Kenyon Connects

Over the years, we have had the privilege of assisting more than 80 home care agencies to start, grow, and develop their business. In addition, we have provided organizational assessments to about half as many home care agencies. Needless to say, we have the unique opportunity to experience multiple organizations and their functions first hand. One of the most significant observations we have made is those organizations that establish their internal operating systems with intent are those that are the most effective and profitable.

To develop a home care agency process with intent means the home care management has assessed the needs of a certain process and designed that process using the latest technology. It also means that the process meets the outcome needs of the organization, both the legal and the financial requirements. However, just creating the process, without monitoring, eventually leads to less effectiveness and a loss of profit. Home care agencies that regularly monitor the internal processes to make sure they are as streamlined as possible, achieve the best outcomes. By doing so, they know well in advance of any breakdown in the process, as well as, the fix for the problem.

To grow a successful home care agency, internal operations must be developed that clearly define the process for recruitment and hiring, orientation, staff retention, continuing education and training, client intake, assessment of new clients, scheduling and staffing, supervision, handling of complaints, quality improvement, personnel evaluations, payroll and billing, collections, budgeting process, development of the dashboard or scorecard, internal and external communications, and the computer system operations. Every process needs to have documented what will be done, how it will be done, who will do it, when it is to be accomplished, and what the lines of responsibility and authority are for each process. If these systems or processes are clear to all and followed as developed, the chances of success for the home care agency are much improved and lend to a positive net profit. The processes, once designed, are not static but dynamic and are always in need of review and potential redesign.

So that you may fully appreciate the complexity and the value that well-developed and continually monitored internal processes bring to your home care agency, let’s take a look at a prime example of process design and redesign as it relates to the accounting of time and activity by the home care field staff. Twenty years ago, 90% of agencies were operating on a paper system. All scheduling and validating shifts was done manually on paper. A typical designed process would be to have the scheduling books laid out by geographic area with a scheduler responsible for each area. Home care cases were opened and assigned to the scheduler for that area. The scheduler would enter the case in her scheduling book with the days of the week and the hours listed for each client. She would then call all the aides that were available for those times to see who was available to cover the shifts. Once she had the shifts filled, the hours to be covered were in the log book, along with the name of the caregiver who would be covering either the shifts or the visits. Needless to say, this was, and still is a very labor intensive process.

The validation process was even more time intensive. All caregivers were required to have their visit or shift notes for the previous week turned in by a certain day of the following week. This allowed the scheduler to validate that each scheduled shift or visit had a shift or visit note dated and signed by the client. Once this was accomplished, the schedule could be sent to payroll and billing to develop the aide paychecks and client invoices. It was not uncommon for the validation process to take two to three days. It wasn’t out of the ordinary to have lengthy exception lists of shifts or visits that did not match the schedule or those missing notes entirely.

Over the intervening years, there has been an explosion of software programs that have dramatically improved the process of scheduling and validating. The admitting home care staff has the ability to do the admission on a tablet with a stylus with Cloud connectivity. Once the document is completed and signed in the home, it is immediately available to the scheduling staff. With the current systems, the scheduler can query the home care software to select caregivers that are available and meet the care needs of the client. The scheduler can simultaneously send a text to the selected caregiving staff with notification of an available shift. The available caregiving staff can easily text or call their acceptance. This innovation makes it possible for a home care scheduler to handle up to 100 scheduled clients. Under the paper system the maximum number of clients a home care scheduler could handle was about 50 and sometimes that was beyond the ability of the staff to manage. We have even seen a home care operation where a team of 4 schedulers schedule and manage 10,000 shifts a week or more. That agency pays close attention to their internal operations and with the on-going help and suggestions of all the staff, has created a sophisticated software system using telephony that maximizes every staff member’s time and efforts. The rewards are increased revenues, decreased internal operation costs with increased net profits.

In addition, there are systems that use GPS technology that allows the caregiver to automatically be checked in when they arrive at their clients address and checks them out when they depart. No longer does the scheduler have to start calling the caregiver if they do not check in or out on time. The scheduler only calls the caregivers who do not arrive at the shift as scheduled. This alone decreased the workload by another 15% to 20% adding to further decrease your internal costs and increase your bottom line.

Creating your internal processes and monitoring them frequently for improvement is critical to your success. In the long run, it may be vital to your survival. If you are struggling with how to create your systems or are stuck trying to determine how to improve your internal operations, contact us at Kenyon HomeCare Consulting or call 206-721-5091. We are here to help!

