The many extracts on these pages are from copyright material. They are owned by the reference given or its owner. They are reproduced here for educational purposes and to stimulate public debate about the provision of health and aged care. I consider this to be "fair use" in the common interest. They should not be reproduced for commercial purposes. The material is selective and I have not included denials and explanations. I am not claiming that the allegations are true. The intention is to show the general thrust of corporate practices as well as the nature and extent of any allegations made. Any comments made are based on the belief that there is some substance at least to so many allegations.

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Introductory page
This corporate web site addresses the issues of corporate health care within a broad framework. A web page describing this broad context should be considered as an introduction to each page on the web site. If you have not yet read it then
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Content of this page
This web page examines developments in home care globally, in the USA and in Australia. It documents the arrival of the largest global home care corporation in the world, the US based Home Instead Senior Care in Australia, and attempts to force authorities to confront the folly of this.

 Australian section   

Home care in Australia  



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Global Developments

An international trend

Keeping elderly people in their own homes and caring for them there costs less and is what most of them want. It is sensible and many countries have gone this way. Losing some of our independence is a crushing personal event.

On the other hand leaving the mentally and physically incapacitated in community settings where neither they or their carers can cope is cruel. This is the danger of government driven by "policy". Look at what happened in mental health when institutions were closed. There was a migration to the streets and our prisons.

Jun 2005 A global trend

Denmark has moved away from the traditional approach of tipping the aged into institutions. Denmark introduced a strong focus on community care programs, with 24 hour home help and high care nursing made available. The elderly prefer to stay in their homes, close to family, familiar surroundings and their friends. Denmark spends 10% of GDP towards aged care. The Danish policy means they have one of the lowest number of aged care facilities per head of population in the industrialised world. Other countries look at this approach as a possible alternative to funding more facilities, for it's not just the Danish elderly who prefer their own homes, that's a common!
AGED CARE SECTOR : The Ageing Time Bomb, Tick, Tick, Tick........Boom! Your Money Weekly June 9, 2005

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The US experience

In the USA home care has been primarily a commercial as apposed to a humanitarian activity. Many nursing home chains and other commercial enterprises offered home care services.

Home care businesses and their employees have been the subject of fraud allegations. Elderly people were misused in their homes. This was such a problem that in 1997 government stepped in to cut funding and reduce the amount of home care given. Many companies abandoned the business when Medicare funding was cut. It was no longer profitable enough. Fraud and elder abuse remain problems in the sector.

If you pay the market the money you will be rorted. If you don't let them do that they walk off and leave you in the lurch. This experience should be a warning as Australia once again follows the same path. Government has once again ignored the warnings and is not only encouraging a market system but is welcoming large US multinationals into our country to lead the process.

A few recent reports from the USA illustrate the ongoing problems.

Apr 2000 Fraud by employees

A Cranston woman was sentenced yesterday to five years in prison, with 18 months to serve, for Medicaid fraud committed while she was working at American Family Home Care Inc., a provider of home health care aides - - -
Woman sentenced in Medicaid fraud The Providence Journal April 15, 2000

May 2000 Corporate providers raped the system

CONGRESS had good reason in 1997 when it acted to rein in runaway costs of Medicare's home-health program - costs that had in part been jacked up by unscrupulous home-health providers' fraud and abuse of the system.

As The New York Times recently reported, Medicare spending for home-health care has been cut by nearly half - from $17.5 billion in 1997 to $9.7 billion last year - and the number of people receiving home-health care has dropped significantly - from 3.6 million to 3 million in just one year.

These reductions come at a time when the elderly population is growing, and so is the need for home-health services for the disabled elderly.
The means must be found to ensure the quality of the health care given to fragile and vulnerable seniors in their home - care that is often provided without oversight or monitoring by doctors, and away from the watchful eyes of seniors' loving relatives. The means must also be found to ensure the legitimacy of the costs that providers bill to Medicare.

Greater accountability is essential. Congress must demand it, for the sake of the thousands of elderly citizens who depend on home- health services, and the taxpayers who are paying for them.
HOME ALONE - AND NEEDING CARE Roanoke Times & World News May 1, 2000

May 2000 If you cut payment services walk and someone suffers!

But the hospital recently announced it is eliminating those services, which were provided by its At-Home Care unit.

The reason: Medicare funding under the federal Balanced Budget Act of 1997 has been cut. St. Elizabeth will lose $2.3 million in Medicare reimbursements this year and has lost $7.9 million since the act took effect.

Jun 2000 Fraud

Lawyers for the owners of an Albuquerque (Home Care) firm accused of defrauding the New Mexico Medicaid Program out of millions of dollars want the charges dismissed or the trial moved because of pretrial news coverage.
Firm Accused Of Fraud Wants Venue Change Albuquerque Journal June 10, 2000

Aug 2001 A web of fraud

At issue, sources said, is whether the medical product manufacturers engaged in a kickback scheme to encourage hospitals, nursing homes or home-care providers to buy pumps and related supplies used to feed seriously ill people by giving the products away or selling them at a discount. Some providers then allegedly billed the products at a higher price to either Medicare, the federal health insurance program for the elderly, or Medicaid, the federal-state health insurer for the poor, sources said.
Abbott Labs Division In Federal Fraud Probe KRTBN Knight-Ridder Tribune Business News: Chicago Tribune - Illinois August 23, 2001

Oct 2001 Finding carers you can trust alone with a frail relative

An older woman's son calls a home care agency to hire an aide to cook meals and do housekeeping for his mother. A caregiver arrives, and within the first 24 hours, she steals money and checks from the elderly woman.

