Union Protections Extend to Minnesota Home Care

The Service Employees International Union (SEIU) will now extend its benefits to home-care workers in Minnesota.

Home-care workers voted last week by a 60-40 split to join the SEIU. Such workers, who largely care for their own relatives, are paid by Medicaid to provide non-medical assistance to elderly or disabled patients (including feeding, dressing, and driving them to complete errands). Under the SEIU, such workers will now have collective bargaining rights to campaign for higher wages and other benefits.

This vote makes Minnesota the latest in a series of states that have extended union privileges to home health workers, even as the union fights several cases challenging mandatory union dues for workers. It is also consistent with the announcement of FLSA extensions to existing minimum wage requirements made earlier this summer.

It remains to be seen whether home-care workers in other states will vote to unionize, and what impact that may have on home care agencies in those states. Regardless of the impact, PRN Funding’s home health care factoring programs can help agencies that struggle to meet rising operating costs. Visit PRN Funding to learn more about home health care factoring and to apply today.

New Minimum Wage Regulations Impact Home Care Agencies

Home Care Minimum WageA pending extension of the Fair Labor Standards Act has significant potential implications for home care agencies.

Starting January 1, 2015, the U.S. Department of Labor will require all direct care workers employed by home care agencies and other third parties to be covered by minimum wage and overtime protections.  Caregivers will be limited to 40 hours a week without overtime, which must be at least one and one-half times the standard hourly rate. In addition, agencies must offer a minimum wage of $7.25 per hour (the current federal rate) or the current minimum wage in their state, whichever is higher.

A particular element of the Department of Labor’s final rule, published in September of 2013, will also narrow the application of the “companionship services” designation and prohibit “third-party employers, such as home care agencies, from claiming the companionship and live-in exemptions.”

What could this rule change mean for agencies, caregivers, and patients?


Home care agencies face an almost guaranteed increase in operating costs: in the first place, if they do not already pay their caregivers at minimum wage they will have to meet that standard. Second, agencies will have to either allow overtime at a higher rate for their nurses to continue working more than 40 hours or hire additional staff to close coverage gaps from a limited 40-hour work week.

Many agencies will have to increase their rates to match their rising costs.


While caregivers will be earning more for the hours they work, many agencies will likely choose to restrict their weeks to 40 hours. Many caregivers typically work as many as 80 hours in a week, meaning that such a restriction would effectively cut their paychecks in half. Another concern: if agencies lose patients due to increased prices, there may be even less work for a caregiver to perform.

Caregivers who face losing a substantial portion of their pay may be forced to take a second job to supplement their income.


While most of the coverage of this rule change so far has centered on home care agencies and caregivers, there are also meaningful potential consequences for patients who rely on home care. As mentioned above, home care agencies may be forced to raise their prices for care or, alternately, provide fewer services to current and future clients. Patients who pay out of pocket or from a trust for their services may quickly be priced out, as would those who have long-term care insurance. Nonmedical home care is not covered by Medicare.

Case Study

There is already an indication of how this rule will impact home care agencies, based on new legislation enacted in California earlier this year.  The California guidelines set a threshold of 45 hours for regular work time and feature a $9 minimum wage as of July 1.

The New York Times profiled one California home care agency, Select Home Care, and highlighted the owners’ options for continuing to operate. In addition to the options presented earlier in this article, co-owner Dylan Hull also presented the option to turn their employees into independent contractors. This option would almost certainly reduce operating costs for Select Home Care, even when factoring in the additional caregivers they would need to recruit.

However, the contractor path opens Select up to periodic audits from the government to ensure that they are in compliance with the IRS definition of an independent contractor. To meet that description, Select would lose the ability to dictate the quality of care they expect and to hold their employees to that standard. According to feedback from other industry professionals not affiliated with Select, the most promising option is to charge more for services and hire additional staff to accommodate a new shift structure.