The Wall Street Journal recently printed a disturbing article! It was about the Hospital at Home and Transition projects springing up around the country and the success they are achieving. The alarming information was that hospitals are using their own nurses and nurse practitioners to provide this service for the senior population. This is both a challenge because of the use of their own staff and a cause to celebrate because they now recognize the need for our types of services.

The article reads as follows:

“Existing research on house-call programs point to their benefits. A study published last June in Health Affairs showed that costs for patients in a Hospital at Home program at Albuquerque, N.M.-based Presbyterian Healthcare Services were 19% lower than for similar inpatients, in part because of shorter stays, and fewer lab and diagnostic tests. Patients with conditions including pneumonia, congestive heart failure and urinary-tract infections who are sick enough to require hospitalization and live within 25 miles are “admitted” in their home. They are then visited daily by a physician and once or twice daily by nurses who administer infusions and perform routine lab tests and procedures”.

It’s no secret that the salaries and wages of home care staff is considerably less than hospital based staff. Home health is much more cost effective. Additionally, home visits are what Home Care staff are trained for. They do not need to factor home visits into their already busy inpatient schedule like the hospital staff nurse and nurse practitioners. This new opportunity, however, will require home care nurses and aides to become better educated about the acute aspects of chronic diseases and the care required. In addition, this will require a much closer relationship with the acute environments, including physician groups. We will be looking at true partnerships with each partner bringing their specialty to the mix for the benefit of the patient, as well as, other entities, like insurance plans, that share in the responsibility of caring for the patients.

CMS has indicated that there are 5 chronic diseases that account for over 80% of all Medicare expenditures. These diseases are COPD, CHF, Diabetes, Dementia, and Depression. To prepare for this opportunity, as mentioned above, all home care staff will need to become experts in caring for all phases of these diseases, as well as, the medications and treatments that are specific to each disease. Many nurses working in the home health field are familiar with and can provide adequate services for these diagnoses, however, adequate will not be enough for the future partnerships. All must become expert in those diseases and the management thereof.

While there is significant course work available to educate clinical staff on the 5 chronic e diagnoses, there is very little for the home care aides who must become our eyes, ears and noses in the home. Who spends the most time with these clients/patients? It is the home care Aide. Therefore, in order for an agency to partner with a Hospital at home, a Medical Home or an ACO, training and education for the home care aides must become a priority and it must be comprehensive.

This is a major change for the health care industry. Up to now, home care aides have been relegated to the role of “baby sitters” and not fully utilized to the benefit of the client/patient or the home care agency. We envision the training and education for the aides to be 8 to 12 hour courses for each diagnosis. The course material will focus on those areas the Aides will need to know to properly notify the nurses and help manage when the client/patient has an exacerbation of their disease.

The home care agencies that survive into the future will be those who see the future coming and prepare themselves with expert staff and data to provide the outcomes and client/patient satisfaction levels required by the potential partnerships.

If your agency is like many other agencies, the budget and available training staff for training is limited. If you need assistance with this critical endeavor to get in front of the future of your home care agency, please call  Ginny Kenyon at Kenyon HomeCare Consulting or call 206-721-5091.

We hear a lot about “Quality of Care” in Home Care, Home Health and Hospice but seldom is it defined in terms that allow us to really quantify what it really means or what it looks like. “Quality” is both objective and subjective. One attempt at measuring quality is outcomes, yet even those have subjective elements. Someone may rave about the food at a restaurant, but when you go, you find it is okay, but not great. The menu may be very varied and with great selections, just not great! So, how do we determine quality? What are the solid elements that tell us we have are achieving quality of care?

Simply defined, quality is what our home health, home care and hospice customers and payors tell us it is. Expectations drive the quality issue. Since expectations can be broad based on who is defining them, how do we set a list of quality indicators that meet the customer’s expectations – indicators we can measure?

It is fair to say, because we are in the caregiving business, the first expectation of our customers is that our home care caregivers will care about them and their issues. That sounds pretty simple – until you define what caring looks like and how you’ll measure it. One measureable criteria is following the care plan. Is it being completed as designed? For home care, care plans are developed around the client’s wishes for care. If it is not being followed, we need to know why. It is also regulation that aides follow the plan of care.

Another element of measureable criteria for the care plan is the frequency with which the aide has identified needed changes to the plan and notified the supervisor that the client needs have changed. For clinical staff, the frequency of care plan updates and changes are also a clue to engagement and the quality of the care being provided. When the plan of care is not being followed, and there are no updates or changes to the care, it may be an indication that the caregivers are not engaged with the client/patient or are not “tuned” into the needs and wishes of the client/patient. While this is still a subjective measure, it can be used as an indicator of caring.

