Home Health agencies that have been in business for a few years can relate to the issue of growing pains. It is almost like you hit a ceiling and cannot grow beyond the increased competition, changes in payor rules and reimbursement amounts, increased regulations and shortages of skilled staff.

So what is happening?

As with all issues, there is never just one cause, but numerous ones that contribute to this problem. It could be that there is more competition, funding sources have changed, a shortage of caregiving staff, a business model that is no longer viable or a mismatch of needed skills with current staff. Any or all of these could be contributing to a decline or a flat line of business growth.

In business as in life, we need to constantly re-evaluate our position and make plans and appropriate adjustments. However, what we see in many home health agencies is that home care organization has never changed or modified their plans, their services or their internal staff. They have continued without any major modifications and are now at a standstill or are declining. What worked when the business was started years ago may no longer be a fit for the environment, the pay sources, the new knowledge in both clinical services and organizational function or skills needed for the new world that is emerging. This is particularly true at this time in our country where health care is undergoing major changes.

The agencies that survive will be those that can re-create themselves to match the changes that are coming. To do this, the agency must first assess their environment.

• What are the challenges and opportunities?
• Where does the agency fit in all of these changes?
• What must the agency do to prepare for the future?

To accomplish a comprehensive analysis, the agency must look inside, as well as outside, to really have a vision for the future. What we have found is that most agencies are fairly good at doing external analysis and making decisions on changes in regards to the service delivery and the financial issues associated with those changes. The area where we find agencies struggling is with the internal operations and staffing. Very frequently, we find that even though the environment has changed and field services have been modified to meet the changing needs, internal structures and most of all the internal home care staff has remained the same.

This is one of the hardest processes for a home care owner or administrator to go through. Many times we see that an employee is kept because of loyalty by them, even though they are not able to perform the needed functions of the new and emerging roles. As painful as this is, an employee analysis must be done if the organization is to survive and thrive in the future.

It all begins with an objective analysis. First, doing an internal function and skills needs assessment requires that the management focus strictly on the functions and skills needed to accomplish those functions. Secondly, evaluate the skill set of the staff in the internal operations to determine the fit or non-fit of the existing home care internal staff. In order to objectively accomplish this task, it requires that the manager eliminate names with positions and only focus on the function of the role. Finally, an objective list of skills that will be needed to achieve success in the role will need to be developed. Only after this is done can an objective review of current staff skillset be done.

If education and training can achieve the needed skills for the re-designed job, then the existing staff may be able to remain in their revised roles. However, it must be clear that failure to achieve results in the re-designed job will mean that the individual will no longer be employed with the organization. This is as important for the managers to understand as it is for the employee.

If you find that making these critical decisions on re-design of internal operations and subsequent job re-alignment and change is a problem, and feel you could use some help or coaching, call Ginny Kenyon at Kenyon HomeCare Consulting, 206-721-5091 or e-mail to gkenyon@kenyonhcc.com. We are here to help

The final area to discuss in making your home care successful is retaining the best staff and giving the best possible services. In order to do that you must have oversight and training that meets the educational needs of your staff and the health care needs of your clients. We have already discussed hiring in a previous article. If you have hired right, you have home care staff who will produce or can be trained to produce the kinds of outcomes that benefit the patients/clients and the agency. Critical to success for home care clinical services are systems of evidence based best practices. It is therefore imperative that you have a strong continuing education program and establish and maintain an agency culture of continued learning. Staff achieving continued learning as evidenced by attendance at continuing education offerings should be rewarded. Those who fail to maintain their competence and continued learning should have that reflected in their evaluations and subsequent pay increases withheld until they are achieving at the desired level. Without strong home care leadership support for this culture, staff will consider it the latest “flavor of the day” and slide back into old habits. The price to the home care agency is the eventual failure to achieve quality home care outcomes for your home care clients/patients with a subsequent loss over time of home care clients and thus revenue to your bottom line.

So how does quality home care look like? First it matches the needs of the clients/patients in your home care caseload and is evidence based care. If, for instance, you have a home care caseload with 80% of clients having some cognitive disability or impairment, then a strong in-service program on Alzheimer’s and Dementia would be expected. Since this is a predominate diagnosis among your caseload, all staff including the office staff should be trained in the diagnosis and there should be mandatory, yearly updates for all staff. Newsletters with the latest changes in practices based on new evidence should be regularly developed and distributed to all staff in addition to the required in-service training. In short, you want to develop a culture of continued learning among all individuals in the organization.

Secondly, there must be measurements in place that help you keep your organization on track. Quarterly chart reviews is one process implemented by some home care agencies to track and evaluate the home care services being provided. Supervisory visit notes with identified areas that were not at the agency standard and the corrections made by the Supervisor are part of the measurement system. Additionally complaint logs and incident reports are also traced weekly by the home care management team. On a monthly basis, the incidents and complaints are collated for similarities and trended for causes. Identified areas of concern that indicate failures in either the quality of the home care services being provided to clients/patients, or failures in customer services needs to be addressed with a plan of action for correction. These plans need to be in writing with evidence of follow up and resolution of the issues raised. Potential buyers will look for this kind of system to assure that the agency is focused on quality and has a system of identification and continued improvement.

