Simione™ Healthcare Consultants


Thought Leadership Series: Bringing It All Home with the Right People

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Bringing it All Home With the Right People

Everything we are reading and seeing in the world of health care speaks to the inevitable – that the home will likely emerge as the primary setting for health care in the United States sooner than later. While we expect years of continued work to get there, we know that non-acute settings present the greatest opportunity to contain costs and meet patients’ preferences for care and services as they age. Whether the focus is clinical, financial or administrative in nature, progress will be impossible without the right people to carry out the work. In its popular 2015 article outlining industry leaders’ thoughts, Home Health Care Newsdubbed home care as the anticipated “Heart of the U.S. Health System by 2024”. Quoting Dr. Steven Landers, President and CEO of the Visiting Nurse Association Health Group, from a keynote address, the article said, “the home setting and health services and supports will become so synonymous that they may not be called home care, rather, they will just be modern health care.” Home care, hospice and other community-based providers are turning to a variety of experts and resources to ensure they are moving forward for greater clinical and financial success. Payment reform and new Conditions of Participation (CoPs) are among the top issues driving fundamental changes, yet many organizations have yet to calculate the likely impact of both on operations, accreditation status, and the bottom line. Without an understanding of this new reality within an organization, leaders cannot establish a clear plan to build strong and loyal teams that will excel in all areas of the business. Through interactions with patients, payers, vendors and partnering care organizations, home-based providers are working to improve their results – often amid competing priorities that require clear internal roles and accountabilities. No matter what size and scope of operations, home care and hospice cannot thrive without two things:

  • Exceptional people to lead, manage, provide care and administer operations
  • Data and expertise from accrediting bodies, trade associations, government agencies, consulting firms and other entities to support sound decision-making

Finding, Engaging and Retaining Top Talent

The competition to build and develop a workforce is reaching staggering proportions in home-based care. In spring of this year, Forbes reported the shortage of home care workers – both skilled and personal care – as “worse than you think.” Citing government statistics that rank home care as one of the nation’s fastest growing occupations, the report identified the need for an additional million workers by 2026. Personal-care aides and home-health aides are two of the 10 jobs that the Bureau of Labor Statistics projects will see the most growth in the next decade. These job opportunities present a challenge, though, as they have a history of poor performance with wages, schedules and advancement potential – making the shortage of professional caregivers likely worse without political support, employer incentives and greater emphasis on staff satisfaction. Recruiting for middle management and leadership roles is highly competitive, also requiring innovative strategies and strong incentives to find and retain top talent.

Pressure at the Top

Leadership and management teams have additional pressure to elevate the role and performance of home-based care in the larger healthcare industry. The task involves all levels of the organization and zeroes in on two areas of responsibility: recruitment/succession planning and employee engagement/development.Strong clinical and financial leadership sets the tone for success in any organization. In home-based care, they are the port and starboard sides of the business, monitoring performance along with regulatory and market conditions to navigate the agency through both calm and choppy seas. While retaining top leaders in clinical operations and finance is critical, so is building a succession plan to identify new leaders in and outside of the organization and implement developmental steps to prepare them for higher levels of responsibility.A report released by Software Advice, an HR and recruiting technology research firm, surveyed employees and employers currently implementing succession plans to find out how these plans impact employee engagement. Among the findings, 79% of employers said they have succession plans in place for mid-level managers and 94% reported a succession plan positively impacts their employees’ engagement levels. Among employees, 62% said they would be “significantly more engaged” if their company had a succession plan, and 90% age 34 and younger said that working at a company with a clear succession plan would “improve” their level of engagement.

Strategies to Engage Employees

With workforce challenges a leading concern and not enough experienced professionals to go around, home-based care organizations that successfully engage employees at all levels will thrive with a stronger, competitive edge. This factor is often underestimated or omitted from many business assessments in home-based care when evaluating the potential financial, regulatory, legal and other impacts on operations.Employee engagement can take on many forms. Training, team development exercises and employee surveys all constitute positive opportunities to improve satisfaction and engagement in home care, hospice, private duty and other non-acute settings. The overriding themes to consider include: making employees feel appreciated, giving them the resources to perform optimally, and engaging them in solutions to organizational challenges.Many provider organizations are taking extra steps to ensure they attract highly skilled and compassionate employees, engaging them with robust executive communication, extensive onboarding, employee satisfaction surveys, and training in customer service to help with retention. Thom Gilday, President and COO of Brightstar Care, summed it up well in late 2017 when interviewed by Home Health Care News: “It’s not about compensation. It’s about feeling a part of the team.”In March 2018, one abstract in the Journal of Advanced Nursing identified “health-promoting leaders” as those who engage employees in maintaining their well-being through open communication and accommodating nurses’ participation in change processes. Through competence development, the abstract concludes that such leaders build strength and the capacity to perform.Although salaries and wages need to be competitive, it’s not just about the monetary rewards. Intangible recognition in the form of team acknowledgements, personal contact, leadership communication and group activities to show appreciation go a long way, too.

Knowing When to Ask For Help

Every home-based care organization has reached a point where the complexity of priorities and timing constraints may require leaders to seek outside resources to make more effective decisions and change the course of activity to address new regulations or other industry developments. The most effective way to connect with experts and other resources is to get involved, serving on committees or initiatives locally, regionally or nationally within health care, and specifically home-based care, and plugging into educational opportunities whenever possible.When more pressing needs arise, the industry possesses a wealth of data and expertise from professionals at accrediting bodies, trade associations, government agencies, consulting firms and other entities to support better decision-making and help drive an organization to the next level of performance. Strong leaders know when to reach out, and the added support for your organization will remind employees that they, and ultimately their patients, are worth the effort.


Care Workforce is More Educated, But Wages Remain Stagnant, Amy Baxter, Home Health Care News, June 28, 2018 The Shortage of Home Care Workers: Worse Than You Think, Chris Farrell, Forbes, April 18, 2018

Health-promoting leadership: A qualitative study from experienced nurses’ perspective, Kristin Akerjordet, Trude Furunes, and Annie Haver, Journal of Advanced Nursing, Leading Global Nursing Research, March 9, 2018

Employment Projections 2016-2026, Bureau of Labor Statistics, U.S. Department of Labor, October 24, 2017

Workforce Development Tips from LHC Group, BrightStar, Great Lakes Caring, Tim Regan, Home Health Care News, September 14, 2017

Aided by Software, Succession Planning Expands Beyond the C-Suite, Industry View 2017

Home Care Could Be Heart of U.S. Health System by 2024, Tim Mullaney, Home Health Care News, March 19, 2015

Turnover in health care: The mediating effects of employee engagement, Stevie A. Collini, MA, Ashley M. Gidroz, PHD, and Lisa Perez, PhD, Journal of Nursing Management, October 2013

About William J. Simione, III, Managing Principal, Simione Healthcare Consultants

Bill Simione is a leading financial expert with more than 25 years of experience working to improve performance in home health and hospice. While leading the team at Simione Healthcare Consultants, he is currently educating providers throughout the nation about payment reform and believes that the right people in all businesses are essential to achieving a healthy bottom line.

About Home Care 100

Home Care 100 is the preeminent conference exclusively for home care and hospice providers. We envision the best in leadership, strategy and innovation and help providers accelerate change towards a value-based system. The 2019 conference takes place January 27-30 at the Fairmont Scottsdale Princess, AZ. Visit for details.