Detective Leslie Albrecht, with the San Diego Police Department's Elder Abuse Unit, investigated this case and discovered that the caregiver had a prior criminal record, including 14 pages of theft convictions, with time spent in prison.
"As I speak around the county," says Paul Greenwood, who heads the District Attorney's Elder Abuse Unit, "the number one concern I hear from families is, `How can I be guaranteed that the person coming to my mother's house has been given complete security clearance?'

"But unfortunately, either the agency is not doing a check at all or the one being done is often incomplete," he says. "The Department of Justice is hindered in not being able to tell a complete picture because of the current state of the legislation."

Home care agencies, which provide nonmedical services in the home, such as cooking, cleaning, running errands, etc., are not required to have background checks of their employees, but many do provide that service. Most utilize the Department of Justice as it is less expensive than using a private investigator.
Meantime, San Diego Police Detective Albrecht recommends that family members ask if the home care agency is getting a more thorough background check than the one through the Department of Justice. If not, family members may want to do their own investigating. At the very least, they can ask the agency for references on the potential caregiver and check those references out themselves. They should make sure the home care agency is bonded, so there would be some recourse for restitution in case a theft should occur. Private investigators (under "Investigators" in the Yellow Pages) can be hired for a quick, thorough review of the caregiver's past.
Caregiver history can be mystery The San Diego Union-Tribune October 21, 2001

Jul 2003 More fraud

A federal grand jury returned a 13-count indictment against Always Caring Home Care Services Inc. and Meridian Medical Supply Inc., according to U.S. Attorney Johnny Sutton.
The indictment claims that Always Caring used Medicare reimbursements to pay expenses for two of its doctors. The scheme allegedly took place from 1993 through 2000.
Sutton estimates that the defendants made more than $7 million as a result of the alleged scheme.
Two Texas Businesses Named in Medicare Fraud Probe Health Care Fraud Litigation Reporter July 10, 2003

Oct 2003 Spending fell but did services?

Medicare spending on home care soared in early 1990's but it fell to $10 billion in 2002 as government adopted more restrictive method of payment and cracked down on fraud; - -
HOUSE AND SENATE WEIGH CO-PAYMENT FOR CARE AT HOME The New York Times Abstracts October 14, 2003

Mar 2005 More fraud

The indictments were the first of care workers accused of defrauding more than $237,000 from the In-Home Supportive Services program, which provides in-home help to about 13,000 poor seniors, blind and disabled adults and children. Nine of the workers have been arrested so far, said District Attorney Tom Orloff.
17 indicted in home-care fraud The Oakland Tribune March 30, 2005

Apr 2005 Theft and elder abuse

Attorney General Hardy Myers today announced that Vanessa Marie Leininger has been sentenced on her conviction of five counts of Criminal Mistreatment in the First Degree, four counts of Theft in the First Degree, one count of Aggravated Theft, and two counts of Possession of a Controlled Substance II.
During the course of Leininger's employment, the victim's physical health appeared to decline and Leininger reported to doctors and others an increase in victim's pain and corresponding decline in mental capacity.
By October of 2003, the victim needed to be hospitalized twice and it was then the victim's family discovered that Leininger had been ordering excessive amounts of prescription medications for the victim, and that many of those medications were missing. As a result, Leininger was fired. Shortly thereafter, the victim and her family discovered that during Leininger's five months of employment approximately $25,000 of unauthorized ATM withdrawals had been made from the victim's bank accounts.

Oct 2005 More fraud

Attorney General Mike Cox announced today that he has charged a Macomb County-based corporation that provides in- home care and nursing services to severely handicapped patients with 31 counts of filing false Medicaid claims. Cox has also charged the corporation's owner and CEO with an additional 31 counts of Medicaid fraud.
Michigan Attorney General Mike Cox Charges Macomb County Home Health Care Corporation With Medicaid Fraud CEO Also Charged in 31 Count Case PR Newswire (U.S.) October 6, 2005

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Developments in Australia

In Australia home care services have traditionally been provided by community and government not for profit services. There has recently been more private involvement. Most Australian companies have not seen home care as profitable. I am not aware of serious problems in Australia but I have not looked. There are strong advocates for home care among the not for profit sector.

May 2005 Advocating home care

IF Mike Rungie had his way, the nursing home as we currently know it would be a thing of the past.

The chief executive of Aged Care & Housing Group (ACH Group) wants to transform the aged care industry and hopes one day the public will not think of nursing homes or hostels as the only option for aged care.

