Fractional Home Care

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by Tim Rowan | Feb 27, 2025 | Admin, Clinical, Recruitment & Retention

by Tim Rowan, Editor Emeritus

Solve Nagging Problems; Raise Revenue

Along with the rest of the Private Pay sector, Jessica Nobles’ Eastern Tennessee agency was struggling with caregiver recruitment and retention. Finding good people is less than half the battle. To keep them, you have to pay a competitive wage and provide enough hours to ensure that wage translates into an attractive and predictable monthly income. We spoke with Jennifer, Founder of Home Care Ops, last week to learn one of her solutions.

Fractional Home Care

What Nobles calls “Fractional Home Care” is providing services in a senior living community with one or more caregivers stationed on site. Residents pay a membership fee or pre-purchase a package of hours. The agency is thus guaranteed a small revenue base and clients are free to request services for a few minutes or a few hours on an as-needed basis.

“Our caregivers love this arrangement because it virtually guarantees them full-time pay. They remain on site at the facility for a contracted shift, which can be their choice of daytime or night hours. If demand warrants it, we will assign more than one caregiver at a time.”

Jessica Nobles

Founder, Home Care Ops

She added that the advantage to the agency is that nearly all of a caregiver’s day is paid hours. There are no mileage reimbursements and no paying for travel time or idle time. “Think of it as a co-op,” she continued. Ten clients can share one caregiver. They get all the care they need and our caregivers are earning for their entire day.”

The benefit accrues to independent living communities as well. Their arrangement with an outside Home Care agency means they no longer have the burden of hiring and retaining a caregiving staff of their own and their residents get better care. The residents pay for the services, not the facility, and they have the option of using the on-site caregivers as needed or through the pre-purchase plan of a block of ten or twenty 15-minute units.

A Typical Scenario

Jessica offered an example of how Fractional Home Care often works. An Assisted Living Facility resident lives independently but occasionally needs help with showers, or help getting to and from the community center, etc. In a typical home care setting, that person would have to bring in a caregiver for four, six, or eight hours, though less than an hour is needed. The family speaks with the onsite agency to arrange for the specific help needed, whether it is a few minutes

every other day or an hour every day. The agency offers a membership at flat fee and both parties get exactly what they need. The caregiver is available to add other residents to his or her schedule, making it possible to achieve a 40-hour work week.

“Some patients might need traditional daily care as they might get from any other agency,” Jessica explained. “They can contract for that for around $1,600 per month. Our caregiver can come multiple times a day since there are no drive time concerns.” She said that not every client needs a membership program. Some prefer pre-sold units, perhaps buying five 15-minute visits in advance. “They never have to pay for down time. Our caregivers never sit idle should their work be done before their shift is up.”

Fractional Home Care Improves Agency Reputation

Jessica has found that her agencies have earned a reputation for such excellent care that they have occasionally replaced franchise home care organizations locally that have national contracts with national ALFs. Some of these facilities have been dissatisfied with the care they were getting with their national organization’s contracted agency. When this happens, they seek a local agency to replace them. Jessica has seen this several times when the franchise was not staying on site.

“We explain our fractional model, with someone on site at specified times when at least three residents have signed on, and one caregiver per 10 clients. The more clients who sign up, the more caregivers we station at the facility. This leads to an additional benefit for the ALF. This level of service delays the day the family decides to move Mom from their community to a nursing facility.”

Fractional Home Care has been so successful, the word spread to other residential communities. Nobles’ company had had to turn some away. When that happened, she and her partner and husband began to teach the system to other agencies.

There was one obstacle, she admits. There were no Agency Management Software systems that could be adapted to the fractional way of providing care. She and her team finally created their own…right before she found one on the market that met their needs. Jessica introduced us to Tim and Gina Murray, co-founders of Cinch CCM. Jessica recommends Cinch CCM to fractional home care agencies. We have scheduled a demo and will have a review in the near future.

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About Jessica Nobles

With over a decade of Private Duty Home Care leadership and knowledge, Jessica Nobles worked her way up through every position from Caregiver, Operations Coordinator, Franchise Developer, and Independent Agency Owner. As the founder and operator of Nobility Care Solutions, she grew her revenue to six figures within the first year of business through grassroots marketing, creative community engagements, and referral partnerships. She is also the Executive Administrator for Home Care Ops where she coaches, consults, and empowers other home care owners and operators to create operational systems and strategies that build lasting business success and consistently increases revenue.

Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Startup Offers $3 Caregiver Recruiting Service

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by Tim Rowan | Aug 9, 2024 | Admin, Product Review, Recruitment & Retention

by Tim Rowan, Editor Emeritus

Costly Caregiver Recruiting

Out of desperation, the nationwide caregiver shortage has driven many Home Care agency owners to resort to expensive recruiting tools. How much, for example, do you spend on services such as Indeed, ZipRecruiter, or Monster, each of which charges per-click?

