As home health organizations fight for a margin in tough labor and payment environments, they are increasingly seeking ways to help employees practice at the top of their licenses.
By applying top-of-license assignments in organizations, less complex work is handed off to the level below. This allows organizations to see more patients, bill for more services, reduce burnout and provide better care. The process helps employees feel more satisfied, and also could help with recruitment.
“What we’ve got to do is improve our margins,” Pinnacle Home Care CEO Shane Donaldson recently said at Home Health Care News’ FUTURE conference. “That means we’ve got to get evaluating clinicians to do as many evaluations and assessments as possible, and we’ve got to get the non-evaluating clinicians doing the majority of straight visits.”
Pinnacle Home Care, based in Oldsmar, Florida, is a Medicare-certified home health care company that delivers services across the state.
The idea is that highly experienced health care professionals trained to diagnose and manage complex illnesses should be able to do so, while colleagues with less training handle routine tasks and documentation requirements. Using this logic, many organizations have added positions to care teams, enabling people with advanced clinical training to focus on using that training.
“We understand trauma levels; consider complexity levels one, two, and three, with three being the most complex,” Mike Johnson, chief researcher for home care innovation at Bayada Home Health Care, told HHCN. “The home health aide could do much of the work for level one, the licensed practical nurse (LPN) for level two and the registered nurse (RN) for level three. This helps us expand the workforce because the nurse isn’t being asked to do everything he or she is now. It should make the clinicians feel more like they’re using their skills to the best of their ability.”
Bayada, based in Moorestown, New Jersey, provides home health, home care and hospice services in 23 states and six countries.
Top-of-license work can increase professional satisfaction because employees use more of their specialized skills. Helping health care workers stay engaged is especially important, given the rising rates of burnout.
Failing to position staff at the top of their license level carries significant consequences, including inefficient operations, negative patient sentiment and a workforce gap of over half a million supporting positions by 2025, according to a Mercer report.
Mercer suggests conducting ethnographic research to identify where employees spend too much or too little time to help identify priorities. Research also suggests optimizing resources to ensure talent performs work that requires their credentials, is engaging and can’t be digitized to free up skilled resources.
“We design our care around how we get paid, not necessarily thinking about how we’ll do our best,” Johnson said. “We need to consider how we redistribute the workload so everyone works to the best of their abilities. How do we leverage more of the value home health aides bring that we have yet to give them credit for?”
Prioritizing delegation, continuing education
Sharing accountability for patient care can be effective, using delegation. However, according to Johnson, it is essential to understand that for this way of working to be successful, the organization must increase communication and build trust between colleagues.
Experts agree that effective delegation can ensure that staff aren’t spending too much time on tasks for which they are overqualified.
Delegation begins with assessing the tasks that are typically handled before identifying which can be safely performed by staff with less training.
To that end, Johnson suggested ensuring the entire team focuses on continuous learning and prioritizes expanding their knowledge and skill sets.
Prioritizing ongoing education helps ensure that staff see working at the top of their license as an opportunity, rather than a burden.