Finally, the home care agency must have a strong quality improvement program that spans the entire organization, not just the direct home care services. Internal operations are as prone to breakdown and failures as the clinical areas of the home care agency. How does the payroll system work? Are there problems or issues with payroll? How are those addressed and resolved? What is the accounts receivable system and issues cause problems for the office staff? How are those addressed and resolved? Continuing education and training for the office staff in areas applicable to their duties is often an area overlooked and has consequences for the entire agency.

Communications in the organization is an on-going issue for all agencies. Open communications that invites input from everyone in the agency is a must. To achieve this one of the most successful systems is the “hallway huddle”. Each morning the office staff gathers for a 10 to 15 minute meeting to briefly state what they are working on and where they are having issues and need help. That way everyone knows what everyone is doing and where they impact or need to assist their colleagues. This is a hard practice to institute and maintain and requires management commitment. The long term benefits are increased staff satisfaction and productivity.

Every system, every person in the organization has a function and role in making the home care agency great and thus a great buy for a potential buyer. Invest in training and solid oversight systems and you will find the reward not only in a stellar reputation with your home care clients/patients, but when you are ready to sell your agency.

All of the issues raised in this article affect the value and potential sales price for your agency. As a result when we do a Due Diligence for a potential seller or buyer, we look at all the above listed aspects of the business. Weakness or failures in any one area can have a dramatic effect on the value of the agency. If you are planning on buying or selling your agency in the near future and could use our assistance, or just need to situate your agency for a future sale, contact us.

Spring is upon us, and that can only mean that CAHSAH‘s annual conference is just around the corner.  This year’s conference will be held in Ontario, California, May 10-12; the planning committee has done a superior job of finding presentations for you.

I will be speaking at the conference, and would be pleased if you joined me on Wednesday, the 11^th, from 1:45 to 3:15 when I will be presenting “Developing an Orientation Program That Sets You Apart.” 

 I look forward to seeing old friends and making new ones.  If you do not attend my session, I will be around the conference and would love to see you, so please introduce yourself.

Remember the good old days when we not only had to do the Medicare Home Health 485, but 30 days after the 485 we had to submit a Medicare Home Health 486?  Oh joy, how we did not enjoy that!!  In looking back at those times however, it occurs to me that perhaps the 486 was a better form — at least the physicians got more out of them. My personal physician complains to me every time we meet about how she finds no valuable information in the 485 and I have to agree, it doesn’t mean much to someone who doesn’t regularly work with them.  It doesn’t mean much to anyone to be frank.  What it has done is make the plan for care disjointed for home care staff and doctors alike. My biggest complaint is that many agencies use the 485 as the plan of care, and staff never prepares a plan that is all together. This causes considerable disconnect, especially for staff new to the industry. 

My other concern is the lack of critical thinking that this form (and computers in general) has created for home health staff.  It has created a “check box mentality.”  Home Health Care is much more than checking the boxes.  I guess I miss the old days when we actually prepared home care plans on a form that had the nursing diagnosis, the interventions, expected outcomes, who would be doing what, and the date of  the expected outcomes.  For a visual learner as I was, and 82% of nurses are, I was able to visualize the plan in one sweep across the page.  It all fit together.  It was also much easier to teach staff new to home health how to do care planning. It fit cognitively and required critical thinking to really individualize the care. 

If I could redo the forms that we are required to fill out for Medicare, I would throw the 485 out completely. I would have a form that listed the working diagnosis and current medications in one, much like the top part of the current 485.  That would be the physician’s form to sign verifying that the diagnosis and medications are correct.  The actual plans of care would be developed by the individual clinicians according to their own discipline.  Each discipline would be responsible for signing their own plans of care.

Physicians would get a narrative note at the end of each 60 days, updating them on their patient’s progress or lack thereof, and the clinician’s plans for the next 60 days.  That would be meaningful to the physicians as members of the team, and make care more coordinated and clear for everyone working with the patient.

Want to start your own home health agency? Here are some things you need to think about: Why do you want to get into this business? Is it for love or money, or both? Where will you locate your agency? What is your competition? Does your state require licensing and where do you go to find out? So many questions and who can you ask?

Investing in a business can be expensive. It is estimated that to start up a non-skilled private pay agency could cost anywhere from $45,000 to $60,000, and much more for a Medicare agency which could run as high as $200,000. Finally, there is the time and commitment to the business. To be successful you need to be able to fully commit to the new venture.

For more on starting up a home health business click here.

