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Having spent the past 3 years growing a home care business, one of the biggest lessons early on was to focus on the caregivers. Almost all our caregivers are bl

Having spent the past 3 years growing a home care business, one of the biggest lessons early on was to focus on the caregivers. Almost all our caregivers are black, single women living at the poverty line. Anything you can do to help them with childcare, making ends meet some months, offering extra hours, etc. is life changing. Ultimately, the caregivers are your product. I always wondered about companies like Honor. Their initial pitch was basically all existing home care companies are still in the stone ages, very inefficient, still using paper (typical SV storyline). The reality is there are a few really well built SaaS companies (Clearcare is the one we use) that can do all the automated scheduling, compliance, billing, caregiver ratings, family portal, etc. Elder care is a really tough business. Seniors are extremely susceptible to abuse and all kinds of things often go wrong. Dispatching caregivers through an app sounds like a nightmare. Seems from the article these guys are beginning to learn the ropes of the business. I hope they figure it out. The growing number of seniors is going to be an incredible challenge.

randycupertino 11y ago
I've also worked in senior care and have seen some incredibly horrific abuse cases. One caregiver would say he was taking the elder to the park for a walk, to a cafe for lunch, to the pharmacy to pick up meds and then to the store, but really he was driving them to his house, locking the elder in the back with the child proof locks enabled, and leaving him inside the car for hours while he went in his apartment and watched TV. We only found out because the elder tapped on the window when someone walked by the SUV (tinted windows) and that person called the police. Other things like triple diapering to not have to change the elder more than 1x per shift and massive yeast infections underneath the breasts due to lack of bathing and not changing clothes. The worst types of places I have seen are the "board and care" facilities for mentally disabled adults run by Russians in the east bay. There were a few rotted/unchanged/septic g-tubes that were absolutely horrific. It's been years and that specific smell of a rotting gtube is still burned into my brain. There was also this case in the East Bay where the facility abruptly shut down and stopped paying their workers and so all the caregiving staff just left except for the janitor and the cook who stayed on and cared for the seniors for several days until the fire department and sheriff finally responded: http://www.npr.org/2014/11/21/365433685/if-we-left-they-wouldnt-have-nobody http://www.npr.org/2014/11/21/365433685/if-we-left-they-woul... <--- Honor should give those two dudes who stayed jobs! It's a very challenging industry.
- marincounty 11y ago
  I've worked as a IHSS worker. I didn't see the abuses you describe, but don't doubt they happened. That said, these workers need to be paid more. I took care of an old friend. I would have taken care of him for free, but since I was offered minimum wage; I took it. I think what bother me most were the people who used the system to get out of taking care of a parent, or family member. I live among very wealthy individuals. They are very cheap when it comes to take care of dad, or mom. Yes, they have busy lives. What am I saying--usually one sits home figuring out the color palate for the third bathroom remodel--that, "just isn't right?". They are shocked to find what Home Heath Care individuals are paid, but go along with the program. "That life?". When they are offered a someone qualified, and charges a living wage for the county; they quietly go with the cheapest option. If the senior is still all there, they always hire the best help. The problem is when it's up to the kids. They cheap it out. I just don't get it. I took care of my friend, until I opened that door, and he was dead on his cheap, rented hospital bed. (Medical rentals charged $200/month for a bed most of you would sit on.) Ah, this is putting me in a bad mood. RIP RB. We had some great times! Those river trips were legendary. I miss the fun we had. I even miss the weekly phone calls asking about the new sound your car is making. He was my best friend.
  - randycupertino 11y ago
    I was a paramedic so generally by the time we were called things were deteriorated pretty badly which is why we saw a lot of horrific cases. Totally agree about the wealthy being very cheap about taking care of their parents! I know a "California super lawyer" who lives in a mansion in Belvedere who was recently kvetching about how his father's medication copays went up a total of an extra $4 per month. He honestly complained to me that because of this $4 increase his father wouldn't be able to EAT any more. It took everything I had not to be like, "I know you drive a Tesla and live in an $8 million dollar mansion so I think you can swing dad's extra copays!" He wanted me to try and find his dad government assistance copay relief, which is a process I'll happily help out with for actually low income patients. I think a lot of other cultures (Asian, Jewish) do eldercare a lot better than we do. To this day, if someone asks me for a recommendation of a place to put mom and dad, I always recommend the Jewish Home for the Aged, they are fantastic and you don't have to be Jewish to live there. They just have a 3+ year waiting list because everybody knows they are the best in the industry. I'm sorry about your friend. Sounds like you were a great friend and caregiver to him.
msabalau 11y ago
Death rates rise as unemployment falls. This is concentrated in the elderly, and there is research that suggests that this may be attributed to the increasing difficulty hiring home health aides, nursing aides, etc. (http://www.nber.org/papers/w17657.pdf http://www.nber.org/papers/w17657.pdf) Perhaps giving their workers full time employment and equity will help Honor grow market share at a time when it's harder for other firms to staff.