The Good News

Fortunately, home care agencies do not have to struggle with increased operating costs alone. Factoring for home care agencies can provide immediate working capital to cover the hiring, training, and payroll costs associated with bringing on new staff. Home care factoring also offers additional benefits that can help home care agencies structure their businesses for continued success. PRN Funding has nearly 15 years of experience providing outstanding service to home care agencies across the country – could you be our next success story? Apply online today to get started!

Obamacare Greatly Boosting Areas of Healthcare Staffing

Obamacare has been receiving plenty of criticism due to accusations that the health care law will hurt employees by eliminating positions or reducing hours to part-time. While the actual effects are still relatively unknown, staffing recruiters and HR professionals are confident that Obamacare will help drive job growth in certain areas.

Since PRN Funding works with numerous healthcare staffing companies, let’s take a look at the positions that are prepping for fast growth in the healthcare realm.

1. Nurse practitioners and physician assistants
Due to an increased demand for routine checkups and preventative medicine, physician services are set to increase at least 2 to 3 percent by next year. Nurse practitioners and physician assistants can perform similar services for the fraction of the cost of a doctor. Not to mention, general physicians are still in short supply and take much longer to enter the workforce. The Bureau of Labor Statistics (BLS) predicts the demand for PA’s will swell by 30 percent and staffing for registered nurses will increase 26 percent by 2020.

2. Medical billing coders
Healthcare IT staffing will be huge. Combine the requirements for healthcare facilities to transition to electronic health records and comply with a new medical coding system (ICD-10) with millions of newly insured patients and you have a recipe for lots of jobs to fill.

The International Classification of Diseases (ICD-10) will include a staggering 69,000 diagnostic codes and physicians will be required to submit claims with the new codes starting Oct. 1, 2014 if they want to get paid. Lots of healthcare IT staffing will be necessary to build these codes into the electronic health records software. According to Staffing Industry Analysts, medical coding is one of the hottest jobs right now.

3. Occupational therapists
Occupational therapists make appropriate modifications to the homes and workplaces of the disabled to accommodate their mobility needs. Since Obamacare prohibits insurance companies from denying coverage, more disabled people will be able to take advantage of health insurance coverage. The BLS forecasts a 43 percent spike in occupational therapy employment by 2020.

4. Wellness and fitness coaching
The need for health education specialists is expected to rise by 37 percent in 2020, according to the BLS. Many employers will want to encourage healthy lifestyles, so the demand for workplace wellness programs will skyrocket.

Aside from healthcare staffing, Obamacare is also expected to help spur career growth for payroll service providers, computer programmers, lawyers, insurance consultants, customer service reps and human resources professionals.

Unions Set Sights on Home Health Care Industry

The government is paying more and more people to care for the elderly in their homes as the U.S. population ages. The Wall Street Journal reported that it’s triggered unions to attempt to organize these workers, who usually get low wages and few or no benefits. However, some question whether home health workers qualify to join a union, stating that many are caring for family members and relatives and could be conceived as being self-employed. A 2011 study authorized by the state of Michigan found that 75% of home-care providers in the state went into the field to care for a family member or friend. This has spurred debate in legislative branches over whether to allow or forbid these workers from unionizing.

Many home health care aides are employed directly by people with disabilities or their families, as opposed to working for a private agency. The workers are by and large paid with Medicaid or Medicare funds managed by the state.

The Labor Department expects the number of home health-care workers to reach 3.2 million by 2020, a 68% increase from 1.9 million in 2010.
Home health-care workers are also known as personal-care aides, and their daily duties usually include bathing, dressing and feeding the elderly and those with disabilities, and they did this for a median wage of $9.70 per hour in 2010, according to the Labor Department’s reports. Many of these workers don’t have health-care coverage themselves.

Democratic lawmakers and unions agree that workers receiving public funds are state employees and therefore can be unionized. However, many Republican lawmakers and those anti-unionization argue that personal-care aides are independent contracts and therefore don’t qualify to join unions.

