The Hidden Struggles of Home Health: Ensuring Quality of Care

Infection Control breaches remain a problem in the home care industry. These are preventable errors for your surveys and in everyday practice.

Recruiting home care staff is challenging and costly, losing and replacing staff is worse. You also must consider lost opportunity costs.

One of the biggest challenges for home care and home health is the recruitment of staff to provide care. The high cost remains an issue for recruitment strategies.

There has been a growing issue with the supply of nurses and home care aides. This is particularly true for home care agencies. With the increased competition from hospitals, skilled nursing homes, Medicare home health and hospices for these workers, it has become increasingly difficult to recruit and hire.

HOPE Question and Answer Repository

Today, this article will look at little different than out typical articles. We all know the costs of losing employees and trying to hire and train new ones. It is exhausting and expensive. So, we think about our wages and benefit packages all the time. What can we do differently that makes people stay? We can’t change the job and we don’t want to keep people that don’t like the work itself. So, how do we acknowledge employees in a way that is valuable to them and that our businesses can afford to do? 5 Things To Consider About Employee Recognition At Your Christmas Party: 1. Years of Service: These can be based on milestone work anniversaries (5, 10, 15 yrs, etc.). If a person has been at your agency 11 years, you pull them up and acknowledge them in the group of employees who have been there at least 10 years up until the time they hit the 15 years landmark. This way longevity is recognized yearly. 2. Special Employee awards: Now, this may be difficult if your staff is very small, but acknowledge the employee who has gone the extra mile in the job they do. Tell the story. The employee needs to know when the employer is proud of the work that has been done. Consider a plaque or certificate. Don’t minimize the value of the employee having them to display. 3. Acknowledge all employees in the mix: Because we are a clinical industry, the administrative staff is often overlooked on day-to-day operations. Ultimately, don’t miss the chance to acknowledge the employee who was able to catch billing errors or collect on a large account. Staff doesn’t like to hear about money, but those types of collections keep Christmas bonuses in place! So, make sure the other staff knows the accomplishments of the finance department or the office manager that every caller loves to speak to. Don't ever forget the IT staff that is on call more than any clinical person in your agency! 4. Letters from the administration: Add a personal note to your staff either collectively or individually depending on the size of your agency. If you are larger, there are employees you don’t often see or get to talk to on a regular basis, so take the time so send a note with that Christmas bonus. 5. Consider the Christmas bonus: Listen, some of you can afford to do substantial monetary bonuses and that is fantastic. However, if you are not in that position, consider something in its place. Maybe small gas cards go with the letter from administration. With the cost of groceries, consider something that helps with the costs of daily living for employees. Big box gift cards in your area will always be used. You may do a lot of these things on a yearly basis to employees. All this being said, it doesn’t mean there aren’t reasons for acknowledgement throughout the year. However, your annual Christmas party is a good way to do it collectively. Between your annual party, write the individual cards to employees when you hear a patient interaction worthy of praise. Or, maybe you buy a gas card for the employee who has picked up extra shifts and always shows up on time. Ultimately, employees will feel valued. You will not regret the time, effort, and energy put into these efforts. Merry Christmas! If you want help with recruitment and retention strategies for your agency, please call Kenyon Homecare Consulting at 206-721-5091 or contact us online today.

