Kenyon Connects

When you consider starting a new home care agency, adding a new service, or are experiencing “issues” with your current agency, a home care consultant is a good resource to have available. But before you jump in to hiring a home care consultant, there are several things you want to know about any potential consultant you are about to hire:

1. How long has the consultant been doing home health consulting? Working as a home care consultant is very different than working in a position in an organization. As a consultant in home health, hospice and private duty, one of the most important systems to develop is the network of service providers in multiple areas of the industry; software developers, sales, social media marketing, specialized trainers, Insurance providers, Accreditation specialists, OASIS and Coding Specialists, outsourcing OASIS specialists, financial experts, merger and acquisition specialists to name a few. Any home care consultant who has been in the business for a while should have a comprehensive list of potential resources for their clients. Their extensive network will save you valuable time!

2. How long have they been in the industry? When you ask about their experience in the industry it is important to know how long they have been in the home care industry and what positions they held. For instance, if you need a comprehensive organizational assessment completed, you will be looking for someone with at least ten or more years experience at the executive level as a Director, Vice President or President of an organization. Additionally, you will want to know if the organization was a small, medium or large sized company. The larger the company or organization, the more complex the skills needed to run the entity.

3. What does the home care consultant specialize in? Consultants come in all areas of specialty. Some exclusively do audit recovery services for denials; others are primarily engaged in due diligence for merger and acquisition companies for buyers or sellers, yet, others specialize in private pay start ups and selected areas only. If you require start up assistance, be sure you are talking to someone who specializes in that area. You want someone who reads and understands the home care state regulations and can help you develop your policies and procedures to match the state rules. Ask what they or their firm does and if they are qualified services for your needs in your geographic area. Be clear about the type of agency you want to start up. Some consultants specialize in Medicare agencies while others specialize in private pay only.

4. Do they have specific experience in all the areas where you need assistance? For instance, if you need an organizational assessment and you have a multi program company, you want to be sure that the consultant has experience with all the programs you offer. If you have both a Medicare Home Health program and a private pay program, you’ll want o make sure the consultant is an expert in both programs to meet your needs.

5. Do they have references for you to talk to? Do they have a list of references who have the same business or combination of services that you specifically offer? Most consultants will be able to provide you with a list of references for you to speak with. This allows you to compare oranges to oranges when making your final decision on whom to engage.

6. What do they charge and what is included in the fees? Many consultants charge a flat hourly rate for their services. The fee includes the time consulting with you by phone and email, gathering information and/or developing materials for you. In some cases, you may incur additional costs for items such as mailing coping etc. Others will have a combination of pricing including bundled packages and a la carte. Always request a sample agreement with all of the details spelled out for you so you know up front what your expenditures will be and what is included in the contract.

There are many great home care consultants across the country. Finding the one that is right for you is a matter of doing your due diligence. The time you spend in the beginning selecting the right person to help you pays dividends in the end. If you are in need of consulting assistance, give us a call at 206-721-5091, or contact Kenyon HomeCare Consulting. We are 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

Over the years the role of the home care aide has evolved. When I began working in the home health arena in 1975, home care aides were used as glorified maids who did primarily home making chores and some personal assistance services. They were assigned to two hour shifts per client and did a maximum of 5 clients a day. Home health was not required to make special training available and in some cases, none was provided.

In the early 90′s it was recognized that the home care aides needed special training to care for the Medicare home health populations. HCFA (now CMS) issued a rule that all aides caring for Medicare clients, whether in the hospital, nursing home or home health had to be Certified Nursing Assistants with the requisite 80 hours of class room and hands on experience. They also needed to be licensed as a CNA by the state in which they resided and provided services.

The training was, and continues to be, focused on the fundamentals of care, such as bathing, ambulation, turning, dressing, eating, etc. and is primarily acute care focused. In the home, the home care aide provides all the acute type of care plus meal preparation, light housekeeping, companionship and can remind a client/patient of the time to take their medications. Not much has changed since the initial curriculum development. The biggest departure from the acute arena of care is in the area of “medication reminding”.

Home care aides may, “tell a client when it is time to take their medications”. In the last decade, both Oregon and Washington State passed legislation allowing for “Nurse Delegation” to home care aides to draw up and give insulin to selected insulin dependent diabetics. Other states are exploring the expanded use of these valuable members of the home care team. I believe it is time for a serious reassessment of all the members of the home health team to see how best to use the team members including the home care aides.

I believe it is time all home care aides were required to have course work on medications, common uses, side effects and medication interactions. I do not know if it is ego or clinical arrogance that has prevented the full use of our “aide colleagues”, but we can no longer afford to keep them in the dark and our clients/patients at risk.

I have been told by surveyors that they did not even want a medication list left for the aide to follow as they were not allowed to know anything about the medications other than to remind when it was time. I have never followed that rule because I wanted my home care aides to know what pills were to be given. It was not uncommon for me to make a list and tape one of the pills with the name of the drug next to it and the times of day each of them was to be taken. I wanted the home care aides, at the very least, to know that the ‘blue pill was taken at breakfast and bedtime’ and if it was not in the cup, they should report it to me.

Since being in the field as a practicing home care nurse, I have become even more of an advocate for the home care aides and the patients we serve. I want the home care aides and the clients to fully understand the medications they are dealing with. No longer does a typical home care patient have two to three drugs but more commonly now an average of 9 to 12 different medications. The statistical chances of the client/patient having an interaction or experiencing side effects is almost a certainty. Most interactions or side effects are mild and not something to worry about, but some are very serious and lead to bad outcomes. Why would we not want the home care aides to recognize and inform us immediately when one of the bad events occurs?

Over the last 10 years I have had several occasions to act as an expert witness for home care aides who have been accused of wrongful deaths as a result of drug interactions. In the last two cases, the charges were eventually dropped against the aides because the states they worked in did not allow them to know or understand the medications. The laws were followed, but the clients died. It’s time to rethink our use of home care aides and what they bring to the table in terms of comprehensive care for our patient/client. Think of how valuable it would be to the patients/clients and their families if they knew that the person who spends the most time with them or their loved one was specially trained to recognize drug side effects and interactions and report them so early interventions could prevent problems associated with drugs, side effects and interactions. I wonder how many repeat hospitalizations could be prevented and how better the quality of life would be if we fully used the eyes, ears, and noses of those very valuable members of our team, the home care aides.

We are in the middle of a paradigm shift in health care in this country. Why not go all the way and make it quality for all, patients, clinical staff and our home care aides? I welcome your thoughts on this subject. If you have questions or are in need of assistance with you home health, hospice or home care private pay agency, please contact Ginny Kenyon. We are here to help.

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