Major breakthroughs and changes in medicine and health care occurred in 2010; some will have profound effects on the home health, hospice and home care industry. Since we care for clients/patients who are affected by these changes, it is important to be aware of the latest trends and issues facing our patients and individual practices. Here is a brief overview:

To begin with, the national healthcare system overhaul is the most extensive since 1965.
• The program expands the number of people able to buy health insurance through subsidization. It also penalizes those who refuse to carry health care insurance and limits the cases for which insurance companies can deny coverage.
• All providers of health care will eventually be compensated on the quality of health care provided. It also bars copayments by insurance companies for preventative health services.
• Children can be carried by their parents until age 25.
• Increases in insurance premiums must be substantiated with data. Additionally, 85% of all premiums paid MUST be used for care and cannot be used for executive compensation or bonuses. Continue reading “A Year of Changes in Health Care. Let’s Hear It for Chocolate!” »

Last week we talked about identifying problems and issues by the use of a complaint log. Problems and issues were not the only things discovered, however; we identified opportunities to grow our agency too! The complaint logs gave us the opportunity to really listen to our customers and quantify their input. Frequently, when clients called about an issue or a concern, the immediate concern was addressed, but we were not always able to see the “whole” picture, so to speak. Through clients vocalizing their complaints and our tracking the concerns through the complaint log, we discovered that they were asking for new services or changes to service delivery that made more sense to them and were considered to be of more value.

One program developed as a part of the data provided by the complaint logs was the “Bed and Bath” program. We provided both Medicare-Certified Home Health and Private Pay services out of the branch. Our Private Pay program had a 3-hour minimum. Several of the clients being served through this program were originally Medicare Home Health patients who wanted to continue with their aide for bathing and making a fresh bed. One complaint that kept surfacing on the logs was, “why do I have to pay for three hours when all I want is for my husband to have his bath and have the bed changed?” Frequently the client would state that they were sending the aide away after an hour because there wasn’t anything for them to do. After much thought and discussion we asked ourselves why, indeed, did they have to have a three-hour shift when all they needed and wanted was a one-hour-or-less shift consisting of two tasks. Continue reading “Complaints Can Lead to Increased Business for Your Home Care Agency” »

Complain, complain, complain. When I was a Branch Director or a Senior VP for Nursing, there were days when all I heard were complaints from my clients. On really bad days, even my staff joined in! It seemed like it was a contest to see who had the biggest grievance. Ever had days like that? As a result of too many days of multiple complaints, I decided to start tracking them so I could identify trends and come up with solutions that were permanent corrections. This was how the “complaint log” came into use — a logging system where all complaints from staff and clients were entered.

When I introduced the complaint log to the office staff, we agreed as a group upon what would constitute a complaint that would be entered into the log. We discovered that frequently people did not complain so much as state a concern. We decided that we would place all concerns and complaints in the log. Every person had a log on their desk and was expected to submit it to the office manager once a week. The responses would then be collated to monitor trends.

In the first 6 months of using the complaint logs, we discovered some very interesting things about our staff and our services. Continue reading “Complaints: How the Home Care Industry Can Use Them to Improve Service” »

You hear the words “Concierge Services” more and more often these days in relation to specialty programs in Private Duty agencies. Some of you may be asking, what is that? Concierge is a French word that means caretaker, custodian, guardian, keeper, and so on. What does Concierge Service mean for a Private Pay specialty program? A Private Duty Concierge Service implies a comprehensive plan that takes care of everything for the client.

A good example of a Concierge program would be a Day Surgery service. This service can be designed any way an agency chooses as long as it addresses all the needs of the client before, during and immediately after surgery. The best source for the kinds of services that are required is the client. A brief survey in a surgeon’s office can help you gather the information you need, or you or someone in your family may have experienced day surgery yourselves and already understand what the needs might be. However you gather your information, it is critical to develop a program that customers perceive as valuable and are willing to pay for. Continue reading “Private Duty Concierge Services May Be a Program for You” »

Leading economists are predicting a gradual improvement in our economy this year.  This could bode well for all of us in Home Health, Hospice and Home Care (Private Pay).  As our economy improves, so will the financial status of many of our Home Health, Hospice and Home Care (Private Pay) clients.

So how do you take advantage of the resurgence of the market and the opportunities that this brings to your agency? Some already have a plan and we applaud you for that.  Every year should start with a plan for the year that includes where you are headed, your goals and your expected outcomes. The plan should also include how you are going to achieve those goals. Now more than ever those plans should include diversification strategies.

Home Health & Hospice Executive Coaching

Coaching support may be needed for some Home Health, Hospice and Home Care (Private Pay) agencies. Being able to look at your communities with a seasoned Home Health, Hospice and Home Care (Private Pay) Coach can make the difference between smashing success and mediocre results.  Having someone look objectively into your agency from the outside brings fresh insights and illuminates new opportunities that those inside the agency do not see or recognize.

As you start the new year, perhaps it is time to engage Home Health & Hospice Executive Coaching to assist you towards success in 2011.  To discover how, contact us.