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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

Do you remember when you and a few others were the only ones in the home care business in your area? While there was competition, there was more than enough business to go around. In some areas of the country this remains true. In other areas, the marketplace has become saturated and agencies are losing market share and staff to the emerging competition. If you have a single line of business e.g. Medicare Certified Home Health, this could be a disastrous situation for the agency, particularly as the industry moves to bundled payments and decreased reimbursements. So what do you do to survive and thrive in this competitive home care environment?

The old adage “don’t put all your eggs in one basket” comes to mind. If your one and only line of business is Medicare Certified business, you are at the mercy of Medicare and the private insurance companies. In order to survive in the years to come, agencies, regardless of the current funding status, must develop additional lines of business. For the Medicare Certified agencies it may be time to develop a private pay, DME or an infusion line of business. All of these services are lines that match well with a Medicare business and have been traditional lines to expand to. Even these lines however are saturated in certain areas of the country.

We would suggest that every home care agency turn to it’s community and listen to what your community is asking for in terms of services. One of the best ways to do that is to keep a telephone log of all calls that come into the agency. (See attached log). Over the years we discovered that the log gave us incredible ideas for new lines of business that our home care customers wanted.

One such program was the home modification program. Occasionally the home care agency would get a call from someone wanting help with a ramp, or modifying doorways to accommodate wheelchairs or to lower counters so the newly impaired individual could be self sufficient in their homes. Initially I found my staff informing the caller that we provided medical home care only and did not provide home modification services. After a few months of reviewing and collating the calls from the log, we had sufficient number of requests for this service that we decided to develop a list of carpenters and contractors that were able to meet these needs. We could have started our own contracting service, but because of time constraints, decided to develop a referral list instead. One of my customers, however, developed the construction program and enjoys a nice side line of business from referrals given by the home care agency.

Additional options for a Medicare Home Health are the value added services such as negotiating a discounted rate with a drug wholesaler for all of you patients. The discounted rate would include home delivery. All patients would be given the opportunity to participate and continue after they leave the home health agency service.

Another option may be providing a medical alert system for all your patients or negotiate with some of the new smart phone service companies that are developing special services for elders that allow them to keep in touch with their family and to notify someone when they need help. With technology changing so rapidly, someone in the agency needs to be appointed to keep up with the latest changes so that the agency is able to offer these devices and services to their patients.

In order to survive the coming changes, diversification must be part of your home care agencies strategic plan. In addition to improving the critical outcomes and becoming masters at chronic care management, agencies must bring other value added features to the table in order to be able to compete for inclusion in the new bundled structures that are being created.

As with all changes, legal and structural considerations need to be made in order to make sure any added lines of business can function without constraints. It is recommended that any new line be established under its own business entity and not under the Medicare program. This will allow the new line of business to function without the constraints that Medicare rules impose on an agency. If you are offering a line of business that could be non-Medicare home care, check with your state to be sure about licensing such a program.

Surviving and thriving in this environment is possible if thinking can occur outside the “Medicare box”. It is time to gather the data, re-envision the agency, redesign the strategic plan and implement for the future.

If you feel you need assistance or guidance with such a project, call Kenyon HomeCare Consulting for consultation services. We are here to help.

I often wake up in the wee hours of the morning wondering about change. As a professional consultant for the homecare industry, change – and all of its trappings – is often the focal point of my discussions with clients. On any given day, I help any number of agency owners and managers explore what change would mean for their organization.

Often we start by investigating what a Comprehensive Organizational Assessment would look like. Let me say up front that the fee for this type of assessment is worth more than its weight in gold. I don’t say this to drum up business for myself or other consultants. It’s just that change can be tricky, and if you don’t have a clear idea of where you are, it’s difficult to carve out a path to a better future. Continue reading “Organizational Assessment Sparks Your Home Care Agency’s Performance” »

Seattle, WA–Kenyon HomeCare Consulting (KHCC) has just implemented a program turnaround for Sound Options, Inc., one of the Northwest’s leading home health care agencies.  A company known for its high quality of service, the turnaround helped refocus and direct company goals and its mission of superior service.  Starting with a complete organization analysis, KHCC developed an intensive plan for improvement throughout the company and oversaw all details of the new strategy.  Creating new organizational charts and redesigning internal systems and structures, KHCC was able to help Sound Options improve its functions and workflows while supporting staff and management. Read More