This article is sponsored by CareAcademy. This article is based on a Home Health Care News discussion with Ginger Barrientez, Director of Enterprise Account Based Marketing at CareAcademy, Brandon Ballew, CEO at AccordCare, and Sheila Davis, Executive Senior Vice President of Area Operations at Always Best Care. The discussion took place on March 30, 2023 during HHCN Capital + Strategy. The article below has been edited for length and clarity.

Ginger Barrientez: I’m excited about today’s opportunity to have a candid conversation about education and its impact in your industry. I am privileged to have Sheila Davis with Always Best Care, and Brandon Ballew with AccordCare. I’m glad they’re able to join us and come together to focus on how education truly is one of the key strategies, if not the cornerstone, to sustaining the home health industry. From that, we see not just education, but quality education, is truly touching on a lot of themes that are going to support recruitment and retention.

Whenever it comes to reimbursement, by upskilling your team members, and growing their competencies, then you’re able to not only meet that market demand that continues to grow, but then also either you raise your rates to offset the reimbursement shortfall or support whatever payment type model you’re going to move forward with. Either way, that additional skill and competency level in your team is going to also be able to elevate how they’re able to meet the higher acuity needs in the population. Sheila and Brandon, can you describe how your teams are utilizing education for your care providers to secure and hopefully even expand your foothold in home health.

Sheila Davis: I think one of the things that we have realized over the past couple of years is that we used to look at caregiver turnover. When we looked at that turnover rate, we thought it was more about wages. I think we did an in-depth study just in-house, and it was really more that they felt like they were insufficiently educated, and they did not have support. We have really tried to increase the educational aspects of the caregivers so that they have the proper training. One of the other things that I think is very important to stop and look at as an industry as a whole is we all need to take a step back and look at where we first began in this business.

Are we still in the same position that we were when we first stepped in this business? I can tell you, I’ve been in the business for 33 years, and I started out as a file clerk in my mother’s office, but that’s not where I wanted to stay. I don’t believe that caregivers, for the majority of them, come into the industry wanting to stay a caregiver for the rest of their lives. I think we have to look at that educational aspect, a track of how we can support them on their journey towards where they want to end, whether it be a nurse at some point, or maybe it’s a dietician, or it may be a diagnostic person, or a lab person.

I think that education can lead them towards the path of their career, and educate them at the same time, which provides a benefit for our services and our personal care needs. That’s how we’ve taken a step back the past couple of years and begun looking at it.

Brandon Ballew: I totally agree with that. To add to that, as we continue to grow the home health segment, we’re asking our folks to take care of the sicker patient. We all meet with our payers and we meet with the hospitals and say, “Hey, we can take that sick patient,” but then have we also compounded that with training our clinicians on how to actually take care of that sicker patient, and how to keep them in the home? Those two don’t always line up. It’s critical to make sure that you’re able to deliver education on those chronic or acute diseases that are going to allow that person to stay in their home.

You can’t just wish them to stay there. There has to be actual training and education and techniques delivered onto those clients so that they can stay better in their home, and you have to use platforms like CareAcademy to help you do that.

Barrientez: Sheila, I’m going to focus on you for a minute because I know you’re a vested member in the National Association for Home Care & Hospice and HCAOA. I understand you’re really focusing on recruitment and retention strategies. Can you share some insights that these two organizations are seeing as viable plays in answering those challenges?

Davis: First and foremost, I like that our organizations have come together and are supporting each other instead of fighting against each other. I think that’s a very positive move. Both of the organizations came together last year and have formed an action group to actually look at the caregiver status and how we can retain caregivers and train them better. Just as it was pointed out, we’re taking care of a lot sicker clients, and our caregivers don’t necessarily understand what is going on with those clients.

Especially our dementia care patients, so many caregivers, when you think of the word dementia, or you think of the word Alzheimer’s, the first and only thing that comes to their mind is that they have a memory problem.

People do not understand that a true dementia person does not hear things the same, they do not process things the same, they can’t control their bodies the same. A lot of caregivers don’t understand that. The two organizations have really tried to come together to show the needs of education– we need to have a standardized platform across the US, number one. Of course, we all know we need to have standardized licensing across the US as well so that all organizations are held accountable. I think there truly needs to be a platform developed that is a standardized platform that all caregivers go through.