"Nobody wants to live in a nursing home and increasingly nobody wants to work in one, so there is a real problem here and yet the big dollars in aged care are still being spent in the nursing home end of the business," he says.
ACH Group is a private not-for-profit organisation that provides more than 20,000 older people with purpose-built accommodation, specialist care facilities and support services throughout South Australia.
ACH Group takes a different slant on aged care by emphasising care at home and engaging volunteers to support positive ageing.
"The point is, only 5 per cent of the people we supported last year, ever lived in a hospital or nursing home," he says.

Dr Rungie says older people are "incredibly clear" about the fact they think aged care should be a service that helps them continue to live well.
"The third one is any form of positive care. Helping people go on holidays, providing rehabilitation, keeping fit and early intervention for dementia."

Dr Rungie has pioneered a number of initiatives to promote better quality of life for ageing South Australians including: - - - -
Elderly boomers to set aged-care agenda The Advertiser May 7, 2005

May 2006 One big company enters and another leaves

Attracted by the demographics, the publicly listed Primelife Corporation launched the community care business Prime Carers a year ago. Managing director Jim Hazel describes it as small but growing.
Ramsay Health Care this year sold its community care business, Silver Circle, to a not-for-profit operator, and DCA Group, an aged-care business answerable to shareholders, has shunned community care because of occupational health and safety risks, tight profit margins and limited workforce.
Private sector ventures slowly into home care for an ageing society The Age May 5, 2006

Note that
Primelife is a corporation with a tarnished track record

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Those in need of home care

Home care for the frail elderly is both an alternative and also a step before nursing homes. The people requiring this sort of care are vulnerable. Some of them have dementia and others are very difficult for the family to manage. Others are simply lonely and need company as well as physical and mental assistance. While some require nursing care, others benefit from a helper.

Nov 2000 The problem to be met

Mrs XXX's granddaughter, YYY, said her grandmother was a "terrible person'' who "won't eat, won't do this, won't do that.'' In fact, none of Mrs XXX's nine children, or any of her grandchildren, were prepared to care for her.
"When I hear a story like this (Mrs XXX's story), I think: that family couldn't take it any more,'' Bohan says. "And why couldn't her granddaughter take it any more? Did she have her own life, her own children, was she trying to hold down a job? Did she have a social life? Or was she left caring for somebody depressed, ill, losing their intellectual capabilities, dressing, showering, medicating them?
Lynnette Moore, executive director of Alzheimers Association Victoria, understands the frustration carers feel. "Often with dementia, there is behavior the family cannot understand,'' she says. "They see it as awkward, bad-tempered, destructive. They may be constantly questioning you. They need physical help. You are assisting them in dressing, toileting, bathing, reminding them to eat, and you have no help, no support.''
Alice In Blunderland The Age November 25, 2000

Dec 2000 Home care meets it

Mission Australia has organised permanent accommodation for Mrs XXX in a single unit with an aged care package attached based on her needs.
Grandmother abandoned by family finds permanent home. Australian Associated Press December 7, 2000

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The risks for the elderly

Because the frail elderly are isolation in their homes there are no witnesses. These seniors are more vulnerable to exploitation, abuse and dare I say it rape than those in nursing homes where all these have occurred. I have not studied this sector but the problems in the USA illustrate the risks.

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Acceptability and the yuk factor

The societal issues are very similar to those surrounding child care and the corporatisation of child care in Australia. Traditionally mothers stayed at home to nurture the young and care for their frail parents. It would have been a dereliction of duty to do otherwise. To have handed them over to someone whose interest was primarily commercial would have been viewed negatively. Help was sought from someone in the community who was known to be dependable - often a family friend, a friend of a friend, or recommended by a friend.

With the emancipation of women, many have embraced the commercial sector as a means of realising their lives more fully. They have been much less willing to forego this for a traditional carer’s role.

Although there are criticisms of this change and real consequences for children, for the elderly and for our way of life, it is a fact of our more individually focussed modern life. Surrogates are commonly employed by working families and singles. These include nannies, child care centres, home carers and day care centres for the elderly. The invasion of the sector by market listed entrepreneurial companies more interested in profits than in those they care for adds a far more worrying dimension to the problem. Is there a yuk factor to this?

Nov 2000 The sandwich generation

Until recently it was assumed that it would be the people the aged-care industry calls the "sandwich'' generation: women stuck between their kids and their parents. Typically, they have spent years at home, waiting for their children to become adults. Then, just as they were thinking: "Wouldn't it be nice to go back to university, or to work?'' they are asked to care for an older relative who might shadow them around the house, ask the same questions over and over, or relieve themselves in the street.
Alice In Blunderland The Age November 25, 2000

May 2006 Examining the yuk factor

Paid companions for the elderly, once the preserve of the rich, may be a boon for the middle-class masses. But it represents another shifting of the outsourcing boundary, and it begs the question of how far is too far in the commercialisation of intimate life.
But every now and then, the limits are pushed and something once considered too personal to outsource becomes fair game for the market. House cleaners vacuumed and dusted but it was once thought inappropriate for a stranger to rearrange your undies drawer; now there are specialists who do just that.
Paid companions for the elderly represent another shift that raises questions about our society and our economy. Is this a smart response to a practical, modern problem? Or a sign that many of us are obliged or enticed to spend too many hours at work, and in shopping malls, leaving too few for what is meant to be the most important thing in life, caring for one's family?

