Wednesday, December 11, 2013

Tennies for Teenz - making a difference this Christmas

Dear Friends of Leading Home Care, Caregiver Quality Assurance®, and The Academy for Private Duty Home Care®,

December is a time of celebration, family, gift giving, and making a difference.  I'm sure you have a number of charities and worthy causes that you support and we applaud you for that.  If you have a few minutes and a few dollars left in your charitable giving account, I'd like to ask you to take a look at a very special program that we have started this year at Leading Home Care.

Here's the story.  

My wife and business partner, Elizabeth Jeffries, and I actively support a social service agency here in Louisville called MaryhurstMaryhurst is a not-for-profit social service organization that provides housing, education, and support to children who have been removed from their homes in crisis because they have been abused or neglected.  For many of these young people, Maryhurst is the only answer.  Recognized as one of the few agencies in the country that is capable of caring for teenage girls who are among the most traumatized victims, Maryhurst helps those who have no where else to turn for healing and hope.

The short story is that when these girls arrive at Maryhurst, they often have all of the possessions in a garbage bag.  They have few clothes and no tennis shoes.  The facility has a new gym and activities center, and the CEO, Judy Lambert, asked us to help stock a closet of tennis shoes and gym clothes for the new kids coming in.   Read ...

We'll Match Your Gift 

If you are willing to dig in and give us $10, $25, $50, or $100, we'll match it.  Click on the link below and read the full story.  Then make a donation.  Our goal is to raise $3,000 for the "Tennies for Teenz" program for 2014.  Every little bit helps, so if you would like to support us, we'd really appreciate it.

Best wishes for a joyous Christmas and a prosperous New Year!


Stephen Tweed, CSP
Leading Home Care ... a Tweed Jeffries company 
Past President, National Speakers Association
Past President, NSA Kentucky
Immediate Past Chair, NSA Foundation

What Owners Want in an Applicant Tracking System Diane West

One of the things that many of the members of Caregiver Quality Assurance® ask about  is an Applicant Tracking System (ATS). This is an online system where applicants can answer some qualifying questions and complete an application.  Then you can track their progress through the selection and hiring process.

We've been exploring available applicant tracking systems to see if we can find one that we can integrate with the CQA pre-employment assessment system to make it easier for you to take applications, do an initial screening, administer the CQA assessment, and document  your face-to-face interview.

In our last issue, we asked you to take a few minutes to complete a short survey about applicant tracking systems to find out what features are most important to you.

Here's What You Told Us.

We had twenty four home care business owners respond to our survey and tell us the most important features they would look for in an ATS.  Here are the top five requests:
  1. Easy to Implement - 87.5%
  2. Ease of use for applicants - 79.1%
  3. Ability to send automatic responses to unqualified applicants - 66.6%
  4. Integrates with scheduling software and /or CQA assessment - 66.6%
  5. Ability to personalize the application process - 58.3%
You also asked that it include a database of all applicants including those not selected so you'll know who has applied previously, and why. You want a system that is easy to search for candidates to fit a specific client need.

We've been talking with several providers of applicant tracking systems, and with our scheduling software Resource Partners Home Trak, AppointMate, and Stratis, about integrating applicant tracking with the CQA system and scheduling software.

If you are currently using, or have found, an applicant tracking system that you think fits those requirements, please let us know so what we can check it out.  You can call me at 502-339-2132 or send an email.

Tuesday, December 10, 2013

Safety and Security for Caregivers in the Home past week, Stephen Tweed, CEO of Leading Home Care and Founder of Caregiver Quality Assurance® was interviewed by Heather Caspi, a writer for EMS World, a publication for Emergency Medical Services.  Heather was doing research on a article about safety issues for emergency responders.

In the article, Heather wrote about the types of precautions that home care and hospice companies take to assure the safety of their in-home care workers.  There are some clear parallels between the safety precautions of Emergency Medical Service responders and home care workers. 

Here are some excerpts from her article:

Home-health agencies have long dealt with this aspect of care delivery, facing questions of security for lone, usually female, care providers. Another way in which the home-health care industry mirrors EMS is that it encompasses numerous business models and forms of care delivery, and has no single lead organization or set of standards.

"Much of the variation in safety policies occurs by geography and business type," Tweed says.
While issues like assault can occur anywhere, the concern is typically highest in high-crime areas.
"Training, including that for safety, is also commonly tied to the level of skill provided by an agency, plus factors of time, pay rate and levels of education," Tweed says.
He notes there are five distinct types of home health agencies that can all have their own approaches: skilled intermittent care; hospice; home medical equipment providers; home infusion therapy; and private duty home care, which ranges from non-medical personal care to companionship.

(Read the Full Article)

How Do You Assure the Safety of your Caregivers?

Every owner and administrator is concerned about the safety and security of their home care workers. Yet there are many different approaches. 

What are your policies and procedures for assuring the safety and security of your in-home care workers?

What kinds of incidents have you had in the past that we can learn from?

What recommendations would you make to other readers on safety precautions and training?

Monday, November 11, 2013

Update on Obamacare and the impact on Home Care

By Stephen Tweed

Last week I had the privilege of speaking for the annual convention of the National Association for Home Care and Hospice (NAHC) in Washington DC.  I've spoken at this conference every year for the past 20 years, and it's always a pleasure to be there with leaders from home health care, hospice, and private duty home care from around the country.  When at the NAHC conference, I always plan my schedule to attend all of the general sessions and as many of the breakout sessions as possible.

One speaker I never want to miss is Bill Dombi, Vice President for Law for NAHC.  Bill is a terrific
Bill Dombi, Esq.
speaker, and he has more information, knowledge, and wisdom about what's going on in Washington and how it will affect home care than anyone else on the planet.

At this conference, Bill gave us an update on the Affordable Care Act (Obamacare) and the Employer Mandate.  He gave us the latest information on how this law will affect home care companies across the country.

Bill began his presentation by tell the story of a large Medicaid provider in Texas that has 1200 caregivers working at $11.00 per hour, and generates over $28 million in revenue.  Based on the latest information, if this company decides not to provide insurance but to pay the penalty, it would cost them $2.4 million dollars just in the first year.  And you thought you were looking at a huge cost. This company has developed a strategy to keep their caregivers under 29 hours per week, which will cause a huge decrease in the availability of Medicaid Waiver home care services.

