Improve Communication With Clients

As part of research for the 2016 Home Care Benchmarking Study, Home Care Pulse’s data analysts discovered that clients’ likelihood to recommend a provider is more closely related to their satisfaction with office staff than their satisfaction with their caregiver. So while many providers focus the majority of their resources and energy on improving their caregivers, they may want to shift their focus to improving office staff communication with clients. Here are a few tips to get started:

Be Consistent
People are creatures of habits. They like consistency and reliability, especially when it comes to their care. You clients want to trust your company, but in order to do this, they need the stability that comes through consistent communication. Set clear times or situation in which you plan to call them, and let them know when those times will be. They may be weekly check-in calls or monthly home visits, or they may be a monthly letter about billing or a daily text message. Regardless of your medium, make sure you’re consistent and that the client knows from the beginning when and how often to expect communication.

Be Prompt
As soon as you are aware of a problem (an error in billing, a schedule change, etc.), inform your client. Let the client know what has happened and how you plan to resolve it, as soon as possible. Forgetting to inform the client, or informing the client only moments before a big change makes your company look sloppy and irresponsible. Make it a priority to contact your clients with promptness, and provide them with updates or additional information as necessary.

Be Flexible
Whenever possible, let your clients determine how often and by what means they’ll receive communication. When you begin services with a client provide them with a few options for communication and then respect what they choose. Perhaps they would like a weekly check-in, or perhaps they’d rather have bi-weekly or monthly calls. If they prefer email or snail mail, accommodate those requests as best you can. When you communicate with your clients using their preferred method, they’ll be happier and more likely to respond.

Be Personal
Conversations with your clients should be more than just factual. They should be personal. When you check in with your clients, be sure to ask how they are and to listen to the answer. You shouldn’t merely rush through the weekly schedule and then end the conversation. Take a few minutes to ask them about their day and their upcoming activities. Write down any key events that are happening so you can follow up the next week. As you engage with them in personal conversation, you’ll build a lasting and trusting relationships based on solid communication.

Boardwalk Homecare Client Survey - Question #4

The strongest relationships are built upon mutual trust and quality communication. Start working with your staff to improve these fundamental areas of communication. As you do, not only will clients be more satisfied with your services, but they’ll also be more willing to tell their friends.

Boardwalk Homecare expands Hourly Services using its Case Management Approach

Neptune, NJ, March 22, 2016 - Since 2006, Boardwalk Homecare has been providing quality live-in home care throughout New Jersey. Mindful that long-term care planning has become sophisticated for discharge planners and onerous for their patients, Boardwalk Homecare embarked on a unique strategy that did not exist in a very crowded home care industry.

Over the course of 10 years, Boardwalk Homecare has developed a Case Management Approach to home care focused on the following principles:

• Be Compassionate, for Everyone You Meet is Fighting a Harder Battle – Help families overcome the stress involved with arranging for elder care on behalf of a loved one.

• If You Want to Do Great Things, Take the Time to Educate - Help families make elder care decisions based on presenting ALL options, merit, suitability and sustainability and NOT by steering them towards a specific provider agenda.

• Better Manage Continuity of Care Through Case Coordination – Help families obtain peace of mind by assigning dedicated case managers to ensure the safety and well-being of their loved ones.

Licensed in New Jersey as a Health Care Service Firm, Boardwalk Homecare’s operation provides much more than the state requires. Boardwalk Homecare’s case managers are proficient at improving communication, education and support for patients planning to return home.

“No other home care provider has made this kind of commitment in supporting not only the initial urgency but more importantly the ongoing responsibility a family faces with managing home care services,” said Brendan Watson, Co-Owner of Boardwalk Homecare. “Discharge planning can be very time-consuming and a patient’s success is typically left to their own devices once they are back home. Boardwalk Homecare’s Case Management Approach addresses both of these needs.”

Boardwalk Homecare looks to build upon their success with live-in care and expand hourly services throughout Monmouth County. Dedicated case managers will continue to play a critical role in providing ongoing education and support to any family exploring home care services.

To simplify the process even further for discharge planners, patients and their families, Boardwalk Homecare does not require ‘minimums’ and has adopted a single flat rate for hourly services.

For more information or to request literature, please contact Boardwalk Homecare.

Company Contact
Brendan Watson, Owner
732-361-7901
watson@boardwalkhomecare.com

GROUNDBREAKING STUDY HIGHLIGHTS LINK BETWEEN HOME CARE AND DECREASE IN HOSPITAL READMISSIONS

Study Shows 30-percent Lower Need for Hospitalization, Millions of Dollars Saved 

Patients who utilize Medicare home health care after a hospital stay are at least 30 percent less likely to require another hospitalization within 30 days, according to a new study released today by the Home Care and Hospice Association of New Jersey.

