Q&A with Margarite Alvarez, CEO of Choice Home Health Care interviews Margarite Alvarez, the owner and CEO of Monterey, California-based Choice Home Health Care, a Medicare-Certified home health agency and winner of the "Home Care Elite" award. She is also co-author of the book "Hidden Shame: The Shocking Story of America's Elderly Ill." In addition to Choice Home Health Care, Margarite Alvarez is the owner of Community Caregivers, a provider of agency-employed caregivers and personal attendants, and Care Solutions, a problem-solving resource for senior transitions and elderly care.

Below she shares what it takes to be a home health nurse and the future of the field.

Q: Can you tell us about your current position?

I'm the CEO of Care Solutions, Choice Home Health Care in Monterey, California. We are a Medicare-certified, state-licensed agency providing skilled nursing care, therapies, and medical social work in the home for people that qualify as homebound with doctor's orders. We also have Community Caregivers with which we provide private-duty, caregiver care with private pay insurance and long-term care insurance.

We've won the CMS Home Care Elite award twice in our county, and we're the only ones that have ever done that.

Q: How did you become involved in home health care?

I started in the business not as a nurse, but actually as a businesswoman. I had a degree in political science from UC Davis and almost finished my master's in communications at the University of Nevada. I really didn't have a background in anything related to nursing. But, I knew with the baby boomers growing that this was the type of business that was going to be going up for a long time.

Q: What can a nurse expect from a home health care position?

We have a lot of paper work. At least 50 percent of what nurses in our business do is paperwork, which is a negative. The positive side of home care for the nurses is that they get to go out and really be the liaison between the patient and the doctor. When most patients leave a hospital or facility, they might not see a doctor for another six or eight weeks. Basically, we're right there when the doctor gives the order for home care. If skilled nursing or dementia care are needed, we can go in and try to qualify [Short Code Error: type value must be either online or ground] was just people in little white hats who went out and took blood pressure, had tea and entertained people. In 2000, things really started to change and the Centers for Medicare and Medicaid in Washington realized that home care was the future of nursing and the future of health care.

Q: What do you see for the future of home health care?

Right now, there are less than 10,000 home care agencies throughout the United States. There are large groups of them in places like Los Angeles and San Francisco. The reality is that there are a lot of places throughout this country that don't have home health agencies, and I think in the next 10 years we're going to see a doubling, if not a tripling of them. Medicare wants home care and they want community-based care. It's much more cost-effective, and it's much more patient-friendly. Plus, it's what the patients want.

We're going to have telehealth medicine, which is going to be able to monitor people at home really well. We're going to have chronic care and long-term care reimbursement. The nurses that are going to be going into home care in the future are going to have the brightest future possible because in the next few years, Medicare will be paying for long-term care, chronic disease management, and disease management overall. They've been doing trial tests throughout the United States now that have shown positively that disease management programs run by home care are much more effective than programs through the hospitals in which patients get a brochure and maybe a class.