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Set clear standards and be sure they’re met
"Having a handbook lets employees know clearly what the rules are for working at your agency, what they can expect from your company, and what the company expects from them," says Kathleen Bailey, owner of Private Duty Solutions, a home health care consulting firm that specializes in private duty/private pay services. "It’s a very important management tool, especially given the litigiousness of our society today. What kind of defense do you have in court without it?"
Bailey divides her prototype handbook into three sections: standard employee policies; policies relating to working with the office staff; and rules for employee conduct in the client’s home. "You need to have employment standards, things that your employees must do in order to remain employed by you," she says.
Bailey says a handbook should also describe the hiring process and specify such items as a dress code, substance abuse, and absenteeism. "Your termination policy should also be clearly stated," she says. "I think it’s also very important to include policies outlining how employees should deal with clients."
She suggests beginning with a statement such as, "The following policies have been established for the benefit of the home care staff to prevent potential conflicts between our clients, their family, the agency, and you, the direct care staff," and point out that if an employee conducts himself/herself in accordance with those policies, a misunderstanding that could lead to claims of abuse, neglect, theft, or any type of criminal conduct can be limited. "An employee policy handbook is really management’s best friend."
An employee sampler
As an example of the kinds of policies she advocates, Bailey points to the 10 sample policies below, which are excerpted from 32 policy examples in her book.1 "These are a sample of commonly violated policies that should be included in all employee handbooks," she says.
Policies for home care staff that relate to clients:
1. Do not solicit money from clients for any school, social, church, volunteer, or charitable organization.
2. Do not accept any gifts from a client. The agency does recognize, however, that on some occasions (birthdays or holidays) a client may want to express appreciation or good wishes with a gift. If so, please inform the client that he/she must contact the office before you can accept any gift. This protects you from confused clients who may think you stole the item.
3. In this state, it is illegal for anyone other than licensed professionals — RNs or LPNs — to administer medication or injection. You may not, under any circumstances, dispense or administer medication (including over-the-counter or prescription) unless you are a licensed professional nurse, and then only with a doctor’s order that has been obtained by the nursing supervisor. If you are not licensed, and are requested by the client, the client’s family, or the client’s doctor to dispense medication, you must refuse to do so and call the office immediately. We will make arrangements to assure the client receives his/her medication. Your responsibility is to say "NO."
4. Do not discuss matters relating to a client’s Last Will and Testament with the client or anyone. If a client asks you for advice, encourage the client to consult an attorney. Employees may NOT sign or witness any documents for the client, such as checks or wills.
5. Never accept private employment from a client for whom you have provided services through this agency during the preceding 90 days. Accepting work within the 90-day period will place you in violation of this policy and may be grounds for termination.
6. Do not bring any unauthorized individual into the client’s home. This means you may not bring your children, family members, friends, or pets into the client’s home during a scheduled assignment or when you are off duty.
7. Do not give your home telephone number or address to any client or institution for whom you may work. Even if the client asks you, do not give your number. They can contact you through the office. The agency never gives employee’s home telephone numbers — for your protection.
8. Employees are NOT PERMITTED TO SMOKE cigarettes or any other tobacco products while on duty in a client’s home. If you are working in an institutional setting, you must abide by the regulations of that institution.
9. Do not discuss your personal problems with the client or their family. A health care worker should never develop a social relationship with the client or their family. Try to maintain a friendly, but professional relationship.
10. Do not discuss your hourly wage with clients or fellow employees.
The necessary element for staying power
"Good quality assurance means different things to different people," Bailey says. "From the agency’s point of view, it means providing what they perceive as good, quality service, doing things like offering supervision, training employees, and meeting accreditation standards." She says that clients don’t care about any of that, and points out that, for the client, quality means that when a caregiver is in their home, that person is compatible with them.
"Clients do want that caregiver to have the necessary skills, however," she says. "They want the same caregiver to show up on a regular basis. They don’t want to see a new face every other day. They also want that agency to provide the service on a continuing basis with no gaps in service."
Employee supervision is essential to quality assurance. The agency might have a policy that a supervisor goes out to monitor the quality of the in-home care every 60 or 90 days, unless state regulations mandate differently. Bailey cites formal visits to clients’ homes and case monitoring by the office coordinator as two excellent methods of assuring quality. "Your coordinator should ask how things are going every time any employee comes into the office. She should also ask the clients how things are going. Keep the lines of communication wide open with the caregiver and the client on a regular basis and document results. That way, you’re keeping tabs and heading off possible problems before they develop."