 

The study comes on the heels of the state’s recent recognition last summer of having the highest percentage of hospitals — 97 percent of the state’s 64 facilities — penalized by the Centers for Medicare & Medicaid Services (CMS) for failing to curb high readmittance rates of Medicare Fee-for-Service patients within 30 days of their initial discharge.

“Those of us in the home care industry have known for a long time that home health care leads to lower rates of readmittance and greater savings to our health care system,” said Chrissy Buteas, President and CEO of the Home Care and Hospice Association of New Jersey. “And now a careful look at the data proves this point. When patients take advantage of home health care, they can dramatically reduce their chances of landing back in the hospital.”

The study was conducted by the Quality Insights Quality Innovation Network, contracted by CMS to improve quality of health care for Medicare beneficiaries in New Jersey, Delaware, Pennsylvania, West Virginia, and Louisiana, and focused on Medicare Fee-for-Service claims from 2014.

The 30-day hospital readmission rate among beneficiaries receiving home health care services was 17.2 percent, as opposed to 24.5 percent among those who received a home health care referral but refused the service. For patients living with multiple (four or more) chronic illnesses, the disparity was even greater, with 23.7 percent of home health care recipients requiring a readmission as opposed to 31.8 percent of those who refused home health care.

Overall, the study suggests that approximately $6.9 million could have been saved from the Medicare system if patients who refused home health care services following a hospital discharge had instead taken advantage of them.

“Home care works because registered nurses and therapists are trained to recognize the subtle differences in a patient’s condition to make a medically sound assessment of which symptoms require a trip to the hospital and which do not,” said Buteas. “More importantly, as this study suggests, home care is playing an important role in allowing people to manage their health not in a hospital, but in the place in which they are most comfortable, their own home.”

Why Choose Live-In Care?

There are many instances where home health care is required but why choose a live-in caregiver vs. hourly care for your loved one? Live-in caregiver offers the optimum in home health care at a more affordable rate. Did you know that the daily flat rate for a live-in equates to about nine hours of hourly care? Not only is this a significant financial value, but your loved one benefits from a caregiver being in the home around the clock.

Continual Trust
In addition to affordability, a live-in caregiver can offer unsurpassed care and companionship. Your loved one can develop a trusting relationship with his or her caregiver. Likewise, your caregiver will really get to know you or your loved one, including his or her daily activities and preferences. Everything from a favorite lunch to preferred hobbies and pastimes. Live-in home care offers your caregiver and your loved one a chance to become friends.

Continual Care
There is nothing more important than continuity of care for your loved one day in and day out.  A live-in caregiver is always there, providing the same caring style seven days a week, with no disruption to the client’s routine. A live-in caregiver is dedicated to ensuring constant and consistent home health care. Even when your caregiver needs a day off, most agencies provide a trained relief caregiver to ensure continuous and seamless care.

Continual Comfort
Opting for a live-in caregiver to care for your loved one can also be a constant source of comfort. Nothing compares to knowing that a quality, trained and compassionate caregiver is with your loved one at all times. Finding consistent, quality of care from a licensed home health agency you can trust is essential to your peace of mind.

When to Consider?
What are some life circumstance examples where live-in home care assistance is especially useful? 24-hour home care assistance is especially useful for anyone with Alzheimer's disease or memory conditions that may cause them to wander, to forget medications or maintain nutrition. It is also beneficial for a person who is a fall risk at night when getting up to use the restroom or is generally frail when moving about. If someone is not able to respond to an emergency and would need assistance, then the presence of a live-in caregiver is needed for both safety as well as comfort. Live-in home care assistance is obviously needed for any bed-bound person who needs total assistance. It is also useful for people who feel anxious or get lonely easily or who have incontinence and cannot do all of their personal care on their own. 

Top 5 Policies for Live-In Home Care Services

While there are a number of policies and procedures to consider in creating a successful live-in home care experience, the following are some key ones that should be addressed right at the start! The list has been comprised using the 80/20 rule (roughly 80% of the effects come from 20% of the causes).  Here are the Top 5:

1. Job Description: While licensed home care providers will institute a Plan of Care for their caregiver to follow based on a nurse assessment, families who hire a caregiver privately are encouraged to clearly identify every task the caregiver will be responsible for performing. In addition to describing which personal care (ADLs) and homemaker (IADLs) activities are required, it is equally important to determine the daily routine. Details around the care recipient’s routine should cover time of day and/or frequency of when specified activities should be performed. Additionally, the routine should include instructions on how to perform these activities to the liking of the care recipient or their family.    