A little bit of good news is that there is a movement in Washington to amend the law to change the definition of "Full Time" from 30 hours to 40 hours.  The challenge is that the Obama administration is very reluctant to allow any amendments to the law because it will open the flood gates for other changes that are being requested by a variety of groups.

Here are some highlights of the law and how they may affect you:

Small Business Tax Credit

There is a small business tax credit in the law that provides money to help small employer pay for insurance.  It only applies to companies with fewer than 25 employees, and pays for 50% of the cost of insurance.  Average wages must be below $50,000.  While this looks like a nice subsidy on paper, very few companies will actually be able to use it.

Individual Mandate

The requirement that individuals purchase health insurance goes into effect on January 1, 2014.  Individuals who do not purchase insurance will pay a penalty.  The penalty is:
  • Year 1 - $95.00 or 1% of gross income
  • Year 2 - $325.00 or 2% of gross income
  • Year 3 - $695 or 2.5% of gross income, with a penalty of $2,085 for families
Since the individual penalty in much lower than the cost of insurance, many young healthy workers may opt to pay the penalty instead of buy insurance.  This creates a huge problem for the insurance companies who need lots of young healthy workers to buy insurance to subsidize the cost of insurance for older workers and those with pre-existing conditions.

Affordability of Insurance

One provision of the law is that when you make insurance available for your employees, the portion of the premium that the employee is required to pay cannot be more than 9.5% of adjusted gross income.  If you have a caregiver who earns $10.00 per hour and works 1800 hours per year, they would not be able to pay more than $1,710 per year or $142.50 per month.  The rest of the premium will need to be paid by the employer.

Measurement Period

One of the decisions you will make is about the "measurement period" when you determine how many FTEs you have, and how many full time employees you have.  It will be important to understand the difference between FTEs and Full Time Employees.
  • FTE - Full Time Equivalent - take the total hours paid per week and divide by 30 to get FTEs.  
  • Full Time Employees - the number of individuals who are working 30 hours a week or more.
There will be a measurement period to determine how many FTEs you have.  It will be based on the previous year - called a "look-back measurement period".  The number of Full Time Employees can very from pay period to pay period, which means it may be difficult to calculate the people to whom you must offer insurance and how to calculate the penalties.

What about 1099 Companies?

What about companies that operate as a "Registry" and pay their caregivers as 1099 independent contractors?  The Department of Labor is looking into this issue, and Registries will be at risk unless they are truly operating as a pure registry.

The Penalty is NOT Tax Deductible

According to Bill, any penalty you pay for not providing insurance is not a tax deductible as a business expense on your tax return.  That means you'll have to pay the penalty out of profits.

There's a lot more where this came from, but that's probably enough to think about for now.  Stay tuned to future issues of Caregiver Quality Today and Private Duty Today for more updates on the implementation of the Affordable Care Act and how it will affect you. 

Tuesday, October 29, 2013

Target Your Talent at a Narrow Market Niche

By Stephen Tweed

What's your talent?  What are you better at than anyone else?  What are you passionate about that makes you distinctive?

Last Friday evening, Elizabeth and I went to hear the Louisville Symphony Orchestra play George Gershwin's Rhapsody in Blue.  It was a fabulous performance and a wonderful way to relax and enjoy some time together after a very busy week.  And we were mesmerized by the performance of the pianist, Kevin Cole.  Kevin is an award winning musical director, arranger, composer, and vocalist who has garnered the praises of Irving Berlin, Marvin Hamlisch, Stephen Sondheim, and the family of George Gershwin.

Despite his amazing musical talent, he's like a lot of other pianists out there. Except for one thing. His focus.  Kevin has spent his musical career studying the works of George Gershwin, and in particular his world renowned piece, Rhapsody in Blue.  Howard Reich, the arts critic at the Chicago Tribune says of Kevin, "When Cole sits down at the piano, you would swear Gershwin himself is at work ... Cole stands as the best Gershwin pianist in America today."

As we sat enjoying the concert, Elizabeth leaned over and whispered, "There's a newsletter article for you."  And she's right.  What a lesson we all can learn from this young man who has focused his amazing talent on becoming the best in the country, and maybe in the world at doing one thing ... Playing Gershwin on the piano.

What's Your One Thing?

As we begin to apply this lesson to our roles as leaders in home care, what can we learn and apply?  What can you learn about being the best in the world at one thing?

First, it begins with talent. What is your greatest talent as a business leader?  What's the one part of your job that you do better than anyone else?  What's your one greatest strength?

In his best selling business book, First Break All the Rules, Marcus Buckingham and his co-author Curt Coffman say that "talent is a recurring pattern of thought, feeling or behavior that can be productively applied."

The key here is the word recurring.  Your talents are the behaviors you find yourself doing most often.

Buckingham and Coffman also say that "the key to excellent performance is finding the match between your talents and your role ... every role performed at excellence requires talent.  Every role performed at excellence requires certain recurring patterns of thought, feeling, or behavior."  

At Caregiver Quality Assurance®, we are studying the recurring patterns of thought, feeling, and behavior that make up talent in various jobs in home care.  By defining the roles of your caregivers, your schedulers, or your sales people, you can then measure their patterns of thought, feeling, and behavior to see which candidate has the talent that is the best fit for the job you have at hand.

Once you have found the talent, then it's a matter of focusing that talent on a narrow niche of potential clients in order to be the best in the world, or at least the best in your local market, at providing care for those clients and families. 

For more information on how you can measure the patterns of thought, attitudes, and behaviors of potential caregivers or office staff, take a few minutes to visit Caregiver Quality Assurance.  Then click on the link for a FREE Demonstration of the CQA Pre-employment Assessment. 

Wednesday, October 23, 2013

What does your IDEAL Applicant Tracking System look like?

For many companies the process of tracking job candidates is one of the most tedious, time consuming aspects of recruiting and hiring caregivers. Someone has to review all those applications to find a few qualified candidates, then contact them by phone or email to schedule an interview and send an assessment link. 

What if that entire process could be handled online with your team receiving applications only for those that meet your pre-set qualifications? Just imagine what your team can do with all that extra time.

What is your current application process?  Do you use paper applications or can applicants apply online? Is your online application part of an applicant tracking system (ATS)?

We’re interested in how you track, and respond to, your applicants. Many companies still use paper applications while others use a detailed online application that is part of an ATS that screens applicants based on pre-determined parameters.  Sounds good doesn’t it?