Rate your caregivers
Bailey also recommends that agencies routinely survey their clients. "The client should receive a survey once a year," she says. "It should be a simple format the client uses to rate the caregiver, their interactions with the office staff, whether their bills are easy to read and understand. You need to survey each aspect of the contact with that client."
On the topic of accreditation as assurance of quality care, Bailey says that meeting accreditation standards mandates good quality control. "But every agency has to decide whether it’s in its best interests to become accredited," she points out, adding that an agency can give excellent care without being accredited.
"Sometimes, you have to be accredited in order to get your contracts," Bailey says. "Now, here’s where it gets tricky. You need your accounting person to run the numbers and find out if the cost of becoming accredited can be recouped. Your total costs may be $6,000 to become accredited, but you’re only going to get $4,000 in business because you are accredited. That’s when management has to decide whether the public perception of quality care from your agency is worth the extra expenditure in your community. In some parts of the country I think accreditation is very, very important. Where I live it doesn’t matter at all because no one is accredited, and we have some excellent home care companies here."
She also says that agencies have to look at how many staff hours it will cost to get that accreditation, hours your staff could instead spend generating new business. "Let’s say you have an employee you are paying to work 30 hours a week and she has to spend 10 of those hours making sure your documents and records meet accreditation standards. That’s 10 hours a week of salary that you can save if you’re not accredited. Your costs will probably be lower if you are not accredited. Many agencies pay a consultant to come in and do a mock survey before the surveyor comes in because of fear the agency won’t meet the accreditation standards. That’s another cost."
Accreditation may or may not be useful in your area for marketing purposes, but proven marketing practices are always important. First and foremost, Bailey emphasizes the need for a marketing plan. "You have to set specific goals with a time frame," she says. "Your plan should identify your market segments. Who are your clients? Who are your referral sources? How do you plan to let your community know about your services?"
She stresses the need for a way to evaluate the effectiveness of marketing techniques used in order to know where your business is coming from.
Bailey also says agencies need to know what their competition is doing because they may be able to plug into one of a competitor’s weak points or strengthen their own offerings. "For example, if they accept credit cards or have a minimum number of hours for providing service, you probably should too. You also want to make sure that the services, prices, and the pay rates you offer are in the same ballpark."
To obtain this information, she suggests picking up competitors’ information at public gatherings and calling them anonymously with specific questions. "Be sure that your application for employment asks for current pay rate information," Bailey says. "When a competitor’s employees come to your agency to apply for work, this information should be slotted into your marketing file."
Bailey recommends hospital discharge planners and social service departments as good client referral sources. "Also, be sure that your local trust officers, attorneys, assisted living communities, physicians, clergy, and adult day care centers have information about your agency and the services it offers." She also advises making one-on-one sales calls.
"If you go to an assisted living facility or a suite of physicians’ offices, it might be helpful to take a tray of sandwiches with you," she says. "Keep it simple and brief, just give them a reason to sit with you for 15 minutes so you can tell them about your services. Concentrate on what’s in it for them. That’s what everyone wants to know."
Try narrowing your audience
She points out that the Yellow Pages are one of the first places people look when they need caregiving services, but she says television or radio advertising is usually not cost-effective because it goes to a very broad audience. "You want to target a very narrow audience," Bailey says. "Sometimes newspapers will have special sections targeted to senior citizens. Consider advertising in any newsletters in your town that go out to higher income-level people. In my area there’s a senior citizens’ expo now. It started out with only about 30 vendors, but now it’s huge! There are probably 150 vendors now, and it’s only three years old. Often, it’s the people in their 60s, who have the time to attend an expo, who need private duty home care services for their parents. You’re getting to the target market, but not necessarily through the target client."
(Editor’s note: The request-for-service document which accompanied last month’s article featuring Kathleen Bailey fell victim to a production error. We are including the corrected form with this issue, although it is not referred to in this article.)
1. Bailey K. Employee Policy Handbook for Private Duty Agencies. Lancaster, PA: Zellem Printing; 1999.
• Kathleen Bailey, President, Private Duty Solutions Inc., 313 W. Liberty St., Suite 126, Lancaster, PA 17603. Telephone: (717) 509-4452. Fax: (717) 509-7397. E-mail: kbailey@ privateduty.com.