Human Resources Advice for Home Health Agencies

Companies are nothing without their staff members, but employees are also one of the biggest sources of risk and worry for homecare providers. From hiring and firing to making sure you’re protecting worker safety, there’s a lot to stay abreast of—especially in a highly regulated, fast-changing industry. HomeCare talked with Anne-Lise Gere, SPHR, who runs Gere Consulting Associates LLC and works frequently with home health agencies on HR matters. Homecare providers consult with her on caregiver recruitment and retention to achieve sustained results. She also works with clients on a retainer basis to provide ongoing HR support.

HOMECARE: What are some HR-related issues home health agencies (HHAs) should be making sure they’re paying attention to? 

ANNE-LISE GERE: Perhaps the biggest HR-related issue is that they can’t get enough caregivers and they can’t seem to keep caregivers—so that’s recruiting and retention. But let’s also talk about compliance, specifically Fair Labor Standards Act compliance around the wage and hour rule. If you’re a multi-state employer, the picture is becoming a total patchwork of rules and regulations. It has always been that to some degree but it’s becoming even more so. For example: Some states mandate paid medical leave, and others don’t. Then there are the ban-the-box efforts (to remove questions on job applications about criminal history), which vary across the country. And there are the regulations and complications brought up by marijuana, which is a topic of a lot of anxiety because employers don’t want to be caught flat-footed but they’re also concerned for their business. 

HOMECARE: How might employers, especially in homecare, be affected by marijuana use? 

GERE: Some marijuana users take longer to eliminate the presence of the substance than others, and the fact that it is present in the bloodstream to register on a drug test may not mean you are using it on the job. The most challenging environment is in states where medical marijuana is allowed. If you’re interviewing a prospective caregiver and after a drug screening you find the presence of marijuana or cannabinoids in their test results—I’ve heard this from my clients—very often the candidate has a prescription from a doctor to alleviate a medical condition. Discrimination in recruitment against candidates with medical conditions might be protected by the Americans With Disabilities Act. 

HOMECARE: How can agency owners make sure their employees aren’t posing a liability when they’re out working with clients in their homes? 

GERE: At the end of the day, it’s very much about keeping in touch and having eyes and ears on the ground. That means periodic training, but also field visits from the nurse or care coordinator. The agencies that have the best people measures—high retention and are considered an employer of choice—have someone who every month is going to be out there and have a personal touchpoint with the caregiver. These touchpoints are not about control so much as they are about creating a relationship and trying to boost their caregivers’ skills… This is also important in terms of retention. Caregivers know when they are out of their depth and instead of asking for help, they’ll just quit a job and find another one within three days 

HOMECARE: Do you have any stories of the worst examples you’ve seen of agencies being caught by surprise? 

GERE: Only once: An agency owner discovering in 2018 that he had to pay overtime to his caregivers when the law changed in 2014! Most of my clients are good business owners who want to be the best, so I don’t see many of the most egregious cases. Often they need an attorney more than HR consultant.

HOMECARE: Should agencies consider outsourcing their human resources functions to make sure they’re not missing something? 

GERE: I am not a big proponent of outsourcing HR in homecare, which relies so heavily on good people and people practices to be successful. In homecare, HR is a competitive advantage. Most agencies need expert support so they can to learn to do it in-house. Your workforce is basically your business advantage—it’s what sets you apart from another agency down the road. Your core business is really HR, and you cannot outsource your core business. 

But what I would say is that I think you can always use help and advice, especially if your administrator is not an HR professional. This is how I work with my clients. They’ll reach out to me with questions, they want to create a new orientation program, to conduct salary surveys or update employee handbooks. If it’s something with clear deliverables, that’s okay to ask somebody to do it for you. 

HOMECARE: We all know that turnover and recruiting are enormous burdens for home health agencies these days. Can you think of one or two key things they can look at to prevent them from being a problem for their business? 

GERE: This is a vast subject! But I think it’s like everything in business: If you want to see change in something, you need to start measuring it and tracking it and probably put somebody in charge of it. For example, with recruitment, agencies need to track their performance: How many applications are we receiving, how many interviews are we doing? How many people accept an interview and don’t show? How many offers do we make, and how many of those people actually start their first shift? There are many ways to track recruitment and if you have the numbers, then you can dig in and see where the issues are. 

HOMECARE: What about keeping the employees you have? 

GERE: That’s the $64,000 question. In essence, you want to recruit the right people. Because if you recruit people who don’t have the heart to be a caregiver, if they don’t have the proper disposition, if they’re just in it for the money, in general they don’t stay in the profession. Those people who stay know they’re doing important work and making a difference in the lives of their clients. They feel appreciated by their agency. That’s all the fuzzy stuff, but you also want to make sure that you are paying them a living wage—which is tricky depending on where you are—and also that you provide enough hours. I always tell my clients: Try to maximize the workforce that you already have. A lot of caregivers don’t work a full-time schedule. Is that because they don’t want to or because no one has bothered to ask if they want to work more? … By not giving your employees the hours that they want to work, you are actually planting the seeds to lose them later. The best agencies are the ones who get away from the chaos and say we’re going to schedule you for 40 hours a week, and we’re going to give you two or three cases. 

If you have additional questions for Gere, visit gereconsulting.com or contact her at [email protected].