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Organizational Restructuring & Transition

As An Employer, Do You Feel Like You Have The Right People In The Wrong Places? Now Is The Time To Make The Change!

organizational restructuringThat first sentence is a handful, isn’t it? Organizational restructuring is tough, but often necessary.  If now isn’t the time, then when? Let’s look at what some of the big hurdles are and how to overcome them.  

“We Have The Best Team” 

That’s fantastic. Not all agencies can make that statement. Long-term employees and bright new talent are a great mix. These are the teams that seem to go with the flow and work efficiently through bumps in the road. If you think you have that mix but aren’t working like a well-oiled machine, then it deserves another glance. Maybe you have all the talent in the world, but employees don’t function in roles that suit individual strengths. This is very common in agencies. It is the adage of putting a square peg in a round whole. Employees cannot function at optimal levels in every role within your agency. Employees can become discouraged and overwhelmed when given job roles that don’t fit them.  

“We Can’t Keep Staff” 

This is another big reason that employees get discouraged. You have your dedicated staff filling so many roles because new employees do not stay. You may have your core team, but for how long? Don’t take for granted that employees are ok with playing multiple roles long-term. This ultimately hurts your process too. Your core and dedicated staff can’t function at 100% at any of roles they are given.  

Organizational Restructuring: 

At Kenyon Homecare Consulting, we have senior associates that can help provide objectivity on workflow. A senior associate will look at staffing and how functioning on clinical and non-clinical levels affect your day-to-day and bottom dollar. Sometimes it becomes difficult to see staff objectively. You have worked with these people for years. You have seen them through good times and bad. An outside source can see things differently than someone deep in the daily routine. Call us at 206-721-5091 or contact us online to see how we can help with organizational restructuring.  

Objective Eyes Looking at Your Home Care Agency Can Have 20/20 Vision For Where And How Change Can Occur

whyHome care owners and administrators are busy. There is no question there. If you aren’t dealing with regulations or chronic disease management, then it is personnel management. Sometimes, you know there are issues, but have been unable to fix them.  A senior home care consultant can give a fresh look at your agency with objective eyes.  

Forest For The Trees Argument: 

Even if you are the hardest working administrator in the business, sometimes, it is not about how hard you work. Working harder may just mean spinning your wheels longer. Organizational issues can be tough in multiple ways. Whether a staffing issue or a need to restructure, it may be difficult to see the forest for the trees.  If you have an outside set of eyes, then the home care consultant can help you put a plan for change in motion based on decades of experience in different agencies.  

Staffing Changes:  

You know your staff. You have been with them for years. Through the good and the bad in personal lives as well as work advancement. This is both good and bad when it comes to organizational changes. Home care consultants evaluate employee capability in current job roles. You may have a fantastic staff but have too many people in roles. It may require restructuring to increase efficiency. That can be a tough thing if you are accustomed to certain cogs in the wheel doing certain things.  

“I Don’t Know Why We Aren’t Making Money” 

This is the most frustrating thing for leaders. You made decisions to control costs, but don’t see the financial reward for it. So many things factor into what you make or don’t make. Turnover, regulation changes, payment reform, and patient census change. All these things affect your day-to-day financial well-being. Is Oasis being done correctly? Is coding being done correctly? How much time is staff spending hunting down orders from other providers? Are staff doing charting in a timely fashion? It can be overwhelming and quite frankly difficult to pinpoint a specific thing. 

Let Us Help Make You Successful: 

At Kenyon Homecare Consulting, we can offer you an organizational assessment based on your needs. Whether you are looking at clinical, organization, financial or a combination of all operations,  Kenyon has the help you need. Call us at 206-721-5091 or contact us online for your free consultation.

How To Survive Year One When Starting a Homecare Agency

Starting a new business is no easy venture, especially if you’re breaking into an industry with which you’re unfamiliar. Fortunately, launching a homecare agency capable of surviving year one of operation doesn’t have to painful! Let’s look at four ways to ensure a smooth startup process.

Homecare Agency

Be Prepared for Your Homecare Agency Startup

Before you ever open your doors, you need to consider the things that can be done to help you prepare for success. Preparing well and early ensures not only a smooth transition, but also long-term stability.

How do you set yourself up for an attainable startup accomplishment? There are several ways, but be sure to consider these two immediately:

  • Come up with an effective, detailed business plan.
  • Save enough funds to sustain the agency while you’re waiting for licensing or certification completion, normally six to 12 months. This is a good policy for any kind of business, even if licensing isn’t an issue, as funds are usually pretty tight your first year.

