Home Health & Hospice Week

Connecticut, Colorado charge most for aide services, new survey says.

Are you charging enough for your private pay services? New survey results could help you say for sure.

Home health agencies increased their charges for private pay, home health aide services 2.9 percent in 2003 compared to the previous year, the MetLife Mature Market Institute says. The 513 licensed HHAs MetLife surveyed across the U.S. in June 2003 charged an average of $18.12 per hour for "the private pay rate, not the Medicare reimbursement rate," the insurance researchers report.

That compares to $158.26 for a day in a semiprivate room in a nursing home, and $181.24 for a private room, the survey says.

MetLife expects the private pay home care market to take off more than ever before as the baby boom generation reaches senior status, the survey report emphasizes. By 2030, the 65-and-older U.S. population will reach an astonishing 70 million individuals, MetLife says.

And most of those will want to stay at home as long as possible and avoid the high cost of nursing home care, MetLife expects.

In 1998, 28 percent of folks between 50 and 64 who required help with activities of daily living used paid home care. For those who were between 75 and 84, a whopping 48 percent paid for home care help, the report says.

That means a huge market for private pay home care ahead. And whether your agency succeeds in tapping into this potential goldmine may depend on some important factors, including whether you charge enough for your services.

Fort Worth, TX was the area MetLife surveyed that charged the most for home health aide services, at an average $26.54 per hour. But Texas Association for Home Care Executive Director Anita Bradberry doubts that figure's accuracy.

She finds the figures for the other Texas areas surveyed - Dallas and Houston - to be more in line with her expectations of private pay charges at $16.62 and $16.61 per hour, respectively.

In Texas, "private pay" rates can mean different things to different agencies, Bradberry tells Eli. Survey respondents may have reported charges for skilled care paid for by insurance rather than just home health aide care paid for out of pocket, which the survey seemed to be after.

"It's not necessarily an apples-to-apples comparison," Bradberry says of the survey. "It's not wrong, it just may have different types of services lumped into 'private pay.'"

Laura Friend, executive director of the West Virginia Council of Home Care Agencies, has similar concerns. West Virginia doesn't have a licensure law and very few Medicare-certified agencies offer non-skilled, private pay care, Friend maintains. "Who did they survey?" she asks.

The state's average charge of $13.82 per hour - among the nation's lowest - probably reflects the state's reimbursement rate for Medicaid waiver services, Friend guesses. "Giving this kind of information to the public" without more explanation of what it means "can be confusing," she says.

Beware Labor Shortage 

Hartford, CT HHAs charged an average of $25.25 per hour, making it the area with the fourth-highest charges in the nation, according to the survey. That figure sounds about right, says Brian Ellsworth, executive director of the Connecticut Association for Home Care.

"High charges are only a symptom of high costs," Ellsworth observes. "We have a fairly competitive marketplace in Connecticut."

It's particularly difficult for Connecticut HHAs to hire aides in areas with extremely high costs of living, he notes. Nurses are also harder to find in those areas.

Scanty Medicaid and Medicare rate increases make it equally difficult to hire aides and nurses for services funded by those payors, Ells-worth adds.

Agencies' biggest obstacle in taking advantage of the coming private pay boom will be securing enough aides to deliver services at reasonable costs, experts predict.

Other locations rounding out the high-rate list were Alaska, Colorado Springs and Denver, CO, (see chart, previous page). The areas with the lowest rates were in Alabama, West Virginia, Louisiana and Mississippi (see chart, "MetLife Survey: Highest 5 Average Private Pay Hourly Rates, 2003").

States with smaller populations tend to have lower private pay rates reported in the survey, Friend notes. West Virginia's small, and often rural, population explains some of why the state's reported charges are so low, she says.

MetLife's survey covered 513 licensed HHAs in all 50 states and the District of Columbia. The researchers surveyed 10 percent of an area's providers within a 20-mile radius, or five companies, whichever was greater.