In an effort to find solutions to help you save time and money Leading Home Care and Caregiver Quality Assurance are asking for your help. We have created a short survey we’d like you to complete.  It's only seven questions.  Your answers will help us understand the issues you face when screening applicants. In turn, we’ll do the research to find the companies that offer an applicant tracking systems and other tools with the features that are important to you. 

Here's the link.  Please complete the survey.   



Wednesday, October 16, 2013

Get the Best and Avoid the Rest

By Stephen Tweed

That's the basic premise of Caregiver Quality.  "Get the Best and Avoid the Rest."  That also happens to be the sub title of a terrific book by my friend and professional speaking colleague, Cathy Fyock.  Cathy is a nationally known expert on human resources issues, and is a frequent speaker for SHRM - The Society of Human Resource Managers.

Cathy's book is called "The Truth About Hiring the Best:  Get the Best and Avoid the Rest."  The concept fits well with our ongoing conversation about creating competitive advantage in home care through caregiver quality.  The 2013 Private Duty Benchmarking Study showed that the number one source of differentiation in home care is caregiver quality.

Tips on Hiring the Best

Let's take a quick tour through Cathy's book and look at her top tips.
  • You are a seller in a buyer's market - The best people are already happily working for someone else.  It's far better to attract the folks who are loyal to their employers, have excellent work habits, and love their work.
  • Your actions speak louder than words - If you can't be the employer the keeps workers, you can't be the employer that attracts top notch applicants.  What's your turnover rate?  (The average in home care is 52.6%)
  • Targeting everybody attracts nobody - Your approach should be to aim very specifically at one narrow niche audience to get the best responses.  If you are dissatisfied with the caliber of candidates, analyze your focus.  
  • You are a talent scout - If you are going to get the best talent you constantly need to be looking for high performers.
  • Use the enthused - Ask your current enthusiastic employees who they know.  Ask new employees who the best and brightest are at their former company.  
  • Your invitation might be chasing applicants away -  The message, "Help Wanted" is pretty desperate sounding and not likely to draw in lots of wish-list candidates.  Create an invitation that appeals to the kind of employee you want in your company. 
  • Ask what they WILL do, not what they CAN do. - We know that just because a candidate can do the job doesn't mean she will.  
There are 53 Truths in Cathy's book, and many of them will help you think through your recruiting and selection process.  If you'd like a copy, just visit The Truth About Hiring the Best.  

You'll find this book is a real complement to our best selling home care eBook, "Get the Best: Nine Steps to Hiring High Quality Caregivers and Improving your Bottom Line" by Leigh Davis and Stephen Tweed.

Wednesday, October 2, 2013

What Caregivers Need to Know ... to provide specialized programs

One of the ways you can create competitive advantage in private duty home care is to create one or more specialty programs focused on providing services to clients with a specific chronic condition.  For example, several weeks ago we presented a live web conference with Katherine Autin on "Building a Specialty Program to Serve Patients with Parkinson's".  In that program, Katherine talked about the things a caregiver needs to know about the disease, and about the clients.

Now, we want to look deeper into what your caregivers need to know, and how you can train them to provide these specialized services.  By providing training for your caregivers and then building that training into the plan of care for clients with specific chronic conditions, you can have meaningful conversations with referral sources about what makes you different.

For example, one new home care business owner in New England studied various chronic diseases, and concluded that persons who had experienced a stroke needed more hours of care for longer periods of time that your typical home care client.  He studied the effects of stroke on the client, including the symptoms, the treatment, and the red flags to watch for.  He created his specialty program and trained his caregivers. Then he went around to every physician, hospital discharge planner, nursing home, and rehab center that cared for stroke patients and presented his program. He immediately began getting referrals and growing his business.

What Your Caregivers Need to Know

To help you get a better idea of what your caregivers need to know in order to create and delivery a Ginny Kenyon, Founder and CEO of Kenyon Home Care Consulting to share with you her experience in training caregivers and in creating specialty home care programs.
specialty program, we're delighted to bring you

Ginny  is passionate about helping clients achieve unique success in the marketplace.  Known for her ability to produce substantial results in a short period of time, her keen understanding of the home care industry allows clients to develop and implement long-term solutions that fit organizational needs and expectations.  She holds a Masters in Nursing Administration with minors in Business and Health Services and is an accomplished writer, guest speaker, and teacher.

Join us on Thursday, October 10, 2013 at 4:00 PM eastern time for the Live Web Conference, "What Caregivers Need to Know to Provide Disease Specific Programs and Services".

This program is free to members of the Caregiver Quality Assurance® program and to Premium Members of The Academy for Private Duty Home Care®.  You will receive an invitation to the web conference in your email.

If you are not a member of CQA or The Academy, you can register online.  

The Perfect Storm Hits Private Duty Caregivers

By Stephen Tweed

Imagine being a caregiver working for a private duty home care company today.  You're out there in the ocean as three major storms come together and the waves are crashing over you.  (Did you see the movie The Perfect Storm with George Clooney?)

The first storm is Health Care Reform, or "Obamacare".  Effective yesterday, October 1, 2013, caregivers could begin signing up to buy health insurance for their state health insurance exchange.  They must purchase health insurance by January 1, 2014 or pay a penalty.

The second storm is the US Department of Labor ruling that wipes out the federal companionship exemption for minimum wage and overtime.  That means that caregivers who were working more than 40 hours a week at straight time will be cut back to 40 hours because neither private payers or Medicaid will pay the overtime rate, so home care companies will limit their workers' hours.

The third storm is again part of "Obamacare".  The employer mandate which goes in to effect on January 1, 2015 requires employer with over 50 FTE employees must provide a health insurance plan for every employee who works 30 hours a week or more.  While there is much discussion about how companies will deal with this requirement, 20% of private duty companies said they will keep the majority of their employees under 30 hours per week. 

It's Hard Enough to be a Caregiver without all this!

You know how hard it is to be a caregiver.  Well, maybe you don't really know unless you've actually worked as a caregiver for three months or more.  My wife and I were the primary caregivers for our son, Jason, from the time he was born until he went off to college 17 years later.  But I can't say I really know what it's like to live the life of a private duty caregiver who works for $10.00 per hour with few benefits, no vacation, and no insurance.  But I can imagine.  So can you.

