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When an agency loses a key employee like the Administrator or the CEO, it is prudent to bring in an interim manager to steer the home care organization while the search for a new replacement can be accomplished. This presents an exciting opportunity for your home care agency to take the occasion to discover new things about your home care agency and use the expertise and time to improve your home care agency.

As defined in Wikipedia, “interim management is the temporary provision of management resources and skills. Interim management can be seen as the short-term assignment of a proven heavyweight interim executive manager to manage a period of transition, crisis or change within an organization. In this situation, a permanent role may be unnecessary or impossible to find on short notice. Additionally, there may be nobody internally who is suitable for, or available to take up, the position in question.”

Unfortunately, we find that home care agencies see this interim management position as a place holder only and, as a result, do not get the full benefit of the interim management contract. Failure to fully use the expertise and time of the interim manager to re-envision, reform and make needed changes in the home care agency is a real lost opportunity.

“There are several factors that make the interim management offering increasingly popular and cost-effective to client organizations. These factors are characterized as a ‘value proposition’ that interim managers offer to their clients.”

“Although there is some variation at the elements of each interim management assignment, the following factors are typical of the interim management value proposition:

1. Return on investment. Interim managers add value by using their skills and expertise to help deliver an outcome, solution, service or mitigate risk that provides a meaningful ‘return on investment’ to a client. Interim managers are paid on the understanding of goals and objectives being performed and delivered, and not simply on the basis of attendance.
2. Speed. Interim managers can be in place within days as opposed to weeks or months which is essential when time constraints are paramount. Being practiced in engaging promptly with the situation, they become effective quickly upon joining a client organization. Because of their experience and expertise, interim managers also conduct and complete assignments effectively and with due speed.
3. Expertise. Interim managers typically operate at a senior level in the client organization, often being sensibly over-qualified for the roles they take on. They often bring skills and knowledge not otherwise in place, to address a specific skills gap or problem. Their experience and expertise enables them to be productive and make a noticeable impact from the outset, maximizing the likelihood of success.
4. Objectivity. Unencumbered by company politics or culture, interim managers provide a fresh perspective and are able to concentrate on what’s best for the business. Being independent operators, they are able to contribute honestly without constituting a threat to the incumbent management team. Not being part of a larger business they are not pressured to unnecessarily extend their assignment.
5. Accountability. Rather than taking on a purely advisory role, interim managers are managers who will take responsibility for and manage a business or project in their own right. They expect to be held accountable for results and by being instrumental in an assignment’s successful delivery. They give clients the peace of mind that the interim manager has stewardship of the project in hand.
6. Effectiveness. Operating at or near board-level gives interim managers the authority and credibility to effect significant change or transition within a company. Unlike a ‘temp’, they’re not just there to ‘hold the fort’. They actively add value to the client organization as a result of their expertise and approach, even when the work and the decisions to be made are difficult.
7. Commitment. Interim managers maintain high professional standards because their future work relies upon referrals and a successful track record. They therefore have a stake in the success of the assignments that they undertake.” Wikipedia the free Encyclopedia

Every productive home care interim management contract starts with a full organizational assessment. This ensures that the interim manager’s time is focused on those issues that place the home care agency most at risk. Once the issues are identified, expect the interim manager to outline a plan of action to address the identified issues with roles and responsibilities, and the goals to be achieved. The findings of the organizational assessment, along with the interim manager’s plan, are presented to the owners or corporate staff responsible for the home care agency for approval and to determine if there are other objects or issues that need to also be addressed.

It is recommended that the plan also be introduced to all home care staff, internal and field staff, so that all staff feel they are included and on board with the upcoming changes. Additionally, the staff most affected should have a separate meeting so their concerns can be addressed. Often we find that home care agencies are over-staffed in certain sections and cuts have to be made. It is the responsibility of the interim manager to address staff reduction concerns and set a plan for those eliminated from the home care organization. We would expect that this very difficult duty is handled with the utmost of respect and compassion for the eliminated individuals.

If it becomes essential that your organization finds the need to use an interim manager for a critical vacant position, please call Ginny Kenyon at 206-721-5091 or e-mail us at Kenyon HomeCare Consulting. We’re here to help.

With more and more private duty home care agencies starting up, new and existing agencies are decrying the lack of qualified home care aides in the field to support their client caseloads. Turnover is generally high (40% – 50% or more) thus making continual recruiting a must if your home care agency is to grow. In addition to the lack of qualified aides, the aging of American is growing rapidly. By 2030, the number of Americans age 85 or older—the group most likely to need the assistance of direct-care staff—is expected to double, reaching 8.9 million. Over the same period, the number of women in their 20s through 50s—the group most likely to make up the ranks of direct care workers—is expected to rise less than 10%. (Linda Hiddemen Barondess)

Current research has identified several reasons for the excessively high turnover rate among home care aides:

• Low wages – According to the U.S. Bureau of Labor, almost a fifth of direct-care workers—far more than the national average of 12 to 13 percent—earn incomes below the poverty level. Furthermore, there is great discrepancy between wages for workers in institutions versus those who work in personal homes. A hospital aide’s compensation is ‘about $18,000 per year. In a nursing home, they may get $15,000; and in a residential care home, it can be as low as $12,000 annually
• Limited opportunities for advancement
  
• Lack of appropriate training
  
• Lack of benefits – One-third of home care aides (32.1 percent) have no health insurance, compared to one-sixth (16 percent) of all U.S. workers.
• Poor public image
  
• Lack of respect
  
• Exclusion from patient-care planning 

Source: VHA Inc. “The Business Case for Work Force Stability”

With the above statistics is it any wonder that the home care industry is having problems recruiting and retaining good home care aides? Astute owners of home care agencies have already realized the causes of their turnover rates and have taken steps to mitigate the problems. You will find them in almost any market place and they are readily identifiable.

First, they tend to pay the best and include health insurance. As a result of these additional benefits provided, they may charge more for their services. Secondly, they have advancement opportunities with programs like “Senior Aides” Scholarship Support programs for advanced education ,”Aide of the Month” programs, and Career Ladders, just to name a few. Third, the home care agency has an aggressive and expanded continuing education program with certifications for completion of each series of trainings. Fourth, the agency conducts inclusive staff meetings where home care aides are recognized for achievement, tenure, customer service excellence, birthdays and other special events. Finally, the agency seeks information from the aides through regularly conducted surveys. They query their work and client needs. Additionally, they seek the home care aides involvement in making changes that benefit the organization, the clients, and the home care aides.

To develop strategies to lower your turnover rate, begin with your home care caregiving staff. Survey them as to why they stay with you. What is it about your agency that draws and keeps them with you? Interview those who leave your home care agency. Why are they leaving and what would it take to keep them? Unless you can address the expressed needs and wants of your home care aides, you will continue to have the revolving door of recruitment, hire, orient, train and redo the process. Once you have the information, you can develop solutions to your turnover rate. You will probably find that there is no one solution to the problem and may in fact require several “fixes”.

If you think it is less expensive just to keep recruiting, do a cost analysis of what you are paying for each home care caregiver that you hire. Multiply it by the number of aides you hire each year to replace those you have lost. This is the true cost of turnover and something you have control over.

High turnover among direct-care staff, which is costly, threatens quality of care, increases workloads, lowers morale among internal office staff, and damages the financial health of the home care agency.

If you need assistance in developing strategies and process to help reduce your home care aide turnover, contact Kenyon HomeCare Consulting. We are here to help

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.

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

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.

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