The eminent sociologist, Arlie Russell Hochschild, from the University of California, who has written brilliantly on the outsourcing culture, says love and care, the very foundations of social and family life, are a source of great confusion today.
But what is the message when a son or daughter sends a proxy carer? Will the recipient be sad that her child did not care enough to come, or happy that her child, stretched between a demanding job and demanding teenage children, cared enough to spend her hard-earned money on a paid companion? "Increasingly, it seems time has become less the language of love and the spending of money more so," Hochschild writes.
A "paid" friend is an oxymoron. A personal relationship built on commerce must always be suspect of being phoney at heart. Yet outsourcing the tasks of playing Scrabble, going to the races, and talking over old times with one's elderly parent introduces a more troubling proposition.
Beyond the new outsourcing boundaries, the vista is far from clear. The service could prove a useful supplement to family care, a handy weapon against the scourge of loneliness, or a warning that the economy and our priorities are pushing us in the wrong direction.
A high price for the personal touch The Sydney Morning Herald May 6, 2006

May 2006 The debate

Social services and aged-care agencies say it is sad that society has reached a point where people are paying for others to spend time with their loved ones.

However, Home Instead and a Canterbury company, which disputes the American franchise's claim to be first to provide such services, say they help those who are not able to give their relatives the kind of care they deserve.
Hay said that while the concept of paying for companionship for the aged was new, society would soon adapt to the idea. "People think nothing of taking their baby and dropping it off all day in day care, whereas in the past that would have been frowned on."
Presbyterian Support's upper South Island chief executive officer, Vaughan Milner, said it was sad such companies were needed but, as society became increasingly busy and the number of elderly grew, more such services would be needed.

Age Concern Canterbury's chief executive Andrew Dickerson said loneliness and isolation among the elderly was a growing concern.
COMPANIES CASH IN AS FRIENDS OF ELDERLY The Press (Christchurch) May 13, 2006

May 2006 Seems to be inevitable

ONE in seven Australians -- or about 2.6 million people -- are caring for their elderly parents or disabled children - - - .
The centre's (National Centre for Social and Economic Modelling) report says that as the population ages, more women will be needed to participate in the workforce but will be increasingly caught between responsibilities for their children and ageing parents. The study predicts that as with childcare, paid-care services for the elderly will become a necessity. It says it is something governments and employers will have to consider for workers in the future.

After government assistance is taken into account, a primary carer forgoes $9300 a year in income they could have earned without caring responsibilities. Other carers lose about $2600.
Family carers pay high price The Australian May 4, 2006

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Government and home care

With increasing costs, shortage of nursing home beds, and recurrent scandals, the government’s interest in home care increased rapidly between 2000 and 2006. The system fell into the gap between federal and state governments.

Jun 2003 Federal/State buck passing

Rampant bureaucracy and buck-passing meant Australia's home care programs for the elderly were in dire need of an overhaul, aged care groups said yesterday.

Experts and advocates at a community care summit in Canberra agreed that caring for the elderly in their homes needed to be simplified, and the $1.7 billion a year in funding should be bumped up to more than $2 billion.

They also slammed the buck-passing between the Commonwealth and the states, who share responsibility for community care, and argued the system would be better run by one or the other.
Home care programs for elderly 'in crisis' The Age June 13 2003

Little was done about it until 2006 when a large US multinational was brought into the country to provide these services. True to its market belief system the government has been receptive to this company’s lobbying. It plans to turn the aged consumer into a customer shopping for services by giving them vouchers. This is the same sort of thinking which saw the frail and demented using a Michelin's Guide to nursing homes when choosing a nursing home.

I am reminded of a time many years ago when I was on a committee planing a new intensive care ward. The administrator and architect arrived with what they clamed was a plan based on the latest international trends. This was for a long corridor with doors leading off into single rooms and the nurses station at one end. We tried to explain that the patients were very ill and the staff needed to watch them. He was upset and angry - if they wanted help they could ring the bell. He was quite unable to comprehend that the patients would be unconscious, paralysed, and on a ventilator. It almost required a rebellion to have the plan changed.

As the nursing home debacle in Australia illustrates insight and balanced decisions do not come with bureacracy. We need to be wary that the government does not do for the aged and demented what they did when they deinstitutionalised the mentally challenged and the psychiatrically ill - pushed them onto the streets and into our goals.

Apr 2006 Home care popular

ELDERLY people are snapping up aged-care packages that allow them to remain at home close to family, friends and community activities.

Federal Ageing Minister Santo Santoro said keeping older people at home for longer was a key plank of the Government's aged-care policy.

"The philosophy that's driving this Government is that we like the idea of encouraging people to stay in their own communities," he said.

"We're trying to get people serviced within their homes still rather than being put into residential care."
Stay-at-home focus by Government The Advertiser April 7, 2006

May 2006 Dreamworld thinking. Is 24 hour one on one care cost effective or practicable?

