The Transylvania Times -


TRH News Has Silver Lining


The announcement by officials at Transylvania Regional Hospital that it will be discontinuing its private, in-home aide program Nov. 1 is not as bad as it may seem. Certainly closing down a program that has provided services for many years will be disruptive to those who either work in or receive services from that program. Thirty-eight people, about half of whom are part-time, will have to find a new employer and that experience can range from unsettling to traumatic. Those receiving the service will have to contract with a new provider. They will have to figure out a way to either keep the staff that currently services them and with whom they are comfortable or find a new staff and develop a level of comfort and security with them.

That could be the extent of the bad news. The other results of the decision should be either good or neutral. For patients, they are not losing access to a service. Bayada Home Health Care and Compassionate Home Care both provide private in-home care in the county. Patients who have a contract with the hospital for this private service can now contract with either of these two providers, or they can skip the middle man altogether and contract directly with the person(s) who have been providing the service. These changes might result in lower costs to the patient.

As for those 38 people who will no longer be employed by the hospital, they too will have options. Some of them could be absorbed into other hospital programs. Those who are not can work for themselves or either one of the other two private, in-home care providers. There is also the possibility another private, in-home aide provider could open up in the county. The hospital already is working with the other two home care agencies to finds jobs for those affected by the upcoming layoffs. For that, the hospital is to be commended. In essence, those who work in this field probably should be able to find similar jobs and there should be no negative impact on the county’s overall job numbers.

This also could help the hospital financially. Although the hospital’s overall finances are affected by decisions regarding Medicare (hospitals will receive less revenue under the Affordable Care Act) and Medicaid (the state’s decision not to participate in extending the insurance to about 500,000 individuals), the in-home aide program is not covered by insurance. It is a privately paid for service. (The exception is a very low percentage of people who have purchased long-term private insurance to cover non-medical needs.) The hospital is cutting a non-medical service that was not paying for itself.

So why TRH is getting out of the in-home aide business while Bayada and Compassionate are staying in it? One possible reason is that hospitals have to follow different and stricter rules and regulations than other providers. (This was a major argument during the recent passage of the state’s anti-abortion bill. By making abortion clinics follow guidelines that are stricter and closer to those that must be followed by hospitals, opponents of the legislation argued that the cost of running such clinics would increase and possibly cause some of the clinics to close.) Hospitals typically also provide better benefits packages than those businesses that are not involved in medical care. Since in-home aides provide non-medical services such as personal care, meal preparation and housekeeping, businesses that offer just those services may not offer their employees as good a benefit package.

We are sensitive to the needs and uncertainty of those 38 people who will no longer be employed by the hospital and those 100 patients and their families who will have to make new arrangements to receive in-home aide. The potential difficulties and hassles they will face in the short term should not be underestimated. And there is the possibility that some aides may not find work or their pay or benefits could be less.

Most people are resistant to change, particularly when they are satisfied with a service they are receiving. But constantly rising health care costs are crippling us financially, as individuals and a nation. The system needs to become more cost efficient. Having hospitals focus on their core services while relinquishing ancillary, non-medical services may be a step in making a small part of the system more efficient.

This change will be rough initially for those directly involved. But the long-term impact could be neutral or possibly even beneficial. In the end, if patients are receiving the same service for the same price or less, if in-home aides find similar work at a comparable wage, and if the hospital is able to improve its balance sheet, then there is indeed a silver lining in this recent announcement.