While you are struggling to figure out how these three storms will affect your home care business, I believe you also need to be putting some attention on the future of recruiting, selecting, training, and retaining caregivers.  As the economy gradually improves, we will find that the caregiver shortage that we saw in 2006 and 2007 will return.  Already, I'm hearing from owners who are finding that the biggest barrier to growing their business is finding enough high quality caregivers to meet the growing demand.  And caregiver turnover peaked last year at 52.6% according to the 2013 Private Duty Benchmarking Study. 

Caregiver Quality is your Number 1 source of Competitive Advantage

While our caregivers are going through their own perfect storm, and you are beginning to see a shortage of
caregivers affecting our ability to grow, the benchmarking study shows that the number one source of differentiation in home care is "Caregiver Quality".  More owners see this as their number way to distinguish their company from their competitors.

That means you have a huge opportunity to refocus your process for recruiting, selecting, training, and retaining caregivers for the future.

Last week, I was at the Home Care Association of America conference in Scottsdale, Arizona and I had three significant conversations with company owners that will change the face of Caregiver Quality Assurance®.   One was a new process for recruiting large numbers of high quality CNAs to serve as personal caregivers in your agency.  The second is a wonderful process for providing online training for caregivers that can help you create unique specialty programs in your agency.  The third was some new ideas for providing tangible recognition and reward to your caregivers for doing the right thing, and this can be huge in improving retention and reducing turnover.

Stay tuned for more new developments in finding the caregivers you need to grow. We will get through the perfect storm, and when the weather clears we hope you will be ready to take advantage of the huge opportunities out there to grow your business and get ready for the future. 

Wednesday, September 18, 2013

Just Issued New Rule: Home Care Companies Must Pay Overtime

The US Department of Labor has issued it's ruling on the "companionship exemption" for overtime and minimum wage for home care workers.  We've been watching this discussion for several years now, and we knew the rule was coming.

It's here!

The US Department of Labor web site shows that effective January 1, 2015, all home care companies will need to pay overtime for personal care aides, home health aides, and certified nursing assistants who work more than 40 hours per week. Fact Sheet #25 issued by DOL specifically for Home Health Care gives details of the old rule which is in effect until January 1, 2015.  It then takes you to a Fact Sheet outlining the new Rule.

What are People Saying?

"Today's home care workers are lumped into the same category as teenage baby sitters when it comes to how much they make.  This is wrong and unfair.  Receiving a fair wage will further stabilize and professionalize a critical line of work that is suffering from a shortage of workers."
Tom Perez,
Secretary of Labor

"Businesses will have trouble because customers won't be able to afford the care.  In the end, the people who will be likely to suffer will be the workers who can't get the work they had before."
Marc Freedman
Executive Director for Labor Law Policy
U.S. Chamber of Commerce

"While intended to help caregivers, this rule will have the opposite effect.  Home care companies will have little choice but to employ workers part-time rather than full-time as Medicaid payment rates and consumers with limited incomes cannot afford higher costs.  Caregivers in the end will receive less pay."
Andrea Devoti
National Association for Home Care and Hospice

"The move will benefit the largely female, minority, and low-wage workers who provide these essential services."
Richard Trumka

"The Obama administration has made good on its promise to extend wage and overtime benefits to home care worker.  It is important that agencies and states not make shortsighted changes to their programs that could reduce benefits or deprive consumer of the consistency of care they receive from their providers."
Mary Kay Henry
Service Employees International Union

While we are just beginning to review the 350+ page final regulation (and supporting materials), our initial review indicates that the Labor Department was not responsive to the majority of concerns raised by HCAOA or others in the home care industry.  For example, the final rule, like the proposed rule, states that the companion care exemption may not be used by third party employers.

The one bit of good news is that the rule’s effective date is January 1, 2015.  In addition, the delayed effective date gives us time to fully consider all of our public policy options and determine how we can best help our members understand the regulation and successfully navigate the new requirements.

While we may not be pleased with the new rule announced today, it is important to acknowledge that HCAOA, its members, and our partners made an incredibly important contribution to the public policy debate around this rule.  We not only made this decision difficult for policymakers, but our efforts are likely at least partially responsible for the delayed effective date.  In addition, we have sensitized policymakers to our concerns and created relationships that could be helpful down the road.  We want to thank all of our members for their hard work in challenging the Labor Department’s proposal."
Peter Ross
President, and
Gale Bohling
Legislative Chair
Home Care Association of America

The Final Regulation - all 358 pages - may be downloaded from the Labor Department's Web site. 

What Does This Mean to YOU?

Owners of home care companies will be hit with a double whammy on January 1, 2015.  First, you will need to pay overtime to your caregivers for more than 40 hours of work.  Second, you will need to either purchase health care insurance for your caregivers or pay a penalty to the government under the provisions of the Patient Protection and Affordable Care Act.     

In our view, these two new laws will have the following effects:
  1. Caregivers will make less money because they will not be able to work more than 40 hours for one employer
  2. More caregivers will have to work two jobs so they can work more than 40 hours
  3. Clients and families will have to pay more for home care services
  4. Home care companies will see increased costs of doing business.  These include:
    • Paying overtime
    • Paying minimum wage and overtime for live-in caregivers
    • Paying for health insurance or paying the penalty
    • The increased cost of recruiting, selection, training, and retention of caregivers.
There are many unintended consequences from these two bills that the legislators and regulators have not considered.  The combination of these two laws will have negative financial impact on clients, caregivers, and home care company owners.

However, be assured that it's not the end of the world.  A number of states already have laws which override the companionship exemption, and Massachusetts has required health insurance for several year.  Home Care companies are resilient, and have managed to survive and prosper in those states.  However, the hourly rates charged to clients are higher in those states than in other states. 

We'll watch these developments closely and keep you informed on the best practices in the industry as you adapt to change. 

Tuesday, September 17, 2013

How do People Pay for Home Care?

Research conducted by The Academy for Private Duty Home Care® shows that there are millions of seniors in the US and Canada who have the personal net worth to pay for home care services on a private pay basis.  This is shown by the number of live-in and 24/7 cases served by private duty home care companies all across the country.

However, we are also seeing an increasing number of people who are tapping into alternative sources of funding such as long term care insurance and reverse mortgages.  Another option that few people really know about is converting an existing live insurance policy into a private market long term care benefit.