A Needle in a Stack of Needles

You know how job seekers use these services, correct? They complete one resumè and send it to dozens, if not hundreds, of companies every day. When you respond to their inquiry, thinking they have a keen interest in applying for your caregiver position, they typically respond, “Now, which one are you?”

Caregiver Recruiting Database Emerges

In the process of building a web site and app for families to find in-home caregiver services, former Home Care agency owner Amit Shrivastava suddenly found himself with more job seekers than he could place in homes, and this after launching in only five states. His solution was to open his collection of resumés to other agencies. After we tested his idea, we believe it will one day give Indeed and the others a run for their money.

Simple Process with Customized Results

After a $200 set-up fee, GoInstaCare users can look at the names, certificates, personality types, and work preferences of 10,000 caregivers, a list that continues to grow. An easy filtering system allows the user to narrow the list by certification, gender, zip code, and experience. Each entry displays whether the caregiver has a driver’s license, his or her own car, languages spoken, and ratings from past employers and clients.

GoInstaCare performs background checks so the hiring agency knows that the caregiver has a higher degree of passing their own checks. By selecting filters, a hiring agency can focus its search to the qualifications it requires. Once the 10,000 names are filtered down to a manageable half dozen or so, the hiring agency pays $3 each to download their contact information. At that point, GoInstaCare steps back and leaves the rest of the onboarding process to their participating agency.

"Uberized" Employer

For Caregivers

Like its counterparts in ride shares, delivery services, virtual assistants, and other gig economy positions, GoInstaCare allows caregivers to set their own schedules, provide flexible rates, get paid daily, and accept or decline a job at will. Caregivers are reviewed by clients and their families directly on the GoInstaCare platform.

For Agencies

The gig job nature of the platform gives agencies the option to cover a gap in scheduling or temporarily raise employee numbers without the hiring, onboarding, training, and retention of a full-time or part-time employee. Agencies can also save a caregiver profile to share with a team, or for future reference.

Where to Find GoInstaCare

As this is written, GoInstaCare has spread to five states, Texas, Illinois, Michigan, New York, and Florida. Mr. Shrivastava told The Rowan Report there are plans to continue to expand.

There are two ways to get in touch with Amit Shrivastava. Click on this link to schedule a product demo: calendly.com/goinstacare-sales/meeting. Or sign up to use the service here: Goinstacare.com/partner-with-us

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Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Recruitment, Retention, and Reward: Product Review

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by Kristin Rowan | Jul 19, 2024 | Admin, Artificial Intelligence, Caring for the Caregiver, Clinical, Product Review, Recruitment & Retention

by Kristin Rowan, Editor

Caregiver Recruitment, Retention, & Reward

The workforce shortage, caregiver burnout, after effects of the pandemic, and the advent of “quiet quitting” have impacted home care agencies’s ability to fully staff and care for their patients. Hiring new caregivers is not always an options. Agencies must put time and effort into recognizing, rewarding, and retaining their existing caregivers and clinicians.

The Rowan Report recently came across a company that is helping agencies do just that and we had an opportunity to sit down with their founder.

How it Started

Victor Hunt’s grandmother was a career nurse who started her own home care agency. However, the operation was too hard for her to handle on her own. She made the difficult decision to close the agency and go back to shift work. Victor realized that we need more home care agencies. But, he knew there had to be a way to help the people who have “home care heart” and can provide great care. There had to be an easier way.

Home Care Immersion

Before Victor and his team could address the difficulties faced by home care agency owners, they first had to understand them. With his co-founder Dan, Victor embedded himself into home care agencies. They took shifts, followed schedulers and recruiters, and experienced the problems up close. During this process, they got to know one agency in particular and one caregiver who was a rockstar. She picked up shifts, did training, contributed the company culture, visited patients in the hospital, and had referred more than 100 caregivers to the agency. In short, she was the home care clinician all agency owners want.

Her Name was Ava

Using this rockstart clinician, Victor and Dan set out to create a system that could turn every caregiver into an “Ava” and make every agency one that caregivers like Ava would want to work for. The mission of Victor’s and Dan’s company is to “make home care agencies destination employers.”

The Problem Statement

Home care agencies suffer from high turnover rates and performance challenges. THere is a lot of legwork that needs to be done to fill in the gaps and fix what isn’t done well. According to Victor, it comes down to a challenge of engagement and morale. Being a home care clinician is a lonely and thankless task. Caregivers can feel stuck in their career track unless they are actively pursuing higher credentials. The problem home care agency owners face is:

“How do we engage employees so their work feels recognized and meaningful?”

