Mr. SCHUETTE. Thank you, Mr. Chairman.

The CHAIRMAN. Our first witness today is Miss Brenda Kerkey, a resident of Woodbridge, VA, who experienced great difficulties in arranging for care that would allow her father to remain at home with his family. I want to thank you, Ms. Kerkey, for your willingness to share your personal story with us, and ask you that you proceed in any manner that you may desire.

STATEMENT OF BRENDA KERKEY, WOODBRIDGE, VA, HOME CARE CONSUMER

Mrs. KERKEY. Good afternoon, Mr. Roybal and members of the committee. My name is Brenda Kerkey, and I appreciate being invited to share with you my experience in trying to be a good mother, daughter, wife, and full time worker without a reliable system of home health services.

While I will talk about my effort to keep my father out of a nursing home, I know that I am not the only one confronting this awful problem of caring for an ill parent. My problems are shared by many American families.

Last January, I brought my father to live with us. He had been living in Arizona with my sister. Two weeks after Dad came to our house, he was hospitalized. The doctors said that Dad has Alzheimer's disease and some other serious health problems. Basically, he can't take care of himself. We were told that Dad was eligible for a nursing home and that Medicaid would help pay for his care after he spent $1,100 of his own money. But Dad also had to contribute $192 a month toward his care by the home health agency.

I'll explain later just what he got for the money. But I didn't want to put Dad in a nursing home and was determined to keep him with us. In Virginia, where I live, Medicaid will also pay to keep people at home if they're eligible for a nursing home, so we thought we'd be able to manage. Medicaid would pay for about 71⁄2 hours of daily help for a home health aide while my husband and I are at work.

The first home health agency sent a companion who quit 2 weeks later for a better job. The agency couldn't find a replacement, so after waiting a week, I turned to the only other home health agency in the area. They sent an aide who showed up pretty reliably, but she told me when I called from work to ask about Dad, that he was just fine. When I got home from work I discovered that he wasn't fine at all and needed medication to relieve a swollen condition. Then that aide quit without notice. I then asked the first agency for help and they sent someone who lasted 2 days. No replacement was sent.

Finally, the State health department decided that Dad should go to a nursing home because we couldn't get the help we need to keep Dad at home. My dad is now in a nursing a home.

My family really tried to keep Dad with us. My husband and I took turns staying up at night while Dad wandered. During that time, I had about 2 hours of sleep at night on a daily basis, and my daughter learned to help Dad, too. But, we never got reliable, welltrained, and steady help from the only available home health agencies in our area. I know that these aides are poorly paid, get no

real fringe benefits, and have little reason to stick with the job if a better one comes along.

In my opinion, American women like me are being torn apart. I have to go to work to help support my family, but when I am at work, I worry constantly about what is going on at home. When I had to rush home because of home emergencies, I jeopardized my job. I couldn't afford to quit work to care for Dad, and I couldn't get the help I needed to keep my family together, and out of an institution. We women are doing our best to try to hold all the pieces together, but we need help. Something has to be done to ensure that the people provided by home health agencies are welltrained, supervised, reliable and committed to their work, and more has to be done to ensure better communication between concerned family members and professionals who are supposed to help

us.

There is a definite crisis for families like mine, and we desperately need help. Thank you.

The CHAIRMAN. Thank you, Ms. Kerkey. I noticed by your statement, you said that something has to be done to ensure that the people provided by home health agencies are well-trained, well-supervised, that they are reliable and committed to their work, which leads me to understand why you believe that they are not.

How would you improve or what would you recommend to make improvements in this area?

Mrs. KERKEY. Well, first my recommendation would be that these home health aides get better paid. They can get better paying jobs at most convenience stores with better fringe benefits.

Second of all, I think they need to be better trained. Most of the agencies in our area have their own training system, and I don't really feel that this is done by the State. It is done by the agencies themselves.

The CHAIRMAN. Well, could it actually mean that there is a shortage of trained personnel and that one of the problems may be the lack of a reservoir of trained personnel to do the kind of work that you are talking about?

Mrs. KERKEY. There is definitely a lack of aides.

The CHAIRMAN. So there are, then, two problems: That there are too many that are involved that are not well trained, and those that are do not get sufficient salaries. Their salaries are low.

