Kenyon Connects

As we work with home care agencies around the country, we hear this lament all too often. With the increased aging of the population, this cry is getting louder. While different areas of the country have shortages of nurses and therapists, the largest challenge for every home care agency is hiring qualified, caring home care aides.

This class of caregiver has different titles depending on the state. There are designated Certified Nursing Assistants (CNA), which is required for Medicare and organizations receiving federal or state funds, Registered Nurse Assistants, or unregistered caregivers. Since every state it’sits own set of rules, the caregiver designation varies from state to state. You’ll want to check with your state.

In addition to the growing need for home care aides, the biggest challenge is finding the right fit for your home care agency. Although CNA schools are turning out multiple graduation classes each year, many graduating CNA’s do not read or speak English sufficiently enough to work in an unsupervised situation. Additionally, many lack the basic skills to care for the very frail elderly or handicapped and do not always have sufficient knowledge to recognize when the client is having issues that need to be brought to the attention of the home care agency management staff.

With the growing staffing frustration, where do you start to find the skilled, qualified CNA to represent your home care agency? Here are four actions to take today:

1. Assess the needs of the clients your home care agency serves, including identification of the skills and personal attributes the home care aides will need in order to properly care for them.

2. Develop a profile of the ideal aide. Use the home care aide profile you develop to screen all home care aide applicants.

3. Require all applicants to take a knowledge test of caregiving (A 50-question test is available through Kenyon HomeCare Consulting.) Additionally, we recommend hands-on skills testing administered on-site or through a local nursing home to establish the presence of the desired skills.

4. Require the applicant to take an online personality test such a s the one through Steven Tweed Leading Edge to determine the presence of desired personality qualities once it is determined the applicant has the basic knowledge and skill.

If you approach hiring using this proven 4-step process, the home care aides you hire will be superior. They will be able to provide your clients with the quality care you need to protect your clients and your reputation to help your business grow. Building a workforce of knowledgeable, skilled, dedicated, loyal, and dependable home care aides is the way to the future for home care agencies.

Don’t be surprised to find that 60% to 80% of home care applications will not meet your requirements. If you have had a very lenient process for hiring, this may come as a shock to you, and a lament from your schedulers! This is only a short term issue. Over time, the stringent process outlined above produces a workforce of quality, dedicated, and loyal employees that help with your scheduling headaches.

Failure to screen and hire for excellence in home care leads to customer complaints and, in some cases, litigation. In cases where we’ve been asked to provide expert witness services, we did an analysis of the root cause of why the agency was sued. In some cases it was because of the agency’s failure to hire individuals with the knowledge and understanding needed to adequately care for such a frail population. Additionally, the language barrier added to the complexity of the situation, with bad outcomes for the agency, the client, and most of all, the home care aide.

In some situations this 4 –step process can prove to be difficult because of the demand for services exceeding availability of home care aides. If this is your situation, move to plan B, which is to develop your own training school to meet your customer needs. Stay tuned next week for a discussion of building a school for training aides that meet your home care customer needs. And, in the meantime, if you need assistance with recruitment, Kenyon HomeCare Consulting is available

How many times do you come to work to find your home care agency in the middle of a crisis? There are times when we begin an interim management contract that it seems the home care agency is in a state of perpetual crisis. While the incidents are all different, in some ways, the response seems to be stress and crisis. Contrast this with a well running home care agency. They still have times of stress and issues that could be classified as a crisis, but the atmosphere and the response is very different. What makes them different?

In our years of experience working with agencies, we have discovered the well running home care agencies have learned from their experience. They anticipate these events and plan and train the staff to handle them as a normal part of business. These home care agencies have well thought-out systems in place to mitigate some of the issues. And, every department has a role in managing events that could become a crisis.

First, the Human Resources department has very clearly defined expectations about who they hire and how employees are oriented and trained. Every position in the organization has a profile of the education, work experience, and personality traits required for the role. The first two are common to HR job requirements and do not vary that much from the efficient home care agencies to the crisis prone home care agencies.  However, the well-run agencies have defined personality traits. Frequently we see traits such as “works well under pressure, outgoing and pleasant, team player, ability to multitask successfully, good problem solver, good interpersonal skills, positive phone presence”, etc. Whatever the position requires in experience also will have the required personality traits to match the home care agency’s culture. In addition to hiring “right”, there is also a plan for cross training for internal positions and a pool of caregivers for the clinical services. Fit and function are addressed in advance, so that at any given moment someone is available to assist with a situation before it becomes a problem.

Secondly, management with an open door policy where concerns are discussed allow for situations that could become a crisis to be identified and planned for, in advance. Additionally, the culture of the home care agency that is inclusive of all staff at all levels and areas of the organization can identify and plan for potential crisis. For example, if there is an issue with timely completion of documentation for field services, someone from the field, management, IT, and clerical support on the planning group may identify potential problems. Any department that has an impact on the issue is part of the group that addresses the problem.