The Solution is Ava

The Ava team surmised that in order for caregivers to feel valued and appreciated, something had to give. The question, they wondered, was whether it would be margins or administrative overhead. AI was at the center of these conversations. But, traditional EMRs limit the implementation of AI solutions.

Recognition and Rewards

Because EMRs limit AI applications, Ava is an app but is also a stand-alone system that operates in a mobile browser. No download is required for use, yielding an 85-90% adoption rate within agencies offering Ava.

Ava connects to the existing EMR first to import data. Then, agency owners create their own rule sets. This offers incentives and engagement around specific metrics the agency wants to see. Examples include attendance, timeliness, number of hours, documentation, and completed training.

Ava will then assign, track, and reward milestones based on the rules set for the agency. Clinicians earn points that can be redeemed directly from the Ava store with more than 100 participating vendors. Agencies can also add internal rewards like branded merchandise, PTO, and raffle tickets. Rewards can be redeemed in $5 increments.

Communication

Ava includes automated messaging to recognize employees without taking valuable time away from administrators. The app sends recognition texts to all staff to congratulate clinicians for reaching certain benchmarks. Announcements can be sent by email or SMS to all employees at once. Additionally, Ava includes HIPAA compliant two-way communication between agency and staff.

Additionally, administrators can create groups within the system to send mass reminders to specific people. For example, you may create a group that includes all employees whose driver’s license will expire in the next 60 days. Within that group, reminders are sent to ensure updated information is added to the employee file. The system updates automatically each week, adding and removing employees from the group based on the criteria created.

Surveys are a great way to keep a pulse on the level of commitment and satisfaction your employees have. Studies suggest that engagement is a large factor in why employees leave their workplace. Ava includes pre-built survey templates but also allows you to crete a survey using an AI query. The survey questions and answers are customizable, can be “required”, set to “read only”, and can include a comment box to gain additional insights. Administators can filter survey responses to only see a certain type of answer.

Marketing

Referrals from employees is not a new concept. However, it is not always a visible part of your recruiting strategies. Ava has a referral bonus program with automated milestones. The bonus program spreads the referral bonus out across multiple agency milestones.

Ava also allows for manual tracking of Google Reviews or any other event or milestone where clinicians can be measured, tracked, and rewarded.

Customizable on Multiple Fronts

In addition to the custom survey questions and benchmarks, Ava includes custom naming conventions to track clinicians. One agency uses the term “activity tag” to categorize achievements. If your agency already uses different terminology, that can be added to the system.

Currently, Ava operates and switches between seven different languages. Additional languages can be added to the system and Ava can support those as well.

Recruitment processes are also customizable. Agencies can give candidates access to the system during the hiring process and they can earn points for attending the interview, completing onboarding paperwork, finishing the first training shift, or other measures. This allows the agency to reward a new employee with, for example, a coffee gift card by the end of their first day.

Track and Reward Your Top Employees

When your agency finds an exemplary employee, the unicorn, the “Ava”, keeping them becomes a top priority. Finding and training new employees is costly and time consuming. It is far easier and less expensive to reward your current high-achievers.

Badges

In addition to daily, weekly, and monthly goals, Ava has a tier system called “Badges.” Badges are long-term drivers of engagement, satisfaction, and success. The current badges are Orange (Avas brand), Silver, and Gold. There are points multipliers at each level.

Once an employee reaches a badge level, they have to maintain a consistent 90% goal completion rate in daily, weekly, and monthly goals in order to maintain their badge level. Loss aversion to lowering back down a level encourages a high completion rate of other tasks.

Training

Caregivers and clinicians should be constantly learning to stay ahead of the newest trends and technologies in the industry. Ava includes learning management system (LMS) integrations with several of the top training companies in the industry. Clinicians can access learning modules through the app or browser and can earn rewards by completing training modules based on individual agency settings.

Reporting

Reports within the system go beyond badges and benchmarks. The system consolidates reporting from various data sources and allows you to see your business health at a glance. These reports can help catch burnouts before they happen, focus performance improvement plans, and automate process than can save an agency hundreds of thousands, if not millions, of dollars per year.

Limitations

Like most software solutions, the first iteration of a usable system is never the last version. Ava has already integrated with WellSky and can access several other EMRs. As they continue onboarding customers, the team at Ava is very open to the suggestions of their users and will continue adding features.

Some current limitations we noticed in our intial demo:

The badge system has only three levels. Longer term employees may want to see higher badge levels to maintain motivation. Victor noted that AI systems can help add account-specific customizations.

The app is designed for caregivers and clinicians. There is not currently a model for back-office administrators and support staff. While some customization could make the app usable for the back-office, it is not designed with them in mind.