A second big issue for customers that relates directly to quality of care is the knowledge of the caregivers and their use of knowledge. Outcome measures, depending on how they are applied, can be a good indicator of expertise and skill in caring. For example, your private duty home care agency may expect aides to monitor the client’s blood sugar values and report when the values fall outside the range established by the clinician. The aide needs to be taught about blood values including how to read the monitors and determine if the reading is within or outside the established range. Additionally, the aides need to be taught the presenting symptoms of high and low blood sugar and what to do in each case for the client. Education and training are critical to quality home care services. IF there is one practice that will provide a strong return on investment, it is education and training of the field staff. Train, Train and train some more.

Whatever parameters you set to measure knowledge, it must be indicative of the diseases and disabilities common in the home care agency’s client case load and should be reflected in the ongoing in-service training program for the agency. For instance, if you have a high proportion of clients with Diabetes, we would expect that you would have initial and ongoing training for Diabetes. Thus, training is always driven by the caseload mix.

With competition becoming increasingly fierce, now more than ever, the agencies that win will be those perceived by their customers as caring and knowledgeable. So, while we all know how to track the agency’s financials and regulatory requirements, you also want to add quality indicators of caring and knowledge to the dashboard.

If you are struggling with trying to figure out how to increase the business of your home care agency and need some help with identifying and applying quality indicators to your agency call Ginny Kenyon at Kenyon HomeCare Consulting at 206-721-5091 or e-mail us at Kenyon HomeCare Consulting. We’re happy to help.

Can you recall a time when you had a home care manager that you loved because they had a capacity to pull the best from you and help you see the best in yourself? I have had the privilege of having at least two individuals in my career that I can truly identify as people who made a difference in my practice and my life. I identify them as my “super coaches.” I was never chastised for making a mistake or written up for a failure, rather they would identify the issue and ask me to rethink the situation and how I might have handled it differently. Those were powerful learning opportunities when a coach-approach is used to mentor and grow your staff.

There is more and more information being released about coaching but do we really know what it is? One of the best definitions of coaching comes from Wikipedia. “Coaching is a teaching or training process in which an individual gets support while learning to achieve a specific personal or professional result or goal. The structures, models, and methodologies of coaching are numerous, and may be designed to facilitate learning new behavior for personal growth, or professional advancement.”

Coaching

As noted in the definition there are various structures and models of coaching. One of my preferred is Cognitive Coaching. This form of coaching was developed in the educational system and is widely used. Cognitive Coaching is a coaching model that requires the coach to be non-judgmental, to encourage reflective practice, and to guide another person to self-directed learning. To encourage reflection, cognitive coaching focuses on a staff members thinking, perceptions, beliefs, and assumptions, and how these affect one’s practices. A cognitive coach collects data and learns to pose questions to engage the home care employee in reflective thinking and is:

• A supervisory/peer coaching model.
• Is non-judgmental.
• Capitalizes upon and enhances cognitive processes.
• Enables home care staff to modify their capacity to modify themselves.
• Allows the thinker to evaluate what is good or bad, appropriate, or inappropriate, effective, or ineffective, etc.
• Mediates thinking and enables the thinker to become meta-cognitive.
• Helps to convey home care staff from where they are to where they want to be.
• Is a powerful approach to enhancing performance and building learning organizations. http://kenyonhcc.com/lead-home-care-industry/

At the heart of Cognitive Coaching is the concept that each of us has resources that enable us to grow and change from within.

When training to becoming a cognitive coach, one learns about the different types of thinkers and the modifications to speech and approaches one must make when coaching. Not only do you learn to model the staff’s language but their body language as well. Additionally, coaching is a planned process. It does not just happen. Just as planning for care of patients is necessary, planning for a coaching session is critical to success. Below is a planning grid for cognitive coaching. As you will note, the focus of the conversation is on the employee/learner. This approach is extremely powerful when working with home health field staff or a manager. The transformation of the staff is truly amazing and empowering for all involved.

Planning Conversation

 
Costa, Arthur L., and Robert J. Garmston. Cognitive Coaching: a Foundation for Renaissance Schools. Norwood, Massachusetts: Christopher-Gordon, Inc., 2002. 398-399.

If you have never been trained as a coach I encourage you to explore Cognitive Coaching as an opportunity for empowering yourself and your home care staff toward excellence. If you need assistance, contact Ginny Kenyon at Kenyon HomeCare Consulting or call 206-721-5091. We are here to help.