Converting an existing life insurance policy into a long term care benefit plan is not to be confused with a long term care insurance policy. We learned about this process from our Resource Associate, Life Care Funding.  They showed us how an existing insurance policy can be converted to a trust fund to pay for home care services.

Here's a great video that gives you a specific example of how one insurance policy holder converted his life insurance after his wife passed away.  Take a look.  Then let us know what you think.

Friday, September 6, 2013

Take the Guess out of Guesswork in Selecting and Hiring Caregivers and Office Staff

By Diane West

By asking the right questions,  you can help determine if your job applicants are a good fit for the job you want them to do.  Whether you are hiring caregivers, office staff, or sales professionals, asking the right questions is critical to your success.

What are the right questions?

To get a clearer understanding of that, we've been working with PeopleClues, a leading psychological testing firm for over six years in the development of the Caregiver Quality Assurance® program.  CQA is your source for information, ideas, and tools for recruiting, selection, training, and retention.  Using the proven assessment tools from PeopleClues, we've helped hundreds of home care companies do a better job of recruiting and selection.

Now, we want to give you a chance to learn more of what PeopleClues knows about asking the rights questions.  By asking the right questions PeopleClues can help you determine if applicants are a fit for what you need.  Plus, PeopleClues does something that other behavioral tests don’t do – They compare an applicant’s answers to statistically proven benchmarks by industry and role to give a true measure of best fit.

Join Julie Moreland, Senior Vice President of PeopleClues, and Meghan Graves, Human Resources Manager at Continuum, on Thursday, September 19 at 1:00 p.m.ET/10:00 a.m. PT for a live web conference to learn how PeopleClues:

·         Helps you screen applicants to find better candidates
·         Assesses performance of your current team members
·         Helps home care companies employ awesome talent 

About our Special Guests

Julie Moreland is Vice President of the PeopleClues Divison of People Matter, based in Charleston, SC.

Julie's division provides behavioral assessments designed to measure job fit, attitude, and level of engagement of candidates and current employees.  She has over 20 years of experience and is a nationally recognized authority on the practical business applications of assessment technologies.

Meghan Graves is the Human Resources Manager of Continuum, Inc. a highly successful home care company in St. Louis, MO.  Meghan is involved in all aspects of the selection and hiring process.  She has nine years of experience in human resources and recruiting for health care, IT, and home care.

Join us at NO Cost!

As a service to the home care industry, Leading Home Care is bringing you this highly interactive web conference at no cost  so that you can get a better understanding of the latest trends in pre-employment assessment design and technology.  While we would obviously love to have you become a member of Caregiver Quality Assurance®, there is no obligation and this is not a 60  minute commercial.  This is your opportunity to learn more about the science of behavioral assessment, and how to ask the right questions in your interviewing and selection process based on proven and validated technologies.

Register now for this FREE webinar,

Have a prior commitment. No worries.  Register for the webinar and we'll send you a link to view the recording at your convenience.  But you have to be registered before the program to get the link.

Don't delay. 

Wednesday, September 4, 2013

You Take Care of Mom, but WHO will take care of YOU?

A recent study by the American Association for Retired Persons Public Policy Institute has uncovered an alarming trend in the number of family caregivers who will be available to care for aging Baby Boomers.  The report is focused on studying the number of potential caregivers between the ages of 45 and 65 for each person 80 or older.

The report, The Aging of the Baby Boom and the Growing Care Gap:A Look at Future Declines in the Availability of Family Caregivers contains some data that will be valuable to owners of private duty home care companies, and shows the huge potential for the future of our business over the next twenty years as today's baby boomers go into retirement and need caregivers of their own.  

Take a look at this infographic that presents the highlights of the study.

Then take some time to read the full report. 

Wednesday, August 21, 2013

Fun Facts About Employment

Since we are into facts and data at Caregiver Quality Assurance® and Leading Home Care, we
thought you might like these fun facts about employment.
  • When 1,500 American workers were asked about being appreciated at work, 60 percent of those surveyed say “extra thank-yous” would make them more productive. 
  • Sixty-two percent of 436 respondents to a survey admit to checking work e-mail in the bathroom. 
  • According to new hiring research, the average cost of a mis-hire according to profession is as follows:
    Senior executive – 15 times their annual salary
    Mid-level manager – 10 times their annual salary
    Laboratory director – 7 times their annual salary
    Programmer – 4 times their annual salary
    Nurse – 2 times their annual salary  
  • When 1,500 U.S. employees were asked “If you care for a child or older loved one, what is the one adjustment you make to your work schedule most often?” they responded
    Make phone calls and/or arrangements during the workday – 24%
    Leave work early – 22%
    Take the day off – 16%
    Arrive late to work – 14%
    Ask spouse to adjust his/her schedule – 5% 
  • When 271 workers were asked: “What is the single most important program/benefit your employer could offer that would keep you working productively and happily as you get older?” the top 3 responses are:
    49% Flexible work schedule
    15% Health and wellness programs
    13% New training/learning opportunities 

Employer Health Care Premiums Rise 5% in 2013

What is your approach to meeting the employer mandate to provide health insurance for your employees?  This portion of the Patient Protection and Affordable Care Act takes effect in 2015, and requires employers with 50 or more FTEs to provide healthcare coverage. 

What will that cost you?

A recent study conducted by the Kaiser Family Foundation and the Health Research and Educational Trust
and reported in the Wall Street Journal shows that the cost of health insurance premiums for a single worker grew 5% from 2012 to 2013, from $5,615 per year to $5,884.  It also showed that workers contributions to premiums were 18% of the cost of single coverage. 

In another part of the study, 29% of large companies said they are considering shifting to a plan where they allot a set sum of money for each employee for health benefits, and the employee picks the coverage from a "private exchange."  The survey also shows that higher deductible plans are popular, with 38% selecting an annual plan with a $1,000 deductible.

What to do about health care reform?

What to do about health care reform continues to be one of the biggest challenges for owners of home health agencies, hospice, and private duty home care companies.  The 2013 Private Duty Benchmark Study from Home Care Pulse and HCAOA shows the following responses to how agency owners plan to deal with the employer mandate:
  • Provide required health insurance - 18.7%
  • Drop my health plan and pay penalty - 1.9%
  • Pay the penalty, never offer insurance - 9.4%
  • Have not decided - 52.6%
  • Keep employees to less than 30 hours - 19.9%
  • Operate with less than 50 FTE - 17.4%
  • Other ?? - 4.2%
As you can see, there's lots of uncertainty.  This survey was done in January and February 2013.  What's your answer today?  Since then, the implementation of the employer mandate has been moved back a year to 2015.  What are you planning to do about healthcare reform what it takes effect in January, 2015?