Mass messaging through email or SMS is limited to one-way, read-only communication. There is an option to add “likes,” but currently there is no option for a group or individual to respond, even privately to a company-wide announcement.

The two-way communication is limited to internal staff. Employees cannot communicate with patients from the app to advise them of their arrival time, reschedule an appointment, or ask questions before an appointment.

The manual tracking of Google reviews is not scalable.

When The Rowan Report sat down with the team at Ava, we asked about some of these limitations and additional ideas for future iterations of the program. Victor and his team have already hired at least one person to focus on new feature requests.

Final Thoughts

Gamification is not a new concept in many industries. In fact, most of us probably have a memory of a teacher or parent with an activity board to earn stars for tasks completed. We’ve been unknowingly using gamification for many years.

Smart phones, advancing technologies, and AI have increased the adoption of gamification and is infiltrating the care at home world quickly. The ongoing workforce shortage will make implementing these types of gamified systems even more important for an agency’s financial well-being.

Ava may not be the first of its kind, but it has shown innovation and ingenuity in it application. If your agency is looking for ways to reward employees, needs to stand out among rival employers, is looking to reduce administrative costs, or needs a simpler way to see reports and statistics from multiple sources, Ava may be a viable solution.

We see great things coming with future iterations of the app and the software and I’m sure this is not the last we will here of Ava. For more information, visit joinava.com.

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Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

A New Path for Recruitment and Retention

Admin

by Kristin Rowan | Jun 27, 2024 | Admin, Caring for the Caregiver, Clinical, Recruitment & Retention, Vendor Watch

by Kristin Rowan, Editor

Recruitment and Retention amidst the national workforce shortage is not a new topic for The Rowan Report. We have feature articles dating back months, even years, talking about how you can recruit the top talent in the industry and keep the best employees you have. A lot of companies look at wages as the driving force for retention of great employees. While there is some merit to that idea, wages are not always the strongest indicator of employee satisfaction. In fact, happy employees say it would take a substantial (more than 30%) raise to get them to leave a great workplace.

The reality for many home health agencies (HHAs) is that higher wages are not always possible with the rising costs of everything else and the lower reimbursement rates from CMS. HHAs have to be creative in their recruitment and retention strategies and find new ways to engage their staff. Incentivizing staff outside of wage increases is becoming a standard part of recruitment and retention strategies and we’ve seen several of these companies popping up recently. And we’re not the only ones who have noticed.

The Rowan Report met with the team at Ava and will have a product review for you next week. In the meantime, you can read the press release from Wellsky here.

About Wellsky

Wellsky, a leading home health technology company, has been focusing on patient-centered coordinated care. The software for home health includes intake, scheduling, care delivery, claims management, analytics, and more. Recently, Wellsky has included caregiver retention as part of their platform, in a partnership with Ava.

About Ava

Ava is a home-care-focused employee management solution that personalizes your employee incentives and sends automated reminders to your staff. Together, Wellsky and Ava created “TeamEngage”, using Ava’s platform connected directly to your workflows. WellSky Team Engage promises to improve retention, incentivize productivity, capture engagement insights, and allow you to hire more efficiently.

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Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Navigating the Home Care Revolution

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by Kristin Rowan | May 10, 2024 | Admin, Caring for the Caregiver, Clinical, Marketing, Recruitment & Retention, Regulatory

by Kristin Rowan, Editor

I was honored to have been a guest on Health Futures – Taking Stock in You Radio Show on Money Radio 1510 AM discussing navigating the home care revolution. Health Futures is hosted by HomeCare expert Bob Roth, owner of Cypress HomeCare Solutions. Cypress just celebrate its 30th anniversary last week and is the recipient of a Grant to Innovate within Medicaid in partnership with PocketRN and is the 2013 & 2018 winner of the BBB Torch Awards for Ethics. You can listen to the full radio show here. Below is the blog based on the show, written by the CEO of Strait Talk PR, Lauren Strait.

Home Care Revolution bob roth kristin rowan

by Lauren Strait, CEO Strait Talk PR

The Aging Population Tsunami

By 2050, the 85-year-old population in the United States is expected to quadruple. As this massive demographic shift unfolds, the already strained home care industry will face unprecedented challenges in meeting the escalating demand for quality care services.

Bob Roth, Managing Partner of Cypress HomeCare Solutions, recently had Kristin Rowan, of The Rowan Report on the radio show and podcast to discuss this trend and everything a consumer needs to know about the homecare industry and how it will affect them.

A Trusted Voice Amid Industry Upheaval

In the latest episode of “Health Futures, Taking Stock in You” hosted by Bob Roth of Cypress Homecare Solutions, Kristin Rowan, Owner and Editor of The Rowan Report, offered insights into how her publication is guiding the industry through this seismic transition.

