Kenyon Connects

Last week we talked about screening and hiring of home care staff, specifically about home care aides. Given that the schools that train aides are designed for acute arena, we in home care frequently find that we have to “jury rig” our aide’s skills and knowledge to meet the special needs of our clients.

There are some states that have recognized the differences between home care and the acute arena and have added curriculum requirements into the course work that partially address the needs of home care. However, we have found that overall, the skills needed by the home care aides in the home are not adequately addressed.

To remedy this issue, you will need to develop a curriculum that is specifically for your home care aides that met the needs, wishes and demands of your clients. If you regularly do client and staff satisfaction surveys, you will have some of the elements identified that you will need to include in your coursework. Chances are that your clients and staff will have identified housekeeping and cooking as two major areas for instruction. Additional to those are the need to educate your aides in the most common diseases or disorders that your clientele deal with.

Specifically, home care aides will need to be educated in the care and assistance of those with Alzheimer’s and Dementia, CHF, COPD, Diabetes, Arthritis, and Depression. We would also add in understanding of the commonly used medication for the above listed diagnosis and be taught the side effects of each and the appropriate actions to take. Of all the staff who interacts with our client’s, it is the home health aide who spends most of the time with them and the ones who need to be better prepared to meet their needs.

To build a comprehensive curriculum for the home care aides it would look something like this;

1. Fundamentals of caregiving:  the basics

2. Caregiving in the home:

• Housekeeping
• Laundry
• Care of fine carpets and furniture

3. Culinary Arts: buying food, storing food, diets, menus, preparation and presentation. This would be a required for all live-in staff and would be taught with a dietitian and a chef in a commercial kitchen. Course work would extend over the entire year with a day each quarter with reading and homework required.

4. Introduction to disease specific diagnosis, care and treatment: Course work would extend over the entire year with a day each quarter with reading and homework required

5. Medications; commonly used per diagnosis and reportable side effects: Course work would extend over the entire year with a day each quarter with reading and homework required.

6. Customer service: Introduction at orientation and reinforced yearly.

At the end of the year, all home care aides that have successfully passed the course work, would be given a certificate of completion. We would recommend that there be ongoing yearly updates for all graduates of the certificate program to keep them apprised of any changes to either nutrition or medications.

When you have a work force that is trained in the above topics, you have a marketing edge and a guard against legal action taken by unhappy customers whose expectations of care were not met.

Our world is changing, and competition is getting tougher. To stand out above the rest, truly delivering quality high end care, agencies will need to make the special investment in their home care aids to assure that the services expected and paid for are being delivered.

If you have a need for establishing a special curriculum for your aides to meet your special group of clients, and you need some assistance, contact Kenyon HomeCare Consulting. We are here to help.

As we work with home care agencies around the country, we hear this lament all too often. With the increased aging of the population, this cry is getting louder. While different areas of the country have shortages of nurses and therapists, the largest challenge for every home care agency is hiring qualified, caring home care aides.

This class of caregiver has different titles depending on the state. There are designated Certified Nursing Assistants (CNA), which is required for Medicare and organizations receiving federal or state funds, Registered Nurse Assistants, or unregistered caregivers. Since every state it’sits own set of rules, the caregiver designation varies from state to state. You’ll want to check with your state.

In addition to the growing need for home care aides, the biggest challenge is finding the right fit for your home care agency. Although CNA schools are turning out multiple graduation classes each year, many graduating CNA’s do not read or speak English sufficiently enough to work in an unsupervised situation. Additionally, many lack the basic skills to care for the very frail elderly or handicapped and do not always have sufficient knowledge to recognize when the client is having issues that need to be brought to the attention of the home care agency management staff.

With the growing staffing frustration, where do you start to find the skilled, qualified CNA to represent your home care agency? Here are four actions to take today:

1. Assess the needs of the clients your home care agency serves, including identification of the skills and personal attributes the home care aides will need in order to properly care for them.

2. Develop a profile of the ideal aide. Use the home care aide profile you develop to screen all home care aide applicants.