PEOPLE living with advanced dementia will be able to stay at home and receive high-level nursing under a scheme to free up places at aged-care facilities.
Home help for dementia The Australian May 2, 2006

May 2006 Sound policy

The Federal Government has announced more than $24 million will be spent on giving people in retirement villages access to community care services such as Meals on Wheels.
Funds to expand services for elderly Australian Broadcasting Corporation (ABC) News May 3, 2006

May 2006 Bad policy

A GIANT American company that provides services to the lonely, needy and well-heeled elderly is set to take off in Australia, raising questions about the commercialisation of community care.
This would represent the first big influx of private for-profit businesses in community aged care, an area traditionally dominated by the non-profit sector.

Its main role, based on US experience, will be to provide paid companions to isolated elderly people whose adult children are too busy, or live too far away.
But at a minimum of $60 for a two-hour service, its carers will also do any task from light housekeeping and meal preparation to recording family history and walking the pets.

The owner of the Australian franchise, Martin Warner, a former franchising manager at Pizza Hut Australia, and head of a pizza chain in the United Kingdom, has already met federal ministers to press a case for changing the way home-care services are funded.

At the National Community Care conference in Sydney yesterday, he urged the Federal Government to issue elderly people assessed as needing home care with vouchers to enable them to buy services from private or public service providers.

In an interview, Mr Warner said: "Clients should be provided with funds so they can make their own decisions about services. Now clients are restricted to the level of service the Government provides, and the organisation in the local area that provides the care packages."

The company's US founders, Paul and Lori Hogan, will visit Australia this month for the launch of the franchise offers, and will meet government officials in Canberra.
But he (Michael Fine, associate professor of sociology at Macquarie University) said government funds should not be directed to private services. "Good entrepreneurs want to expand business; there is no incentive to wean people off services they no longer need," he said. "And I would be surprised if the Government was so generous as to pay for companions."
Giant US care franchise will visit Gran for $60 The Sydney Morning Herald May 4, 2006

May 2006 An giant opportunity for profit or too few wealthy retirees to pay.

The private sector's interest in taking care of the old, frail and disabled in their own home is still small. Only 4 per cent of community care providers in 2004 were believed to be commercial operators.

Anecdotal evidence suggests the shortage of government-funded services and an ageing society encourages private operators to take a closer look.
There's also the argument that privatisation increases the cost and lowers the quality of the service because private companies are answerable to investors first and clients second.
ACSA chief executive Greg Mundy, who runs a not-for-profit nursing home on the Sunshine Coast, believes increased participation from the private sector will depend on whether operators can make money.

"No one's managed to do it on a large scale and lots of people have had a look at it," he said. "Something like 93 per cent of the clients of community care programs are pensioners so they don't have a lot of dough. That makes turning it into a money-making business tricky."
Private sector ventures slowly into home care for an ageing society The Age May 5, 2006

May 2006 Pushing people into home care

LOOKING after ageing parents at home is a challenge more and more families are likely to face, with figures revealing that nursing homes have received funding cuts for the first time in a decade.

With the population ageing, the onus is shifting to family members for care, with more money funnelled into home care packages and less into nursing homes.
But while the amount of money spent on home-care packages has increased, a new report says looking after elderly people at home is more costly.
Care burden on families The Courier-Mail May 8, 2006

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Franchising and other issues

This government’s track record shows its propensity for supporting the corporatisation of health and aged care, and its recurrent vulnerability to US con men selling snake oil. It should not surprise us that they would bring in a US multinational to care for Australia’s elderly. The current fashion in US health care is franchising. A few years ago it was the latest fad in health and aged care in the USA. Large aged care and nursing home companies like the troubling Beverly Healthcare sought out and appointed CEO's with experience in franchising. Beverly has been the ultimate evil empire for aged care advocates in the USA.

It is no surprise that this should be a company which makes money by franchising others to use its name to provide services. In franchising the driving force for both parties is profitability and not care. It increases the commercial pressures. Once again the government is trumpeting the claimed benefits of choice and competition without evidence for the benefit of either in this sector.

Jun 2006 Debating the commercialisation of aged care and franchising

KERRY O'BRIEN: One of the biggest long-term challenges facing the nation is providing care for the increasing number of elderly. Demand is increasing not only for beds in residential care, but also for services that allow elderly people to remain in their own homes.

With this in mind, the Federal Government is looking at a major shake-up of the way it funds community care services through the introduction of a voucher system, in which funding would go directly to individuals rather than to aged care organisations.

But this voucher system could also open the door for private for-profit companies, and is being championed by a giant US aged care franchise Home Instead that is hoping to expand its business in Australia.
MARTIN WARNER, HOME INSTEAD SENIOR CARE: We see an opportunity to grow to 60 to 70 offices around Australia over the next 10 years.

PETER McCUTCHEON: Faced with the growing financial burden of an ageing population, the Federal Government is now considering a new funding system that could assist that expansion. One that provides funding directly to the elderly and their families, allowing them to choose what sort of service they would like.

