SimiTree consultants weigh in on retention strategies

A continuing staffing shortage has home health and hospice agencies shuffling staff and getting creative, looking for new ways to continue seeing patients while thinning numbers of available field staff pose daily challenges.

“Many agencies are telling us they feel like they’re drowning, trying to keep up with patient volume when they just don’t have the resources they need right now,” said SimiTree Principal J’non Griffin, who works with agencies to fill outsourcing needs.

“We’re seeing increasing numbers of agencies turn to outsourcing as a way to handle the workload – and not just for billing or coding,” she said. “They’re also looking at our live QA outsourcing services and other ways we can step in and take over some of the workload to help them.”

Top to bottom vacancies

The SimiTree Insider, a free monthly report offering insight and analysis by SimiTree experts on the industry’s most pressing issues, reported in its January issue that the worker shortage is top to bottom for most organizations. From leadership and supervisory roles to caregivers and aides, agencies are struggling with unprecedented vacancies.

A study conducted late in 2021 by the Home Care Association of America indicated that as many as 66 percent of its 4,000 member agencies had between 10 and 40 openings unfilled. The same study reported that more than half the agencies surveyed said they had turned away multiple cases in the months preceding the study because they lacked the staff to provide adequate care.

Ongoing vacancies are taking a toll on agency leadership, according to SimiTree Managing Principal Eric Scharber, who directs talent solutions, working with agencies affected by the shortages to put into place new retention strategies and create internal leadership development programs.

“Staffing and scheduling problems tend to have a cyclical impact, frustrating and burning out leaders who are constantly dealing with the shortages,” Scharber said. “When you add the regulatory burden to the mix, especially under exceptionally stressful and confusing circumstances, it becomes even more challenging.”

Join us for a complimentary webinar

Scharber will offer some leadership pointers during a complimentary webinar titled, “Retention Strategy: Just Be a GREAT Leader,” at 3:30 p.m. Eastern time on Tuesday, Feb. 15. Register for the webinar here.

Fielding office staff

Stakeholders are responding to ongoing staffing problems by looking hard at caseload comparisons and staffing models, upping wages, and offering hire-on or referral bonuses.

And, in some cases, they’re making tough decisions to deploy office staff in the field, at least temporarily. It’s a risky proposition, since many RNs working in quality review or coding may be reluctant to return to field work, and agencies don’t want to encourage additional resignations.

“But they may not have a choice,” Griffin said. “Prioritizing patient care may require sending RNs from the office to the field.”

Agencies need to be having hard conversations about how best to shift personnel around as necessary to meet patient care obligations, Griffin said. “Even options such as requiring RNs to make home visits one or two days per week may help relieve the staffing burden.”

Examining service delivery

SimiTree consultants often work with agencies to evaluate staffing and workflow as part of operational assessments designed to improve overall agency efficiency and productivity. Re-thinking service delivery models may be necessary to address staffing problems, they say.

Discharging patients earlier, based on patient needs rather than standard lengths of service, may be one way to address staffing issues.

Hospice agencies, as an example, may need to look at discharging patients whose length of service and condition indicates the patient is requiring custodial care rather than true hospice services.

“We sometimes see hospices serving an Alzheimer’s patient for years, although that patient is still eating and gaining weight and not declining,” said SimiTree Clinical Consulting Senior Manager Maureen Kelleher.

In addition to creating ongoing staffing needs, providing custodial care instead of hospice can contribute to staff burnout. “When hospice nurses are not doing what they trained for, providing hospice care, burnout can occur,” Kelleher said.

Using telehealth services

Another consideration for providing effective patient services during the staffing shortage may be relying more strongly on telehealth services, even though telehealth visits are not yet billable through Medicare.

Payment or not, Medicare providers may see an ROI through reduction of visit costs while increasing interaction with the patient. “By adding virtual visits to the Plan of Care, the clinician can ‘visit’ the client in less time and continue interventions toward goals,” said SimiTree Clinical Consulting Managing Director Laura Wilson.

Numerous studies show such marked patient improvement through the use of telehealth. In addition to better patient outcomes and reduced risk of rehospitalization, telehealth may offer patients a higher sense of connectivity with their health care provider, and improve overall patient satisfaction, Wilson said.

“Progress often requires someone being the forerunner, willing to take the risks to solve the problem and demonstrate viability,” she said. “There are so many advantages to the use of telehealth that it needs to play an increasing role in an agency’s service delivery model.”

Lingering reluctance in the industry to use telehealth services for an older population may be unfounded, Wilson added.

“While there’s a mindset that older patients are not tech-savvy and will not welcome telehealth services, that may no longer be true. Social media is popular with Baby Boomers, and a recent study indicated that as many as 65 percent of older Americans look at some sort of social media account daily. Our patients are more tech-savvy than we sometimes tend to think.”

Telehealth offers staffing benefits as well, Wilson said. Virtual visits may play an important role in keeping staff engaged, offering clinicians the chance to work some of the time from their own homes, increasing job satisfaction. “There are ways to develop hybrid models using telehealth and allowing field clinicians a day at home each week doing virtual contacts,” Wilson said.

Identifying burnout factors

Recognizing and addressing staff burnout factors is an important part of an agency’s retention efforts, SimiTree consultants say.

“Every agency is different regarding what the staff wants, and what’s causing burnout,” said SimiTree Clinical Consulting Director Charles Breznicky. “Agency leaders need to look hard at areas where they can make changes to address burnout.”

Mileage may be an example, Breznicky said. With rapidly rising fuel costs, staff may be reluctant to drive so many miles to see patients. Can scheduling adapt to develop more fuel-conscious visiting patterns?

SimiTree works with agencies to set up employee engagement surveys to help determine pain points, so that agencies can take steps to address them.

“But it’s important for agencies to be prepared to follow up on the results,” Wlson cautioned. “Otherwise, the employee survey will just create more ill will.”

SimiTree can help

SimiTree experts say the company offers an array of services to help agencies weather the staffing shortage. Here are a few.

An Operational Assessment will help agencies determine how best to optimize workflow and deal with staffing issues. Consultants work with clients to streamline processes, address timeliness required for compliance and target other operational obstacles hindering productivity and profitability.
Outsourcing services can remove the burden on an agency’s back office for services such as billing, revenue cycle management, coding and OASIS review, Live QA services – even QAPI program oversight, data monitoring and reporting.
An employee engagement survey can identify issues specific to an organization. SimiTree evaluates results and provides an in-depth summary of key findings with specific recommendations and industry insight.

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