3. Require all applicants to take a knowledge test of caregiving (A 50-question test is available through Kenyon HomeCare Consulting.) Additionally, we recommend hands-on skills testing administered on-site or through a local nursing home to establish the presence of the desired skills.

4. Require the applicant to take an online personality test such a s the one through Steven Tweed Leading Edge to determine the presence of desired personality qualities once it is determined the applicant has the basic knowledge and skill.

If you approach hiring using this proven 4-step process, the home care aides you hire will be superior. They will be able to provide your clients with the quality care you need to protect your clients and your reputation to help your business grow. Building a workforce of knowledgeable, skilled, dedicated, loyal, and dependable home care aides is the way to the future for home care agencies.

Don’t be surprised to find that 60% to 80% of home care applications will not meet your requirements. If you have had a very lenient process for hiring, this may come as a shock to you, and a lament from your schedulers! This is only a short term issue. Over time, the stringent process outlined above produces a workforce of quality, dedicated, and loyal employees that help with your scheduling headaches.

Failure to screen and hire for excellence in home care leads to customer complaints and, in some cases, litigation. In cases where we’ve been asked to provide expert witness services, we did an analysis of the root cause of why the agency was sued. In some cases it was because of the agency’s failure to hire individuals with the knowledge and understanding needed to adequately care for such a frail population. Additionally, the language barrier added to the complexity of the situation, with bad outcomes for the agency, the client, and most of all, the home care aide.

In some situations this 4 –step process can prove to be difficult because of the demand for services exceeding availability of home care aides. If this is your situation, move to plan B, which is to develop your own training school to meet your customer needs. Stay tuned next week for a discussion of building a school for training aides that meet your home care customer needs. And, in the meantime, if you need assistance with recruitment, Kenyon HomeCare Consulting is available

The Internet is an amazing tool for marketing, communicating and doing business, but the downside of the World Wide Web is that, unfortunately, nothing online can be absolutely guaranteed as 100 percent safe and secure. Viruses and malware can infiltrate computers, social media accounts, and websites. You can get infected without even knowing it, simply by visiting an already infected website, if your computer is not up to date on its software and security patches.

Even the most sophisticated and seemingly secure sites are vulnerable to tech-savvy hackers. Luckily, however, website software is updated frequently with new features, enhancements, and fixes designed to patch holes or vulnerabilities in the software’s infrastructure to ultimately keep your site running smoothly and securely. So, if you have a website, it is essential to stay informed and up to date on the latest software for your site, or to partner with a legitimate firm that does just that. A monthly check of updates is essential, and immediate updates when a security patch is issued are imperative.

Fighting a Cybercriminal Gang and Winning!

WordPress is one of the most popular platforms to build websites, and last month, 30,000 WordPress blogs were hacked and infected by a “cybercriminal gang whose primary goal is to distribute rogue antivirus software,” according to this article from Networkworld.com. While these kinds of hacks are nothing new, what is most relevant is the following: “Many of the blogs compromised in these recent attacks were running outdated WordPress versions, had vulnerable plug-ins installed or had weak administrative passwords susceptible to brute force attacks,” said David Dede, a security researcher with website integrity monitoring firm Sucuri Security.

When a business builds a website, it is oftentimes considered “done” and no updates or maintenance is secured. Unlike a brochure or a printed piece of marketing material, a website is a living and changing marketing/business tool. Many websites are compromised because site owners/administrators fail to keep their website software up to date; thus, vulnerabilities in the old software can be discovered and exploited. When a website is hacked, and there is a malicious result in visiting that site, Google may completely block the compromised website from being shown, adding it to a blacklist of infected pages. This blacklist is used by web browser companies to block known infected sites, so when users try to visit an infected site, a warning message is shown, informing them of the danger. This is helpful in that it helps prevent the virus from spreading, but it’s definitely not a good thing for your company’s website to be on that list. And it’s hard to remove that label even if the site has been cleaned.