To agree or disagree, is that the question?

Probably more now than at any other time in history, there is constant dissention among people. But, it typically doesn’t end with topics such as religion and political parties. It is typically alive and well in the work world. As people it seems we have a drive to have an opinion and further to believe that this opinion is right.

With healthcare on a continuous and perpetual merry go round of change, it will require as leaders that we become experts at listening and particularly to new ideas and even ones we initially disagree with. To reshape healthcare in a way that actually benefits the people we serve will take creativity and innovation. It won’t be a business as usual approach or we will in fact realize the definition of insanity coined by Albert Einstein – “Doing the same thing over and over again and expecting different results.”

Teams become high performing when they achieve the ability to speak freely and explore new things and ideas without fear of reprisal. It requires the leader to be open and to not have to be right. I don’t know about you, but as a strong leader, I love problem solving and it is easy to think your ideas are the only ones that work. It was a behavior that had to go in order for me to have a high performing team. It also requires the leader to create an environment of safety for everyone – limiting snide, curt, and rude comments from people when someone comes up with a new way of thinking or approaching a problem.

The leader has to be able to live with the fact that as new ideas are tried, some will work, some won’t and more importantly, the leader likely will not have the answers until it is tried and tested. That requires comfort with ambiguity and many of us aren’t very comfortable living there – it is that land of gray when we often want black and white. During these times of uncertainty we are going to have more questions than answers and we will do well to accept that fact.

While there are many plans for healthcare reform, and some are articulated, most are not and it is foreign territory. The walls have to come down between disciplines and care providers inside and outside an organization. The post-acute world is so important to the future, and many legislators agree, but how it becomes more important is unchartered territory. It requires healthful debate within and likely outside of your organization to come up with ideas and a plan that works for your community.
What is your vision for the future – for your company and how it fits with this new and uncertain healthcare world? If you don’t know, begin brainstorming with your management team and come up with a clear vision – one that is a stretch for your company. Brainstorming ground rules during a session are important – such as not judging an idea, not discussing the idea – but asking clarifying questions to understand it, and letting everyone speak and share freely their ideas. The natural process will be for someone to shoot down each idea that is shared. If you can set ground rules and adhere to them, you will likely have a great outcome with some new ideas for where your company can head. Once you have accomplishing a great brainstorm session, begin to discuss everything, and be ok with dissention. In fact, it is healthy to get it out on the table. If everyone does so with respect, your team will get very good at it and over time you will have a team that thrives with different ways of thinking about problems.

Once your management team is comfortable with this, they can then begin to engage staff to do the same. Before long you will have an entire organization that looks forward to new ways of thinking and you will be in a great position to thrive through this exciting healthcare transformation.

I’ve often felt that leadership is not for the faint of heart, and leading your organization differently through this new environment will take courage, but will lead to inspiration within your organization. If all of us embrace this new world and the dissention that comes with it, people will get a great healthcare system in the end. We will rise above the need to uncomfortably agree when we don’t agree and comfortably and respectfully disagree when we disagree so that when everyone has been heard your organization will move forward with the best decision for people. And, we all benefit.

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

Wallin Enterprises formed because of Terri’s drive to help organiza¬tions succeed with culture and sys¬tem transformation. With extensive experience in executive leadership and operations, Terri is highly skilled in leading organizational transformation. Leaders seek Terri for coaching on leadership and transformation. She is a published author on ar¬ticles related to leadership transformation. She can be reached at terri@wallinenterprises.com or 206.755.7747. You can connect with Terri at www.linkedin.com/in/wallinenterprises

Through the years I have been fortunate to have both mentors and coaches to aid in the growth and development of my home health career. I truly doubt that I would be where I am today if it had not been for those few special individuals who recognized my potential and helped nurture that potential to what it is today. Everyone needs others to help them. No one achieves great things on their own. Somewhere along their journey, mentors and coaches helped them achieve the success they enjoy.

Although there are major differences between coaching and mentoring, the two frequently overlap and are readily confused. Mentoring is the transfer of wisdom or the process by which an individual learns from someone who has worn the same shoes, whereas coaching refers to the process of amplifying the individual’s own knowledge and thought processes.

If you have never experienced coaching, “Imagine having someone alongside you who is motivated solely to help you succeed; someone immune from but aware of company dynamics and politics; someone who takes time to listen and to guide you without any personal or political agenda other than the success of you and your company. There are few who would not benefit from such a relationship. “This is coaching at its best. “Coaching is then a way of speeding up how people learn. It is a learning tool, a method for changing behavior. Coaching is simply a way of changing (hopefully improving) the way people apply themselves to any situation.”

