Home Health Agency’s New Subsidiary Offers Nonmedical Care

Giving somebody a bath shouldn’t get a hospice in hot water.

With that in mind, Livingston Memorial Visiting Nurse Assn., the county’s oldest not-for-profit home health agency and hospice program, has created Gold Coast CareGivers, also nonprofit. The new subsidiary specializes in nonmedical assistance for people who have difficulty caring for themselves.

The spinoff came about in July as a way to more smoothly negotiate federal laws regarding the not-so-fine line between home health and what is broadly defined as “personal care.”

Home health is medical assistance, usually provided by a nurse, but personal care can include a range of chores that don’t require a nurse--the kind of help family members might give an ailing relative.

“This kind of care wasn’t needed so much when I was young because families lived in the same town,” said Holly Cole Black, program manager of Gold Coast CareGivers.

A Ventura man whose wife has Alzheimer’s disease recently decided he needed a few hours’ help each day with cooking meals and looking after his wife. Hiring a full-time nurse would have been more than was needed, Cole Black said, let alone trying to get Medicare to pay for it.

The same held true for a woman seeking a travel companion for her mother, who was moving from her Ojai nursing home to the daughter’s house in North Carolina. Gold Coast CareGivers helped both families.

Medicare requires that home health-care providers get approval and regular updates from a patient’s doctor for all services. The laws can turn into a lot of red tape, however, when someone provided by the Livingston Memorial Visiting Nurse Assn. gives nonmedical care: travel aid or help with baths, meals and housekeeping while a patient is bedridden.

“Under Medicare guidelines, if someone wanted a bath, even a privately paid-for bath, [a visiting nurse association] still had to send a registered nurse out to do a full assessment, then do a physician’s order,” Cole Black said. “For a bath? It became real complicated.”

With rising health-care costs--especially for Livingston, which subsidizes services for some patients on limited incomes--the red tape was becoming absurd.

Not to mention that a bath given by an R.N. is expensive.

Thus it was Gold Coast CareGivers to the rescue. By using only home health aides, nurses’ aides and “companions” to provide only nonmedical aid, Gold Coast frees up Livingston Memorial’s nurses to do what they do best.

“What Livingston did was pluck a lot of the private-duty work from under the Medicare umbrella,” Cole Black said. “Gold Coast is not Medicare-certified, so we can do private care-giving without a physician’s orders.”

They are also cheaper. A one-hour visit from a nurse can cost more than $100. Medicare may not foot the bill for a bath by a home health aide, but at $14 to $30 through Gold Coast CareGivers, no one gets sent to the cleaners.

And with no doctor’s approval needed, “they can just call us here in the office and it’s so much quicker,” Cole Black said.

The logic applies to other services. A “companion” can do meals, errands and light housekeeping for an average of $13 an hour, Cole Black said. Hands-on care is just a few dollars more.

“Our 24-hour rate is less, assuming the person can sleep through the night,” she said.

Cole Black and one associate run the office and schedule the 30 caregivers.

“Livingston is not looking to make a huge profit,” she said. “They’re looking to build it up and keep it going and pay our salaries, but it’s a community service as much as anything else, I think.”

Cole Black wants clients to have the peace of mind that comes with Livingston’s excellent reputation, so all 30 of Gold Coast’s personal-care assistants meet strict standards set by the parent company. The agency’s board of directors is also the board of Livingston Memorial Visiting Nurse Assn.

Cole Black said the response so far to Gold Coast has been positive.

“We had an elderly woman who couldn’t sleep in the hospital and was driving the nurses crazy,” she said.

A family member paid Gold Coast to have a nurse’s aide stay in the patient’s room. “She wasn’t hanging on that buzzer all night long, so the nurses were glad to have us too,” Cole Black said.

Assignments can come with fringe benefits, such as the man who needed help on his vacation, a cruise to Mexico.

“The man had multiple sclerosis and just needed help getting up and getting dressed,” Cole Black said. “Robert [a home health aide] was there to help him, and he got a first-class cruise.”

She said a surprisingly large amount of business comes from out-of-state relatives who want to buy a little peace of mind.

“People don’t have their elderly parents live with them any longer, and a lot of them don’t want to live with their sons and daughters,” Cole Black said.

“They don’t want to admit they can’t make it alone.”

In January, the agency plans to begin offering postpartum care “for new moms who come home from the hospital and just need a few nights’ sleep, if she just wants someone to stay in the nursery and feed the baby two times a night or do light housekeeping or prepare a meal,” Cole Black said.