Behavior Styles Correlate with Sales Success

What selling style works best in home care & hospice sales? 

One of the biggest challenges facing leaders in home health care, hospice, and private duty home care is recruiting and selecting sales professionals who can hit the ground running and generate referrals that convert to admissions.  We have seen a particularly high incidence of companies hiring sales reps who fail to get results and are fired or quite after 90 days on the job. 

At Caregiver Quality Assurance®, we are continually looking for information and data that will help you do a better job of hiring the right sales people.  To get some insights, we often go outside the home care industry to see what we can learn from other companies.  Here's one example: 

A leading retailer of western apparel wanted to improve the productivity of its sales associates across its 8 store locations.  The company worked with a provider of pre-employment assessments to administer a basic skills test and a behavioral styles inventory to its existing sales force. The company then conducted a validation study comparing test scores to performance data provided by company management.  The study showed significant correlations between test performance and productivity as measured by average sales per hour data compiled by company management.

The study found that sales associates who scored high on the extroversion scale had higher sales per hour than those with lower extroversion scores. 

"Top-scorers on the extroversion scale averaged $106.35 sales per hour, which represented 28% higher productivity than was achieved by the lowest-scoring group, which averaged only $83.27 sales per hour."

What Do You Look for in a Home Care Sales Person?

From our experience and research, it is clear that the most effective predictor of success in sales is behavioral styles.  When the candidate has a natural style that is a good fit for the job, the likelihood that they will be successful goes up dramatically.  And the category of behavior that is most highly correlated to a good fit for the sales job is the extroversion scale.  

In the Caregiver Quality Assurance® pre-employment assessment, we measure behavioral styles, and the extroversion scale is bench-marked against the sales job.  As you can see in the graphic on the right, the green bar represents the job benchmark, and it is all the way to the right at the Outgoing Talker end of the scale.  The red bars on the left represent the Reserved Listener end of the scale. 

To get a sense of how well you would do in sales, you can take a complimentary sales assessment to see where your extroversion score ranks on the scale.  Once you see where you fit, you will see the value of using a tool like this to help you in the selection of your next sales professional.

To get your FREE CQA Sales Assessment demonstration, pick up the phone and call Diane West at 502-339-2132 or go to 

Wednesday, July 24, 2013

Measuring and Managing Caregiver Satisfaction

By Stephen Tweed

Caregiver retention is a critical issue for today's home care company.  Research conducted by Leading Home Care and Caregiver Quality Assurance® shows that is costs about $1,576 every time an employee turns over, whether they quit or are terminated.  The annual turnover rate in the home care industry was 52.6% in 2012, so if you had 100 caregivers and 52 of them turned over, it would cost  you $81,952.00.

That's a lot of money.  And that doesn't count the cost of unhappy clients who really want the same caregiver every day.

Client satisfaction is a huge factor in reducing turnover in your company,  so measuring and managing satisfaction is important.  How do you know how satisfied your caregivers are?  Ask them!

At Caregiver Quality Assurance®, we are seeing a real need for companies to pay more attention to caregivers, engage them in conversation, and show them appreciation and recognition.  The process begins by asking caregivers what they feel and think about your company.

It's hard to do it alone

We've found that most home care company owners have a hard time doing their own caregiver surveys.  It's often easier to ask an expert.  So we are asking our expert, Aaron Marcum at Home Care Pulse to give us some insights into the factors that are important to caregivers and the kinds of questions we should be asking.

Aaron and his team at Home Care Pulse have mastered the process of conducted telephone surveys of caregivers to accurately measure their level of satisfaction.  By asking a series of carefully crafted questions, and then comparing the data among caregivers, and comparing to industry benchmarks, you can get a more clear picture of their satisfaction.

What questions should we ask?

There are really three categories of questions that give you a picture of caregiver satisfaction:

Orientation and Training
  • What has been your experience with new employee orientation?
  • What has been your experience with ongoing training?
Company Culture
  •  How accessible is my supervisor?
  • How accessible is senior management?
  • How much do you feel valued and appreciated?
  • How clearly defined are your job expectations? 
  • What is the overall morale in the company?
Overall Job Satisfaction
  • What is the caregiver's overall level of satisfaction?
  • Would the caregiver recommend this company to another employee?
  • Would the caregiver recommend this company's services to a client?
While these are the categories of questions, a critical skill is crafting the questions, asking the questions, and documenting the results.  Then you need to tabulate the results, analyze the results, and decide what action you want to take to increase your level of caregiver satisfaction.

It's very clear.  The old saying is very true:

"Client satisfaction is a mirror image of employee satisfaction"

To get  more insight into how you can more effectively measure and manage caregiver satisfaction, join us on Thursday, August 8th at 4:00 pm eastern time for a live web conference when our special guest will be Aaron Marcum from Home Care Pulse.  Aaron will be sharing his knowledge and experience on how to measure caregiver satisfaction, and what you can do with the information to grow your company..

This web conference is free to members of Caregiver Quality Assurance®, and to Premium Members of The Academy for Private Duty Home Care®.  Non-members may register on a pay-per-view basis.

If you missed the live web conference, the recorded version is available on the web site.  Members can log in and view for free.  Non-members can order a copy in the Academy Store. 

Thursday, July 11, 2013

HCAOA Works to Protect the Federal Companionship Exemption

As members of the Home Care Association of America, we appreciate what our association does on a
regular basis to advocate for home care companies across the country.  This morning we received an update from HCAOA regarding legislation to protect the federal Companionship Exemption for home care workers.

"HCAOA Member,

Tomorrow, July 11th, the Senate Appropriations Committee will take up consideration of the fiscal year 2014 spending bill for the departments of Labor, Health and Human Services, and Education.  The HCAOA requests your immediate action to support an amendment relating to the companion care exemption under the Fair Labor Standards Act that will be offered tomorrow.