When you think in practical terms, what does your ICD 10 coding mean to the clinicians in your agency? It probably isn't as important as you would like. Realistically, your nursing staff cares about hands on patient care. If you want the code itself to be more meaningful, then you need to attach the concepts of patient care to the ICD coding. You may think the code itself goes hand-in-hand with the care, but this is not always true. As a clinician, there are concepts within the nursing care plan that are automatic and some that are instinctual based upon the body system causing the need for care. It's a given that medication, diet, and disease process teaching are going to be in the care plan (or should be). When you get to disease process, our experience shows the clinician doesn't always run deep into the specifics of the disease when it could lead to valuable interventions being included in care. For example, when clinicians do a care plan related to cardiac disease, are the interventions very broad to include all things related to any type of cardiac disease? If you have a patient with right sided heart failure versus left sided heart failure, how many nurses would assess the patient differently? Would your nurses change the frame of mind to look for distended neck veins or anorexia and nausea if the patient had right sided failure? Would they be in the head space of considering whether the patient's appetite changes are more about just having been in the hospital than about potential venous stasis in the abdomen? The point is that although there are certain interventions that would be the same regardless the type of heart failure, picking up on different symptoms and critically thinking through the cause is often missing in the hustle and bustle of the day-to-day. This is not a judgment on the capabilities of the nurses but more about how our nurses are trained to consider care planning and assessment. We have people for ICD 10 coding now. Most nurses are not in the ICD coding manual looking up their own codes anymore because of the specificity that wasn't the same 25 years ago. So, the nurses go out with an H&P from the hospital or doctors office and develop a care plan. It isn't necessarily with the coding in mind. So, we need to get back to basics when it comes to coding and clinical care. We need to train out staff to look harder at the coding. Our coding departments need to have open communication with clinicians and understand the concepts of care planning to understand if things are missing in the care plans. What about your clinical manager's role? Are these things considered when reviewing care plans? What about your record review process? Are your ICD 10 coders nurses that understand care planning and is it part of the coding process to review the care plan? These are things to consider when you look at your clinical practice as well as your coding solution. At Kenyon Homecare Consulting , we have a comprehensive ICD 10 coding department that can provide education to clinicians, accurate ICD 10 coding, care plan and Oasis review. Call us at 206-721-5091 or contact us online to see if we can help you merge the code with the clinical practice in a way to improve your outcomes and your bottom line. We will offer 5 free recodes to any agency that would like us to check the efficacy of their current coding system or talk about becoming your coding solution.

When your survey is done, is there a collective sigh of relief at your agency? Is it because it was successful and you can continue as usual? Is it because you have so much to do and now you don’t have to be at the surveyor’s beck and call? Or, maybe your policy and procedure manual just got annihilated and you are going to have a huge plan of correction with an overhaul of your manual? The latter means we need to talk about fixing your manual and what way to do it. Do I Buy An Online Manual Or Fix Mine? Well, that truly depends on you and your business. If you only have a policy or two that gets cited, updating your manual may be a quick fix for your agency. This is normally the case if someone is routinely updating it and the manual is used to run your business. Ultimately, your agency needs to keep the document a living breathing manual or it will not serve its purpose. If your policy and procedure manual is not typically updated other than for survey, then you need to consider buying a manual. Your rule of thumb should be if your agency has not updated the manual within the last 3 years, you should consider purchasing a new one. There are many benefits to purchasing on online manual: Customization: Pick a manual that allows you to fully customize policies to fit your operations. You should not buy a manual that doesn’t provide this option. You need to be able to prove to the surveyor how your agency complies with the regulation. If the policy is written a certain way and you don’t change it to meet how you operate, you will still be cited. Forms/ Documents: Certain online manuals also provide forms that coincide with the policies. This makes it easy for you to implement changes because forms are already generated. There is no reason to reinvent the wheel by making your own. Most of these forms allow you to place your logo and any specific personalization within the document. · State Rules: Several vendors have incorporated specific state rules into manuals. For instance, Kenyon Homecare Consulting offers skilled, non-skilled and hospice manuals as well as ones that have incorporated California and Washington state rules. This eliminates the individual business having to go back in and add state rules to the manual. Consulting Services: Pick a vendor that also has consulting available should you need assistance in customizing your manual to meet your state rules or specific program rules. This makes the process easier especially if you are new to the policy writing and editing. Up-to-date: This is the biggest advantage. These manuals have been updated to include the rules you need. We have seen so many agencies over the last several years not keep up with COP changes and it cost them at survey and with compliance. These manuals are routinely updated with changes so when you purchase your manual it will have the current federal regulations. Ultimately, you have to decide whether it makes sense to rewrite your manual with updates or purchase one that is currently up-to-date. At Kenyon Homecare Consulting , we offer customizable manuals for all service lines, accreditation, and incorporated with certain state rules. Please call at 206-721-5091 or contact us online before purchasing your manual so we can ensure you have chosen the correct one to meet your needs. We also offer consulting services to help incorporate your state rules should you need assistance.