2. Defining the Workday: Based on Department of Labor regulations, licensed home care providers will define the number of hours a caregiver is expected to work in a 24 hr. period. This is typically between 8-13 hrs. per day (a standard set of hours has not been adopted across the industry yet because new federal regulation was recently passed and licensed home care providers around the country are still trying to figure out its application to live-in home care). The two most important aspects both licensed home care providers and families hiring private caregivers will be to establish the critical times of day for the care recipient and the uninterrupted sleep time/meal times/ break periods for the caregiver. In defining the workday, it is very important to allocate appropriate times in the day (e.g. break periods) for when the caregivers can use the time for their own purposes such as making calls on their cell phone, using the internet, watching television, exercising or reading.  

3. Food Appropriations: We have covered food appropriations extensively in the past. This is because it can be a pretty big hurdle if left unaddressed. The three key aspects to food appropriations include: food expense, food purchasing and food preparation. The food expense should cover whether or not the family provides the food for the caregiver or if they would prefer giving the caregiver a daily food stipend. The food purchasing should go over who is responsible for buying groceries and what the process is for doing so. In addition, methods should be put into place to limit identify theft (using debit cards, credit cards or checks) and to track petty grocery cash and receipts. The food preparation piece should go over cooking safety, meal preferences as well as any type of diet, allergy or nutrition requirements of the care recipient.

4. Theft Prevention: The mission should be clear – implement methods to prevent the loss or theft of care recipient valuables. Some of this risk can be reduced prior to hiring a caregiver by conducting criminal background checks and purchasing insurance coverage such as a commercial crime bond. Additionally, families are encouraged to safeguard a care recipient’s valuables and keep them out of reach from people in and out of their home. For care recipients suffering from a neurological impairment, such as Dementia, it may also be a good idea to keep a detailed inventory of personal items in case they become confused or paranoid. From a policy perspective, families should be very clear on their position when it comes to giving gifts to caregivers and under what circumstances – if any – it would be permitted.

5. Emergency Preparedness: Orientating caregivers on emergency planning is certainly a topic that needs to be addressed. It should begin by providing a list of contacts and their phone numbers (family members, neighbors, doctors, fire department, etc.). The list should identify and prioritize who should be called in the case of any specific events. Clearly the primary care physician would not be the first one called if the household has run out of milk! In all seriousness, it is too often that incidents are not reported by caregivers so families need to be firm on the protocol and make sure the caregiver understands the importance of notifying them on a regular and/or emergency basis.

Live-In Home Care: Acceptance of Care

People have a tendency to delay long-term care decisions until absolutely necessary. Naturally, we can all understand how an individual of declining functionality might have difficulty facing the reality of waning independence. The concept of live-in home care, in which a stranger is entrusted to live and care for someone in their home, can be challenging and it is often avoided due to the individual’s denial of their need for care.  

While it is very common for elders to disagree with family members on their need for live-in home care, it is just as common for elders to refuse assistance from caregivers once service has started for a number of reasons. The primary obstacles to acceptance of live-in home care include:

• Fear of losing their independence
• Alarm about the cost of live-in home care
• Distress of having a stranger live in their home
• Conflict around other cultural backgrounds and/or language barriers 

It is important for families to understand that a care recipient may have these feelings no matter how compassionate, caring, attentive and competent the caregiver may be. Some ways in which we have seen success in helping a care recipient overcome their anxieties include:

• Explain that assistance in one area may provide them with independence in another area
• Explain that the caregiver is there to provide a break for other family members directly involved with providing care to help avoid ‘caregiver burnout’
• Reinforce the advice of their medical professionals (e.g. physician, rehab facility, etc.) that live-in home care is necessary in maintaining their health, safety, and independence even if it is for the short-term
• Refer to any friends, neighbors or relatives who have had a good experience
• Get the care recipient to open up about their own fears or discomfort with live-in home care and explain what measures will be taken or support included to overcome those objections 

A family meeting is a good way to launch a cooperative effort for care of a loved one. As a forum for sharing information, feelings and thoughts on the best way to set up live-in home care, it can also improve communication and cooperation as it relates to the care recipient, caregiver and other family members.
Be very clear about the purpose of the family meeting and about the topics to be discussed. Expect there to be some differences of opinion. It may be helpful to provide everyone with a checklist of items ahead of time. These might include:

• How much and what kind of care is needed?
• What tasks and routines will be assigned to the caregiver?
• Are there any special instructions in handling these tasks?
• What involvement is expected of other family members?
• Will there be a need for a fill-in caregiver for scheduled breaks or will family members provide gap coverage?
• Which family member will be listed as a single-point-of-contact for the caregiver and the home care provider?
• Which family members will be listed as emergency contacts?
• Who will be responsible for handling the medication setup?
• Who will be responsible for grocery shopping, running errands or taking the care recipient to doctor appointments?
• Which family member will take the responsibility of maintaining contact with the physician or skilled nurse?
• Which family member will be responsible for purchasing medical equipment or making arrangements to modify parts of the home if needed?
• Who will handle the finances?