randycupertino 11y ago

I've also worked in senior care and have seen some incredibly horrific abuse cases. One caregiver would say he was taking the elder to the park for a walk, to a cafe for lunch, to the pharmacy to pick up meds and then to the store, but really he was driving them to his house, locking the elder in the back with the child proof locks enabled, and leaving him inside the car for hours while he went in his apartment and watched TV. We only found out because the elder tapped on the window when someone walked by the SUV (tinted windows) and that person called the police. Other things like triple diapering to not have to change the elder more than 1x per shift and massive yeast infections underneath the breasts due to lack of bathing and not changing clothes. The worst types of places I have seen are the "board and care" facilities for mentally disabled adults run by Russians in the east bay. There were a few rotted/unchanged/septic g-tubes that were absolutely horrific. It's been years and that specific smell of a rotting gtube is still burned into my brain. There was also this case in the East Bay where the facility abruptly shut down and stopped paying their workers and so all the caregiving staff just left except for the janitor and the cook who stayed on and cared for the seniors for several days until the fire department and sheriff finally responded: http://www.npr.org/2014/11/21/365433685/if-we-left-they-wouldnt-have-nobody http://www.npr.org/2014/11/21/365433685/if-we-left-they-woul... <--- Honor should give those two dudes who stayed jobs! It's a very challenging industry.

marincounty 11y ago
I've worked as a IHSS worker. I didn't see the abuses you describe, but don't doubt they happened. That said, these workers need to be paid more. I took care of an old friend. I would have taken care of him for free, but since I was offered minimum wage; I took it. I think what bother me most were the people who used the system to get out of taking care of a parent, or family member. I live among very wealthy individuals. They are very cheap when it comes to take care of dad, or mom. Yes, they have busy lives. What am I saying--usually one sits home figuring out the color palate for the third bathroom remodel--that, "just isn't right?". They are shocked to find what Home Heath Care individuals are paid, but go along with the program. "That life?". When they are offered a someone qualified, and charges a living wage for the county; they quietly go with the cheapest option. If the senior is still all there, they always hire the best help. The problem is when it's up to the kids. They cheap it out. I just don't get it. I took care of my friend, until I opened that door, and he was dead on his cheap, rented hospital bed. (Medical rentals charged $200/month for a bed most of you would sit on.) Ah, this is putting me in a bad mood. RIP RB. We had some great times! Those river trips were legendary. I miss the fun we had. I even miss the weekly phone calls asking about the new sound your car is making. He was my best friend.
- randycupertino 11y ago
  I was a paramedic so generally by the time we were called things were deteriorated pretty badly which is why we saw a lot of horrific cases. Totally agree about the wealthy being very cheap about taking care of their parents! I know a "California super lawyer" who lives in a mansion in Belvedere who was recently kvetching about how his father's medication copays went up a total of an extra $4 per month. He honestly complained to me that because of this $4 increase his father wouldn't be able to EAT any more. It took everything I had not to be like, "I know you drive a Tesla and live in an $8 million dollar mansion so I think you can swing dad's extra copays!" He wanted me to try and find his dad government assistance copay relief, which is a process I'll happily help out with for actually low income patients. I think a lot of other cultures (Asian, Jewish) do eldercare a lot better than we do. To this day, if someone asks me for a recommendation of a place to put mom and dad, I always recommend the Jewish Home for the Aged, they are fantastic and you don't have to be Jewish to live there. They just have a 3+ year waiting list because everybody knows they are the best in the industry. I'm sorry about your friend. Sounds like you were a great friend and caregiver to him.

msabalau 11y ago

Death rates rise as unemployment falls. This is concentrated in the elderly, and there is research that suggests that this may be attributed to the increasing difficulty hiring home health aides, nursing aides, etc. (http://www.nber.org/papers/w17657.pdf http://www.nber.org/papers/w17657.pdf) Perhaps giving their workers full time employment and equity will help Honor grow market share at a time when it's harder for other firms to staff.