CareAcademy is one of our great partners that are helping us to do that. I think it’s something from agency to agency, especially in non-licensure states, that sometimes you don’t even know what the platform is for training. I know everybody here has a higher level of standard, but there’s a lot of need out there. The caregivers just don’t even understand the basics. I think we truly have to develop that basic standard, and that’s one of the things that the organizations are trying to come together and do.

Barrientez: Just curious, is there any kind of a timeframe that they’re putting on that, or is it just conversations starting?

Davis: They’re hoping to do that in 2023. The Homecare Workforce Crisis Action Report came out on Friday. You can go to the National Association of Home Care’s website, or the HCAOA’s website and download the publication. It’s got some great information in there, but it tells you then what the action workforce is going to work on this coming year. One of those tracks is to develop a standardized care track so that we can go to all of our training partners, whoever it might be, and say this is what we as an industry think is the basic needs for caregiver training, and then how can we increase that training to the next level for them to be better?

Barrientez: I want to ask the question about creating more standardization in care. Are you thinking that it is more advantageous, to provide that kind of training in-house for those that currently use their own in-house training programs? Or do you think there really should be a shift more to outside resources? I find I don’t clean my house as well as somebody who professionally does it, or when I did meeting planning, I would much rather trust an event planner than I would just say, “Hey, I’m going to hop in here and try to put together an entire conference.”

I’m curious, what are the thoughts there on standardizing education and going the route of in-house versus relying on an outside resource?

Davis: This is my personal opinion. Not necessarily the opinion of all of our franchise systems. I truly think that you need to have an outside source to train your caregivers. We get so tied up as owners, managers and executives of an organization, and so do whoever our designated people are to do that training. It’s just like you said, as far as cleaning your house, you may get in the midst of that training, but then you get sidetracked or an emergency comes up, there’s a shift that got canceled all of a sudden, and so we step away. Then, do we come back and we finish that training the proper way that we should?

What we have found in our organization is it really is better to outsource it and have someone else to provide that. I will say that one of the things that COVID did provide us as a good aspect is there’s so much technology now that can be utilized, and to where we used to have to bring our caregivers in-house, we don’t necessarily have to do that anymore. It’s a benefit to us as well as it is to the caregivers, because a lot of times they may be on a 12-hour shift and the client may be asleep for two or three hours. They can do some caregiver training that is responsible to them. I think that technology has brought an advancement to that.

I have to agree on that point. I do think you need to have some type of source. Maybe you can contract to have someone come in, but I think there needs to be a dedicated platform for that.

Ballew: I agree. Especially the more size and scale you get within an organization. In order to get that standardization within your own internal group, you need to be able to have a similar platform that has it. What I like is using your people not to worry about delivering the content, but to help them partner with you around content that is important for us. That I would agree that I need in-house, that I need to work with that partner as opposed to the vendor is to be able to develop the right content for us in our particular areas. Unfortunately today, there are state-specific requirements you have to have. We really need someone who knows “What am I supposed to do when I enter into a new state and how do I go do that?” It’s great to have a partner who’s in all of those areas.

Barrientez: I’m curious to hear both of your perspectives on the future of education in terms of recruiting new candidates. Do you see a difference in how education is used for recruiting new candidates in home care versus home health or do you see it about the same?

Davis: I think that your training platforms and your educational platforms play a big role in your recruitment process. I don’t think, especially not necessarily on the skilled care side, where you have skilled clinicians who have to have X number of CEUs to continue their license. On the non-medical side, personal care side, with those home health aides and caregivers, a lot of them are seeking education. I think that sometimes what agencies miss out on is that we get focused on the dollar amount to bring them in. That plays a very vital, important part. Don’t get me wrong, it’s definitely a differentiator.

I think there’s more to it. I think caregivers want an education. I think they want the training, they want to be able to do their jobs well, and in order to do that, they need the training to do that. I think they’re very receptive to that. I think that if you can acknowledge the type of training platform that you have upfront and what knowledge you can help provide them during the course of their job, I think it becomes a very, very valuable recruiting tool and retention tool as well.

Ballew: That’s what I was going to add. The recruiting piece does get it there, but it’s really the retention. That’s just as important as recruiting because if you have as many people, particularly in the personal care side, retention rates are so low today that you’ve turned over these folks so much. If you can reduce that, the hiring piece becomes just exponentially compounded better and that retention is driven by the person’s want to be there and their need. The good caregivers have a need that they want to be in the home taking care of somebody and they want to do a better job. The way to do a better job is to get better training.