The process of implementing live-in home care successfully takes a good amount of effort so families should expect to provide ongoing encouragement and to help target the causes of a care recipient’s opposition prior to the start of service. Being proactive to ‘solve the solvable problems’ will be a key ingredient in helping gain the acceptance of a caregiver when they offer a lending hand.     

Live-In Home Care: How best to manage food appropriations – Part 3

Food appropriations combined with meal preparation is often one of the most challenging aspects of live-in home care for both the care recipient and the caregiver – not to mention for other individuals or family members involved in the process. 

To adequately cover what can be considered a broad topic with many parts, we have created a Three Part Series to cover key aspects which includes:

• Part 1: Introduction to Food Appropriations 
• Part 2: Assessing Needs and Making Preparations
• Part 3: Implementing Policies and Procedures

Part 3: Implementing Policies and ProceduresIn Part 1, we discussed the importance of families making a decision on how they would prefer to handle food appropriations prior to setting up live-in home care services. While each situation is unique, the family will have to decide on either purchasing food for their caregiver or providing their caregiver with a food stipend so they can handle this responsibility on their own.

In Part 2, we discussed the importance of families making preparations in the home. Readying the kitchen in terms of basic cleaning and fresh food supplies for both the care recipient and the caregiver is a good start. Additionally, families are encouraged to go over safety measures with their caregivers as well as providing input on how best to prepare meals for their loved one to ensure nutrition and well-being are the priority.

Good preparation is the key to success when managing the food appropriations and meal preparation piece of live-in home care services. With some of the bigger tasks out of the way, families are encouraged to implement a procedure on how food is delivered and a policy on how to handle food purchasing. In Part 3, we will present recommendations for both.

It is not uncommon for families to assume their need for a ‘driving’ live-in caregiver who is has a valid driver’s license and who is also willing to handle this task so they in turn can assist with transportation for medical appointments, picking up prescriptions at the pharmacy and of course handling the grocery shopping.

When analyzing the live-in caregiver ‘labor pool’, it is important to note that there are very few caregivers who are legally licensed to drive in the United States. Of the live-in caregivers who do have a valid driver’s license, a fractional number actually possess their own vehicle. Additionally, many live-in caregivers hired directly by a family or through a licensed home care agency are very apprehensive about driving due to insurance liability concerns, the risk of leaving a care recipient alone or the unknown potential behavioral issues which can occur while driving a care recipient suffering from a neurological impairment.

When a care recipient does not have a family or friend network in place to assist with these driving matters, Boardwalk Homecare often times looks to provide them with community-based volunteer organizations which provide transportation services to homebound seniors. Typically, we recommend families contact their local town’s senior center or county office on aging to inquire about such volunteer organizations. Additionally, a number of supermarkets are making it easier for people to shop online (or over the phone) for at-your-door grocery delivery. One of the larger online services is Peapod which has a partnership with Stop & Shop and Giant Food Stores. As you shop online you can compare items and check out the nutritional labels to see if the food fits your dietary needs. Peapod also features sales and deals on select items every week and there are even coupons you can download and clip. Additionally, Peapod has added a number of features for their Mobile App making it even easier for caregivers to manage the grocery shopping process on a Smart Phone. This is extremely beneficial considering the number of situations that occur where senior care recipients do not have internet access or a personal computer.

When a caregiver has been assigned to assist the care recipient with purchases, such as buying groceries, we strongly suggest the family institutes a policy or system of expense monitoring. The purpose of the policy is to make sure caregivers are fully aware of their responsibilities and the family guidelines when paying for goods or services with the use of care recipient’s private assets including checks, bank cards, credit cards, cash and any other method of payment.

If the caregiver is responsible for purchasing items on a regular basis, we typically recommend the family obtaining a credit/debit card that can be used solely by the caregiver. One card makes expenses easy to track and anything inappropriate should be easily identifiable. Families should be sure to guard security information with the financial institution issuing the card and credit agencies.

Another option is to set aside a designated amount of petty cash which can be kept in the same envelope as the receipts. With this type of arrangement, we suggest the family reconciles the receipts and change with the caregiver prior to adding more funds to the petty cash envelope.

In conclusion, spending time to work out all of the details with food appropriations and meal preparation will make a big impact on the success of the live-in home care experience for everyone involved!