Mrs. KERKEY. That's correct.

The CHAIRMAN. And no doubt, their benefits are also low, so there is a combination, then, of things that have to be corrected in order to ensure a supply of well-trained individuals that could or would come to the home.

Now after that is all done, how should home-care services be paid for? From a Medicaid/Medicare fund, or what would be the way to finance a thing like this?

Mrs. KERKEY. Right now I can only speak from my dad's point of view. He is on Medicare and also Medicaid because of his various illnesses. He has emphysema, heart problems, something that can't be helped, and he is drained financially due to other medical bills. So, on his side, it would need to be picked up by the State.

The CHAIRMAN. Yes; but there was a time when your dad could have been taken care of at home and no doubt at a cost that is much less than the cost for his care today.

Mrs. KERKEY. That is correct. It would have been more cost-efficient to keep him at home, which is what I wanted to do.

The CHAIRMAN. Now, I realize that this matter of financing is a difficult situation, but nevertheless it is part of the problem. The other side of the coin is that we want to be sure that others do not face the same difficulties that you have had in caring for your father. What, in your mind, should be done first to ensure that others do not experience the same difficulties? Are there any recommendations you can give this committee?

Mrs. KERKEY. One recommendation that I would give stems from my experience when I first went to Medicaid to get him enrolled in the Medicaid service. The paperwork was astronomical. People who are not well educated or can't fend for themselves and don't have anyone to do this for them would be lost in the paperwork. I even had to ask for assistance myself to get through the paperwork.

The CHAIRMAN. I have just one more question, because I'm supposed to be asking questions for only 5 minutes.

Mrs. KERKEY. I'm sorry.

The CHAIRMAN. And if I don't obey the rules, I don't think that the others will.

One more question, and that is the question with regard to the reliability of home care as a concept. Do you believe that having access to reliable home care would make it possible to take care of family members at home rather than place them in an institution? Mrs. KERKEY. Absolutely.

The CHAIRMAN. Do you also feel that the matter of cost would be less if that person were to be taken care of at home than in a hospital or other institution?

Mrs. KERKEY. It would.

The CHAIRMAN. So your recommendation to this committee is that we look into, then, the advisability of improving home care facilities and the training of individuals in an effort to assist in the reduction of care for individuals in question.

Mrs. KERKEY. Yes.

The CHAIRMAN. Would that be about a correct statement?

Mrs. KERKEY. That would be very correct.

The CHAIRMAN. I thank you very much.

Mrs. KERKEY. Thank you.

The CHAIRMAN. Mr. Regula, any questions.

Mr. REGULA. No questions.

The CHAIRMAN. Mr. Synar? Mrs. Bentley, any questions?

Mrs. BENTLEY. Mrs. Kerkey, do you know of any other States that use Medicaid funds to pay for home care in order to keep people out of nursing homes?

Mrs. KERKEY. No; this is the only State that I have dealt with, and I just started dealing with this the first part of this year. So this has been my very first experience with Medicare and Medicaid.

Mrs. BENTLEY. Are there any adult day-care centers in your area that your father and others like him could attend?

Mrs. KERKEY. Not that I am aware of.

Mrs. BENTLEY. Do you favor adult day care?

Mrs. KERKEY. If it would serve the purpose of keeping the parent or the elderly person at home, yes.

Mrs. BENTLEY. What would the cost have been for your father's care at home if you had to pay for it privately?

Mrs. KERKEY. If I had to pay for it privately, I'm not sure.

Mrs. BENTLEY. You didn't get any estimates on that.

Mrs. KERKEY. No, ma'am.

Mrs. BENTLEY. Thank you, Mr. Chairman.

The CHAIRMAN. Thank you. The Chair recognizes Mr. Saxton. Mr. SAXTON. Mrs. Kerkey, when you began to look for a home health care agency, did you have a single source that you could go to or an agency that directed you to several agencies to give you a choice?

Mrs. KERKEY. When I went to Medicaid I was told that there were only two home health agencies in my area that would supplement the care for home health aides at home, just two.

Mr. SAXTON. So you were referred to them by the Medicaid people.

Mrs. KERKEY. That's correct.

