When I said, 'You can do severe disability home care without a license, right?', they replied that that's exactly the point
“Actually, you can start severe disability home care with just training, even without a helper license, right? So, isn't there no need to go out of your way to use expensive nurses?”
When I asked that, my husband (a current nursing manager who is preparing to open a visiting nursing service) replied, “That is exactly the point.”
Me: Is severe disability home care a job that anyone can do?
Husband: In terms of the hurdle for qualifications, it's actually quite low. If you complete the training called 'Severe Disability Home Care Worker Training,' you can start working in as little as a few days. Since you can start without qualifications or experience, it's a job that people from various backgrounds can get involved in, such as those with initial training for nursing care staff, practical training, certified care workers, nurses, and assistant nurses.
Me: Oh, I'd never thought of that. I just thought it would be fine to run it with cheap helpers.
Husband: I think many people actually think that. But when it comes to users who need medical care, the story changes.
Me: What exactly is medical care?
Husband: It refers to medical procedures that directly involve the body, such as sputum suction or tube feeding. Helpers can do this, but it's not impossible, but the conditions are quite limited.
Once you complete the integrated course of the 'Severe Disability Home Care Worker Training,' you have finished the basic training for sputum suction and other training. But from there, only after receiving practical training for each individual user under the guidance of a nurse can you perform medical care for that specific user.
Me: For each user, that means...
Husband: Yes, even if you receive practical training for User A, you cannot handle User B. Every time the user changes, you need training again. And each time, you need the guidance of a nurse.
On the other hand, nurses and assistant nurses have medical procedures included in their qualifications themselves, so they can handle users from the start without being limited to specific ones. Moreover, nurses can also assess conditions during sudden changes and report to doctors within the scope of their qualifications.
Me: I see, that's the decisive difference.
Husband: That's right. That's why the idea of 'it's a job anyone can do, so let's run it cheaply' is dangerous. Whether or not you can accept users who need medical care completely changes the range of users you can handle.
There are actually many cases where people who use ventilators or need tube feeding have trouble finding a place to accept them. Having a system that can handle that is a strength for the office itself.
Me: So that's the reason for hiring expensive nurses.
Husband: Exactly. Of course, the labor cost for nurses is high. But the range of users you can handle expands, and you can accept requests that other offices cannot. This also comes into play in terms of unit price, as there is a mechanism in the 'Specific Office Addition' I mentioned before where the track record of handling people with severe disabilities is evaluated.
Last time, I talked about thinking in terms of the formula 'Profit = Sales - Cost,' and it's the same here. Don't just look at the amount of labor costs, look at the range of users you can handle. I think it's a matter of needing to consider not just superficial labor costs, but also the range of users you can accept, whether you 'run it with only cheap helpers' or 'bring in nurses to expand the range of support.'
What I thought while watching from the side
Until now, I only thought that hiring expensive nurses was because 'they have expertise.' But when I heard the story, what my husband was looking at wasn't whether the qualification was high-ranking or not, but the range of users he could handle. I also learned for the first time this time that 'jobs that can be done without qualifications' and 'things that can only be done by nurses' are mixed within the same severe disability home care.
Following the previous topic of 'looking at profits,' this time we look at 'looking at the range of services that can be provided, rather than just labor costs.' It's a slow process, but I feel like I'm starting to understand where business owners look when making decisions.
Summary
Severe home care has a low barrier to entry for qualifications, and a wide range of personnel such as home helpers, certified care workers, and nurses can work in it.
However, medical care such as sputum suction and tube feeding is a separate category. For home helpers to perform these, they need practical training for each individual user, and the scope of care is limited.
Nurses and assistant nurses can handle medical care within the scope of their qualifications, are not limited to specific users, and can make judgments in the event of a sudden change in condition.
The point of employing higher-cost nurses lies not just in labor costs, but in the 'breadth of the user base that can be served.'
Next time
Next, I plan to ask about whether severe home care can be used during hospitalization. Apparently, there is a system that allows your usual home helper to accompany you even during hospitalization if certain conditions are met, and I will dig into that little-known mechanism.
This note is based on conversations between an active nursing manager (husband) who is preparing to open a psychiatric-specialized visiting nursing station and a writer (wife) who is watching the process from the sidelines.