Playing It Safe

The time and money involved in investigating and fixing these hacking messes far exceeds the time it takes to provide a simple maintenance strategy on an ongoing basis. In order to decrease your vulnerability online, follow these steps:

• Keep the website software and back-end up to date: As mentioned earlier, website software is updated on a regular basis in order to keep sites safe. Either make a routine of updating your software on a regular basis or hire someone to do that. You can use this site: http://sitecheck.sucuri.net/scanner/ to search for known viruses on your website.

• Strengthen all your passwords:A strong password limits the ability of hackers to gain access to your site. The U.S. Computer Emergency Readiness Team recommends the following when creating passwords:~ Don’t use passwords that are based on personal information that can be easily accessed or guessed.~ Don’t use words that can be found in any dictionary of any language.

  ~ Develop a mnemonic for remembering complex passwords.~ Use both lowercase and capital letters.

  ~ Use a combination of letters, numbers, and special characters.~ Use different passwords on different systems. Additionally, it’s a good idea to make your passwords at least 8 characters long. Check that any password access to a site is terminated when employees or web masters leave.

• Keep an eye on your site: If a website does get infected, the site owner should be the first to know about it. Monitor your site regularly for signs of a virus and always have a routine back-up of the site. How do you know if your site has a virus? Things will look and act differently. If it feels strange to you, or unusual, then check it out.

If a site gets hacked, it’s important for your business and marketing efforts to get it back online as quickly as possible to avoid being quarantined by Google. A good web developer will offer a maintenance plan and a service because, once a site is hacked, your site’s log files need to be examined to determine the source of the hack or virus. Once the source has been found and the virus has been cleaned, the web developer will download any necessary patches to prevent any further infections from happening, and clean up any messes that the hackers left behind.

While there are laws against hacking, including 18 U.S.C. 1029, which deals with making and using devices and programs to gain unauthorized access to secure computer systems, the hackers are managing to keep ahead of the law in this still “wild frontier” of the Internet. In the case of website security, it seems that for now the best defense is a good, solid offense.

Merrily Orsini, MSSW

Merrily Orsini, MSSW, has a unique background that combines skills in technology and people. As President/CEO of corecubed, an internet marketing company, she works with talented staff to service clients in 35 states and Canada. Her roots and her passion, however, are in home care. She is a pioneer in the geriatric care managed in-home care model that she created, grew and sold in 1996, garnering her, for that venture, the prestigious Ernst & Young Entrepreneur of the Year Award for service businesses in Kentucky and Indiana.

Visit her blog www.MerrilyOrsini.com to follow her weekly insights and read where she is speaking, and the articles she writes for national publications. Tweet her @MerrilyO and find her on FaceBook.com/merrily.orsini. See examples of her creative work at www.corecubed.com.

Time to Re-envision Your Agency

With continued cuts to Medicare Home Health, we are beginning to see some reputable Medicare Home Health agencies go out of business. To say the industry is in crisis would be an understatement. Living in the Medicare box can be very constraining and inhibits your vision. An inability to “see” beyond today can cause you to miss other opportunities outside the Medicare program.  So how do agencies survive? Perhaps now is the ideal opportunity to spread our wings and expand our horizons. While Medicare reimbursements decline, home health agencies need to look to other sources to make up the lost revenues.

Depending on your state, most Medicare Home Health agencies are already licensed to provide non-Medicare or government reimbursed services to their communities. Unfortunately, because of “Medicare think”, many agencies do not see or visualize other areas of service upon which they can expand. There are multiple opportunities in every community, depending on what the community looks like and what the community will pay for.

One potential profitable service an agency could develop would be an Occupational Health Program aimed at the small to middle sized businesses. Many larger companies already have an Occupational Health Program, or Employee Health program, and sometimes they are looking to outsource this service if the price is right.