Get Your Homecare Agency Resources in a Row

The next step to take is to create and/or organize all necessary paperwork, tools and resources required to operate an agency. Don’t wait to long to get started on this as most must be complete before licensure/certification is granted. Having a clear understanding of your business plan, completed in the step above, should give you an idea of what you need to include in each of your documents.

Consider incorporating these required homecare startup necessities:

  • Policy and procedure manual
  • Employee handbook
  • Tools to measure staff competency including an aide competency testing kit
  • Resources needed to meet state and federal regulations

Based on what type of homecare organization you’re starting, these resources vary in content and purpose. Within the industry, there are numerous variations of policy and procedure manuals. For example, a skilled Medicare home health or hospice agency requires different specifications than a non-skilled or private duty homecare organization, according to the legalities surrounding each.

Spread the Word About Your Homecare Agency

Now that you have a clear-cut plan for your organization, the necessary paperwork, tools and resources obtained and the money retained to cover a year of expenses, it’s time to get the word out.

Next step is to search for, find and hire the ideal job candidates. Retaining a startup consultant before launching into this step may be prudent as the hiring process can be a long and requires experience. Before writing and placing ads and holding interviews, create job descriptions for all positions. In addition, having the knowledge of what’s required to create an elite aide staff will set your start-up apart from the competition.

Begin laying the groundwork to build your network and client base. Here are four ideas to get you started:

Ask for Help With Your Homecare Agency Start-Up

The best way to ensure the success of your start-up is to seek help from experts in your field. These experts steer you in the right direction concerning employee relations, (human resources to leadership skills), legal requirements and regulations, and how to retain the necessary software, tools and resources.

When it comes to giving your organization the best chance possible for success and long term stability, don’t be afraid to ask for help!

At Kenyon HomeCare Consulting, we offer everything you need to get your agency off the ground and running smoothly. From providing temporary management during times of growth, to helping you educate your employees, we give your organization the startup boost to succeed.

Interested in speaking with us? Schedule an appointment online or call 207-721-5091 today.


Impact of Consolidation on Post Acute Care

What will be the impact of consolidation in post acute care for home health, hospice, and private duty home care? Time For Change Clockface

I was reading an article about Health South acquiring Reliant Hospital Partners for a reported $740 million.  This follows on the heals of Health South acquiring Encompass Home Health for $750 million.  That makes Health South one of the larger players in post acute care with home health, hospice, and rehab facilities in 33 states and Puerto Rico.  The article made me think about what I see happening across the country, beginning right here in my home town.

Louisville KY is the Mecca of Long Term Care

Downtown Louisville based, Kindred Healthcare has become the largest post acute provider with the acquisition of Gentiva Health Services, one of the four large publicly
traded home health and hospice companies.  Kindred has completed 17 acquisitions since 2010 and at March 31, 2015, Kindred had approximately 102,600 employees providing healthcare services in 2,787 locations in 47 states, including 97 transitional care hospitals, 16 inpatient rehabilitation hospitals, 90 nursing centers, 21 sub-acute units, 664 Kindred home health, hospice and non-medical home care sites of service, 100 inpatient rehabilitation units (hospital-based) and a contract rehabilitation services business, RehabCare, which served 1,799 non-affiliated sites of service.

Across town, Signature Healthcare, a nursing home and rehabilitation company has also moved into the home health and private duty business.  The company has 126 Signature Logolocations in 10 states, including Signature Home Now, a home health agency with 11 branches in Florida, and Silver Angels, a private duty business focusing on Medicaid, with 8 locations in Tennessee.

Around the corner from our office, Almost Family, Inc. has grown to become a leading provider of home health and private duty services.  One of the Big Four publicly traded home health companies, Almost Family has 250 locations in 15 states.

Long Term Care Companies Acquiring Home Health and Private Duty

Not just in Louisville, but across the country long term care companies are acquiring home health and private duty home care companies.  In Mission Viejo, CA, Ensign Group has recently acquired Hospice of the South Plains in Lubbock, TX and Alarys Home Health in Scottsdale, AZ.  Ensign group has facilities and branches in 11 states.Almost Family logo

Pruitt Health, based in Norcross, GA, has 170 locations in NC, SC, GA, and FL, as well as home health and hospice services.

In a reverse of the trend, Golden Living, once one of the country’s largest nursing home companies, sold their home health business Assera Care to LHC Group.  LHC Group now has over 300 locations in 26 states making it one of the big four publicly traded home health companies.