Contrast this to mentoring where the strength of mentoring lies in the mentor’s specific knowledge and wisdom. “Based on these definitions, most coaches and mentors agree that a good coach will also mentor and a good mentor will coach.” When a home health leader/manager shares their wisdom and knowledge to the employees and coaches them to their best performance, everyone in the home health agency wins.

We can all agree that these are powerful tools for positive change for the home health agency and the individuals in the organization that grow and develop as a result. For the home health leader/manager, this is their primary function. When all home health leaders/managers within your home health organization are mentoring and coaching, member of the staff know and understand your expectations. They continually strive to uphold your standards of excellence. Consequently, the home health leader/manager does not have to spend their oversight time correcting errors. Rather, than can better spend their time moving the staff and the organization forward.

One of the primary reasons for high burnout rates among home health leaders, managers, and supervisors is because they are performing as the cleanup crew rather than the leaders, teachers, and cheer leaders for the home care agency staff.

Imagine what could be achieved in your home care organization if the home care manager/leader invested time working one on one with their staff, reviewing case load client/patient care plans, and personal goals of the employees rather than reviewing OASIS assessments and coding all day. There are certified coders who do this and do it well. This, along with teaching when they find repeated errors, is the main role for the OASIS certified coder. The OASIS certified coder is part of your support home health staff which frees you up to be the leader. Can you imagine an organization where the primary role of the home care leader/manager is to mentor and coach? For some home health agencies, this means a paradigm shift to how internal management is accomplished. With pay for performance on the horizon, there may be no choice if the home health agency is to survive.

There several different forms of coaching. One that I find most effective is cognitive coaching. The next article will discuss cognitive coaching in more depth. Meanwhile, if you are struggling with changes or direction and need some help, call Kenyon Home Care Consulting at 206-721-5091 or e-mail Kenyon HomeCare Consulting. We are here to help.

Here are some additional articles you might enjoy.

http://kenyonhcc.com/run-home-care-agency/

http://kenyonhcc.com/succession-planning/

http://kenyonhcc.com/cost-benefit-interim-home-care/

Without a doubt, performance evaluations and/or appraisals are one of the least liked and hardest requirements of a home care leaders job. This is particularly true for those in mid management. But, they aren’t the only ones! For members of your staff, performance appraisals are often the least liked requirement of their positions. I often wonder why something so powerful and life affirming has been met by both sides with such dissatisfaction. Is it possible that the words “evaluation and/or appraisal” has gotten in the way of the real goal – that of mentoring and coaching staff to stellar performance?

To evaluate or appraise is to determine right or wrong, good, or bad, and points in between. Words are powerful. They sometimes have a powerful impact on the subconscious state. What if the words “evaluation and/or appraisal” was changed to “accomplishments and goals?” Would that change the mind set and send us in a different direction – one in which we all looked forward to discussing performance? Currently, the primary focus during performance appraisals is on the weaknesses of the individual. There is an old adage that “you cannot play to someone’s weakness only their strengths.” Given that, why do we continue to focus on the weaknesses? Is it the current viewpoint performance appraisals? Wikipedia defines performance appraisals as the following: “A performance appraisal (PA) or performance evaluation is a systematic and periodic process that assesses an individual employee’s job performance and productivity in relation to certain pre-established criteria and organizational objectives.”

I propose that we relook at the entire function of the performance appraisal process for the home care industry, and change it to one where the manager/leader and the employee look forward to it as an opportunity to be reaffirmed in function and in role, to support and mentor to higher attainment and goals. To do so, would require us to reconsider job descriptions and rewrite them to support a more positive and affirming process. For example, home care employee’s job descriptions contain verbiage to the effect that paperwork is submitted timely. Instead, what if it were to read as follows: “understands the need for and accomplishes the goal of timely submission of required paperwork?” Can you see how this would change the way this function is approached by both the home care manager/leader and the home care employee?

No one wants to fail. However, when they do, the leader/manager needs to look at what has been provided in terms of understanding and necessity of the goal, including support for the same. For a home health agency, untimely submission of paperwork prevents timely billing and could affect the ability of the agency to process paychecks. Do you think any employee knowing that would consistently be negligent of timely submission of their paperwork? If untimely submission continues, an opportunity exists for the home care manager/leader to discover the barriers to successfully achieving the goal, and to mentor, and coach the employee. This truly is the role of the manager/leader – to empower employees to grow and expand.