To build a comprehensive Occupational Health Program, you need to know what business in your community views as value. To help them decide, you need to develop a catalog of potential services with associated prices that would make up their program. Elements of the program could include, but may not be limited to, the following;

• Monthly or biweekly or weekly Health Clinics for:

o BP checks with consulting and referral

o Diabetes check-ups, with consulting and referral o CHF check-ups with consulting and referral

o COPD check-ups with consulting and referral

o General health issues with consulting and referral

• Yearly flu shot clinics

• Pneumonia vaccine administration

• Health education and training (general)

• Health and safety training specific to the industry

• Health and Fitness classes

• Nutrition education and consulting

• Nurse Practitioner or physician examination and treatment

These are just a few of the services that could be offered through a comprehensive Occupational Health Program. If this is a program that would be viable in your area, you may want to engage the services of a Masters prepared Occupational Health Nurse Practitioner or a physician who specializes in this area of practice. You could add their services to the package which would potentially make the program more valuable to the prospective business owner. As you develop the program, and the marketing and sales plan, do not forget that community colleges are also employers and will sometimes buy some of the services you offer in an Occupational Health Program.

The goal of Kenyon Home Care Consulting is to encourage all Medicare home health agencies to begin to think beyond the Medicare box. Look for the opportunities that may exist in the community that will allow agency to not only survive, but to begin to thrive in the current environment of reimbursement cuts to their programs.

If you have found an opportunity, or need some assistance with identifying potential opportunities, contact Kenyon HomeCare Consulting. We can be reached at 206-721-5091 or by e-mailing gkenyon@kenyonhcc.com. We are here to help.

HELP! The Home Care Surveyors are here!

Have you ever said those words or heard them in your home care agency? All too often we are in agencies that react that way when the surveyors show up on the doorstep for the annual or semiannual survey. Panic sets in and everyone is on edge. Why? It’s usually because the homecare management is not sure everything is in order as it should be, and they are afraid they will be cited for deficiencies.  Minimize the “home care surveyor stress” with methodical systems that are maintained with a religious fervor.

Internal systems set up for compliance include:

• chart audits for completion of all required documents; e.g, initial assessment, care plan, signed orders and interim orders if clinical, visit notes that match the scheduled visits, and frequencies that match plan (again if Medicare Home Health).
• pre-billing audits to assure all required documents are in the file before the bills are submitted.
• personnel file audits to assure that all required documents are in the file including updated licenses, auto insurance, etc.

Clinical chart audits include:

• integrity of assessment to diagnosis and coding (if you are a Medicare Agency) and maintaining of the care plan with changes as appropriate.
• required supervisory visits.
• required reassessments especially for therapy (Medicare only agencies).

One of the most frequently cited items in a survey is the lack of congruency between the orders for the home care plans and what the home care aides report they are/are not doing. A home care aide plan of care needs to be followed exactly as written. If a client/patient does not wish a bath on the day it is scheduled, the aide should note that the client/patient declined, and not leave it blank.

The second most frequently cited area of the home care survey is the lack of updates to the plan of care for both the aide and any clinical services being delivered. Even if there are no changes, there must be evidence that the supervising staff member has reviewed the plan and signed and dated to that effect. Additionally, the medication profile requires maintenance. Even if you are only providing medication reminders to the client/patient, the profile must show evidence that it has been updated and is being maintained.

Staff education is another area worthy of attention and an audit system. For Medicare agencies, the required 12 hours a year of aide continuing education must be documented for each home care aide. For states that have mandated continuing education for aides in private duty agencies, there must be evidence that the aides have received the education. Some states require specific types of continuing education. Know your state laws and confirm you are keeping up with the requirements, and that your aides are attending the sessions as required and that the content matches the state requirements.

With strong internal systems in place and field supervisors effectively managing the external services mandated by the rules of the state and/or federal government, your home care survey issues will be minimized. Should you feel you need assistance with establishing any of the audit systems, call Kenyon HomeCare Consulting at 206-721-5091 or e-mail to gkenyon@kenyonhcc.com. We are here to help.

Website bounce rate is one of the most important metrics you should be tracking in your analytics. Bounce rates tell you what percentage of visitors click-away after viewing only one page of your website. This is obviously a critical statistic when you are trying to convert browsers into buyers. A simple mistake in your website strategy and design can send visitors away even if you offer the best homecare services in your area.

