The recent influx of Intensive In-Home Agencies and the issues associated with them.

I would like to know if anyone has noticed a recent influx of Intensive In-Home agencies in your area? I am asking because there are literally like 1000 in just the Richmond, VA area alone! Now Richmond is not that big, but with all these agencies, they have to be servicing the same people.

Issue #1-They service and actively solicit services pretty much 100% low income people. Why? Because most of these people are recieving Medicaid and most of these agencies are Medicaid based paid which = guaranteed payment, unlike relying on private insurance.

Issue #2- This type of business has very low startup costs but the rate of return is GREAT, which means you could pull in almost $50K in less than 6 months. This is why there are so many agencies in the area.

Issue #3-Ethics. There is soooo much room for unethical behavior it's not even funny. The basic premise of these types of business are you see a person (aka a client) for 10 hours per week, submit paperwork to Medicaid for approval for payment. Voila! How easy is that? As it stands now in Virginia, Medicaid pays approx. $60 per hour per client. So if you have 3 clients, that's $1800 per week. This leaves a lot of room for unethical behavior, such as not really seeing clients for those 10 hours, overbilling, billing for services not rendered, client and agency being in cahoots, etc.

Issue #4-Many of the client population who are being serviced, who also happen to be low income, are being overly diagnosed with disorders such as Bipolar Disorder, ADHD, Oppositional Defiant Disorder, Conduct Disorder, etc. Is there a strong correlation between being low-income and having a mental health disorder? Maybe that should be studied instead of putting a band aid on the problem.

Issue #5- Because many of the kids being serviced by these agencies have been diagnosed with ADHD, many of the parents now see that as a way to bring in income via SSI. And what's worse is that many of these agencies are pushing for this.

cont'd

cont'd Issue #5- Although the pay incentive is only a marginal amount, these agencies promote and support the reciept of SSI for kids with ADHD.

Issue #6- These agencies are a step down from Social Services and CPS and a step up from outpatient care. The major issues are not looked at, such as un/undereducated, un/underemployment, social/environmental factors (living in violent neighborrhoods), and other social issues that contribut to these people's issues. Instead these agencies offer a temporary solution to a permanent problem, which is a bigger problem in itself.

Issue #7-The pay sucks. Many of these agencies low ball their employees, who are referred to as QMHP or QMPP. They don't reimburse for mileage or gas, so you use much of your own personal money to put back into their business. You will also find yourself using your own personal resources (car, phone, email, jump drive, etc.) to conduct business for them with no compensation or reimbursement.

Issue #8-You are inundated with paperwork weekly. You could have had a "Harry Potter" type series of books written based on the amount of paperwork you will write over the course of your "career" as a QMHP. Be prepared to not have a social life.

Issue #9- You will get burned out quick and these agencies know it, but they don't care. As long as you turn in that weekly paperwork, they could care less about the lives of the people who keep the business going, the people in the field. And you will find these agencies often defer to Medicaid and licensing.

Issue #10- The people who start up these agencies don;t really care about the people they are supposed to be servicing. You will find that all they care about is the money. You have to have a passion for this field because you will find out very quickly that most of the issues of the client population you will service are self-inflicted; meaning they are victims of their own bad decision making and expect others (QMHP) to fix their problem

I was an daytreatment and youth counselor for six years they changed the medicaid laws left me with no work and i am a very good counselor. Im sorry that companies messed things up if anyone can help me find new employment at one of the better companies i would appreciate it and also the paper work at these inhome companies is ridiculous i agree with that but what can you do.