SENATOR SANTO SANTORO, MINISTER FOR AGEING: I think that it certainly is a proposal that Government can look at. It's all about choice, isn't it, it's all about flexibility.
DR MICHAEL FINE, SOCIOLOGIST, MACQUARIE UNIVERSITY: I don't see the need for any franchised corporate care program that would do to the Australian community care system what, really, McDonald's and Pizza Hut have done to the Australian dietary system.
PETER McCUTCHEON: Community care - or looking after the elderly at home - is a service in Australia that is almost entirely provided by non-government, not-for-profit organisations. Groups like Meals on Wheels tender for government funding through the Home and Community Care Program.
MARTIN WARNER: Clients want choice. And it's not just the clients, but it's also the client's family, who are the baby boomers, who have raised higher expectations.
GREG MUNDY, AGED AND COMMUNITY CARE SERVICES AUSTRALIA: We would have no particular problem with private providers being involved in community care. I think a mixture is a good thing - provided that there are adequate safeguards in place and that the priorities don't get distorted.

DR MICHAEL FINE: We've gone a long way in Australia to developing world's best practice, and I see that moving to this American system would be a major step backwards.

PETER McCUTCHEON: Sociologist Dr Michael Fine is more sceptical about the opening of community care to the private sector. He's concerned that a voucher system would also need a complex system of assessments and accreditation.
Elderly community care is already big business in America. The extent to which franchises like Home Instead and Homewatch can expand in Australia could well be determined by crucial policy decisions now under consideration. The challenge is to ensure profit-taking doesn't outstrip any improvement in service.
US aged care franchise sets sights on Australia Australian Broadcasting Corporation
Transcripts 7.30 Report June 15, 2006

Jun 2006 A sleeping giant market opportunity - or a collection of poor pensioners?

Care services for the aged may be the sleeping giant of Australian franchising. The Australian Bureau of Statistics estimates that between 2011 and 2031, the number of Australians aged 65 years and over is projected to grow from 3.2 million to 5.7 million.
The market in Australia has been dominated by government-funded services, Young says, but there is potential for other types of providers to start up just as long as the business is ethical and meets the key business objectives.
Evans (Franchise Council of Australia chief executive) believes there is a gap in the market for franchisors to provide a variety of aged-care services in Australia.
When we're 64, we will still need you Australian Financial Review June 29, 2006

Jun 2006 A good sounding idea - aged friendly communities

MINISTER for Ageing Santo Santoro has announced initial funding of $250,000 to boost Australian Government and industry action to help develop "age-friendly" communities.
Senator Santoro said it was well known that, in their desire to stay independent, older people preferred to remain in their homes, or at least stay in familiar, comfortable surroundings.

"Good planning and design can help us to meet their needs," he said.
`Age-friendly' communities Herbert River Express June 29, 2006

Jun 2006 Offering a range of services

"The 2006 Aged Care Approvals Round reflects the Government's commitment to the principle of choice for older people providing care not only in aged care homes, but also to support older people who wish to continue living in their own homes and communities," Senator Santoro said.
COMMUNITY PLACES LIFT SUPPORT FOR OLDER AUSTRALIANS : Senator the Hon Santo Santoro Minister for Ageing AAP MediaNet Press Releases June 30, 2006

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Home Instead Senior Care

The concerns

The arrival in Australia of a massive non-medical global home care operator (Home Instead Senior Care) from the USA and their welcome by government is a matter for concern. This is not only in light of our experience of other operators from the US health and aged care marketplace but because of the problems which have occurred in that sector in the USA. It is also because of the introduction of US views about the rights of individuals to exploit the business opportunities of every sector for their personal benefit, and the problems already being experienced in nursing homes in Australia.

In a talk I gave in Canada (pdf file) in 2004 I alluded to the way in which capitalism and democracy had been combined in the USA so that democracy was seen as about the rights of individuals rather than their responsibilities. Responsibility to the community and to each other are no longer seen as a key component of democracy. The consequences of this for humanitarian services in that country are apparent. Those who provide these services do so for their own benefit rather than for the community and its members.

Australia in contrast has seen social services as a key component of its culture and its democratic process. They were protected by an understanding that only suitably motivated and responsible people would provide these services. Marketisation of welfare and other humanitarian services is eroding this. The introduction of US style corporate thinking and executives into one of our most vulnerable sectors will further erode our culture and entrench this one sided understanding of democracy. Few Australians would consider this desirable if they were aware of the implications.

Nov 2005 A global enterprise

Home Instead Senior Care, the world's largest supplier of non-medical home care services for seniors and the winner of a 2004 award from the American Society on Aging for its Alzheimer Training Program, will showcase potential ownership opportunities for the Canadian market at the Franchise Show in Toronto.

Hamilton couple Neil and Wendy Farnworth are setting up the first New Zealand division of Home Instead Senior Care. Home Instead, which operates in five other countries, provides home-based care services for elderly people.
MOVING AND SHAKING : HOME CARE Waikato Times November 21, 2005

May 2006 Launching in Australia

After caring for over one million seniors throughout the US, Europe and Asia, the world’s largest senior care company, Home Instead Senior Care, is now launching in Australia.