Here are 5 factors that may be boosting your homecare website’s bounce rate and tips to more effectively optimize your site:

1. No call to action. One of the main reasons visitors bounce from your website is that you haven’t made it easy for them to know what to do next. Attention spans are short (and even shorter online), so it’s important to make their experience smooth and natural to move from browsing mode to action mode. They want and expect guidance. They should know the next step to take within seconds of arriving on your website.

• How to fix it: Place calls to action strategically and prominently in the right places on the page. They should be above the fold and specifically relate to the reason a visitor landed on your website in the first place.

2. Too many options. While the call to action is important, having too many options will compete for visitors’ attention and cause confusion and frustration. This competition for attention naturally causes a higher bounce rate and the probability that the prospect will click-away from your website without taking the desired action.

• How to fix it: Stick to one option per landing page. If you want visitors to subscribe to your blog and buy your eBook, don’t ask for them to do both on the same page. Creating separate landing pages for each offer will reduce your bounce rate and result in higher conversions.

3. Unmet expectations. Visitors expect to see exactly what they asked for when they arrive at your website. If your page is about anything other than what is advertised, you can count on a higher bounce rate and lost revenue.

• How to fix it: Make sure the messaging in organic searches and referring sites is authentic and leads prospective customers to content that piqued their curiosity. Remember that the source of the lead can be just as important as the content on your website, so beware of referring sites that send you unqualified prospects.

4. Bad copy. Engaging, persuasive copy is crucial to reduce your website bounce rate and keep visitors wanting to learn more about your homecare services. The fastest way to lose prospective customers is to have dull, descriptive copy that doesn’t include the benefits of hiring your business.

• How to fix it: Create benefit-driven headlines, subheads, and bullets that make it easy for visitors to quickly scan content to see how your homecare company will fulfill their needs.

5. Poor design. A visually unappealing website is just as ineffective as bad copy. Put them together and you have a page that makes visitors flee to another site almost immediately – even if your homecare services are better than your competitors’. Template sites are the worst and are recognized by savvy visitors right away. An unprofessional design will hurt your credibility and increase your website bounce rate.

• How to fix it: Use high-resolution graphics, maintain your company’s branding, create an easy-to-navigate user experience, and make sure the copywriter and designer are literally on the same page. Your best bet is to hire a Web designer who knows your business and the intricacies of conversion optimization.

Avoid these common usability gaffs and implement these recommendations to reduce your website bounce rate and improve your conversion rate.

Scott Siders is the owner of Novo Writing, a company specializing in SEO (search engine optimization) copywriting and content marketing. Novo Writing works closely with businesses in a wide variety of industries to increase their exposure online, drive more traffic to their websites, and ultimately increase sales of their products and services. Novo Writing’s targeted online marketing strategies include optimized Web sites, article marketing, email marketing, blogs, social media, and much more. Get more information and start building a better brand by visiting www.NovoWriting.com, emailing scott@NovoWriting.com, or calling 714.335.5677.

How many times do you come to work to find your home care agency in the middle of a crisis? There are times when we begin an interim management contract that it seems the home care agency is in a state of perpetual crisis. While the incidents are all different, in some ways, the response seems to be stress and crisis. Contrast this with a well running home care agency. They still have times of stress and issues that could be classified as a crisis, but the atmosphere and the response is very different. What makes them different?

In our years of experience working with agencies, we have discovered the well running home care agencies have learned from their experience. They anticipate these events and plan and train the staff to handle them as a normal part of business. These home care agencies have well thought-out systems in place to mitigate some of the issues. And, every department has a role in managing events that could become a crisis.

First, the Human Resources department has very clearly defined expectations about who they hire and how employees are oriented and trained. Every position in the organization has a profile of the education, work experience, and personality traits required for the role. The first two are common to HR job requirements and do not vary that much from the efficient home care agencies to the crisis prone home care agencies.  However, the well-run agencies have defined personality traits. Frequently we see traits such as “works well under pressure, outgoing and pleasant, team player, ability to multitask successfully, good problem solver, good interpersonal skills, positive phone presence”, etc. Whatever the position requires in experience also will have the required personality traits to match the home care agency’s culture. In addition to hiring “right”, there is also a plan for cross training for internal positions and a pool of caregivers for the clinical services. Fit and function are addressed in advance, so that at any given moment someone is available to assist with a situation before it becomes a problem.