The Rowan Report’s Unbiased Expertise

What began as a print magazine reviewing home health technology has evolved into a comprehensive digital hub covering regulatory updates, workforce solutions, marketing strategies, and groundbreaking innovations. Rowan emphasized the publication’s commitment to neutrality when evaluating new products and services.

“We do our best to remain as neutral as possible…that’s one of the things that Tim [her father and the founder] established early on in his relationships with tech providers.”

Empowering a Strained Workforce

With a redesigned website offering robust search capabilities, The Rowan Report curates resources to help agencies streamline operations and alleviate administrative burdens on overstretched staff. “The solution is not more people because they’re just not there,” Rowan stated. “But the solution is collaboration to better utilize the people that you have.”

The publication explores leveraging AI, voice technologies, automated claims processing, and outsourcing to reduce paperwork and maximize efficiency, enabling care professionals to concentrate on frontline patient care.

Preparing for the Age Wave

As the population ages, The Rowan Report recognizes the need to educate professionals and families on navigating the complexities of long-term care. By convening experts, the publication covers crucial topics like choosing providers, understanding Medicare/Medicaid, and planning for future care needs.

An Indispensable Industry Guide

With over 25 years of experience, The Rowan Report stands as an indispensable guide for the home care industry as it braces for the challenges and opportunities of an aging America. Access their insights at www.therowanreport.com.

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Bob Roth is Managing Partner of Cypress HomeCare Solutions. He assisted in creating Cypress HomeCare Solutions with his family in 1994. Bob brings the depth and breadth of his nearly 36 years of consumer products, health care and technology experience to the home care trade. Over the years, Bob has received a number of awards. These include the January 2014 CEO of the Month and finalist for the 2015 Phoenix Business Journal’s Healthcare Heroes award. Cypress won the Better Business Bureau’s Business Ethics award in 2013 and 2018.

In March 2017, Arizona Governor Bob Ducey appointed Bob to the Governor’s Advisory Council on Aging. This was the first time in the Council’s 40 years that a home care/home health care agency owner/manager has served on the Council. Nationally, Bob serves on the Board of Directors for the Home Care Association of America (HCAOA). Locally, he serves on the Board of Directors for DUET Partners in Aging. Additionally, he is on the ambassador committee for Aging 2.0 – Phoenix Chapter. On September 11, 2019 Bob won the Home Health Care News Future Leader Award. The award recognizes up-and-coming leaders elevating the home health industry. When he’s not working, Bob enjoys spending time with his wife Susie, their three daughters, and playing golf, tennis, hiking and walking with Ruby and Lacey, our pet therapy dogs.

Bob Roth is Managing Partner of Cypress HomeCare Solutions. He assisted in creating Cypress HomeCare Solutions with his family in 1994. Bob brings the depth and breadth of his nearly 36 years of consumer products, health care and technology experience to the home care trade. Over the years, Bob has received a number of awards. These include the January 2014 CEO of the Month and finalist for the 2015 Phoenix Business Journal’s Healthcare Heroes award. Cypress won the Better Business Bureau’s Business Ethics award in 2013 and 2018.

In March 2017, Arizona Governor Bob Ducey appointed Bob to the Governor’s Advisory Council on Aging. This was the first time in the Council’s 40 years that a home care/home health care agency owner/manager has served on the Council. Nationally, Bob serves on the Board of Directors for the Home Care Association of America (HCAOA). Locally, he serves on the Board of Directors for DUET Partners in Aging. Additionally, he is on the ambassador committee for Aging 2.0 – Phoenix Chapter. On September 11, 2019 Bob won the Home Health Care News Future Leader Award. The award recognizes up-and-coming leaders elevating the home health industry. When he’s not working, Bob enjoys spending time with his wife Susie, their three daughters, and playing golf, tennis, hiking and walking with Ruby and Lacey, our pet therapy dogs.

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

80/20 Finalized Rule

CMS

by Kristin Rowan | Apr 26, 2024 | CMS, Recruitment & Retention, Regulatory

by Kristin Rowan, Editor

The Centers for Medicare and Medicaid Services (CMS) has finalized the “Ensuring Access to Medicaid Services” rule, more commonly known as the 80/20 rule. The 80/20 finalized rule requires at least 80% of Medicaid payments for home care services goes to caregiver wages. No more than 20% can be spent on administrative or other overhead costs. The White House, citing a study by The Commonwealth Fund, says that higher wages for caregivers will reduce turnover. Facing massive workforce shortages, home health, hospice, and supportive care at home agencies have been struggling to recruit and retain an adequate number of caregivers. The higher wage will also increase the quality of care, according to the study.