That’s one of the things that allows us to recruit and train people better, is by offering those platforms because a lot of our competition does not do that because it is such a tight-margin business. You got to make the investment and do it and it does pay off.

Barrientez: I’m glad you mentioned that because I think you’ve got to look at ways, whether it’s clinical or non-clinical, what are ways you’re going to help those folks want to stay and truly look at that cost of if you lose somebody, you’re losing the quality, you’re losing the patient experience and you’ve got a whole other ramp up time. Whereas if you could just provide that education resource to them, or maybe it’s to level up, giving them a career path, you’re more than likely going to have them stay with you and maintain your higher standards of care.

I think it’s great just to echo that. Thinking too about just how we’ve got the staffing crunch, where does that take you and your business? What areas do you anticipate will augment because of the staffing crunch? Are you going to augment perhaps more technology resources or are you going to augment more of a line of business and go into, let’s say hospice in any area?

Ballew: At the end of the day I think everyone here knows if you’ve been in home care in any amount of time, we will never have enough caregivers, ever. Even if we passed a handful of bills and got people away from flipping burgers and doing whatever, we just don’t have enough. You’re going to have to augment. You have two things. I think there’s technology improvements that are critical, which I agree with Sheila. There’s not a lot of good that came out of COVID, but, being in the home, we’ve now seen technology partners that were outside of the home care industry start to get interested in home care.

They’re starting to apply products that they had in other areas and say, “Hey, I think that might work for in-home care.” They just don’t know anything about home care. They’re coming to us and we’re going, “I think I can actually possibly reduce some hours, maybe reduce a visit because I’ve got technological connections and we can be smarter about care interventions in the home by using that technology.” I think that helps out a tremendous amount. The other thing is with the aides and utilizing each discipline, push the envelope on what you can do with their training and their licensure.

I’m not going to go outside of it, not saying to do that, but I need that aide to do as much as they possibly can. Historically, that’s more than they’ve done in the past and we hope we can get them to do more in the future. That goes for LPNs, PTs all up and down the board. Again, as we’re trying to get a sicker patient in the home and keep them there. You’ve got to have everyone working to the max of the level of their license.

Davis: I agree with Brandon wholeheartedly. I think technology is definitely going to be part of our future. I don’t think it’s going to be a competitive part of our future. I think it’s going to be an assistive part of our future. It’s going to be a way to keep our clients at home longer. We all know people are not going to want to return to skilled nursing facilities or other acute hospital facilities. I think that telehealth, artificial intelligence, all of those aspects are going to play a part in keeping that client at home where they really want to be. I think we’re going to have to embrace that because I think it’s going to be an assistive asset, not a competitive asset.

Ballew: What I have seen with a handful of these products is a lot of times they would try to sell it themselves. They just didn’t get the stickiness. Then we would try to go implement things but it wouldn’t work. Together, that really seems to be catching folks. You just have to measure or you have to pair technology with the caregiver and use it in order for it to get sticky with that client. Say you have an 85-year-old person. You give them a piece of technology, they’re not going to use it. You teach them about it, they don’t get it. I show up for 30 minutes, I showed them, I gave a nice demo, it’s got beautiful wrapping, but it just doesn’t stick.

When I teach my aide or my nurse to go in there and use it with them, then it becomes sticky and now I can actually change the care pattern. It’s amazing to me that it’s seen they both have to work together. They cannot be independent of each other.

Barrientez: I think that still goes back to the heart of all this, it really is still a human service, human industry. The technology is definitely going to help, and further things, and bridge that gap. I think at the end of the day it still comes down to the human.

Davis: Just to also iterate, once we put those two things together, just like you said Brandon, to make them work, we’ve got to educate the caregivers that are going to be in the home with that piece. We can’t just say, “We’re going to combine you together now and you’re going to work effectively.” We’ve got to train effectively. That’s another piece of the caregiver training platform that you have to bring in and put in place when you decide that you’re going to add those things to your services.

Barrientez: Something that I think is interesting when we think about education is talking to more and more clients who are really leveraging education as more of a brand standard. They’re creating it as a pillar of their company and wanting to, let’s say, create this golden standard of care. I’m curious to know if either of you have that as an initiative for your organization, where you’re going to elevate your brand by standardizing a certain level of care.