By Jed Hammel: I started my career in the 1990s working for GE, a company led by one of the greatest business leaders ever to have lived, Jack Welch. Jack left GE in 2000 (and so did I - haha). One of his great quotes was "What you measure is what you get." In that theme we've been exploring a lot about measurements. When we first started building home care software it was all about transactions: Onboarding a client, scheduling, clocking in and out, billing, etc. This is the work we do to run the business, but what do we do to grow our business - measure! Home Care Growth Measurements - The Most Important Ones! Our customers told us that the most important measures are as follows: Growth: Hours per week and revenue are the key ones. Note that you might think that number of clients should be on that list as well, but remember that an agency with 5 24x7 clients has more revenue than an agency with 80 10-hour per week clients. Gross-Margin: One of the most troubling statistics in the Home Care Pulse Home Care Survey has shown that the profit margins of home care agencies have been dropping in the past two years. It's not surprising because there's increased demand for home care and there have been fewer available caregivers so the amounts we're paying caregivers have gone up. To combat this, agencies need to charge more and look hard at the cases where the caregiver pay or overtime is eating up all the revenue. Operations: Most of our agencies use electronic clock-ins and clock-outs. On the Medicaid side this is called Electronic Visit Verification (EVV) but essentially all of our clients (including agencies who mostly support private pay and long-term care insurance) are doing it to have real time status and to streamline billing and payroll. Billing for All Available Hours: One metric that some but not all agencies track is whether they're delivering and and getting paid for all of their available hours. Again jumping to the Medicaid side, most Medicaid agreements come with a specifically authorized number of hours (or units) per week or month and the way Medicaid works is that you are encouraged to deliver all the hours be penalized if you go over. Most of you private duty folks are probably counting your blessings that you don't have to deal with that, but a nice thing about it is that it establishes a target number of hours for the agency and let's you know that you're getting it done. What Metrics are Recommended by Home Care Growth Champs like HomeCare Evolution by Steve the Hurricane? Coincidentally, we recently we were joined by Melissa Bagley, one of the expert coaches from Home Care Evolution, on our Home Care Heroes Podcast. You can listen to her episode here: https://podcasts.apple.com/us/podcast/adapting-your-home-care-agency-for-the-future-with/id1548408985?i=1000551422539 Two follow-up thoughts: If there's no way you're going to listen to the podcast, Melissa's recommendations are totally in line with the list above :) If you think Podcasts aren't your thing, you might want to reconsider for the reasons that A) Home Care leaders spend a good amount of time in the car visiting prospects, referral partners and clients, and B) Rather than listening to news (which is mostly bad news), podcasts are educational and uplifting. Best Practices: Dashboards should summarize information so you can get an immediate sense of how things are going. Your dashboard should answer the question "Are we delivering and getting paid for all the services we've been asked to deliver." It's a powerful end to end measure of operational efficiency. Best Practice: Summaries are great, but you need drill down to see where the problems are. Referring to the same dashboard, note that it's great to see a summary, but you also need to be able to drill down to see where the issues lie. Best Practice: Graphs are Nice but Managers generally prefer numbers. A good view of caregiver compliance lets management know at a glance how their caregivers are doing with clock-ins and clock-outs. In this case the pie charts are very useful. By contrast, managers generally prefer numbers and pride themselves on knowing their numbers off the top of their head. Overall business owners can usually tell you their number of clients and weekly hours, whereas recruiters can tell you their number of applicants, number of hires, percentage of candidates attending interviews and percentage hired. Here's a pure numbers dashboard with week by week data. Best Practice: Manage by week, but be prepared to provide data by month, quarter, and other ways. There are weekly summaries of growth with week over week comparisons, but monthly results should be accessible with the touch or a button. Similarly, you want to be able to look at pretty much any time period, but we recommend not looking at less than a week's worth of data because most agencies have fewer visits on the weekends. Takeaways: My church pastor once told me that no matter what sermon they were writing, the initial outline was "What?, So What? and Now What?" So, what should you do after reading this article. Here it is: Identify your key metrics - if you're not sure where to start go with weekly clients, weekly hours of care, gross margin, and recruiting Find an easy way to see the data - hopefully via dashboards with drill down as explained above (if you don't have this, we'd be happy to help - here's how to contact Ankota). Assign leaders to own and drive each of your key metrics Review them regularly, ideally week by week If you have any questions about dashboards or how Ankota's home care management software can help your business, please click below to contact us ! 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. To learn more, please visit www.ankota.com or contact us . Kenyon Homecare Consulting can help you with all of your agency's needs. Whether you need assistance with your start-up, recruitment and retention, clinical or operational issues, regulatory compliance, or financial concerns, we can help. Call us today at 206-721-5091 or contact us online to see how we can help you reach your goals Kenyon Homecare Consulting reposted this article with permission of Jed Hammel who authored it and originally posted it to the Ankota Blog.