Prior to the 80/20 rule, there was no law or rule requiring home care agencies to report how they were spending money from federal medical payments. The rule includes requirements for states to create advisory groups to consult on rates and compensation. This changes the current Medical Care Advisory Committee regulations by increasing the percent of beneficiaries on the committee from 10% to 25% over the next two year. The Home Care Association of America (HCAOA) and the National Association for Home Care & Hospice (NAHC) argued that the rule adds administrative requirements to home care agencies while simultaneously reducing the resources available to fund them. NAHC President Bill Dombi said, “We all agree that more needs to be done to support the direct care workforce; however, this policy will make things worse, not better.” NAHC suggests the policy will force some agencies to close and others will leave the Medicaid program altogether, causing patients to have even more problems accessing care.

Exceptions to the Rule

From the text of the final rule, CMS acknowledges additional comments that the minimum direct payment to caregivers in this rule will create hardships for some agencies. Across the country, there are substantial differences among waiver programs for HCBS that are not accounted for in the rule. There is some flexibility built into the rule to account for these factors, according to CMS. Some of the flexibilities include:

Excluding some costs from the calculation
Including clinical supervisors in the calculation
Allowing states to set a different minimum for small providers
Allowing states to develop their own criteria to qualify as a small provider
Allowing states to develop criteria to exempt some providers from the rule

Exemption from the minimum payment rule for all Indian Health Service and Tribal health programs

The final rule also changes the timeline for complying with the rule from four years after the date of publication to six.

Objections to the Rule

Other comments included the need to address various reasons for the workforce shortage. In addition to low wages, commenters cited the social valuation of direct care work, lack of governmental support for some workforce pipelines, and immigration policies as deterrents to recruitment. One suggested that CMS start looking at creative strategies for developing an atypical workforce.

There were several submitted comments stating the either HHS or CMS or both does not have the authority under the Affordable Care Act to make specific requirements for minimum payments, but only to ensure that each State is assessing payment regulations and ensuring payments are economical, efficient, and ensure quality of care. A specific section of the Affordable Care Act, section 2402(a)(1) requires the Secretary of the Department of Health and Human Services (HHS) to ensure states implement service systems to allocate resources. The provision does not give HHS the authority to dictate the terms of those service systems, only to ensure the states develop those systems. Not surprisingly, CMS disagreed with those comments.

Many people questioned the 80% as being unrealistic, too high, and not based on quality data. CMS cited data from several states, who have pass-through requirements of 80-95% for all rate increases. This is not a minimum payment from all Medicaid payments, only a requirement for a minimum pass-through to direct care workers of increases in rates. Two states, Minnesota and Illinois, currently have minimum payment requirements set at 72% and 77%, respectively. CMS used these two states as justification for the 80% rule, acknowledging that it is higher than both states while also acknowledging that they did not perform a state-by-state study of the impact the 80% rule will have. CMS states the rate was set higher than those states to “encourage further steps towards improving compensation for workers.” CMS believes that requiring HCB agencies to pay their direct care workers a higher percentage of Medicaid rates than any state currently does will somehow make those agencies want to voluntarily pay even more.

The 80/20 Rule and Technology

Technological advances in telehealth, remote patient monitoring, revenue cycle management, scheduling, employee benefits, assistive technology, EVVs, EMRs, CRMs, and other software solutions can and will lower overhead costs and increase efficiency in your agency. Paperwork automation can reduce the time spent on documentation by a significant percentage. Revenue Cycle Management software can reduce claim denials and decrease reimbursement payment cycles so you can get your money faster. They can also reduce the number of unpaid claims. Employee benefit and training software can reduce responsibilities for HR teams, lessen the requirements for clinical supervisors, and cut training time in half, getting your newly recruited caregivers out in the field faster. Scheduling and onboarding software can increase your intake capabilities. The advances in generative AI allow you to create robust reports almost instantly so you can see your agency’s strengths and weaknesses and create plans for improvement.

Some of these costs will be excluded from the calculations for the 80% rule. Now is the time to invest in technology for your agency. Not only will your agency be more efficient and more effective, but you will be able to care for more patients with the same staff you have now, and the software solutions are as close to cost-neutral as they will ever be. We have a list of technology solutions that we’ve recently discovered and will be writing about in the next few weeks. If you are in immediate need of a software solution, contact us directly for a consultation.

