Business Spotlight: HealthForce

by Ashleigh Behlmann

SBJ Contributing Writer

sbj@sbj.net

As changes within insurance and Medicare have taken hold, home health care has continued to grow.

Changes to Medicare have curbed hospital stays for those with long-term illnesses such as diabetes, heart disease and dementia. Bringing assistance, whether a nurse or domestic companion, into the homes of patients can keep them out of nursing homes and in better health for longer periods of time.

It was for this purpose that Susan Haralson and Jim Goff founded in 1992 Home Care Advantage, which later became HealthForce.

"Statistics show that people recover much better at home. They have one-on-one care, they don't have to worry about the person in the bed next to them, and in cases of dementia, being in a familiar place calms them," said Haralson.

Director of Clinical Services Maureen Youngman added that many people with aging parents or relatives may want to have their loved ones with them rather than in a nursing home, but encounter difficulty because "if you have two adults working and children in the home, you don't have any time left and somebody gets shorted." In-home care can ease this burden.

HealthForce provides assistance to the homebound on a variety of levels, tailoring an individual assistance program to each client.

For those who need limited assistance while recovering from an injury such as a fractured hip, HealthForce can deploy a companion to assist in light physical therapy as well as household chores and errands. Those with long-term issues may employ any level of assistance they feel is suitable, from homemakers to nurses, nurse aides and live-in assistants. The cost varies depending on intensity of care and geographical location of the patient.

Generally, nurse aide services run $14 to $15 per hour, while lighter duties, such as homemaker services, run $12 to $13 an hour.

Haralson said her company's services are not only for those living at home. HealthForce also provides help in assisted-living communities, nursing homes and hospitals. Youngman added that their role in these facilities can be an important one "whether it's just being there to keep them from falling or to give them that little bit of extra attention."

Haralson and her colleagues have weathered a lot of changes over the years. "We started as a private meaning no Medicare or Medicaid live-in companion agency," said Haralson. " By 1994 we were overwhelmed by the need for our services. We usually had a waiting list of about 10 people."

HealthForce began as a five-employee company serving five clients in the Springfield area, but it has grown to a 200-employee agency serving 18 counties.

In 1994, when the company saw demand increasing, Goff and Haralson bought into the HealthForce franchise in order to compete more effectively. They later bought themselves out of the franchise but retained the name. "We grew and got into Medicare and Medicaid. We staffed nursing homes and hospitals and provided people with live-in companions and sitters," Haralson said.

However, as the Medicare system began to attract national attention from legislators, it became difficult for HealthForce and similar agencies to cope with changes to the system.

"Medicare has always been troubling in the sense that it changed so much. Especially in 1997, when Congress began to change the whole face of Medicare. When they enacted the Balanced Budget Act, we could only take care of these people for so long, and a lot of people had to go into nursing homes because their home health care just ran out. They give you so much money per diagnosis, and when that money runs out, you're on your own," said Haralson.

According to Haralson, this severely affected the company's ability to assist patients with serious illnesses.

"We were probably 50 percent Medicare. The changes to Medicare have affected us dramatically. We gave up our (Medicare) license and got out of the program in August. Our caseload was such tough cases we couldn't give them the care they needed and pay our bills. If you've got someone with, say, a broken hip, and they need only light physical therapy for a few weeks, you can make money and pay your bills. But if you have the tougher cases heart disease, diabetes, patients with multiple diagnoses you have to do it for free, or cut those people loose before they are ready. We couldn't do it anymore. We couldn't afford to."

HealthForce currently works with clients who are under Medicaid, private insurance or self-pay.

During its difficulties with Medicare, Haralson attributed HealthForce's survival to the fact that it accepted multiple methods of payment. "We survived through our private pay and Medicaid. We never put all of our eggs in one basket."

Relinquishing their affiliation with Medicare has prompted Haralson to work to improve HealthForce overall. "What we have done is to bring our Medicaid and private pay up. I would say now we are probably 50 percent Medicaid and 50 percent private pay. Our referrals mostly come word-of-mouth, which is the best kind of referral to have because you start out with a trusting relationship."

Haralson also said that the company was working to attract new clientele by educating its employees.

"I would say the one thing we are really focused on right now is education for our live-in companions. The more they know, the better. We have people come in and give talks, films, and we require CPR training. With private pay, there are no regulations in Missouri. You could start your own business tomorrow knowing nothing, and a lot of people do," said Haralson. This upgraded care and education is part of HealthForce's "Premium Live-in Companion Service."

"We're trying to bring more of a nursing aspect to it," said Haralson. She believes that as her company ages, it improves.

"When you're small like this, you have to do as much as you possibly can and climb that much harder. We've been serving Springfield for 13 years and there's nothing that you can throw at us that we can't handle."