Mr. SAXTON. What were the requirements that you had to meet or that your father had to meet in order to be eligible for the care that he got?

Mrs. KERKEY. He had to have a spenddown of $1,100 through Medicaid, and then pay out of his Social Security $192 a month. Mr. SAXTON. Were there any other requirements in terms of a financial obligation on his part?

Mrs. KERKEY. No; that was it.

Mr. SAXTON. And you expressed some dissatisfaction with the care that your father received. Did you find that that was a result of dealing with a single agency or was that in your view a widespread type of practice that is prevalent in your area in the home health care industry?

Mrs. KERKEY. Well, in my opinion, I dealt with both agencies in my area, and with both agencies there was the unreliability of aides showing up.

Mr. SAXTON. Thank you.

Mrs. KERKEY. Thank you.

The CHAIRMAN. Thank you. Mr. Fawell.

Mr. FAWELL. Thank you, Mr. Chairman.

Mrs. KERKEY. In your last statement you stated that one of the conditions was that your dad had to—I think you said, spenddown of $1,100?

Mrs. KERKEY. Yes; that's correct. From what I understand his income from Social Security, which is $513 a month, was too much since he had no assets, that was the only income he had, and he was living at home with us, and he had to spend $1,100 of his own money to even qualify.

Mr. FAWELL. The point I was getting at was that he was deemed to be indigent. From a monetary situation, that was a condition for the Medicaid ability to even come into the picture?

Mrs. KERKEY. Yes.

Mr. FAWELL. Thank you.

The CHAIRMAN. Mrs. Meyers, any questions? Mr. Wortley?

Mr. WORTLEY. Just one very brief question. How would you assess the quality of home health care that your father did receive? Mrs. KERKEY. That I didn't receive?

Mr. WORTLEY. That you did receive.
Mrs. KERKEY. Oh, that I did receive?

Mr. WORTLEY. Yes; was it good home health care?

Mrs. KERKEY. I would say "yes" for the first agency that I had until the aide quit. The second home health agency, I would say, no, and the reason being that when I would call home to ask how my dad was doing, they would tell me he was doing just fine, and then I did get home and find a very serious medical condition with him where his body was swollen to almost twice his size, and I stayed up with him on that particular night and put ice bags on him and got prescription medicines for him. It was just a terrible experience.

Mr. WORTLEY. Others that you have spoken with who also have engaged people to come in for home health care, had they had comparable problems with the quality of the care that was offered by the aide or the nurse?

Mrs. KERKEY. I really have not talked with other people about this.

Mr. WORTLEY. Thank you very much.

Mrs. KERKEY. Thank you.

The CHAIRMAN. Thank you. Mr. Rinaldo.

Mr. RINALDO. Thank you, Mr. Chairman. Mrs. Kerkey, do you favor home health care?

Mrs. KERKEY. Yes; I do.

Mr. RINALDO. Did you feel confident leaving your father with the home health aides that were assigned to him.

Mrs. KERKEY. At first I felt confident. I had no reason not to. I was advised that they would be there while I was at work to take care of him, and I shouldn't worry about it. So I did feel confident. Mr. RINALDO. Do you still feel confident?

Mrs. KERKEY. No.

Mr. RINALDO. Why not?

Mrs. KERKEY. Well the experiences that I have had personally where they didn't show up, they called in late, they just quit without any type of notice, then when I started delving into this to ask why the aides were quitting or why they weren't showing up, I was advised at that point there was a shortage of aides, and the reason there was a shortage of aides is because they are not well-paid. They have no incentive to keep their jobs.

Mr. RINALDO. What are your recommendations? What do you think would solve the problem based on your own situation?

Mrs. KERKEY. Based on my situation? I think an incentive to aides would be to raise their salary at least to match whatever the fast food chains are getting. That's mostly where these aides go afterwards in my experience that I've had; to give them fringe benefits. They really have no fringe benefits, the ones that I have dealt with. They need motivation to keep on working.

Mr. RINALDO. Thank you very much. I have no further questions. The CHAIRMAN. Thank you. Mrs. Kerkey, I would like to commend you for your testimony. As you were presenting your testimony, I was thinking about the many experiences that I have had in