Secondly, management with an open door policy where concerns are discussed allow for situations that could become a crisis to be identified and planned for, in advance. Additionally, the culture of the home care agency that is inclusive of all staff at all levels and areas of the organization can identify and plan for potential crisis. For example, if there is an issue with timely completion of documentation for field services, someone from the field, management, IT, and clerical support on the planning group may identify potential problems. Any department that has an impact on the issue is part of the group that addresses the problem.

Finally, we find that the culture in the successful home care agencies is one of openness, togetherness, creativity, and learning. Staff feel like they are part of the home care agency and responsible to contribute to the problem solving for the agency. Staff take an active role in problem identification and potential measures that the home care agency can take to prevent or deal effectively with the issue, if it arises. Learning and problem-solving are encouraged and rewarded.

Home care agencies will always have problems and “crises”. It is the nature of our business. However, how you plan and deal with these situations makes the difference between running a crisis-prone home care agency or one that is able to take it in stride as an event with prescribed and thought out plans for how it is handled. Not only does this approach reduce the number of incidents, staff is much less distressed by them as they know how to respond and what is expected.

If you are finding that your agency is running from crisis to crisis, Kenyon HomeCare Consulting can help. E-mail gkenyon@kenyonhcc.com or call 206-721-5091.

There’s no end to the information available today on leadership. Typically it is about how important it is. If it is written about so much and seems to be the secret for success, why isn’t great leadership present everywhere? Many people in management may manage processes and systems well, but they may not be great leaders or even leaders at all. So what does today’s healthcare market need in terms of leadership?

The Encarta World Dictionary defines leadership simply as “somebody who people follow, somebody who guides or directs others”. It sounds simple, but in working with groups and asking names of leaders that come to mind, there seems to be a void – few if anyone can come up with a name.

How we have led up to this point prior to health care reform isn’t necessarily going to work in the future. We will need to shift from managing an admission, episode or patient event to managing a population and achieve a quality, outcomes driven system. That means managers need to embrace leadership and be equipped with a different set of tools and skills in order to transform the healthcare system.

It is a time to reflect on oneself as a leader and improve any area that might prevent us from leading well. Are we leaders? If yes, how effective are we? How effective are we at embracing this new world? Do we know what the “new world” in healthcare might look like? How good are we at implementing new things and achieving a target, and sustaining it for months and years? How good are we at hiring well and systematically hiring for fit? How good are we at engaging people and having them enthusiastically follow you to achieve a goal? Are you an authentic and transparent leader? Are you a truth teller or do you tend to skirt away from an answer or bend the facts just a little toward your benefit? Are you able to speak up in opposition, respectfully? Do you have to be right? Do you take credit for wins or do you shine the light on others? Do you take feedback well that helps you improve?

Upon reflection of these questions, there is probably at least one each of us can identify with as an area and opportunity for growth.

No matter what healthcare arena we serve in, home health, homecare, hospice or another area, we need to be part of the solution in transforming the system. The start of transformation starts with good leadership.

We must be able to crystallize a vision of the future with the caveat that it requires revisiting since today’s leaders must be able to embrace ambiguity and uncertainty. What is clear is that tomorrow’s healthcare dream is to truly achieve a quality, value based system that is economical. Only courageous leaders will get us there. So what is needed?

First, find a trusted colleague or coach who can hold up the mirror and give you honest feedback to help you grow as a leader. To lead others well we must develop the habit of working harder on ourselves than others. While we must become masterful at coaching and mentoring others, it starts with ourselves. While in graduate school a few years ago, one instructor poignantly articulated the reality of the higher one goes up the hierarchical ladder in an organization, the less likely people will be honest with you. In positions of authority, this truth can’t be over-emphasized. I learned this the hard way and found it to be true.