An estimated 25 percent of home care workers in America belong to unions. Perks vary for unionized home-care workers. The article noted that in northern California, personal-care aides who are members of SEIU make more than $12 per hour and a small number of them have health care through union contracts. However, in Michigan, SEIU organized 41,000 home-care workers in 2005, and today, many earn only $8 an hour, just slightly more than the federal minimum wage of $7.25 per hour. During the eight years of being a union member, those workers didn’t attain health benefits, sick leave, or vacation time.

The home health care industry expects a huge boom in coming years. Will your home health care agency have the working capital to meet the increased demand? If rapid growth impedes your cash flow, PRN Funding can help. Our home health care factoring services will keep your company operating effectively despite slow payment, HMOs, Medicare and other factors.

Medical Transcriptionists Face Dictation Challenges

For years, physicians have been dictating their patient reports while medical transcriptionists have been trying to figure out what they’re saying. A recent article in For the Record discusses how technology such as electronic health records (EHRs) and speech recognition are turning these transcription challenges into serious downstream problems and what can be done to fix it.

Various habits and practices cause poor dictation, and even articulate dictators can sometimes fall victim to one or more of them. The propensity to multitask also can undermine the quality of the dictation. Physicians may eat or yawn while talking. They may be trying to speak on a speakerphone while driving in the car with the windows down. Oftentimes, dictation is done with others in the room so the medical transcriptionist must decipher one voice among four others in the background.

Unfortunately, the more physicians in a health system, the broader the range of poor dictation excuses. Melissa Campion, RHIA, CHDA, CHPS, CMT, an eHIM senior systems analyst for transcription at a big integrated health system in Melbourne, Florida, says that foreign accents, which many would assume to be an issue for transcriptionists, aren’t always a challenge. “The accents are actually easier to deal with because most of the doctors with a heavy accent are aware of it and try harder to make it clear,” Campion says, adding that her team has more difficult with dictation from physicians from the Deep South who may be oblivious of how their accents come through in the reports.

However, poor dictation isn’t really about accents, background noise, or speech patterns. Manager of transcription services at Lancaster General Health in Pennsylvania Kathy Lengel says communicating correct and complete data in an effective manner also can notably influence the quality and timeliness of the final report. “Poor dictators are very inconsistent in the format they use,” she states. “They don’t provide good patient information, and some of our poor dictators enter no patient demographic information. They jump all over the place. They have no rhyme or reason to how they’re dictating.”

The safety and quality of patient care are the main concerns when dictation challenges arise as they affect the timeliness and accuracy of the report. Treatment decisions are based on information in a patient’s chart so accuracy is of utmost importance as incorrect dosages could be disastrous or fatal. Many organizations refuse to fill something in if they aren’t 100 percent sure. The uncertainty impacts turnaround time and often requires reports being sent to the hospital to be manually fixed.

Being a good dictator takes several qualities, including being cognizant of the fact that someone on the other end has to be able to make sense of what you’re saying.

Medical transcription service organizations (MTSOs) may want to contemplate including contract language that tackles dictation problems. Medical transcriptionists are paid on a production basis, so having to struggle with poor dictation hampers their income potential. MTSOs may want to consider charging more if physicians are poor dictators and unwilling to improve the quality of communication.

Nursing Home Staffing Faces Shortages as Population Ages

According to a recent article appearing in the Wall Street Journal, a worsening labor shortage in the care of the elderly is hitting the country just as older generations need help most. Looming retirements in the current labor force, of which one-fifth is over 55, is also a big concern of skilled care facilities and home-care agencies. The three major reasons for the staffing shortage are:

1. Low pay: The median pay for nursing aides is $11.74, almost $5 less than the national average of all occupations at $16.71. Some nursing aides start hourly at barely above minimum wage. Nursing home operators say that while they would like to increase pay, recent cuts in Medicare and Medicaid reimbursements make it impossible to do so.

