Plight of the Home Care Nurse

cars driving in fogSince May of 2012, the book has received a decent amount of advance press due to various speaking engagements. With that, though, comes the perfectly reasonable and necessary demand to back up claims with factual information.

One particular area of skepticism has been the source material for the data point that home healthcare professionals drive nearly 5 billion miles per year, more than twice that of courier service UPS. This is where an author gets nervous, even with a team of technical and editorial reviewers working behind the scenes. There’s always a nagging tendency that incomplete or inaccurate fact-checking has resulted in gross generalizations, just for the sake of proving a point. Or that the research has not been as thorough as it should have been, because the numbers fit too neatly into a circular argument.

Such might be the case with statistics around the driving habits of home care workers, which includes nurses, occupational therapists, physical therapists, home care aides, nuns and volunteers. Their collective mission is to serve the “homebound patient,” those who are chronically ill, elderly, disabled and undergoing long- or short-term rehabilitation. The homebound patient population numbers 12 million people who are confined to the home and cannot leave without assistance.

Statistics from a 2006 National Association for Home Care & Hospice (NAHC) survey were based on Federally-mandated Medicare cost reports, which indicated 4.8 million miles had been driven across all fifty States. According to the NAHC, 4,786,052,493 miles were driven to cover 428,676,938 visits to critically ill homebound patients. Nurses and therapists in North Carolina alone drove over 232 million miles covering 15 million visits.

That said, it’s easy to glance at these figures with cynicism and think, “Well, of course. The NACH is looking to procure more funding, so they’re bumping up the statistics in order to elevate the urgency of their profession.” And that would be a fair comment upon which to pressure-test the data. After all, the Bureau of Labor Statistics 2010 Occupational Outlook Handbook only indicates 198,000 physical therapists and 108,000 occupational therapists currently working, and not all of them are driving.

In fact, many OT/PT professionals work in hospitals and facilities where patients come to them. So if we round up those two figures to, say, a combined 500,000 just for the sake of argument, we’re stil making a very generous assumption. If we then assume that a mere 20% of PT/OT professionals are actually driving, we have to conclude that a fifth of the PT/OT workforce is driving 10,000 miles a week or 2000 miles a day. And that just isn’t logical.

However, the NAHC survey is not limited to PT/OT professionals. Remember that this covers a wider swath of home care aides, including volunteer workers. According to the same 2010 Bureau of Labor Statistics report, there were 1,878,700 jobs in home care nursing with an expected growth rate of 70%.

So even if we assume that the same 20% of those 1.8 million workers are doing a bulk of the driving (remember, these are home care professionals), the result is a much more realistic 13,307 miles driven a year. Factoring a two-week vacation, that’s only 266 miles a week or 53 miles a day. That’s a standard commute for most people, and I’ve intentionally excluded 80% just to make the comparison fair.

A quick glance at the National Association of Social Workers introduction to hospice and palliative care reveals that “a great deal of driving to visit clients and some off-hours emergency coverage may be required.” Further insight can be found in a 2008 Wall Street Journal, “Gas Price’s Unlikely Victims,” where the toll of fuel costs has curtailed not only home health but also food delivery and other services for homebound patients.

It’s not only about the numbers; it’s also the experience of the PT/OT worker. One therapist told me, “I just assume that if I don’t see a patient everyday, then he’s going to get worse. Problem is, I can’t be at his home every day because I have another patient 140 miles in the opposite direction.” Such isolated comments expose the pain point behind the numbers, one that might be alleviated through digital means if devices were made available via reimbursement subsidies or accountable care plans.

The point is clear: people who are confined to their homes due to illness, injury or disability rely on a healthcare infrastructure whose services are dependent upon the automobile. The financial or logistical inaccessibility of remote monitoring technology threatens to marginalize a patient population who could most benefit. Lacking a self-supported model of care or the means to implement it, home health professionals are left to take up the slack, and the only way to do that is to get in the car and drive.


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