Senator Mike Johanns (R-NE) is planning to offer an amendment to prohibit the implementation of the proposed companionship exemption rule relating to the Fair Labor Standards Act until certain conditions are met.  Specifically, the amendment would not allow federal funds to be appropriated to finalize, implement, or enforce the proposed companionship exemption rule (76 Fed. Reg. 81190) until—(1) the Administrator of the Centers for Medicare & Medicaid Services certifies to Congress that the final rule will not increase the financial burden on State Medicaid budgets; and (2) the National Council on Disability certifies to Congress that the final rule will not increase the costs of in-home care for individuals with disabilities.

As a member of the HCAOA you are specifically being contacted because one of your Senators sits on the Senate Appropriations Committee and will have a vote on the Johanns Amendment.  Please use the link below to submit the message.

Thank you!

Kevin W. Smith
Director of Operations
Home Care Association of America

Click the link below to log in and send your message:"

While it may be too late for you to take action on this immediate request, we want you to be aware of what the companionship exemption is, and what our national association is doing to look our for our members, the clients of those member companies, and the state Medicaid programs that will bear the increased costs of removing the exemption.

Thanks, Kevin and the HCAOA team for all you do.

Tuesday, July 9, 2013

Why Your Mission and Culture Matter

An Interview with Alex Chamberlain of EasyLiving
By Shannon Martin of AgingWisely

Alex Chamberlain, Executive Director of EasyLiving, Inc. in Clearwater, Florida shares some of the innovative ways they have built a strong team culture amongst their caregivers, and how that has resulted in success.

Tell us about your mission and why you think it is so important.

EasyLiving’s mission is to create an environment where we set our team members up for success empowering them to provide the best in home care to the community. To be honest, I don’t think you should be in the home care business if you just see it as a money-making opportunity. There’s been a lot of press about the growing demand of our aging population, and I think that sometimes attracts people who don’t truly care about the client and what it will take to provide excellent care. We approach this as a professional business and take being an employer in our local community very seriously. The only way we can accomplish our goal every day is to hire, train and treat our caregivers the best. This in turn leads to satisfied clients, more business and therefore helps keep our caregivers employed with plenty of work.

We look at everything through the lens of our mission and take any concerns that arise as a sign we need to be doing something better to support that caregiver. For example, if we have a client who requests a caregiver not return, we have that caregiver come in for a caregiver coaching session (which we also perform at regular intervals) to talk about ways to improve or how to resolve the concern.

Tell us more about how your culture ties in with your mission.

We want to rethink the image of caregivers and the culture of home care. Caregivers are amazing people with caring hearts and they need to be thanked for what they do. There are people out there who think of caregivers as “the hired help” and do not always respect them. We expect professional behavior from our caregivers, so we also demand our clients show that respect. We have “fired” clients who do not do so.

We take our mission to mean that we must hire, train, and treat our caregivers in the best way possible. It means constantly figuring out the best ways to do this. When you do this, you demonstrate that you take your mission seriously and your team begins to feel pride not only in what they do, but in where they work. When you have a team that buys into your mission and culture it attracts other like-minded individuals.

What are some of the specific initiatives you have set up to reward and appreciate caregivers?

We believe it’s essential to reward good behavior. A punitive system only reduces bad behavior; it won’t necessarily develop good behavior. We have a comprehensive rewards program we call iCaRewards™ which allows caregivers to earn rewards points they can redeem for great prizes. They can earn points for everything from getting a “kudos” sticker from a client to attending a training or event. Some of the neat things we have done for caregivers include:
  • Sending a personal thank you note when they do something great or we get good feedback.
  • Setting up a “personal pizza party” where we send pizza to their home so they can enjoy a complimentary family meal on us.
  • Providing a “day off” pass, eight hours of PTO.
  • Car washes, massage gift certificates and magazine subscriptions along with a variety of gift cards they can choose from to redeem rewards.
We recently created an “Inspirational Caregiver Award”. Each month we choose five finalists, who exemplify top quality caregiving. They each receive a gift card and we create a lot of excitement about the award. We partner within our community network to feature this award on a local radio show. The winner gets a spotlight on the radio show, our website and social media. This takes the recognition to a whole new level and shows a wider audience the positive picture of caregiving. It’s one thing to be recognized, but it adds a lot of excitement when it’s being shouted out to the world.

What are some of the challenges to creating this culture and some advice you would give to other business owners?

Buy-in takes time. It took us almost two years for every one of our caregivers to acknowledge our rewards program and start to talk about the differences in working at EasyLiving. You have to be persistent and creative and take every opportunity to share about your mission and why you are doing what you do. Culture is so much more than one event. Caregivers have to see that it underlies everything you do…in other words, you really mean it and it shows. Communicating is key. We take a multi-pronged approach to communication…mailing, emailing, calling and texting our caregivers about events and initiatives. We have an intranet site where we share upcoming events and company updates. We also use social media to help us push messages out to the team and build the sense of community. We don’t use social media primarily to reach new clients; we have harnessed its power instead to communicate to our caregivers and spread our mission.

How do you measure your success?

The obvious benchmarks include recruitment (referrals from current caregivers especially) and retention rates. But more importantly, your caregiver efforts should be reflected in your quality scores. We see this at EasyLiving, with consistent top scores in our independent Home Care Pulse surveys. The efforts you put in to your caregivers mean clients will be requesting those caregivers to come back and your clients become ambassadors for you in the community. When our clients are asked if they’d recommend our agency in our surveys, almost all of them respond positively and most have already done so.

Beyond the numbers, you can feel the shift in your culture. We felt it at our recent Memorial Day party, when we had a large crowd of caregivers (and some of their family and clients), staff and friends gathering for camaraderie and relaxation. We also feel it when we see our caregivers telling their friends how great it is to work at EasyLiving, encouraging each other and interacting on our Facebook page.
Alex Chamberlain is Executive Director of EasyLiving, Inc., a private duty home care agency serving Pinellas County, Florida. Alex was recently named Clearwater Chamber’s Young Professional of the Year. Under his leadership, EasyLiving has been named a “Best in Home Care” agency by Home Care Pulse and one of the fastest growing businesses by the Tampa Bay Business Journal. Alex is also the founder of EZFingerprints, an electronic fingerprinting service which is currently offering franchise opportunities.