Unfortunately, when we go into a home care agency, particularly a Medicare Home Health, the home health manager/leader is confined to their desk reviewing and coding OASIS assessments and plans. As a result, there is no mentoring and coaching to the home health field staff. Instead, actions are punitive and demanding. (Get your paperwork in or you will be written up!) This is not the way to grow your business. Employees are a home care agencies most valuable asset.

With your rewrite of the job descriptions, include verbiage that is directive and empowering. The goals and accomplishments need to be revised to reflect the new direction. This changes the new job accomplishments/goals process.

It’s important to have both the employee and the manager/leader fill out the revised form. These forms should be submitted to each other prior to the date set for the coaching and mentoring meeting, so each is properly prepared. If disparities between the two exist, a discussion that clarifies each other’s observations and considerations are explored. If there are areas of performance that are not being met according to the updated goals and accomplishments of the job description, there should be a place on the form that allows the employee to explain why they are not meeting the goal and ask for the help they feel they need. In my experience, most people are harder on themselves than others are on them. The objective of this meeting is to determine if the goals of the home care organization and the employee are being met, and if not, how the manager/leader can coach and mentor the employee. If, perhaps, the job is a mismatch, this approach allows the home care employee to explore this and come to their own conclusions, sometimes with the needed help of the manager/leader. The employee is usually relieved as they know the job is not for them. Saving the dignity of the employee is done with grace and value and not condemnation as a failure.

Home care mangers/leaders that adopt the position that their employees are their customers are the most successful. With this in mind, the entire process is changed for the better. In the end, the goal is to have staff that are empowered to grow and learn and managers/leaders to provide the wisdom and mentoring that staff need to meet not only the agency goals but their own.

If you are struggling with this process and feel you need some support and assistance, contact Kenyon HomeCare Consulting at 206-721-5091 or e-mail Kenyon HomeCare Consulting. We are here to help.

How strong is your Home Care orientation program? Do you do the bare bones minimum, as quick as possible and out the door, or do you make it an event to remember? With the data indicating that home care workers currently are in short supply and are projected to be more so in the future, everything you do should be focused towards home care staff retention. Do you remember the old saying “You never have a second chance to make a first good impression?” Orientation is your chance to make that first good impression. With the data indicating that home care workers currently are in short supply and are projected to be more so in the future, everything you do should be focused towards home care staff retention.

There are five basic sections that make up an effective home care orientation program:

1. introduction to the organization;
2. regulatory requirements and laws;
3. agency requirements;
4. policy and procedures that directly impact care, and
5. specialty services.

Too often orientation only covering rules and requirements that are required by law; e.g., infection control, and little or nothing else. To create a comprehensive home care orientation that is welcoming, you’ll want to address and expand upon the above listed elements based on your type of home care agency.

First, the introduction. How are the new employees welcomed? Do you have a designated greeter to direct them to the room for orientation? Are their Employee Handbooks personalized with their names ? Do you give them a token from your home care agency, like a pen, or a coffee cup with the agency name as a welcome gift? Do you provide an overview of the home care agency? Are tours of the facility conducted so the new home care employees have an opportunity to meet the office staff? The purpose of the introduction is to give them a clear picture of who your home care agency is and, by the introduction in action, the value you place on each of them as members of your home care agency. This is your home care agencies first opportunity for a good impression.

Second, the governing rules both federal and state under which your home care agency operates. Even if your home care agency operates in a state that does not require a license for home care services, there are federal rules that apply to all business’. These include EEOC, Violence in the Workplace, Drug, and Alcohol use in the Workplace etc. Additionally, by Federal rule, all health care providers are required to offer the Hepatitis B vaccinations to all field or direct care staff. These are important regulatory requirements and laws that need to be covered as part of your home care agencies comprehensive home care orientation program

Third are the policies and rules that are unique to the home care agency. This includes items such as payroll, and the submission of time slips and documentation, use of the computer system and telephony if used by the home care staff, dress code, supervisory visits, and expectations of conduct on behalf of the home care agency. These are only a few of the requirements your home care agency will want to communicate to your new and excited staff members.

Fourth, similar to the home care agency specific policies, and practices, are policies and procedures that directly impact the care of the clients/patients. One would anticipate that the following would be covered in this phase of your comprehensive orientation program: policies and procedures for emergencies, such as sudden death, expected deaths, natural disasters such as tornados, floods, or snow, etc. Charting and documentation requirements would also be covered in this section of your orientation, as would food handling, medications distribution, equipment, and supplies, the client bill of rights and confidentiality of personal information.