Hospitals Affiliating with Post Acute Care

One of the outcomes of the Affordable Care Act is that hospitals are focusing on reducing preventable readmissions.  The new law penalizes hospitals for excessive readmission of Medicare patients.  As a result, hospitals are partnering with skilled nursing facilities, rehab hospitals, and home health agencies to find new ways to help keep patients from going back into the hospital. According to CMS data, more than 20% of hospital patients discharged to a SNF are readmitted to the hospital within 30 days.

Leaders at North Shore-Long Island Jewish Health System in New York assessed potential post-acute partners using several quality metrics, such as nurse staffing ratios and star ratings on Medicare’s Nursing Home Compare. They also reviewed geographic proximity to system hospitals, referral patterns, and other criteria. From a list of 266 potential facilities, the health system selected 19 for its SNF affiliate network. Parker Jewish Institute for Health Care and Rehabilitation, New Hyde Park, N.Y., was the first SNF to join North Shore-LIJ’s affiliate network.

In Pittsburgh, PA, University of Pittsburgh Medical Center recently acquired Family Hospice and Palliative care in Mt. Lebanon. UPMC now has 16 hospitals, 19 outpatient centers, 6 SNFs, 4 ALFs, 4 CCRCs, and 3 home health agencies.  Cross town rival Allegheny Health Network just entered a joint venture with Celtic HealthCare to provide home health services to patients from Allegheny’s 7 hospitals in western Pennsylvania.

Home Health Agencies Moving to Private Pay

One of the biggest trends we are seeing in the industry is home health agencies moving into private pay home care.  This trend plays out in three ways;  agencies starting private duty, agencies acquiring private duty, or agencies refocusing on private duty businesses that have struggled for years.  The cut in Medicare home health payments has caused agency leaders to look for ways to reduce their dependence on Medicare and Medicaid.  Private pay is one answer.  As we have studied private pay services that are affiliated with home health agencies,  we see that the affiliated companies are larger, have easier access to referrals, and are less profitable as compared to independent and franchise private duty businesses.  As these home health agencies work to refocus on private duty, they need to improve gross margins and control overhead expenses in order to be profitable and grow.

Perhaps the biggest area of growth for private duty home care are the not-for-profit Visiting Nurse Associations across the country.  The VNAs really started private pay home care back in the late 60’s.  However, with the growth of Medicare Home Health many agencies lost their focus on private pay as they grew their Medicare businesses.  Over the past decade, we’ve worked with dozens of VNAs from New York to California, and from Boston to Atlanta to grow their private pay businesses.  The key has been finding an entrepreneurial leader to run the business, and then giving them as much autonomy as possible to perform all of the functions of a successful private duty company.

What is Your Strategy for Growth in a Dynamic Post Acute Care Environment?

With all of this change going on in post acute care, what is your long term strategy for growth?  What are you and your leadership team doing to get ready for the future? What are you going to do to differentiate your agency from your competitors.

Need some help?  Leading Home Care can help by providing a facilitator to guide you through the strategic thinking and planning process.  We will help you evaluate where your agency is today, develop a clear vision for the future, measure the gap between now and the future, and help you develope focused action steps to bridge the gap.  For assistance with Strategic Planning, Board Strategy Retreats, and Executive Team building, call us today at 502-339-0653

StephenTweedphotoStephen Tweed is an internationally known health care and business strategist, award winning professional speaker, and published author. He is the CEO of Leading Home Care … a Tweed Jeffries company.  He can be reached at

This article first appeared as Coming Together in Post Acute Care at Leading Home Care blog on June 16, 2015.



Can Healthcare Reform Be Funded By Reducing Overkill?

We generally blog about very specific and actionable ways that home care agencies can thrive.  A lot of our content is about best practices and marketing, and we have a specific focus on managing care transitions, which we view as the right step for home care agencies to take now in order to position themselves for a broader role in the continuum of healthcare.

But, the biggest conundrum with managing care transitions and the biggest question we’re asked is how do we pay for it?  Everyone we talk to agrees that managing care transitions is a great way to avoid preventable hospitalizations, but the big question is always: “How do we get reimbursed or paid for care transitions work?”

It’s tricky…  We’ve offered advice on this topic before, including in a very popular recent blog post entitled, “2 Steps for Selling Your Home Care Agency’s Care Transition Services to Hospitals.”  Today, we look at a totally different answer to that tough question.  Perhaps we can fund care transitions by avoiding overkill in Medicare spending.Doctor's hands with health care words isolated on white

Medicare Spending Overkill

One of my favorite writers is Dr. Atul Gawande who writes and talks about how health care can be improved.  He’s written book that we reviewed called The Checklist Manifesto about how check lists, like the ones our home health aides use each day, are being used to save lives in critical care settings.  He also writes on healthcare for the New Yorker magazine and his most recent New Yorker article, entitled, Overkill, is the subject of our post today.