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Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

1 Thing You Must Do At Work During National Stress Awareness Month

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by Rowan Report | Apr 4, 2024 | Admin, Caring for the Caregiver, Recruitment & Retention

by Bryan Robinson, PH.D. Contributor
author of Chained to the Desk in a Hybrid World: A Guide to Balance

April is National Stress Awareness Month with the goal of raising awareness of the impacts of stress. According to the American Psychiatric Association, 26% of respondents anticipate they will be more stressed in 2023 and their mental health will be worse. Two out of five adults ranked their mental health from “fair” to “poor.” When you have fewer stressors, you have increased emotional stability, better moods and overall superior health. This month is a time to pay special attention to how you can remain stress-free throughout your workday, and you can do that in very simple ways. You don’t have to quit your day job or even work fewer hours. You can continue your daily work routines while practicing stress reducers at the same time. The one thing you must do is have a stress awareness plan that you can practice at work.

A Stress Awareness Plan Keeps Job Stress At Bay

My 2023 New Years Resolution was to do one kind thing each day for someone—especially strangers. It has heightened my awareness of how important and easy it is to be kind to others without taking extra time. Plus, how simple it is to practice and how good it makes me feel (and hopefully the other person) in just minutes. A work stress awareness plan has the same effect. Here’s how it works. Simply choose one thing to commit to each day that you can accomplish in three to five minutes to mitigate stress during your workday.

A max of five minutes of chill a day can have mental and physical benefits to keep you engaged, calm and energized on the job. These short work breaks lead to higher job engagement and performance as well as better sleep, increased immunity, lower blood pressure, improved digestion and increased emotional well-being. In fact, research from scientists at North Carolina State University shows the value of what I call Microchillers or taking what the researchers call Microbreaks throughout the workday. These short breaks—I recommend five minutes or less—are effective energy management strategies as simple as stretching, walking up and down stairs, gazing out a window at nature, snacking or having a five minute mindful meditation.

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Forbes. All rights reserved. For information on reprinting any of our articles, contact editor@therowanreport.com

Getting the Silent Treatment: 5 Reasons Applicants Don’t Pick up Your Calls After They Apply

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by Rowan Report | Feb 7, 2024 | Admin, Recruitment & Retention

by Jen Waldron,

Recruiting caregivers for your home care agency franchise can be challenging enough, but it’s even more frustrating when those same caregivers don’t bother to pick up the phone after applying for your jobs. You may have put in a significant amount of time, money, and energy into trying to find qualified caregiver applicants, only to be repeatedly met with radio silence, missed calls, or unanswered texts.

In my mission to help home care agencies recruit more efficiently, I have identified the top five reasons why caregivers do not pick up your calls and what you can do about it.

1. You are not offering competitive pay or benefits

In a comprehensive study Pew Research found that the number one reason people leave their job is, in fact, for more money. But the number two and three reasons are “no advancement opportunities” and “feeling disrespected at work.” If your compensation package — and your career advancement opportunities — are not competitive, caregivers may choose to ignore your calls and continue searching for better opportunities.

2. Your job ad looks like spam; your hiring process does not stand out from the crowd

Candidates do not read your job description, especially if it is wordy. All job posts look like spam to the applicant, they apply to too many jobs, as many as 16 or more at one time!, and, as a result, they never read job descriptions.

This confusion can lead to candidates feeling apprehensive about texts and phone calls from unknown numbers and explain why they often opt not to answer your phone calls. The screen shot below is an example of how caregiver applicants get too many messages about jobs. To stand out from the crowd, an agency HR team must find a different way to communicate with the applicant about the value and challenges of your jobs.

3. You are not demonstrating professionalism in your hiring process

Caregivers are professionals and they expect you to have a professional hiring process. Many agencies use hiring software built for other industries and, as a result, their hiring process is clunky. On many job boards, applicants “1-click” apply with a job seeker profile they may have made several years ago. When they are followed up with through some sort of automated text system (which they think looks spammy – see pic!), they are annoyed that they are being asked to “apply” again.

4. You have poor online reviews or ratings

Today, people trust online reviews and ratings as much as personal recommendations from friends or family. If your agency has too few positive or too many poor online reviews from clients and/or employees, caregivers may not have confidence in you as an employer. Even if the impression they glean from your reviews is inaccurate, they may choose a competitor whose reviews reflect the culture and work ethic more suitable to their own. Therefore, it is imperative that you invite positive feedback from satisfied clients and employees and respond quickly to negative online reviews. This is critically important to attracting caregivers interested in working for you.

5. Your recruitment process takes too long; caregivers are moving on

The data shows that 57% of applicants today expect to hear back about the position they applied for within 1 week. With regard to retention after onboarding, one of the reasons caregivers leave is they are not given enough hours to make full time work. They say they want those hours to be in the right location and compatible with their scheduling needs and experience level.

You do not want to incur the cost of going through the whole interview, orientation, and hiring process if you do not have the right clients to match their needs and preferences at that time. Therefore, it is vital to streamline your recruitment process and to implement fast and efficient process with the best applicants.