Finally, we find that the culture in the successful home care agencies is one of openness, togetherness, creativity, and learning. Staff feel like they are part of the home care agency and responsible to contribute to the problem solving for the agency. Staff take an active role in problem identification and potential measures that the home care agency can take to prevent or deal effectively with the issue, if it arises. Learning and problem-solving are encouraged and rewarded.

Home care agencies will always have problems and “crises”. It is the nature of our business. However, how you plan and deal with these situations makes the difference between running a crisis-prone home care agency or one that is able to take it in stride as an event with prescribed and thought out plans for how it is handled. Not only does this approach reduce the number of incidents, staff is much less distressed by them as they know how to respond and what is expected.

If you are finding that your agency is running from crisis to crisis, Kenyon HomeCare Consulting can help. E-mail gkenyon@kenyonhcc.com or call 206-721-5091.

There’s a lot of discussion about the education and learning needs of the home care caregiver staff; sometimes because it is required by law, and other times it’s because home care owners and administrators believe strongly in caregiver continuing education. However, how often do you hear about continuing education and training for the internal home care office staff? There are at least two major reasons to invest in the continuing education of your internal staff – a better educated staff means better service to customers and your continuing education investment goes a long way toward retention of this valuable resource.

One of the major challenges home care owners and administrators experience in providing this education and training is the lack of available courses or trainings that relate to the job the individual performs within the organization. That was one of my biggest challenges as a home care executive. It does require managers to employ creativity. Sending the receptionist to courses on “How to deal with difficult people”, as well as, courses on selling and phone presence was a real positive. The receptionist is the first contact with your agency and, therefore, creates the first impression. The old saying “you never get a second chance to make a first good impression” applies . A caller to your home care agency will make a decision about your agency in the first five seconds on the phone with your receptionist. If the exchange is less than positive, it takes an additional five to ten minutes with another person to revise a bad impression. Training your first line of contact is both desirable and critical to success of your agency.

The next position that is most frequently ignored is the billing and payroll clerical staff. If you do not have tenured payroll and billing staff in your office to train new employees, the employee will have to learn by trial and error. You want to avoid this if at all possible. What do you do if you are a new agency, or have no tenured staff, and your payroll and billing staff is new to their role? One of the more creative solutions I have seen is to negotiate some time with a respected home care agency for your new employee to shadow the payroll and billing staff of their agency. Frequently the financial software company you use will have other users who are tenured business owners and can provide you with a contact for setting up the learning experience. There should also be training for the billing and payroll software that you acquire. The software companies usually provide direct training on-site for the software which is something you want to take advantage of even if it costs more to do so.

The next biggest challenge for continuing education for the internal home care staff is to find on-going courses or classes that will keep your employee engaged and learning. One of the things we did when I was a home care executive was to make selected in-services mandatory for all employees annually. The in-services included the internal home care staff. This achieved two things: it provided inclusiveness for all the staff, and it signified to the internal staff that we valued them and their contribution to the agency success. Some of the mandatory in-services included customer service updates, safety in the workplace, and the staff “Brain Storming for the Future”. “Brain Storming for the Future” was an opportunity for all the staff to dream about the future of the organization, where they would like to see it go, and how that future would look and feel. All staff participated and contributed from their perspective position in the organization. It is a great way to build your teams and your home care organization.

The bottom line for your home care organization is that you recognize and invest in the internal staff of the home care agency. Undoubtedly, other home care agencies have other additional creative training and education opportunities for the internal staff. We would love to hear about them from you.

Each member of your home care is a valuable asset. To keep them interested and growing, learning opportunities must be provided for all. If you need assistance in designing an in-service training for your internal staff, or assistance with the overall management of the home care agency, call Ginny Kenyon at 206-721-5091 or e-mail gkenyon@kenyonhcc.com. We are here to help.

Nothing is more unsettling to a home care organization than the loss, or impending loss, of an essential leader. Home care agencies that fail to plan for this event experience major disruptions in their business; initiatives lose momentum or are completely lost, uncertainty increases staff resignations, and business drops off causing a decline to the bottom line. To avoid this problem, a home health, or hospice organization must have both an emergency succession plan, as well as an established succession plan.

What is a Succession Plan? A sound home care succession plan is an ongoing process that contains the following:

1. Identification of critical positions needed for your home care agency.

2. Determination of the requisite skills needed for those positions.

3. Identification and assessment of potential successors or sources capable of providing individuals with the requisite skills.