Monday, July 8, 2013

Top Three Strategies for Retaining Top Talent in Home Care

By Stephen Tweed, CSP

What can you do to keep your caregivers?  The 2013 Private Duty Benchmarking Report shows that caregiver turnover is again this year for the 4th consecutive year, hitting 52.6%.  That means that 53 of every 100 caregivers quit or was terminated last year.

Using the Bad Hire Calculator from Caregiver Quality Assurance,  we calculated that the average cost of a bad hire was $1,576.24.  That means that if you had 100 caregivers last year, and 53 of them quit or were terminated, it would cost you $78,812.

I don't know about you, but there are lots of things I can do with $78,000 to grow my business.

Top Strategies for Caregiver Retention

Because caregiver turnover is such a huge issue in home care, and getting worse, we've continued to do research on this topic to help you understand what you can do to reverse the trend.  Our research shows that the three most significant factors in caregiver retention are:

1.  Appreciation and Recognition - your caregivers will stay with you and your company if they feel valued and appreciated.  That means we need to find innovative ways to show appreciation for caregivers so they feel valued.  And, we need to find innovative ways to provide formal recognition, including tangible rewards.

2.  Meaningful Work - your BEST caregivers are folks who really believe in what they do. They love their clients and really believe they are making a difference in their lives.  As a business owner, you can keep your best caregivers by making sure they have the opportunity to do meaningful work for their clients with a minimum of hassle.

3.  Servant Leadership - there is plenty of evidence to support the principle that caregivers will continue to work for a leader who puts service before self.  The concept of "Servant Leadership" was first describe by Robert Greenleaf, a retired AT&T executive who studied leadership and employee engagement. He wrote a now-famous essay about the concept, and then followed with several books.

If you are serious about growing your home care business, and you would like to create a culture of exceptional customer experiences, then you may want to explore the principles of Servant Leadership.  A servant leader is significant because they:

1.  Create a sense of hope through mission and vision

2.   Are guided by core values that are clear

3.  Accept and show reverence for their followers

4.  Trust others and release control

5.  Demonstrate frequent, persuasive communication

6.  Listen to those they influence

7.  Make a commitment to personal transformation

Over the years, I've met a number of gifted home care leaders who really demonstrate these principles.  The result is a growing and profitable business that makes a difference in the lives of clients, families, caregivers, and office staff. 

To help you develop a more clear understanding of the principles of Servant Leadership, we'll be hosting a special live web conference this week featuring a nationally known author, award winning professional speaker and executive coach Elizabeth Jeffries, RN, CSP, CPAE, the CEO of Executive Mastery ... a Tweed Jeffries company,  will be with us to discuss the principles of Servant Leadership and how you can apply these concepts to increase the quality of your caregivers, reduce turnover, save money, and serve more clients.  

Join us on Thursday, July 11, 2013 at 4:00 pm eastern for Servant Leadership in Home Care with Elizabeth Jeffries.

Wednesday, June 26, 2013

How Will You Meet The Future Demand For Home Care Workers?

Much attention is being focused on how home care companies will meet the growing demand for quality home care workers. The U.S. Dept. of Labor states the “employment of home health aides and personal care aides is expected to grow by 69%-70% from 2010 to 2020, much faster than the average for all occupations”. 

Deane Beebe, Paraprofessional Healthcare Institute Media Relations Director, writes “the demand for home care workers will grow from the 3.3 million employed in 2010 to 1.6 million new positions projected by 2020”. 

Where will you find these caregivers?  According to the 2013 Private Duty Benchmarking Study, published by Home Care Pulse, the Top Five Caregiver Recruitment Sources/Methods are:

·         Internet – Job Ads

·         Internet – Career Builder

·         Employees – Current Employees (Employee Referral Program)

·         Advertising – Daily Newspaper Classified Ads

·         Referral Sources – Word of Mouth (Reputation)

If you want to learn more about the Private Duty Home Care industry, order your copy of the 2013 Private Duty Benchmarking Study, published by Home Care Pulse, at

Wednesday, June 19, 2013

What's the Level of Employee Engagement in your Home Care Company?

In its ongoing survey of the American workplace, Gallup found that only 30 percent of workers "were engaged, or involved in, enthusiastic about, and committed to their workplace."

The poll, released last week, examined worker engagement beginning in 2010 and ending in 2012.

The survey classifies three types of employees among the 100 million people in America who hold full-time jobs.

The first is "actively engaged," which represents about 30 million workers.

The second type of worker is "not engaged," which accounts for 50 million. These employees are going through the motions at work.

The third type, labeled "actively disengaged," hates going to work. These workers -- about 20 million -- undermine their companies with their attitude, according to the report. 

The less employees are engaged with their work and their organization, the more likely they are to leave to an organization. Turnover can be costly, and turnover in professional roles, such as nurses or engineers, is more costly than turnover in entry-level or front-line roles.

Organizations can do several things to increase their employees' engagement. Gallup researchers found that identifying and hiring top management talent can influence workers' engagement and organizations' business performance.

What does this have to do with Home Care?

At Caregiver Quality Assurance,  we have taken this issue of employee engagement into account in the Leading Home Care Pre-employment Assessment.  The fourth part of this assessment measures employee engagement.  Asking a series of validated questions, the assessment will give you a graphic image of the level to which your prospective job candidates were engaged with their previous job and their previous employer.

The report then gives you a graph like the one on the right.  Top top bar shows the job candidates level of engagement with their previous job.  The lower bar shows the candidates engagement with their previous employer.  

Having this information about caregiver engagement will be one more tool in your toolbox to help you recruit, select, train and retain high quality caregivers, office staff, and sales professionals.  

There are four things you can learn about job candidates that will help you select the best:
  • attitudes, 
  • behavior, 
  • cognitive ability, 
  • engagement. 
By having this information about a candidate before the job interview, you will be able to ask behavioral interview questions that give you a clearer understanding of the person you are considering for the job.  When you have this information in advance, and do a better job of interviewing, you are going to hire the very best candidates, and you will increase the performance of the caregivers, the satisfaction of your clients, and the profitability of your company.

A recent study conducted by Caregiver Quality Assurance using our Bad Hire Calculator shows that the typical cost of making a bad hire of a caregiver will be just over $1,500.00 if they quit or are terminated.  What does it cost you if you made a bad hire, the caregiver is actively disengaged, but stays on the job?

What is your experience with job engagement?

What is the level of engagement of your employees?  Are they actively engaged, not engaged, or actively disengaged?