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.

“I tell people that coming to work in home health care is sort of like learning how to drive a car or ride a bicycle,” he said. “The first day or two it’s nuts, and then it’s not so bad.”

Although the home care agencies have been around since the 1880s, growth exploded in the 1980s with the rising cost of medical care, which drove providers to find ways to control expenses. In the last few years, home care industry revenue has increased 12% or more a year--a pace that is expected to continue--and accounts for about 3% of national health care spending, the home care association estimates.

Home health care agencies flourish because treatment at home is much cheaper than the same care would be if provided in a hospital. And when insurers insist on shorter hospital stays, patients may require more or higher-tech care than their families alone can provide. Then there’s the issue of an aging population that needs help with chronic conditions, as do people with illnesses such as cancer and AIDS.

The industry is dominated by giants. Two of them are merging: Homedco Group in Fountain Valley and Abbey Healthcare Group in Costa Mesa. But the bulk of the agencies are run by hospitals or are smaller independents such as ColbyCare Nurses.

Registered nurse Carolyn Colby started ColbyCare in 1987 when she couldn’t find a job that came close to the vice president post she left after several years with a large but struggling home care agency.

“No one would hire me at that level,” Colby said. “I don’t know if it was because I am black or because I am female and black, but I couldn’t find a job. I said, ‘I’m starting my own company.’ ”

ColbyCare Nurses struggled as well. Colby said her nursing expertise and her bachelor’s degrees in microbiology and health care administration did not prepare her for the headaches of entrepreneurship.

ColbyCare needed money but couldn’t get a bank loan. Colby and her husband had just bought a house but didn’t have enough equity to satisfy lenders.

“In 1988 and ‘89, the only people who could get money were people who had money,” she said. Colby achieved her business’ growth using funds from other financing sources.

Then in about 1990, ColbyCare began to feel the benefits of the medical industry’s push to lower costs by using home health care companies, and it went after the business of state-funded regional centers, which provide services to the developmentally disabled.

Along the way, Colby got a master of business administration degree from Pepperdine University, which she considers important to the success of her business.

“It’s a difficult business for the large companies, and I think it’s even more difficult for the smaller independent companies,” she said.

Competition is tough, employee turnover is high and recruitment and training are expensive, she said.

“You’re sending people into the home, which always sets up a situation for liability, fraud and abuse,” Colby said. “You have to trust that they will carry your philosophy about the level of care you want to provide. Sometimes that trust is misplaced.”

To combat the problem, ColbyCare spends a lot of time on recruitment and orientation of employees, she said, adding that the company does an intensive background check and provides continual training.

Home health care agencies are heavily regulated and the profit margin is thin, according to Colby.

“It’s easy to open one of these agencies, but it’s very difficult to keep one running,” she said.

“A lot of people think all you need is a pen and a phone, and that’s not true.”

Today ColbyCare has 250 employees, compared to a mere five-person nurse pool in the early days. Revenue last year reached $3.8 million, and Colby said managing the company’s growth at a steady but not overly fast pace has been her latest challenge.

ColbyCare provides home care throughout Los Angeles County, including certain neighborhoods that other companies avoid, she said.

“We are one of the few agencies in Los Angeles County that has no difficulty covering the inner city, which is one reason why we do well,” Colby said. “Wherever their home is, we can go and take care of them.”