Since all of us have strengths and weaknesses, it behooves us as leaders to know them and be good at improving both. The quest to become an effective and great leader can be lonely at times, eye opening in terms of other people’s perceptions of you compared to your own, a constant learning journey, highly rewarding if you listen and put what you have learned into practice.

Frankly, these transformational times are exciting. To think that at even government levels we are embracing the word “innovative” is unprecedented and should give hope. It is an opportune time to challenge current thinking. It is a time to lead with courage into a future that doesn’t have known details. The only known is that we have the requirement to provide a quality service with defined outcomes. Our customer’s lives depend on us succeeding. What a laudable goal to achieve. As leaders, a goal such as this doesn’t get better, does it?

Terri Wallin, CEO and Consultant Wallin Enterprises,
Transforming the way you do business.

Wallin Enterprises formed because of Terri’s drive to help organiza­tions succeed with culture and sys­tem transformation. With extensive experience in clinical, adminis­trative and executive operations, Terri is highly skilled in leading system design. Terri is sought out by leaders to speak to and coach others on improved business and system/process implementation. She is a published author on ar­ticles related to quality and busi­ness outcomes as a result of system transformation changes. She can be reached at terri@wallinenterprises.com or 206.755.7747. You can connect with Terri at www.linkedin.com/in/wallinenterprises

There’s a lot of discussion about the education and learning needs of the home care caregiver staff; sometimes because it is required by law, and other times it’s because home care owners and administrators believe strongly in caregiver continuing education. However, how often do you hear about continuing education and training for the internal home care office staff? There are at least two major reasons to invest in the continuing education of your internal staff – a better educated staff means better service to customers and your continuing education investment goes a long way toward retention of this valuable resource.

One of the major challenges home care owners and administrators experience in providing this education and training is the lack of available courses or trainings that relate to the job the individual performs within the organization. That was one of my biggest challenges as a home care executive. It does require managers to employ creativity. Sending the receptionist to courses on “How to deal with difficult people”, as well as, courses on selling and phone presence was a real positive. The receptionist is the first contact with your agency and, therefore, creates the first impression. The old saying “you never get a second chance to make a first good impression” applies . A caller to your home care agency will make a decision about your agency in the first five seconds on the phone with your receptionist. If the exchange is less than positive, it takes an additional five to ten minutes with another person to revise a bad impression. Training your first line of contact is both desirable and critical to success of your agency.

The next position that is most frequently ignored is the billing and payroll clerical staff. If you do not have tenured payroll and billing staff in your office to train new employees, the employee will have to learn by trial and error. You want to avoid this if at all possible. What do you do if you are a new agency, or have no tenured staff, and your payroll and billing staff is new to their role? One of the more creative solutions I have seen is to negotiate some time with a respected home care agency for your new employee to shadow the payroll and billing staff of their agency. Frequently the financial software company you use will have other users who are tenured business owners and can provide you with a contact for setting up the learning experience. There should also be training for the billing and payroll software that you acquire. The software companies usually provide direct training on-site for the software which is something you want to take advantage of even if it costs more to do so.

The next biggest challenge for continuing education for the internal home care staff is to find on-going courses or classes that will keep your employee engaged and learning. One of the things we did when I was a home care executive was to make selected in-services mandatory for all employees annually. The in-services included the internal home care staff. This achieved two things: it provided inclusiveness for all the staff, and it signified to the internal staff that we valued them and their contribution to the agency success. Some of the mandatory in-services included customer service updates, safety in the workplace, and the staff “Brain Storming for the Future”. “Brain Storming for the Future” was an opportunity for all the staff to dream about the future of the organization, where they would like to see it go, and how that future would look and feel. All staff participated and contributed from their perspective position in the organization. It is a great way to build your teams and your home care organization.

The bottom line for your home care organization is that you recognize and invest in the internal staff of the home care agency. Undoubtedly, other home care agencies have other additional creative training and education opportunities for the internal staff. We would love to hear about them from you.