In Summary

As a home care agency owner, it is essential to understand why caregivers may not answer your calls, even after applying for your jobs. Based on our five reasons applicants do not pick up your calls after they apply, there are steps you can take to improve your odds of attracting the best applicants:

- Evaluate your recruitment process, compensation package, job description, communication methods, and online reputation.
- Ensure you demonstrate professionalism through your interactions, online and during interviews.
- Make your job description and requirements stand out amongst the spammy looking emails and texts out there today.
- Take steps to eliminate bottlenecks in your hiring process.

By doing so, you will attract the best caregivers who will choose to work with you, and your agency can grow and thrive.

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Jen Waldron is one of the co-founders of Augusta Home Care Recruiting She started working in the senior care industry in 2009 as a professional caregiver in a memory care community. Since then, she has been an executive supporting thousands of home care agencies and other senior care businesses through software solutions. Augusta is an innovative software company designed entirely for home care. The platform gets caregivers to show up to interviews through inspiring confidence in the applicant, speed to hire and identifying top talent.

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com

No Nurse Shortage Here

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by Tim Rowan | Aug 16, 2023 | Admin, Caring for the Caregiver, Clinical, Marketing, Recruitment & Retention

by Tim Rowan, Editor

When Joseph Furtado, RN, COS-C, moved from one Phoenix-area Home Health agency to another earlier this year, he faced a seemingly insurmountable problem. The new place had dropped to a 600 census during the pandemic and got stuck there. Marketers had nurtured strong relationships with referring physicians, but the agency was turning away most of them for lack of nursing staff.

Over a span of 70 days, Furtado hired 60 nurses. As of our conversation this week, none of them have left.

Furtado, the Administrator at MD Home Health told us about his hiring philosophy that helped grow the company’s census to 1,000 and boost it to second largest in the area. “People want to work here because of the way we treat them,” he said. His plan includes several strategies:

Pay clinicians what they are worth:
- Free up funds for salaries by eliminating marketing positions
- Free up funds for salaries by reducing most training costs
- Reduce training costs by hiring only experienced nurses from other agencies who need little or no training
Treat clinicians like professionals:
- Center orientation days around presentations about company culture, not nuts and bolts of the job
- Include presentations by top employees
- Include presentations by actual patients, who talk about what the company has done for them
- Eliminate obligatory mass training sessions. Replace them with as-needed meetings with nurse supervisors, sometimes in a patient home, sometimes in a nearby coffee shop.
- The invitation is never “you need to stop doing this wrong” but “may I take you to lunch?”
- Adapt schedule and pay policy to accommodate the needs of the professional
- Replace minimum productivity requirement with mission-driven expectation and rewards
Replace marketers with a single visit from the administrator:
- We are the best, we will keep your patients out of the hospital, we will not turn away your referral
Constantly monitor Indeed and other online job sites:
- respond to new job seekers within seconds
- schedule same-day interviews when possible

Favorite Hiring Story

Furtado enjoys telling the story of his favorite hiring win. “I was a few minutes late to call a top-notch, experienced Home Health nurse who showed up on Indeed,” he began. “When I called her, she had just parked her car and was on her way into an interview appointment with another agency. Thinking fast, I said, ‘What do I have to say to stop you from walking in that door?’ She couldn’t believe I was asking her to do that; actually, I couldn’t believe I had said it either. I told her our agency was the best place to work in Arizona and she should get back in her car. I kept her on the phone and said, ‘Let me hear you start your car.’ Then ‘Let me hear you drive away.’ She drove straight to my office and I hired her.

Today, she is our Director of Nursing.

Productivity Without Mandate

He told us that he has heard criticism from peers at various conferences and other meetings for his lack of a visit-per-week requirement. “I use a point system,” he explained to us. “A one-hour visit is one point, an OASIS visit is two, and there are other points for driving distance and other factors. We ask for an average of five points per day, and we pay bonuses when they exceed that. We tell clinicians during an interview that we offer a generous base salary, but that he or she can earn 20 or 30 thousand more than that. By doing that, we achieve two things. We hire an enthusiastic clinician, and we have the luxury of not having to hang onto underperforming nurses out of desperation.

Next Up

Now that MD Home Health has a full clinical staff, Furtado plans to implement a medical scribe system, based on the concept taught to him by his Medicare reimbursement consultant, Michael McGowan, a former CMS OASIS instructor and founding owner of OperaCare. During an OASIS visit, the field nurse consults live on a speaker phone with a QA nurse in the office. There is no computer between the nurse and the patient, and the OASIS is complete, quality checked, and ready to be submitted that day.

“We will make it optional,” Furtado said. “If it works as well as it has for Michael’s other clients, our hope is that more and more OASIS nurses will opt in once they see their co-workers going home at the end of the day with all their documentation already complete.”

©2023 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com