Because a phrase like “matching service registry” can cause readers’ eyelids to droop, let me tell you instead about three women in Oregon.
Marcia Watson and her mother, Ethel Green, live in Jefferson, Ore., in a small house with a ramp for Ms. Watson’s wheelchair. She’s disabled, at 51, in the aftermath of myasthenia gravis, and needs help with bathing, dressing and organizing medications. Her mother, 77, is frail and sometimes finds it difficult to rise from a chair. Neither can manage laundry or grocery shopping on her own.
They qualified for part-time home care through the state Medicaid program, but were unhappy with the workers dispatched through an agency. “I called my case manager and said, ‘What else can we do?’” Ms. Watson told me. “She said, ‘We have a database of providers who’ve been screened and trained and had criminal background checks.’”
If the women had owned a computer, they could have logged onto this database, the Oregon Home Care Commission Registry and Referral System, themselves. Because they didn’t, commission staff members ran the search for them. The registry allows both workers and employers to search for one another after specifying their preferences and requirements: Do you want someone to come mornings or afternoons, or to live with you? Do you need an aide who speaks Russian or Somali? Or drives? Do you need someone with special training in dementia care?
Ms. Watson and Ms. Green requested a nonsmoking English speaker who wouldn’t be fearful of a large dog and two parrots. Among those listed: Beverly Haynie, now 65, a veteran caregiver and dog lover who lived five minutes away. When she came for her interview, Ms. Watson said, “We were sitting here yakking about stuff for half an hour.”
When Ms. Haynie said she’d call in a few days to learn their decision, Ms. Watson recalled, “I looked at my mom and she looked at me, and we said, ‘That won’t be necessary.’”
Three years later, Ms. Haynie comes to their home 81 hours a month at $10.20 an hour, a rate negotiated by the union representing public home care workers in Oregon and a huge bargain for state taxpayers, compared with any kind of institutional care. Clients who pay privately for home care can also use the registry, free of charge. Workers generally charge them more because private employers rarely pay benefits. Yet the clients still will wind up paying less than agencies charge.
More than 17,000 approved workers, about two-thirds of whom are currently working, are listed with the registry, said Cheryl Miller, the commission’s executive director. Almost 1,100 Oregonians looking to hire help consult the service each month.
These are three happy women. “It was so much better being able to choose for ourselves,” Ms. Watson said.
“I don’t have to advertise in a newspaper anymore,” Ms. Haynie said. “The registry provides you with employers who need you.”
Sixteen states have such matching registries, according to a recent report by the SCAN Foundation; five more registries function in regions within states.
(A map from P.H.I., an advocacy group working to support direct caregivers, indicates which states maintain registries and contains links to the organizations that sponsor them, including state governments, public authorities, nonprofit corporations and centers for independent living.)
Some registries serve only clients receiving Medicaid services, but most, like Oregon’s, are also available to people paying privately. Some charge modest fees; most are free. All report on workers’ qualifications and availability; most include criminal background checks. When I poked around these Web sites, it seemed clear that some were more useful than others, but generally the idea makes sense.
“They gather information on both sides of the equation: consumers’ needs and preferences and workers’ requirements,” said Dorie Seavey, director of policy research at P.H.I. and a co-author of the SCAN Foundation report. “Then they help workers and consumers find each other.”
More people hire home care independently (through what’s been called the “gray market”) than through agencies, Dr. Seavey pointed out, because non-agency workers charge less (since an agency isn’t taking a major chunk of their wages) and are often more flexible about hours and duties.
But families worry about how to find candidates and evaluate their abilities and integrity. With luck, they find aides through trusted friends; otherwise, they post notices on supermarket bulletin boards or trawl through Craigslist and cross their fingers. “Registries have great potential to overcome the difficulties of a very decentralized, atomized system,” said Dr. Seavey, a labor economist by training.
The need for home care aides will certainly grow, not only because the population is aging but because the Class Act’s cash benefit for long-term care (if its opponents don’t kill it off) will allow more people to hire them. The Class statute requires “adequate infrastructure” to create a sufficient supply of trained caregivers. These registries could help. But for now, Dr. Seavey acknowledged, they’re in their infancy — and in some places, notably Michigan and Wisconsin, they are already on the chopping block as states slash budgets.
The registries must be among the better-kept secrets in elder care, perhaps because most are less than five years old. Ideally, hospital discharge planners, doctors, social workers and local aging agencies would be spreading the word. But that doesn’t seem to happen much outside Medicaid programs. “People don’t know about them,” Dr. Seavey said. “There’s a lot more public education needed.”