Each member of your home care is a valuable asset. To keep them interested and growing, learning opportunities must be provided for all. If you need assistance in designing an in-service training for your internal staff, or assistance with the overall management of the home care agency, call Ginny Kenyon at 206-721-5091 or e-mail gkenyon@kenyonhcc.com. We are here to help.

Many home care agencies strive for and claim they have excellent services, but rarely do we ever hear a home care agency talk about a culture of excellence  - one that sets them apart from other home care agencies. This discussion is essential for home health leadership. To better understand how to create a culture of excellence, we must first understand the two elements: culture and excellence.

What is organizational culture and why should it be of any concern for the busy home health executive? We go into many agencies that are self described as in a state of chaos or decline and are desperately in need of major change to correct the direction of the agency. We find the best laid plans fail because the culture of the organization does not support the changes being made. Understanding organizational culture helps us better understand this conflict.

Gareth Morgan describes organizational culture as: “The set of beliefs, values, and norms, together with symbols like dramatized events and personalities that represents the unique character of an organization, and provides the context for action in it and by it.” Beliefs and values are words that will pop up in other definitions, as well. Norms are described as traditions, structure of authority, or routines.” (From AdChoices)

Beliefs, values and norms are very powerful forces in a home health agency. How do beliefs, values, and norms originate? And, how do you change them if they are contrary to where the home care agency needs to go? Unlike creativity and entrepreneurial attributes, which are randomly spread throughout an agency, culture is created and sustained by the home health agency leader.

Culture starts at the top. If you, the home health executive, want to create a culture of excellence, you must first look at yourself. As an executive, this was the hardest thing I ever had to do! Yet, as it turns out, it has been and continues to be the greatest gift I have given to myself and those with whom I work.  Ask yourself, “If I was one of my employees, would I like working with me? Why or why not? The answers may surprise you. They did for me.

As a home health leader who creates a culture of excellence, you must inspire trust, safety, enthusiasm, appreciation, respect, inspiration and acceptance. How to gain this is the hardest and longest process of all. To begin this process, ask yourself the following:

~ Have I ever worked in an organization where I felt trust, safety, enthusiasm, appreciation, respect, inspiration and acceptance? Who was the leader? What were the traits they exemplified that lead to my feeling of joy in the organization? (I do not use the word joy lightly. People working in a culture of excellence have a feeling of joy in their jobs.) Make a list of all the attributes you appreciate in that leader.

~ What were their behaviors? How did these behaviors make you feel? List those as well. Be as detailed as you can be as this will help you model the behavior you want to emulate.

Excellence is the result of culture and a concerted effort to reward and honor the efforts and outcomes of all the individuals in the home health agency. Excellence is meeting and exceeding the expectations of your customer. Do you know who your customers are? Do you know their expectations of you and your staff? To shape a culture of excellence, everyone in the home care agency must have a clear idea of who are their customers… This includes the individuals we care for, their families, and the friends and neighbors involved in their life… Also included in the definition of the customer are all the individuals that refer potential clients to your home care agency. And, we can’t forget all your employees are customers to you and to each other. Multiple research projects have been conducted on staff retention. The top ten reasons cited for why employees remain loyal to their companies are:

1. Exciting work and challenge
2. Career growth, learning and development
3. Working with great people
4. Fair pay
5. Supportive management/good boss
6. Being recognized, valued and respected
7. Benefits
8. Meaningful work and making a difference
9. Pride in the organization, its mission and its products
10. Great work environment and culture

A culture that nurtures excellence stimulates what employee’s value about their organizations. An organization that fulfills all the ten listed values is an organization that has a culture of excellence. To build that culture of excellence, it starts with the top.

While all of the customer elements are important, the one most often missed, and the most critical for building a culture of excellence, is everyone involved within your home care agency is a customer of each other. If you are ready to create a home care agency with a culture of excellence, Kenyon HomeCare Consulting has a long history of assisting agencies to achieve excellence. We can be reached by e-mailing gkenyon@kenyonhcc.com or calling 206-721-5091.