Stethoscope? Check. Bandages and medications? Check. Money for fuel? Uh-oh.
     U.S. home health care workers, particularly those in rural areas, are suffering from financial headaches caused by the escalating cost of transportation, forcing some to borrow cash from co-workers in between paychecks and others to consider leaving the industry altogether.
     Providers of home care in New York, California and other states are doling out prepaid gas cards, rental cars and other perks in an effort to retain their workers, who care for roughly 12 million elderly and disabled patients nationwide and drive an estimated 5 billion miles a year, according to a recent study by the National Association for Home Care and Hospice.
     The industry is also contemplating abandoning uneconomical home visits in far-flung locations, and increasingly checking patients' blood pressures, heart rates, blood-sugar levels and other vital signs via remote monitoring systems, which many companies previously deemed too expensive.
     Industry officials said they had not heard of any instances where a patient's care was compromised by the high cost of getting a health care professional to their home, though they are worried it could happen. After some home health providers threatened earlier this year to cease operations in rural parts of South Dakota, Democratic Sen. Tim Johnson said he would push Congress to revamp the Medicare payment system to account for the industry's rising fuel bill.
     While lots of industries are suffering as a result of gasoline prices that have risen more than 80 percent in the past 18 months, experts said it's a particularly knotty problem for nurses, aides and other employees of home health care agencies - many of whom are responsible for their own travel expenses and depend on government reimbursements that haven't yet caught up with the rising prices at the pump.
     A recent survey by the National Association of Area Agencies on Aging underscores the impact: half of the respondents said they had already cut back on home visits because of surging fuel costs - and 90 percent said they expected to make cuts in 2009.
     The Northern Montana Home Health Care and Bear Paw Hospice, a not-for-profit company based in Havre, Mont., that covers two counties made up of 24,000 people across 7,136 square miles, is looking at discontinuing service in the state's back country.
     The company's director, Lisa Genereux, said the formula underpinning Medicare reimbursements simply doesn't account for $4.09-a-gallon gasoline, the average price at the pumps in the Rocky Mountain states these days.
     Donald Wagoner, a nurse who travels up to 100 miles a day traversing New York's Adirondack region, said his newest professional challenge these days is simply not running out of fuel. "I've come close a couple of times," said Wagoner, who drives a Saturn Vue SUV that gets around 25 miles to the gallon.
     Photo Credit: 1. MIKE GROLL/ASSOCIATED PRESS


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