When Etelka Froymovich immigrated to Indianapolis in 1977, the Ukrainian-born pediatric nurse found the only job available to her was as an aide at Colonial Crest, a local nursing home later purchased by Arkansas-based Beverly Enterprises.
She had never worked with the elderly, but quickly found her life's passion.
Twenty years after arriving in the city, Froymovich opened Home Services Unlimited, a licensed home-health care agency on the northwest side that provides care for elderly and developmentally disabled people.
Froymovich's parents and uncle had immigrated earlier to Indianapolis, but it took four attempts before Froymovich and her husband, Phil, were allowed to leave the former Soviet Union.
In the late 1970s-like today-there was a nationwide nursing shortage. But before Froymovich could work as a registered nurse at Colonial Crest, she had to earn degrees here-a process that took nearly two years.
She first had to obtain a high school equivalency degree, because she finished high school in less time than students in the United States.
"In Russia we go to school six days a week and get out of school much quicker," said Froymovich, 53. "We don't go 12 years."
She also had to pass an English proficiency test and sit for nursing board exams before receiving a bachelor's degree in nursing.
"I had all of the prerequisites that were equivalent to a nurse practitioner degree at home, but it was in a way a stumbling block because the State Board of Health had to verify the courses that I took were those equal to a registered nurse here," she said.
She was fortunate that one of the members of the licensing board was a woman who had visited hospitals in Moscow as part of a state delegation.
"She knew exactly what my profession was and knew exactly what I studied," Froymovich said.
Shortly after receiving her RN degree in 1979, Froymovich was named director of nursing at Colonial Crest.
During the 12 years that Froymovich worked with Colonial Crest's elderly residents, she observed that some had no visitors and that those who did had no opportunity to visit with them in private because residents lived two to a room.
Whether residents received visitors or not, there was one common thread.
"Once people enter a nursing home," Froymovich said, "they're not saying 'This is my home.' They say, 'I want to go home.' I thought, why can't people be served at home?"
What was missing, Froymovich said, was a person-centered approach to care. While the staff of many nursing homes want to provide the best care possible, the challenges of caring for as many as 60 to 70 people per floor leaves little time for individual attention.
Froymovich began researching homecare agencies and joined the Indiana Health Care Association, an Indianapolisbased, statewide advocacy organization that provides resources and information to health care providers and consumers. The group had a training track for people wanting to enter the home-care industry.
With $150,000 in savings, Froymovich took the money to National City Bank and opened a certificate of deposit. Against the CD she acquired a line of credit.
"The way I looked at the money was that it was my gambling money," she said. "I was betting on me."
She never returned to borrow more because the business was profitable from the beginning-in spite of challenges like Medicare reimbursement rate cuts for health care providers that drove many companies out of business.
Home Services Unlimited started in 1997 with three clients and a staff of about eight: an occupational therapist, a physical therapist, a nurse and about five aides. It has since grown to more than 100 employees and an average of 300 clients with revenue of nearly $4.5 million in 2005.
Seth Finn, a professor at Robert Morris University in Pittsburgh, hired Home Services Unlimited to care for his 90-year-old mother, who has lived independently in Indianapolis since his father's death in 1989. Finn's brother lives in Seattle.
During a visit here last summer, Finn's brother spoke to Froymovich and one of her staff nurses, Natalie Richardson, to learn about support services available from Home Services Unlimited. Richardson and a home-health aide now regularly monitor her health and keep the brothers informed.
"It was our intent to have someone monitor Mom's health in the hope that we could head off any major problems," Finn said. But what they have found to be most helpful, he says, is Richardson's ability to advise the brothers about their mother's care when she has been hospitalized or during an extended stay at a skilled nursing facility.
"It has been fantastically reassuring to have Natalie visit my mother both in the hospital and at the nursing facility when we can't," Finn said. "She knows the institutional standards of care that are expected and speaks knowingly and tactfully with nursing and social work professionals to make sure that our mother is getting consistently good care."
Changes in home health care
In 2003 Indiana passed a law designed to remove barriers to home- and communitybased long-term health care for the elderly.
Three years after its passage, the law has yet to be fully implemented. Because it requires changes to Indiana's Medicare and Medicaid laws-changes that must be approved by the federal government-the Indiana Family and Social Services Administration is still ironing out the details.
Older Hoosiers can request a waiver to divert Medicare or Medicaid funds to home care, but there is a waiting list of several years to receive the waiver.
"I truly applaud the governor on what he's doing for the elderly in trying to keep them at home with self-directed care," Froymovich said, "but they need to also get the financial piece in order to do what's needed for the elderly."
Despite the challenges, Froymovich believes that, by keeping true to the agency's mission-providing "excellence in home health care"-the company will weather any storm.
She shares the company's financial statements each month with the staff-whether the numbers are good or bad.
"If it's bad, I ask, 'What do we need to do?' 'What are we missing?' 'Where are we wasting money?'" she said. "By doing this-especially during the first year of business-we broke even."
Froymovich says it's also about treating the staff in the same way they want patients treated-with respect-and recognizing their contributions.
She believes in constant assessment and learning from mistakes.
"If there is a client who we didn't live up to his or her expectations, those lessons we take very seriously," Froymovich said.
Perhaps it was her family's past that led her to work with the elderly.
"My parents were both Holocaust survivors," she said. "I grew up without grandparents. When I worked in a nursing home, I took care of people who could have been my grandparents.
"I kept thinking to myself that if I can help it, my parents will never be there. There has to be another way to take care of our elderly population. They deserve better."