A recent article in Public Policy and Aging suggests that the cutting edge of growth and innovation in aging services since the 2000s has been in the area of long-term services and supports. The author outlines three major trends in this area and their implications.
The first trend is in growth of non-medical home care agencies, which employ personal care aides, homemaker/chore workers, and companions for private payers. Between 2009 and 2014, there was a 53 percent reported growth rate of these agencies. Of the estimated 7,000 such agencies, 28 percent are franchises. The majority only provide non-licensed aide services. About 70 percent of these agencies’ revenue comes from out-of-pocket payment, with most of the remainder coming from long-term care insurance (10 percent) and Medicaid (10 percent). For such agencies, the biggest ongoing problem is a shortage of direct care workers. Yet even in light of this, these agencies commonly try to limit worker hours to avoid paying overtime or offering workers employer-sponsored health care.
The second trend is the development of new variations on home care agency delivery. This includes greater flexibility in scheduling workers and on-demand services that can be delivered on short notice. Rather than more typical two- to four-hour minimum visits at regularly scheduled intervals, some agencies now offer durations of as little as an hour without any service contract requirements and requiring as little as two hours’ notice. In some cases, such services can be arranged via a smartphone app.
The third trend is online referral services that connect individuals seeking work with individuals seeking to directly employ them. These services serve as job boards that may charge individuals seeking work a listing fee or charge consumers a fee to use their registry. Some job boards include customer reviews or ratings of potential employees. However, this places employer tax and labor law responsibilities on the customer. In some cases, the services even ask customers to perform criminal background, driving record, and credit history checks for potential employees.
Through use of advances in information technology, the above trends offer customers greater flexibility and cost savings, but sometimes with additional risks for consumers.
Doty P. Private pay home care: new models of access and service delivery. Public Policy & Aging Report (2017); (27)3: 111–120.