Your home health care aide is not your maid, landscaper or party organizer

Donna Ivey didn’t set out to be an entrepreneur. The 54-year-old businesswoman created her home health company to generate family income.

Twenty-five years on, Ivey’s small-scale, family-owned company is in a growing industry of critical importance, as tens of millions of baby boomers live into their 70s and beyond.

She is the founder and chief executive of Northern Virginia-based I-Care Home Health Care.

Long-term care is something everyone will be touched by, whether it’s for yourself, a spouse, a parent or a close relative.

“We are all getting older,” Ivey said. “People want to have viable lives.”

Ivey has seen it all, from a 30-something mother who acquired early-onset dementia to elderly people suffering from Alzheimer’s, whose decline not only requires constant care but also can inflict a huge emotional and physical toll on family members. She has had one elderly couple both suffering from Alzheimer’s.

I-Care has been around since 1993. The company has grossed above $1 million in the past five years and should gross close to $1.5 million this year. About 70 percent of that pays for 25 full-timers and 80 part-time, hourly caregivers.

The rest of the revenue covers insurance, administration and marketing. In a good year, I-Care turns about a 10 percent profit. The profit goes to Ivey’s income.

On any day, at any hour, a small brigade of I-Care aides spreads out across the Washington area to as many as 50 clients.

I-Care specializes in caring for people with neurological disorders, such as Parkinson’s disease and multiple sclerosis. They also serve people debilitated by dementia, stroke, and knee and hip replacements.

Most clients are temporary. Ivey’s job is managing the business, but she also works her network to keep clients coming in. Many come from her church and through word of mouth from membership in the Loudoun County Chamber of Commerce, Business Network International and the Rotary Club.

The routine varies.

“I can serve 50 clients, four hours a day, three days a week. Or I could have 25 clients, and a third are eight to 24 hours a day, seven days a week,” Ivey said. “We probably have fewer clients and more hours.”

I-Care has clients who receive care 24 hours a day, seven days a week. One client with a chronic disease has had the same caregiver for 10 years, 24 hours a day, every day.

Do that math on 24/7 care, and you quickly get near $200,000 a year to cover the round-the-clock costs for I-Care and its caregiver.

Anyone who has worked with home health-care aides knows it can get complicated.

The boundaries for client and employee can be tricky, emotionally and practically. The client needs to manage expectations about what the caregiver does.

“They are not your maids,” Ivey said.

I-Care aides perform light housekeeping duties, such as cleaning areas where the client normally goes. They also prepare light meals — think soup, sandwiches — run errands and transport clients to and from appointments. Depending on the health of the client, aides can play a key role in daily activities such as dressing, bathing, toileting and reminders about their medications.

Some elderly people come to think of the home health-care aide as part of the family, creating a dependency that can get awkward. Tipping, free food and gifts are discouraged, because they can lead to all kinds of complications, including accusations from family members regarding honesty.

“People say, ‘I want this person to be like a family member.’ You have to keep boundaries,” Ivey said. “The caregivers get very, very close.”

I-Care supervisors do spot-checks, showing up at a home unannounced, checking paperwork and making sure the caregivers are doing their job but not going beyond it.

“I had one client ask an aide to mow the lawn,” Ivey said. “We had one client that wanted us to grill for the family.”

The money for these workers isn’t generally great, but there is a growing demand.

Human resources consultant Mercer said the United States will need 2.3 million new health-care workers by 2025 to care for the elderly, including 423,200 home health-care aides such as the few dozen caregivers and managers Ivey employs.

The majority of aides hopscotch among multiple providers, serving one client for one firm and jumping to another client for another firm.

Ivey said her average aide is paid $12 to $18 an hour. I-Care bills its clients anywhere from $20-plus per hour to $30-plus. About a third of its paying clients are private individuals. The rest are long-term-care insurers.

The aides, who are carefully screened, can earn $25,000 a year working eight hours a day, five days a week. Caregivers are required to complete courses that last from 40 to 120 hours.

“It’s not terrible,” Ivey said. “But you can’t live on $12 an hour in D.C. They will work eight hours for I-Care for five days a week, and then work for another eight hours for another agency five days a week. That’s the way it is. That’s the way they can live in metropolitan D.C.”

Ivey keeps overhead low. Her family members, including her husband, three children and son-in-law, work at the company. Her husband, Tony, an engineering and logistics specialist, plays a key management role. I-Care uses on-demand office space to give her employees a place to gather and do their paperwork in Ashburn, Va., Fairfax and Chesapeake, Va.

Her office is wherever she is at the moment — at home, in her company car, or at one of the luncheons or meetings she attends to drum up business.

Ivey developed a fascination with health care growing up in Toledo, the second-oldest of five girls. Her parents divorced when she was young, and Ivey and her sisters were cared for mostly by her mother, a legal secretary.

“I watched ‘Medical Center’ with Chad Everett,” she said, referring to the television series of the 1970s. “I was intrigued by the medical field.”

She studied chemistry at Bowling Green State University for a year and then, in 1982, transferred to Oklahoma State in Stillwater, where she met her future husband the first week she was there.

Ivey quit Oklahoma State to raise a family (she later completed a business degree, cum laude, from Strayer University in 2003). In 1987, she and her husband moved to Washington, where he worked as an engineer for the U.S. Department of Transportation.

The young mother eventually worked at a physician-owned rehabilitation facility, where she developed an expertise in how to efficiently assign therapists to at-home patients undergoing rehabilitation for knees, hips, fractures and whatnot.

About 1993, she and Tony found themselves out of work at the same time and living in Northern Virginia. She decided to launch I-Care, which began as a scribbled logo on the back of a sheet of paper as she was lying in bed one day.

“You can’t say, ‘I care,’ if you don’t care,” Ivey said.

Ivey taught herself how to start a company. Tony, who was working in construction management by then, helped with state licensing and regulations. She sent away for a mail-order package on how to incorporate. She kicked her son out of his bedroom so she had an office.

Clients began to trickle in, just as in most business: The nurses she knew from her job managing the rehabilitation center started referring patients.

“It was not expensive to start,” she said. “I kept it small. I was just naive enough to say, ‘I can do this.’ ”

Well, she could. And did.

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