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!