4. Management and leadership involvement at all levels throughout your home care agency in developing the plan.

5. Ongoing commitment to developing internal talent and monitoring their progress.

A successful home care agency leadership succession plan identifies the environment, prepares for contingencies, and minimizes disruptions. Therefore, effective succession planning must be an ongoing process of regularly identifying, assessing, and developing talent to ensure leadership continuity for all key positions in a home care agency. The process must be in keeping with your home care or hospice agency’s ongoing strategic goals and objectives. This may mean that the kind of leadership style, skills, and behaviors needing to be developed and promoted might be different in the future from those in the existing culture. Therefore, the plan must be visited yearly and updated to match what your home health or hospice agency needs going forward.

“It must be understood that “succession planning is not a “replacement” strategy. A properly prepared succession plan is a proactive, systematic effort designed to ensure the continued effective performance of an organization, division, department, or work group.”

Christopher Simoneau, The Business Review

With an up-to date succession plan, a situation creating one or more vacant leadership positions is less of an emergency for your home care agency. If, however, individuals within your home care agency are not capable of taking the helm and leading your organization, an alternative will need to be implemented as soon as possible to prevent damaging disruptions to your business. This replacement frequently is an interim home care manager with the requisite skills to fill the position.

With both an emergency and a succession plan in place, the selection of an appropriate interim home care manager is considerably easier. The requisite skill sets have been identified and updated, and the essential work elements are in place with all staff on board with their identified responsibilities during the interim home care manager’s time with your agency.

As with all things in our lives, planning makes a big difference. We never want to think of disasters occurring, but we all know that they do. People experience fires at their homes and business, hurricanes occur, earthquakes happen, and people become ill or die. How we plan to meet these times dictates the outcome. As interim home care managers, we too often see the failure to plan.

Kenyon HomeCare consulting can assist agencies with succession plans that help them through leadership transitions and lay the groundwork for when an interim manager is needed to fill the gap until a permanent leader can take the helm. It you need assistance with either developing succession plans or interim management, call Kenyon HomeCare Consulting at 206-721-5091 or e-mail gkenyon@kenyonhcc.com. We are here to help.

You have just experienced the loss of the top leader of your home care agency. There in no one in the organization with the skill set or leadership to temporarily take on the role. What to do? Some agencies turn to consulting firms that offer interim home care managers. However, not all interim home care managers are equal. To assure you are getting the right fit for your organization, there are several factors to consider in your selection of the interim manager.

First, what is the reputation of the consulting firm or interim home care consultant? If you’re working with a consulting firm, you will want to know how they vet their interim managers. What are their requirements for the position? And, how does the home health consulting firm assure the associates have the requisite home health and hospice background, experience, and competency? A quality consulting agency should be able to address all of these concerns with an accurate description of the process and how they determine which interim associates best fit your needs. If you are thinking of using an individual who does interim home care management, you will want to do the vet them like you would a permanent replacement.

Secondly, how much actual experience does the potential candidate have in a leadership position for either home health or hospice? How current is that experience? If your agency is both home health and hospice, do they have experience in both? Do you have multiple offices? If so, has the potential interim home care manager managed multiple offices? What do their references look like and, will the home care consulting firm share that information with you? A good home care consulting firm will have already checked their references and be able to provide those to you if you wish. Most firms we are familiar with do a good job of vetting their consulting associates and this may not be a necessary step for you to take.

Thirdly, you will want to interview the candidate(s) for a fit with your needs and your agency staff. A home care consulting firm will usually have a couple of potential candidates for you to interview. Interview the interim candidates as you would the permanent replacement. Sometimes the interim home health or hospice manager will, in fact, turn out to be your replacement, so it is important that you approach the interviews in the same manner as you will for the permanent replacement. You may want the middle managers and selected field staff of your home care agency to also be involved in the interviews to assure this is someone they can respect and follow.

Finally, even the best interim home care manager will have difficulties initially if you do not have a clear plan for them to follow. Place any major initiatives on the list of objectives for them to achieve. If you are engaging a consulting firm, allow them to do a full organizational assessment that will provide identified issues and areas that the interim home care manager must address and resolve, as well as, the identified initiatives that the agency is working on. We all know that the objective of the home care agency is to find a replacement as quickly as possible. We also find that most home care agencies can take anywhere from 6 to 10 months to find that permanent replacement. In the end, no matter how desperate you are to fill the position, be sure to select the interim home care manager carefully.

View the time you have the interim manager as an opportunity to clean up the agency and set a course for the future with an expert at the helm. Rather than viewing the interim as “just a fill in”, an expert from the outside can take a new look at your agency, upgrade your agency and systems, and prepare you for your next adventure.

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.

The holiday season is a special time of year. It is an opportunity to gather with friends, family, and colleagues. Regardless of our faith or beliefs, the holiday season is often filled to the brim with an array of festivities that reflect precious memories. While most of us barely have time to catch our breath between parties and concerts, gift exchanges and joyful gatherings, for the elderly, the holidays are often a time to focus on what they have lost.

