Addus HealthCare, a national provider of in-home care services operating in Spokane since 1979, helps mainly senior clients with daily-living tasks, and increasingly, long-term care insurance providers are paying at least part of the cost, a company executive here says.

Teresa Michielli, Spokane-based Addus agency director, says more long-term care insurers are recognizing that state-certified in-home care aides can provide a cost-effective way to help seniors stay in their homes, as an alternative to hiring a nurse or moving someone into a care facility.

Addus' home-care aides provide clients with nonmedical care that can include help with bathing, getting dressed, taking medications, shopping, making meals, light housekeeping, and driving to appointments. The time spent per client ranges from an hour a day to 24 hours, Michielli says.

She says the distinction between an in-home care service aide, sometimes called a personal-care or long-term care provider, and a home-health service aide is that in-home care workers are trained as aides but typically don't provide medical care. Home-health aides generally are certified nursing assistants or registered nurses, she adds.

Michielli says most of Addus' clients qualify for financial support from sources such as Medicaid, the U.S. Department of Veterans Affairs, and some long-term care insurance providers. However, some of its clients pay directly under a private payment option for care that typically runs from $22 to $24 an hour, she says.

"Over the last three years, I have noticed a trend where LTC insurance companies are offering options of in-home care in addition to home-health care," Michielli says. Previously, many LTC insurers would pay only for a registered nurse to be an in-home aide, she says.

"Some long-term care insurers allow for and see the value in in-home care," Michielli says. "I tell people, read your long-term care insurance policy."

Michielli adds that if seniors can remain at home, often what they need is someone regularly monitoring and supporting their health and welfare. Addus also can offer respite care services that provide a break for family caregivers, she says.

"The bigger our pool of seniors, the more people are looking at what makes sense," she says. "Do you really need someone at that (nurse's) rate?"

Addus operates in five Eastern Washington counties and has a total of 400 employees in those operations.

In Spokane, the company operates in about 2,000 square feet of leased space at 1121 N. Argonne and has slightly more than 300 employees. Michielli says 15 employees comprise the company's administrative staff, with the majority of workers being aides who help in clients' homes in a mixture of full- and part-time positions.

Overall, she says, Addus' number of Spokane-area workers has declined in the past two years by roughly 60 employees, which she attributes to the company attracting people who as a career move want to work at full-time or nearly full-time hours. The agency previously had a large number of part-time employees, she adds.

"Historically, our home care aides were the stay-at-home moms helping an individual a couple of hours a day for a couple of days a week," she says.

Michielli declines to say how many clients the company serves here, but she estimates that number has grown by at least 2 percent to 3 percent annually for the past five years.

Michielli, as agency director here, oversees the company's services in Spokane, Whitman, Stevens, Ferry, and Pend Oreille counties.

Addus HealthCare is owned and operated by Addus HomeCare Corp., which is a publicly traded company based in Palatine, Ill. The company operates in 18 states.

Michielli says Addus often coordinates with the family members to decide care options for their senior relatives, and she estimates that at least 80 percent of its clients are ages 60 and older.

A majority also live alone and have health concerns or are frail, she says. Addus often gets a call after an elderly relative is discharged from a hospital or care facility, she adds.

"Typically, what our role here is when someone leaves the hospital or needs assistance because of a health condition or frailty, we provide in-home care," Michielli says. "It could be help in getting dressed in the morning, maybe after a hip fracture."

She adds, "Often, family members move away because of a job, and they need help taking care of their mom. Most of the time, a family member is present when we do the assessment in the home. I've done assessments when a son has been back East, and we'll set it up with a speaker phone."

For clients who have Medicaid support, the company can on occasion have its aides perform some nurse-delegated tasks, Michielli says. One example is having the aide provide wound care, she adds, and the nurse provides training for the aide.

She says she encourages family members who are overseeing the care of an elderly relative to seek out community resources and ask questions about services offered to the elderly population.

Voter-approved Washington state Initiative 1163 has new state-certification requirements for home-care aides, and the rules became effective in January 2012. The measure upped the number of required training hours and added a criminal background check requirement.

Michielli says all of the company's aides are state certified and also receive additional training from Addus that goes beyond state requirements.

To ensure that clients have a clean and healthy environment, Michielli says the roles of an aide often includes regularly changing and cleaning bed sheets, or perhaps making meals that are appropriate to diabetic needs.

"We're great at monitoring health and wellness and working to improve a person's well-being," she says. "You're looking at such things as, is your 70-year-old grandma not feeling well? Is she more distant or not smiling as much? Our staff is trained to look for that and report it."

She says all aides use a call-in system to report into the company at the start and end of assigned hours to report the tasks completed, and if they have any concerns about clients. The aide also can call a physician's office if changes in a client warrant a need for medical attention, she says.

A majority of Addus' clients need its care for six months to a year, but the company sometimes provides an aide for many years, she adds, such as when an individual has multiple sclerosis.

Michielli says that Addus also will contact community support organizations as needed, such as Spokane Neighborhood Action Partners, on behalf of clients who qualify for home improvements or other elder services.

Overall, Michielli says Addus strives to create an in-home care plan that's individualized to a person's needs. It also tries to assign the same aide on a permanent basis to one client, she adds.

"Our model is to keep people at home for as long as possible so they can be with family and friends and be in an environment where they're comfortable," Michielli says. "We are a 24/7 business."