Finally, include a description of any specialty services offered by your home care agency. These can include Infusion, or Vent care, if you’re a skilled home health agency. Or, if you’re a private pay agency, it may include Sick Child Care, Live-In services, or Alzheimer’s Care, etc. Whatever specialty service you offer, or distinctive subsection of the population you serve, you will want to introduce the new staff to the service and the unique needs inherent in the services.

Although this seems like a long and involved process, the payoff is worth the effort. For the home care agencies of the future to remain competitive and attract and retain the best staff, orientation must be more than a brief coverage of the rules. A comprehensive orientation for your home care agency will require no less than a day and possibly two full days when done correctly. Plan for the future of your agency today. Make your orientation the grand welcoming that makes that first great impression.

If you need assistance or help in designing an orientation program that fits your agency, call 206-721-5091 or e-mail Kenyon HomeCare Consulting. We are here to help.

If you think hiring good home health caregivers is difficult now, prepare yourself for the future! It is going to become considerably more difficult to hire caregivers at all, let alone those you will deem “good hires.”

An article by Soliant Health entitled, Worker Shortage: America’s next healthcare epidemic, stated, “About 30 percent of today’s working nurses are over the age of 50, and more than half of them could retire in the next 10 years.” Adding to the health care worker shortage was the passing of the healthcare bill in 2010. It ensures that more people will be able to afford the necessary health care; subsequently health care workers will be in demand. Along with the aging of America, the U.S. Labor Department has projected that, in addition to RNs and other skilled providers, home health and personal care aides will be among the fastest-growing jobs over the next decade! Approximately 1.3 million positions are to be added, increasing at a rate higher than any other occupation. This is going to create shortages in all categories of health care workers and make hiring good workers harder than ever.

Meeting this challenge will require efforts at all levels of government and private industry. As healthcare providers we will want to join in ongoing discussions with our elected officials to increase funding to the universities and community colleges to open more positions for all levels of health care workers. In addition, there are steps your mid-level manager can take to assure that your home care agency recruits and retains the best.

First, it is critical to develop a profile for all positions in your home care agency. When developing a profile of your home health workers, particularly the field staff, you want to consider the clients/patients you are caring for. Do you specialize in a particular diagnosis or type of client/patient? If so, your profile will need to reflect this. For instance, if your home care caseload includes individuals with dementia, you want to look for direct caregivers that demonstrate patience, softness, and the ability to redirect in a gentle and quite manner. Conversely, if you have a Mom and Babe program, you will want to hire individuals that have patience and enjoy engaging with children. Your profile may look very different from other home care agencies in your area because it is built around the needs of your clientele.

Once you have clearly defined the type and character of your home health caregivers, the next step is to develop a reliable and consistent process for recruiting and hiring.

The first system to develop is the recruitment process. A defined process becomes routine and requires less time to manage. Your process will include such things as the development and posting of ads, the intake of applicants, and the selection of the interviewees. Your position profile helps greatly with the selection of those to be interviewed and saves the mid-level home health manager considerable time and paperwork.

The next system is the application through the interview process. Prior to an applicant completing an application, we highly recommend the applicant take the required tests of your home care agency. This ensures your applicant possesses the understanding and knowledge necessary to work in home health agency. There are home care aide written basic tests to determine knowledge. One is available through Kenyonhcc.com. Other tests for clinical expertise, such as IV or Ostomy care, may be obtained from other home health agencies. We also recommend that the applicants complete the on-line Caregiver Quality Assurance Test developed by Steven Tweed to screen for the personality traits that you desire in your caregivers. Once the applicant passes the tests, they would then be asked to complete an application and schedule an interview.

As with the other systems developed for recruitment, we highly recommend that the interview process be systemized. Schedule set days of the week for interviewing. Develop standard interview questions that will elicit the qualities, characteristics, and experiences important to your home care agency and your patient/clients. A scoring system for the interview questions is also helpful as it gives you an idea of the degree of fit of the applicant to your needs.

Finally, if you have a specialty service like infusion, it will be important to have the applicant take the test before making a final hiring decision. This is also true of the home care aide. If you do not have an in-house-trainer, you can contract with your local nursing home to conduct the hands-on test. This will provide you with the needed information to make a quality hiring decision.

Hiring the best home health caregiver now, and in the future, as noted earlier in this article, will continue to be a challenge. However, to survive and thrive in the future, hiring the best is your only option. Having a solid streamlined recruitment and hiring system in place is a must for survival of the agency and of the midlevel manger. If you need assistance in developing a recruiting and hiring system that works for you, call Ginny Kenyon at 206-721-5091 or e-mail Kenyon HomeCare Consulting.

