour here and a half hour there nor is there a surplus of caregivers willing to work odd hours at low pay. Finally, they are surprised to realize that most agencies do not have a full-time staff ready and waiting to visit a client on a moment’s notice. Others think providers are like a taxi service, able to pick you up and drop you off then return later to bring you home and allow you to pay only for the travel time each way.
Most people can understand the rationale for why services can’t be so customized or micro-managed at a low-cost but they usually only reach that point after the shock has worn off. Most go through a predictable progression dismissing the first agency they speak with as greedy and uncooperative. Agency number two has a better chance of getting past the shock and the caller might be more or less polite in their rejection, but chances are they will also be rejected. At this point the person seeking care will either call agency number three with an open mind or start a new search with different parameters based on the lessons learned. They read between the lines looking for an edge to make it work better for them. It is about this time that they become distrustful and wary of agencies, casting them as carpetbaggers out to take advantage of those in need.
The next step for some of the more skeptical is to stop searching and figure out how to provide the support as a family or they give up and decide maybe moving mom to a “home” is the best choice after all because then they don’t have to deal with all those gouging home care agencies. Of course then they will experience déjà vu as they go through the same process with assisted living residences and their costs. Okay, I may have exaggerated things but the description is not so far off the mark.
There are two issues that emerge from this initial effort by families. The first is that they are angry and distrustful of the agency they finally do hire, often out of necessity – if you are trying to get more than you pay for it can easily become an adversarial relationship. Second, they make a bad decision to eschew help altogether and take on the very real risk that the eventual costs of not getting help (both financially and emotionally) is often far higher. There is a significant need to trust an agency in order to get the best results for a loved one.
In some ways, presenting Extended Family’s model of support makes this process easier on us than if we had a different model. Our model’s focus is on premium services and becoming more involved and more connected with our clients and their families. There are plenty of services provided at no added cost to the hourly services. When someone starts the conversation by asking what our rates are, I have gotten into the habit of suggesting that we end the conversation immediately and wish them luck. They are quickly confused so I explain that we provide a higher level of commitment and more attention to do this so we charge more than the typical agency.
Frankly, if they are this price sensitive before they even know my name they will not be a good client! But more importantly it is an indication that they are looking for quantity (lots of hours) over quality (a good fit and a caring support staff). They want to be able to rest knowing that their $100 provided someone at their mom’s home for five hours making sure she was okay in place of spending $100 to be sure someone engaged and connected with their mom for four hours, including getting her to take a shower and eat a healthy meal. This is a simplification, but it is to the point – better service and care costs more money. Period. If you asked someone whether they would prefer someone actively engaging their mom for four hours over someone sitting across the room texting, internet surfing, or watching TV their answer would be obvious. But that isn’t what they ask first – at least not often enough.
Basically there is a lot of education involved with those first couple of calls with agencies. As with anything new there is new terminology, the system of charges is not always clear, the legal and regulatory requirements are unknown, and that doesn’t include the emotional aspects of the situation. Sometimes the role of educator is an opportunity to show your compassion, sensitivity, and knowledge. Sometimes no matter how good an opportunity, though, the result is that they walk away frustrated and angry about the costs and problems associated with aging parents and you are the messenger in the crosshairs.
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