Gas prices climbing over $4 per gallon have hit the local home health care industry hard, sapping the budgets of agencies that pay staff members for home visits. The costs contribute to a staffing crunch and service changes. However, local providers say that their services are still more cost effective than sending clients to a hospital or long-term care facility.

Rich Kucera, owner-operator of Interim Healthcare, said his 60 staff members drive their own vehicles. Private health insurance providers and government programs like Medicaid and Medicare have not increased travel reimbursement rates "and consequently we can't pay our aides what they need to be paid in order to be able to afford more fuel-efficient vehicles, so it's always a challenge."

Lezlie Snoozy-Kaitfors, owner of Comfort Keepers, said even though most of her clients pay directly for their service, rising travel expenses forced the end of one-hour minimum visits. "Our minimum visit is now three hours, to make the length of the service worth the travel costs," she said. In some parts of the country, minimum visits are now six hours to compensate for travel-related costs.

Rapid City Regional Hospital's Home Care division serves around 600 patients with 80 staff members in Pennington County, Custer and Hot Springs. Director Dodie Brown says her staff uses six company vehicles, which typically are assigned to staffers who travel the farthest.

Staff members who drive their own vehicles are reimbursed at the federal IRS rate of 50.5 cents per mile, the highest rate according to various agency policies. "We try to cluster our visits, and I have hired as many people as I can close to the caseload, but it is sometimes hard in our rural area to find qualified staff," Brown said.

She said mileage is considered when assignments are made. "We can't be quite as accommodating as we used to be regarding visits, and ask patients to work with us, since it is not cost-effective or as easy for an aide to come back another day as it once was," she said. "We'll try to assign staff to a full day in a town or an elderly complex to maximize cost-effectiveness," she said.

Like Brown, Snoozy-Kaitfors said that her primary challenge in the face of rising costs is to maintain a balance. "We want to do what's right for staff, but there's a limit because of costs. We are continually faced with questions like, 'How much can we pass on to the consumer, where can we still afford to go, and how much is sustainable?' and we must be more selective regarding home visits."

Because the majority of Comfort Keepers' clients are self-paying, although some receive funding from the Veterans Administration and the state's long-term care program, Snoozy-Kaitfors said that she has been able to manage costs by instituting a surcharge for fuel costs. That reimburses staff members, but passes the higher costs to the consumer.

Snoozy-Kaitfors said her staff is much more concerned about their schedules than they were five years ago, asking for more compressed visits and less driving miles.

Rising fuel costs have caused the Rapid City Comfort Keepers office, as well as locations nationwide, to experience an "employee crunch," according to Snoozy-Kaitfors.

Comfort Keepers in Rapid City is one of 500 agencies nationally that provide assisted living in people's homes. Its staff of 43 provides customized housekeeping and hands-on care, such as bathing and hygiene assistance to around 70 current clients from Belle Fourche to Hill City who might otherwise not be able to continue to live independently.

"Many of our clients are seniors who have no family here, and their children are typically our contacts. Our service alleviates the need for children to travel long distances to manage their loved ones' care," said Snoozy-Kaitfors.

"Staffing is difficult," she said. "There are definitely greater concerns over mileage, and questions about fuel reimbursement from potential employees started to increase about two years ago. That never used to be something people asked about."

Kucera's Medicare-certified Interim Healthcare receives referrals from Rapid City Regional Hospital and covers the Black Hills area, from Belle Fourche to Hot Springs, serving mainly an elderly population. Because Medicare, Medicaid, and private health insurance reimburse home health care services at a pre-determined flat rate, and costs over and above the reimbursement cannot be passed on to clients, it is up to agencies to manage their funds to remain cost effective, he said.

"Gas prices are a major contributor, but all costs, including medical supplies and equipment, are going up, putting home health care between a rock and a hard place," he said.

When he started the business 16 years ago, Kucera said he paid his staff a mileage rate. Now, they are now reimbursed on a per-visit rate, and those visits are planned by location to limit expenses. "We group and arrange our clients in segments of particular towns to avoid excessive driving," he said. "We also have employees who live in the Northern Hills, and they typically serve clients in those areas."

While Brown, Kucera, and Snoozy-Kaitfors agree that rising fuel costs have definitely changed the landscape, they say home health care is still a good choice for elderly and homebound clients, monetarily and for other reasons.

"We provide a full range of professional services-delivered by registered nurses, licensed practical nurses, speech, physical and occupational therapists, aides, social workers and homemakers - specific to the needs of each patient, sometimes once a day, once a week, twice a month - as opposed to $100 to $200 per day for in-facility care," Brown said.

Terminally ill patients given care at home for several months, as opposed to being hospitalized, save Medicare around $2,000 per beneficiary.

"Being able to stay in their own homes for as long as possible, in familiar surroundings, sustains a greater quality of life, and we also have an extremely low rate of re-hospitalization. It is definitely working," Brown said.

"I'm sure if you lined up 10 folks and asked them whether they'd rather stay in their homes or go to the hospital, they'd all choose to stay home," said Kucera.