2. High injury rates: Occupational injury rates for nursing home aides are higher than that for factory and construction workers—almost double the yearly rate. Back injuries are prevalent as their duties include lifting patients out of bed, and they are often are bitten, kicked, and spat upon by residents with dementia.

3. Draining work: According to nursing aides, as the shortage continues they are asked to work more hours and care for more patients than they can handle. Industry turnover is high at 43%-75%, compared to other health occupation turnover at 28%.

This story is important for factors and brokers to know about because skilled care facilities and home care facilities, prime factoring clients, are going to face cash flow shortages. Government agencies are giving less money back and facilities need more employees to cover the shortage, a combination which means a shortage of cash. Factoring companies are in a position to help these institutions through this tough time and ensure that the elderly are always cared for.

PRN Funding Exhibiting at Private Duty Conference

Las Vegas, NV- For the fourth year in a row, PRN Funding, LLC will be exhibiting at the 15th Annual Private Duty National Conference and Expo. The event is taking place from November 14-16th at the Monte Carlo in Las Vegas, and will feature the home care industry’s best and brightest providing tips and solutions for making the best business decisions.

Account Manager Ryan Elliot and Marketing Associate Stephanie Chmielecki will be in booth #204 offering information on PRN’s invoice specialty factoring services, which includes factoring for home health care agencies.

Stephanie and Ryan will also be holding daily casino chip giveaways. Visitors of booth #204 will be entered into drawings taking place on 14th, 15th, and 16th at various times. Contest winners will receive casino chips, get their picture taken, and receive free publicity on PRN’s social media and blogging sites. If you are attending the conference, be sure to stop by!


With years of experience in the healthcare industry, PRN Funding has a precise understanding of the unique challenges within the private duty and homecare industry.  PRN Funding offers financial resources to these companies by purchasing their accounts receivable–a process known as ‘factoring,’ which provides the cash needed to sustain and grow a healthcare business.

Marketing Directly to Consumers of Private Duty Health Home Care

October 12, 2012
A recent article in the Private Duty Today newsletter addresses an issue that home healthcare providers often face: how to effectively market their services without breaking the bank.  After conducting market research, the author of the article put together a breakdown of the most effective marketing methods for this important field. The top four of the top results are displayed below, along with the percentage of responders who found the technique highly effective:

  1. Website (62.5%)
    You must have a functioning website that ranks high on search engines.
  2. Health Fairs (45.2%)
    Take advantage of opportunities for networking with other health care providers and getting that referral when the time comes.
  3. Sponsorship of Community Events (34.3%)
    A banner ad isn’t enough; you have to be actively involved with the event you sponsor (such as an Alzheimer’s Association or Parksinson’s disease fundraiser)
  4. Writing for Local Magazines and Newspapers (25.8%)
    A great way to build your brand is to write a column or an “Ask the Experts” in the local newspaper dealing with aging issues .

See the original article, Marketing Directly to Consumers of Private Duty Health Home Care.

ASA Staffing Index Weekly Report – Aug 13-19, 2012

During the week of Aug. 13-19, 2012, the American Staffing Association reported that “temporary and contract employment ticked up 0.10%, pushing the index up one point to a value of 93. The index is currently up 23.6% since the beginning of the year and is 5.9% higher year-over-year.”

Moreover, the staffing employment in August 2012 is up 6.0% from August 2011, according to the ASA Staffing Index.

Click here to read some additional temporary staffing industry statistics.

Hospitals for Profit or for Help?

Did anyone see the article A Giant Hospital Chain is Blazing a Profit Trail in the NYTimes earlier this week?

The article talks about HCA’s revamped billing procedures and revised patient screenings that have led them to be extremely profitable health care industry giant during a time when so many of America’s hospitals have been struggling to stay out of the red.

According to the article, “Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the costs of its medical staff, a move that sometimes led to conflicts with doctors and nurses over concerns about patient care.”

What are your thoughts on this article?