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NOTE: Last week’s article was by Pat Drea, Chief Operating Officer of Visiting Angels, and we inadvertently left off the acknowledgement of that. You can contact her at: 866.293.6847 or by email.

Come gather ’round people, wherever you roam, and admit that the waters, around you have grown!

Just like the Dylan song said, The Times They Are A-Changing in private duty home care. What are the issues that will impact how we conduct our business of home care over the next 5 years and what strategies will serve us as we await clarification on those issues? The home care industry is likely to be significantly affected by Patient Protection and Affordable Health Care Act (PPACA), changes to the Companionship Exemption and the introduction of licensure in states that have not had licensure in the past.

Most Home Care employers are likely to be paying penalties under the PPACA. Under clarifications issued August 30, 2012, employers with 50 or more full-time or full-time equivalent employees will be required to provide minimum essential health care coverage for their full-time employees or pay an annual penalty beginning in 2014. Although the statute defines full-time employee as one who works an average of at least 30 hours per week in any given month, much uncertainty remains in the calculations affecting variable-hour and seasonal employees.

Elimination of the Companionship Exemption?

Since early 2011 the Department of Labor has issued proposed rules that if adopted will significantly change regulations defining “companionship services” to eliminate the exemption for home care aide/personal care attendant services. The proposed rule would also eliminate the so-called “live in” exemption for caregivers employed by third-party employers.

According to the study Companionship Services Exemption Survey, January 23, 2012 conducted by PDHCA and NPDA , The summary of findings of the 1428 home care companies representing all 50 states reported:

• Moderate to significant increases in business costs
• Agencies expecting to restrict overtime hours
• Quality of care impact including loss of service continuity, and weakened staff competencies
• Costs would be passed onto the elderly, infirm, and special needs clients/patients in private pay
• Clients/patients will seek out services from underground economy through untrained, unsupervised and unskilled workers

Companionship Services Exemption Survey, January 23, 2012, page 22.

Spread of Licensure Requirements

Many of the states currently without private duty licensure are actively moving toward mandated licensure in the near future. These states have studied the licensure frameworks available in other licensed states. Their proposals show evidence that they are incorporating more of the features and language of licensed states that have gone before them.

Responding to the Changes

Home Care managers and owners are advised to apply lean operating methods to their business. With overarching regulatory changes to the industry that are likely to add moderate to significant operating business costs, owners and managers must focus on running a leaner operation.

We can identify the budget categories in which home care companies tend to overspend:

1. Print advertising without a proven ROI. Often the agencies continue prior print advertising strategies out of habit but are these investments still paying off? The internet has changed how people shop for goods and services. Boomers, the main decision makers for care for their elderly parents, are very comfortable seeking information and services on the internet. Home Care print advertising continues to be a category of diminishing effectiveness although costs have risen considerably in recent years. In office staff and caregiver recruitment, classified print ads tend to be more costly and less effective than internet online job recruitment resources.

2. Expenditures on marketing personnel and materials without significant results. If that investment doesnt lead to a significant increase in revenue in a reasonable period of time (3 to 6 months) the personnel and/or approach need to be changed to yield results.

Does your marketing staff know: Who to call on within each type of referral source? What questions to ask and how to overcome possible objections? When/how often to meet with each referral source?

4. Old contracts for telephone, cell phones & internet services? If you havent shopped for the best plans and services available, chances are you could upgrade your service and save a significant amount by shopping around a little.

5. Inefficient processes. Building greater efficiencies in processes can save cost while building higher productivity. The processes that you should examine include:

• Lead management, intake, start of care
• Scheduling, rescheduling
• Billing, payroll & collections
• Management of complaints & incidents
• On call
• Employee application process
• Orientation, supervision,
• Customer, employee and referral satisfaction
• Caregiver turnover and performance issues
• Record management

The approaches to re-engineer your processes include: Develop the first 90 day plan, Measure and report improvement results, Conduct periodic reviews, Compare results to goals and Reward team members.

What are the strategies agencies should consider when details about change are slow to be issued? Keep track of the clarifications as they are issued. Attend association events and learn from industry leaders. Participate in on line industry chat forums to hear the approaches being considered by others in the industry. Engage your team in planning and preparation as information unfolds. Continue to build a lean, well functioning organization.

Last, heed Dylans lyrics:

For the wheel’s still in spin, and there’s no tellin’ who that it’s namin’ For the loser now, will be later to win, for the times they are a-changing’.

Pat Drea Chief
Operating Officer
866-293-6847