Dr. Gawande’s articles and books are really compelling and I encourage you to read the full article, but the gist is that there are a bunch of medical services that are being performed regularly that deliver zero value for patients.  Here are some key facts:

  • CT or MRI scans are often prescribed for lower back pain, whereas research shows that these tests are only useful if there are associated neurological disorders.
  • EEG exams are often prescribed for uncomplicated headaches, even though these exams are only useful for seizure disorders
  • Stents are routinely implanted in patients with stable cardiac disease, despite the fact that the likelihood of heart attack or death in five years is unaffected by the stent
  • The research cited by Dr. Gawande lists 25 useless procedures that are readily performed
  • In one year it was estimated that between 25% and 42% of the Medicare population (primarily made up of Americans over age 65) had at least one of these treatments
  • The amount of money waste on these procedures is more than America spends on K-12 education for the entire country

Perhaps eliminating this waste could fund all the care transition services that could virtually eliminate preventable hospital admissions?

What Can We Do Today?

Unfortunately, the problem described above isn’t something that we can solve individually in our home care agencies, but there is something that we can do… We can start providing care transition services.  Ankota provides care transition management capabilities through software and we’d love to help you to future proof your agency.  Also, please read the rest of the Atul Gawande article.

If you’re interested in differentiating yourself in the marketplace, Ankota offers a free White Paper about the opportunity in Care Transitions, Why Care Transitions Is The Next Big Thing for the Home Care Industry

Click here if interested in scheduling an Ankota online demo of our home care or care transitions software solutions.

“Healthcare Reform Can Be Funded With Reduction In Overkill, per Dr. Atul Gawande” first appeared on the Ankota blog on July 6, 2015.

Ken Accardi founded the software company Ankota. Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota’s primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. 


Interim Home Health Management Fast Tracks Your Agency’s Success

interim home health management

The competition for home health care companies is growing, especially as more and more Baby Boomers reach retirement age. With more agencies entering the industry every day, you need to be on top of your game if you expect to compete. But that can be difficult when you don’t have a solid management team to chart the way forward.

If a key member of your team suddenly leaves or your agency experiences any other disruption, you have to be able to move very quickly. When that happens, interim home health management can be the temporary solution you need to get back on track. An experienced home care consultant can step in to fill the void, assess the situation, and provide guidance when you need it most.


Merging Geriatric Care Management and Private Duty Home Care: The Dos and Don’ts

A guest post from Mary Lynn Panen, RN, BSN, CCM; President & Owner Sound Options, Inc.

Merging Geriatric Care & Private Duty Home CareWe are at a pivotal moment as an aging society. According to Pew Research Center, 10,000 baby boomers will turn 65 every day for  the next 19 years. Currently a quarter of adult children, mainly baby boomers, are providing personal and financial care to a parent. It is clear that this generation is changing the way we think about aging and how we address the coming tsunami of eldercare.

Money is tighter at the same time care needs are more complicated. And, many families are seeking a holistic and personalized approach to healthcare. While the needs are growing, as a business owner seeking to merge private duty home care and a geriatric care management, there is much to consider.


Change is Inevitable – Have You Embraced it?

Change_Inevitable_EmbraceGuest Writer, Terri Wallin, Wallin Enterprises CEO and Consultant, shares ways to be a leader in embracing and leading your staff through inevitable changes in the healthcare industry.

Change seems to be the only constant in the world and certainly in health care. Today’s leaders constantly have to adjust to the world swirling around them. In order for healthcare organizations to thrive, leaders do best if they embrace and master the art of transformation. To help staff through a constant changing marketplace, the leader must be proficient at self-adaptation to the outside changes as well as leading others through organizational change.


Improve Your Home Care’s Efficiency & Profitability with Internal Processes

Over the years, we have had the privilege of assisting more than 80 home care agencies to start, grow, and develop their business. In addition, we have provided organizational assessments to about half as many home care agencies. Needless to say, we have the unique opportunity to experience multiple organizations and their functions first hand. One of the most significant observations we have made is those organizations that establish their internal operating systems with intent are those that are the most effective and profitable.


Reenergize Your Home Care Agency with Interim Management

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.