Founders Paul and Lori Hogan will visit Australia for the first time later this month to officially launch the franchise in this country.

"We are very excited about expanding the business to the Australian market. The business has achieved great success around the world and I predict a similar growth down under," Paul Hogan says.
Warner says Home Instead Senior Care’s hourly, overnight and round-the-clock services are designed for seniors who require companionship, personal care, assistance with meal preparation, housework, shopping, and transport for social outings or medical appointments.
Brisbane first port of call for aged care giant May 26, 2006

Jun 2006 What Home Instead does

Leading the way into this market gap (in Australia) is the US-based Home Instead Senior Care, the world's largest aged-care franchise. HISC has more than 650 offices throughout the United States, the United Kingdom, Japan, Canada, Portugal, Ireland, Spain, Taiwan, New Zealand and Australia. The business was started in 1994 in the US by Paul Hogan and his wife Lori after Hogan saw his grandmother thrive with devoted at-home care.

A HISC franchise was opened in 2005 in Brisbane with another to follow soon on the Gold Coast.

The first Australian franchisees, Martin and Sarah Warner, are responsible for HISC's Australian development. Martin, who moved to Australia from the UK 20 years ago, says HISC's hourly, overnight and round the clock services are designed for seniors who require companionship, personal care, assistance with meal preparation, housework, shopping and transport for social outings or medical appointments.
Last month, the couple (the Warners), along with Paul and Lori Hogan, met Prime Minister John Howard and the Minister for Ageing, senator Santo Santoro, to introduce the HISC model to them.

While there are many private senior care providers, particularly in residential care and home and community care, few are established under a franchise model and none focus on providing companionship and non-medical care.
When we're 64, we will still need you Australian Financial Review June 29, 2006

May 2006 The founder's mission

Simple services such as grooming, housework and shopping that enable the old and frail to live largely independently were hard to find.

He set about starting a company that would help fill the void. A decade later, Mr Hogan runs the multimillion-dollar franchise business, Home Instead Senior Care, which has 650 offices in 10 countries, including Australia.
Private sector ventures slowly into home care for an ageing society The Age May 5, 2006


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Adverse information

In fairness Home Instead is privately owned and not market listed so less likely to have offended but is also less closely scrutinised. Many of these private companies do provide good services. Available information from the US reveals only one complaint which causes some concern. While this is an isolated complaint it is the sort of thing which we might expect from profit driven operators in this sector and is a pointer to problems. Overall Home Instead seems to have been one of the better private for profit US operators.

Mar 2002 Complaint

My 96-year-old grandmother contacted the Home Instead agency to get information on their services. She contacted the agency for information only because she was concerned that she may need some help in her home if she became ill.

The Agency immediately sent a representative to her home who pressured her into signing a contract for services she did not need. Also, the representative told my grandmother that her insurance policy would pay for the agency's services, knowing that they are not a licensed agency and most insurance companies will not pay for services from unlicensed agencies.

After Home Instead tried unsuccessfully to bill my grandmothers insurance company they started calling her and requesting payment. When they called they would threaten to attach a lien to her house if she did not pay her bill and also threatened to attach service charges.

Finally, my grandmother paid for the services herself. However, she overpaid the agency. I have called Home Instead twice and requested that they mail my grandmother a check for the overpayment, they have told me that they "are sending the check today", however my grandmother has yet to receive it.

My grandmother paid over $800 for services she did not need. Home Instead owes my grandmother $397 and they have not paid her.
Home Instead Senior Care 565 Union St. NE Suite 208, Salem, OR Julie of Pittsburg CA writes (3/22/02):

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Positive information

A search of US reports reveals large numbers of positive reports and advertorials. It is clear that public relations is a key issue for the company. It is very successful in this. It funds research into aged care, makes grants, initiates community charity efforts for the aged and is the subject of multiple positive press reports. The company and its management are quoted as authorities on multiple occasions. It appears to be exemplary but what is not clear is how much of this is written by the company or its agents.

Dec 2005 One of many community projects it leads

To help curb senior loneliness around the holiday season and to provide needy seniors with some of the gifts they are wishing for and extra holiday cheer, Home Instead Senior Care (HISC), the world's largest organization providing non-medical services for aging adults (companionship, running errands, shopping, meal preparation, etc.) kicked off its second annual national community service program called "Be a Santa to a Senior" on November 1, 2005.
Be a Santa to a Senior Program Aims to Brighten Holiday Season for Seniors Business Wire December 2, 2005

May 2000 In the USA the elderly pay

But that same squeeze is proving to be a boon to a fledgling business in Belleville - Home Instead Senior Care. Home Instead, a franchise owned by Beth Roussel of Belleville, provides nonmedical services to elderly people such as meal preparation, bathing, house cleaning and companionship.

None of these services is paid for by Medicare. So Home Instead's clients have to have enough savings or money from relatives to pay the $13-an-hour fee (for most services) that Home Instead charges.