Davis: First of all, we have a standardized level of care for all of our agencies. It’s part of our platform. I think what we are moving more and more towards is exactly what you’re saying, is if it’s a cardiac patient, be sure that we are educating on that type of diagnosis before we put that caregiver in the home. I know a lot of agencies are dementia certified and that’s great. I think there’s more to it. I think you have to look at the holistic picture of the client. You have to see what all is involved with that client. Then you have to make sure that there’s adequate education for that caregiver to take that type of diagnosis.

I think also, on the flip side of that, there’s some other educational opportunities with caregivers that we sometimes forget about. That’s when they are taking care of a very, very sick client there’s some coping mechanism training, some support training because we sometimes forget about what is on them caring for that patient. How can we effectively teach them and train them to cope with the type of care they’re having to provide? Those are some things that we’re putting in place this year to assist our caregivers.

Ballew: I completely agree with that. Particularly even customer service, just how you’re dealing with it. Just some basics that you wouldn’t think through are really showing a big impact on our caregivers’ quality of work and their satisfaction in what they’re doing. I’ll go back to what you were saying, training being a key component to differentiate yourself. I think it is important for all of us to make sure that we’re adopting that to where it does become minimum-level standards. Unfortunately in our industry, there’s still a lot of smaller agencies that maybe can’t afford it or just don’t want to put the investment into it and that hurts us overall as an industry.

For all of us here, whatever size of organization you are, we need everyone to rise. We need the tide to rise in home care in order for us to have more consistency of care and a larger voice in places like Washington so you can do that. In order to do that, we have to be able to deliver that consistency and you have to be able to maintain training in order to make sure you’re delivering that care.

Barrientez: Well said. When it comes to education and the impact of training, I’m curious to know are you all at this very day measuring outcomes or satisfaction levels? Are you actually putting some metrics there behind the effects of training?

Davis: We effectively are trying. Yes.

Ballew: Yes. We track several different clinical outcomes, which we’re tracking both on the personal care and the home health side. Employee engagement surveys are very critical and a lot of that has education components into it. To Sheila’s earlier point, the reason folks are leaving it’s not necessarily the wage, it’s because they don’t feel they were properly trained. That’s one of the top three things that the employees will say, so we know that we need to invest in those areas. We do track both clinical client and caregiver satisfaction and outcomes.

Barrientez: I’m curious to know. You did touch a little bit on the types of metrics that you’re using. Do those resonate with you too, Sheila?

Davis: Yes. I was going to say caregiver satisfaction has really become one of the main tracking points of exit interviews. When caregivers do leave, are we finding out what is the real reason that they’re leaving? Sometimes we’ve found it to be such a simple thing that we can do something about it and end up with them staying. In the past, I don’t think we would have done that. Also, the types of training that they feel like they need. Are we adequately asking our staff? Not only are we giving them the opportunities to have this training and to be better educated, but are we asking them what type of training they would like to have?

Sometimes what we think they need and what they think they need are two different things, and so I think it’s very important to bring the caregivers into the circle and ask them, “What type of education do you feel you need to be better supported in your job and in your position and to take care of those critical clients?”

Barrientez: I think that’s really important too. It’s very easy to get fixated on the outcomes and the care quality and readmits, but I think truly when we’re trying to tackle the challenges here of the staffing crunch, it’s going back to caregiver satisfaction and what can be done differently to keep them there and potentially grow them and benefit your business thus even more.

Well, very good. Then I want to move on to more of a futuristic question. How do you see education delivery changing in the next three to five years? Do you think it’s going to be more commonplace as a strategy on recruitment or retention or both? I think I know your answer already, but we’re going to go ahead and ask.

Ballew: I think it will continue at the advanced pace that it has over the past several years. I’ll echo Sheila’s earlier comment that COVID and being remote really accelerated a lot of initiatives within an organization. One of the biggest ones being, how do you train and educate? I used to have to have a room or get the place and bring everyone in and we’re doing our annual reviews. That is now much more remote than it has ever been. That will continue to be. I think there’s a lot of positives to that.

That being said, over the next three to five years I see us continuing to chase a sicker and sicker patient. When we do that, education around those specific disease states, it’s not the general ‘here’s what training that everybody else has.’ It’s going to be very important for us to find out what in-home training care looks like per discipline, per intervention at different times. We’re going to have to get better at it. I think us as an industry needs to..