For many, that loss is defined by physical disabilities that make it difficult for them to participate in customs and celebrations that were once very much part of their lives. For others, the holidays are poignant reminders of the loss of a spouse or a friend.

Yeas ago I realized how important this time of year was and what it meant to my clients who found it harder and harder to take part in the holiday season. In response, I created a Holiday Helper program that allowed my clients to maintain many of their favorite traditions while creating a much needed resource for local college students.

At the start of the holiday season, I began recruiting home care ‘helpers’ from the local universities and colleges. Logic said that college students might be looking for part-time work to earn a little extra money during their break. It turned out my instincts were correct, and almost immediately my office was flooded with responses. All I had to do was match each student to one of my elderly clients.

Here’s how it worked. The home care services provided under the Holiday Helper program varied and depended on the client, as well as their religion or customs. Their personal Holiday Helper provided gift shopping, holiday cooking, decorating the home or apartment, and transporting their client to any special productions or services that were part of their holiday tradition. I charged my clients a fee and paid their personal Holiday Helper a respectful part-time wage.

When I began the program, I thought it would be a good service for my home health clients. What I discovered after the fact was the students were served as well. Universally, they reported they did things they had never done before. For some it was the first time they had made holiday cookies or treats. For others it was the first time they had attended the Messiah or a live production of the Nutcracker or a Christmas Carol. While most had helped their own families with holiday preparations, working as a Holiday Helper allowed them to learn about another family’s traditions. The primary benefit, of course, was the deep satisfaction of helping others.

For the elders, it was an opportunity to be with “the young ones” again. Rather than being isolated during the holiday season, they were surrounded by youthful energy and enthusiasm. Most importantly, they had someone to share the meaning of the season with and to pass on traditions that were important to them. It also refocused their thinking towards positive things in their lives rather than what they had lost.

I encourage every home health agency to instigate a Holiday Helper program. Even though it is a bit late in the year, there is still time to pull one together. While the program generates moderate seasonal revenue, the goodwill garnered from the program far surpasses any fiscal gain. It is the essence of a good deed and the benefits to all can be seen in the happy faces of your clients and the young students. And frankly, from the warm fuzzy feeling you’ll experience knowing that you’ve made a difference in someone’s life and made his or her holiday happy, joyous, and bright

For additional holiday treats see the links below.

KHCC Holiday Traditions: A Kenyon Family Feast

KHCC Holiday Traditions: Dolores Nagel’s Spritz Cookies

KHCC Holiday Traditions: Miriam’s Mandelbrot Biscotti

Today, more than ever, home health agencies must diversify if they are to survive.  It makes no difference whether you are Private Pay or a Medicare-certified home health agency, diversification will build the strong fiscal foundation you need to weather this current and any upcoming economic storms.  

For Private Pay agencies, this means investigating new opportunities that might exist within your marketplace and offering unique services that that will immediately and directly appeal to customers in your community.  For Home Health and Hospice agencies, diversification means expanding your horizons and seriously considering the benefits of starting up a Private Pay agency or a Durable Medical Equipment agency, or both.  Continue reading “Diversifying Services: A Matter of Survival for Home Health” »

The holiday season is a special time of year.  It is an opportunity to gather with friends, family, and colleagues.  Regardless of our faith or beliefs, the holiday season is often filled to the brim with an array of festivities that reflect precious memories.  While most of us barely have time to catch our breath between parties and concerts, gift exchanges and joyful gatherings, for the elderly, the holidays are often a time to focus on what they have lost.

For many, that loss is defined by physical disabilities that make it difficult for them to participate in customs and celebrations that were once very much part of their lives.  For others, the holidays are poignant reminders of the loss of a spouse or a friend.

Yeas ago I realized how important this time of year was and what it meant to my clients who found it harder and harder to take part in the holiday season.  In response, I created a Holiday Helper program that allowed my clients to maintain many of their favorite traditions while creating a much needed resource for local college students. Continue reading “Holiday Helpers: A Win-Win Program for Home Health, the Elderly, and College Students.” »

Starting a new Private Pay Agency from scratch can be exhilarating and exhausting.  It is the moment when all your dreams come true or your worst nightmares come to fruition.  Taking a few basic steps before you start the journey can have a very positive impact on the outcome.

Step 1.  Know Your Community
We all know the best product in the world will not sell if the need does not exist.  Get to know your audience by completing a community assessment.  This will let you know if there is a buying public in your area and give an accurate read on the demographics and resources available.  Zipskinny.com can help you identify household incomes as well as social and economic indicators.  From there, you can make an informed decision about what area of the community will be most responsive to your new business concept. Continue reading “Starting Up: Launching a Private Pay Agency on the Road to Success” »