The issue of staff retention in home health is a major concern for most Medicare certified agencies as they strive to remain competitive in today’s constantly changing homecare landscape. The effects of PPS reforms enacted over the last decade and the resultant changes required in programming have prompted providers to place a previously unseen emphasis on staff retention as a means of stabilizing the workforce during this unsettling era. We will examine the issue of staff retention and discuss the concerns in general regarding the specifics of an efficient and quality based home health team.
The homecare industry has evolved into a significantly different entity since the introduction of PPS in 1999; the New Rule changes installed in January of 2008 serve to refine home health delivery even further. As the fee-for-service era became obsolete in light of the initial Balanced Budget Act reforms, the future of homecare was not particularly well-defined by the impending capitated PPS structure. Administrators of Medicare agencies all experienced the uncertainty prompted by the reforms; reimbursement principles appeared cloudy, programming models were significantly altered and clinical mandates became inverted. In addition, many veteran homecare clinicians opted to leave the profession. Clearly, experienced nurses and therapists were needed in all areas of healthcare. To further exacerbate the staff concerns, IT and clinical advances presented an entirely new set of challenges for the homecare clinician. As a means of achieving general stability in home health agencies, a decided emphasis was placed on staff retention.
Today, it is a commonly held belief that staff retention is necessary to achieve a desired level of success as a home health agency. As home health educators and consultants, we at HHSM have worked with many agencies (of varying size and location), homecare clinicians, and home health administrators or managers. When helping specific organizations improve clinical efficiencies with the goal of achieving better OBQI results, the role of quality care delivery (and its relationship to veteran staff) is easily identified. In our experience, staff retention in relation to agency success appears quite at odds with the standard industry beliefs.
Most home health education today revolves around the topic of change. Changes in clinical technique, programming mandates, IT use, coding, and therapy utilization are a few examples. These changes represent stressors for clinical, clerical and administrative staff simultaneously. Meanwhile, clinicians, in short supply in all areas, are constantly recruited for positions in hospitals, nursing homes, or private offices. Many of these alternative employment opportunities offer working environments that appear more structured and professionally supportive than homecare.
In our experience, clinical staff seeks peer support and professional advancement in the workplace in order to experience job satisfaction. With factors such as pay neutralized, the home health employer must determine exactly how to provide such an employment environment in order to retain desired staff members. In order for the homecare nurse or therapist to feel empowered and ultimately successful in their job, pro-active education must be ongoing. ALL clinicians feel the stress of the fluid programming and reimbursement changes. Supportive employers understand the need for clinicians to experience a level of professional competence as a major factor in job satisfaction. Those agencies most able to provide a meaningful level of education experience a lower level of staff turnover.
One of the more misunderstood aspects of home health staffing in the post-PPS world is the opportunity realized by the recruitment and ongoing addition of clinical staff members entirely new to homecare. As clinicians with experience in the fee-for-service era reminisce about “the good old days”, we have noticed a previously unseen phenomenon in home health staff maintenance. In contrast to agencies who attempt to retain staff members at any cost, the dynamics created by the near constant addition of new hires are consistent and directly related to success in the areas of both employment satisfaction and clinical outcomes. The turnstile effect, as we call it, offers job satisfaction to an entirely new group of licensed clinicians that haven’t had to unlearn habits of the fee-for-service era. The infusion of new staff members also serves to create a staff defined solely by the ability to provide home health services at a quality level. Quite commonly, we see veteran clinicians evolve their practice while working next to a clinician new to homecare. The experienced nurse or therapist often finds it easier to evolve their skills or professional approach while noting the enthusiasm of the staff new to homecare.
In closing, we advocate the natural and ongoing rate of turnover and replacement augmented by the ongoing replacement and addition of staff entirely new to home health. The presence of new licenses and enthusiasm in your staff will prompt a level of performance, job satisfaction and retention that your agency desires.
Teri N. Thompson and Arnie Cisneros are physical therapists with nearly 40 years of combined home care experience. Co-owners of Home Health Strategic Management in East Lansing, MI, they provide clinical service management and home care consulting expertise. They are nationally renowned speakers regarding the PPS refinements of 2008 and therapy utilization under the New Rule.