Jan 2004 Franchising mania in the USA

The fastest growing franchises in the US are devoted to senior care, especially those firms planning to keep ageing boomers out of nursing homes.
Meanwhile, Jeff Huber, of Home Instead Senior Care, predicts: "Elder care will replace child care as the number-one social issue in North America."
GRANNY DAY CARE Sunday Age January 18, 2004

Mar 2004 Home Instead's marketing adviser

This year has started out as a hallmark year for Off Madison Ave, adding new clients and celebrating the success of others - - -
For the Phoenix-area offices of Omaha-based Home Instead Senior Care, the world's largest provider of comprehensive, non-medical companionship and non-medical home care services for the elderly, Off Madison Ave will provide public relations counsel.
Off Madison Ave, - - -, was founded in Phoenix, Arizona in 1998 as a full-service integrated marketing communications agency specializing in the development and implementation of comprehensive branding strategies. Evolving beyond typical advertising and public relations practices, the agency has adopted a progressive business model to promote true customer/agency partnerships.
Off Madison Ave Welcomes 2004 With New Clients PR Newswire (U.S.) March 22, 2004

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Australian operations

Home Instead has adopted a similar approach to marketing in Australia to brand its name. Its Australian managers are already being interviewed and quoted extensively in advertorials in local community papers. They are presented as authorities on multiple aged care issues, e.g. vulnerability to hot weather. We should remember the sad case of Andrew Turner who was widely accepted as an authority on nursing homes in the USA and Australia. His widely accepted beliefs resulted in the neglect of thousabnds in US nursing homes and arguably in homes in Australia as well.

Jun 2005 Being an authority on aging

THE greatest fear for most seniors is a loss of independence.

That fear can stop them asking for assistance that can help retain their independence.
Toowong-based Home Instead Senior Care's Sarah Warner said it was often up to adult children to look for signs that their loved one needed help.
"By helping adult children identify resources their parents might need to remain independent, families can avoid some of the stress that goes with caring for an ageing loved one."
The fear of ageing Westside News June 1, 2005

Jan 2006 Heat and the elderly

Martin Warner, director of Brisbane-based non-medical care provider Home Instead Senior Care, said the elderly were particularly vulnerable to the risks associated with summer heat.

"A heat wave is dangerous for anyone, but studies have proven that seniors cannot handle the heat as well as their younger counterparts.
Home Instead's CAREGivers are trained to identify the signs of heat illnesses and the situations that could make an elderly person susceptible to a problem with the heat.
Take care in heat Albert Logan News January 4, 2006

Mar 2006 Risks of injury

A STUDY of almost 3000 seniors has found that help with daily tasks, such as bathing, dressing and preparing food reduced the incidence of injury and illness in the elderly.

Director of non-medical aged care provider Home Instead Senior Care Martin Warner said he was not surprised by the results.

"All of these services assist a senior to remain living safely and more independently in their own home for as long as possible," he said.
Mates tie down European deal Westside News March 15, 2006

Apr 2006 Advertorial

* Where do you work? Home Instead Senior Care.

* What do you like about the company? Employees and clients are valued.
* What areas of study have you undertaken? Most study has been on the job. Home Instead Senior Care has a comprehensive training program for its employees about caring for the elderly.
CareerOne : Care taken in being a companion The Courier-Mail April 1, 2006


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Objecting to Home Instead

At present the concern is not so much about Home Instead’s record as about turning the care of vulnerable seniors over to people whose real interest in them is the profits which can be generated. Even if Home Instead is an exemplary company other market listed groups will follow and we will face all the consequences of a system driven by personal ambition and pressures to compete in putting profit ahead of care.

Home instead has met with the prime minister and with the health and aged care department. It is therefore very probable that it plans to secure outsourcing contracts from government.

I believe that there are real and important issues here. In the face of a government and administration which sees the exploitation of seniors for profit as not only legitimate but desirable there is little prospect of blocking the company. Nevertheless it is important to document concerns and to force authorities to confront them.

For this reason I lodged objections with the Foreign Investment Review Board (FIRB) and with the Commonwealth Department responsible for assessing approved providers of commonwealth services.

I also made these concerns known to a selection of politicians by sending them a copy of my letter to FIRB. My local member responded first defending the government’s position with standard marketplace arguments. I have written to him challenging his justification and setting his response within the wider issue of government ideology.

The department and the ministers chief of staff both responded and set out the governments commitment to the sector, the money it was spending and the processes set in place to ensure standards were maintained. None addressed the key issues of the inappropriateness of marketplace processes and economic rationalist thinking in the sector

I have therefore put some of this correspondence on the web site. Please understand that I am not alleging any misconduct by Home Instead itself but am concerned by the likely consequences of importing large global corporations into this sector in Australia. We have not learned from past experience.

Click on the items below to access this correspondence

the letter to FiRB. (Foreign Investment and Review Board)

the letter to the Commonwealth authority

my local members response (pdf file)

my response to the local members justification

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Home Instead’s web pages

For Updates:- A good way to check for recent developments in aged care is to go to the aged care crisis group's search page and enter the name of the company, nursing home or key words relating to any other matter in the search box. Most significant press reports are flagged there. The aged care crisis web site has recently been restructured and some of the older links used from this site may not work.

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This page created Sept 2006 by
Michael Wynne