Monday, November 06, 2006

For-Profit Home Care Company Gets Federal Grant for Telehealth Equipment

REDSTONE TWP. PA - Hundreds of patients a year in Fayette, Greene and Washington counties in Pennsylvania could benefit from a federal grant to Family Home Health Services Inc.

The U.S. Department of Agriculture-Rural Development is giving the health-care service $62,900 from the Distance Medicine Rural Development Fund. The money will be used to buy 15 telemonitoring units and three nursing monitor systems that will allow physicians to access data from the patient monitors through a secure Web site.

Family Home Health Care is one of four Pennsylvania agencies receiving a USDA telemedicine grant. The USDA recently announced that 103 Distance Learning and Telemedicine grants are being given out nationwide.

Thursday, November 02, 2006

Home Health Care is Big Business in Florida

Gene Tischer, executive director of the Associated Home Health Industries of Florida, Inc., was recently quoted in the Daily Sun that “The demand for home care will far exceed the home caregiver resource supply. Whoever is able to hire and retain good home health care nurses will be successful.”

This is great news for those thinking of becoming a home health caregiver. Business is booming and the demand for qualified caregivers is at an all time high. The significant baby boomer influx is creating a huge demand on the home caregiver infrastructure and means big bucks for those entering the industry.

The growth has been unprecedented. There are 1,625 licensed home health care agencies, according to the state Agency for Health Care Administration. That represents a 53.4% increase from the number of firms from the year 2000. Home health care expenditures just in the state increased 34 percent to nearly $3 billion from 2000 to 2004, the federal Centers for Medicare & Medicaid Services advised earlier this year in the most recent report from its Office of the Actuary. On the national level, Florida accounts for about 6.9 percent of all home health care expenditures. It ranks fourth behind New York, $6.1 billion; California, $5.6 billion; and Texas, $3.7 billion.

source: my nursing degree online blog

Saturday, October 21, 2006

P4P for Physicians

The Centers for Medicare and Medicaid Services (CMS) announced a new initiative to pay physicians for the quality of the care they provide to seniors and disabled beneficiaries with chronic conditions, reflecting the Medicare Administration's ongoing commitment to reward innovative approaches to get better patient outcomes for the health dollar.

We intend to provide better financial support for quality care," said CMS Administrator Mark B. McClellan, "Through this demonstration and the rest of our set of value-based payment demonstrations, we are finding better approaches to doing that than ever before. This is another important step toward paying for what we really want: better care at a lower cost, not simply the amount of care provided."

As the next step in its efforts to make higher payments for better quality, CMS announced the implementation of a new demonstration aimed at physicians practicing in solo or small to medium sized group practices. CMS has already implemented several other "pay-for-performance" demonstrations, including the Premier Hospital Quality Incentives Demonstration which involves acute care hospitals and the Physician Group Practice demonstration which involves 10 large multi-specialty group practices across the country.

The Medicare Care Management Performance (MCMP) Demonstration was authorized under section 649 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). It will be implemented in four states: Arkansas, California, Massachusetts, and Utah in 2007.

A question for home care leaders: With CMS working on P4P for hospitals and physicians, how long do you think it will take to also create a P4P for home care? We've heard a lot of talk about P4P for our industry segment. Will it really come soon, and what will it look like? Give us your comments below.

November is National Family Caregiver Month

New York, NY – This November, Companion Connection Senior Care, a national home care membership organization, honors Americans who are the primary caregiver for an aging or disabled loved one during the annually celebrated National Family Caregiver Month.

With over 50 million Americans caring for an aging parent and more than 50% of those caregivers reporting “burn-out,” National Family Caregiver (NFC) Month offers validation and support for the growing population of family caregivers. One of the key ways that family caregivers can avoid burnout and practice self-care is through finding support and outside help. Professional non-medical home care is a perfect solution for family caregivers because it offers assistance with caregiving duties and support and expert advice for the family caregiver.

Respite or supplemental care reduces caregiver stress, helps restore balance and enhances the relationship between the caregiver and their loved one.Companion Connection Senior Care offers support and respite resources for family caregivers through referrals for home care to supplement and relieve family caregivers. Americans can locate quality, compassionate and trustworthy home care.

Elda DeLorenzo of Hollis, New Hampshire, is one of millions of Baby Boomers who is currently facing the responsibility of managing care for an aging parent. DeLorenzo brought her elderly mother home to live with her after she began declining in nursing care. “I first tried putting my mother in a nursing home but she was getting worse. I knew that the only option was to care for her myself but I quickly found myself in over my head,” said DeLorenzo. “Finally I sought help from Classic In-Home Care, a local home care agency and member of Companion Connection Senior Care, and now I receive support 20 hours a week from wonderful and compassionate caregivers. Before I got help I was going crazy. Getting help that I could trust was such a relief and made my life so much easier.”

Across America, more and more aging Americans are choosing to stay at home and be cared for by family members instead of entering institutionalized care. In fact, according to a recent AARP study, 89% of people over 50 wish to remain at home as long as possible. This shift towards aging at home is putting pressure and responsibility on adult children, grandchildren and loved ones of elderly. Suddenly they are faced with the responsibility of providing care and aren’t always prepared for the emotional and physical toll.

National Family Caregiver Month was developed to recognize and validate the roles of family caregivers.“Supporting and caring for loved ones of family caregivers is a privilege for our members and as leaders in the home care industry we understand the challenges that these caregivers face,” said David Goodman, president of Companion Connection Senior Care. “We honor and support family caregivers by providing them with referrals to high quality respite or supplemental help if and when they need it.”

About Companion Connection Senior Care

Companion Connection Senior Care is a national membership organization for non-medical home care agencies. Members are provided with regular ongoing training and support and are held to high standards. With over 80 members across the United States, Companion Connection Senior Care is a pioneer in the home care industry, meeting the exploding need for non-medical home care services.

About National Family Caregiver Month

NFC Month—observed every November—is a nationally recognized month that seeks to draw attention to the many challenges facing more than 50 million family caregivers, advocate for stronger public policy to address family caregiving issues and increase the community programs that support family caregivers. NFC Month is sponsored by the National Family Caregivers Association.

Friday, October 20, 2006

NPDA Starts Florida Chapter

The National Private Duty Association (NPDA), a group for private duty home care providers, has formed a Florida state chapter.

NPDA President Sheila McMackin said a large percentage of the nation's private duty home care providers currently operate in Florida.

The nonprofit organization already represents more than 600 home care agencies in 44 states and Puerto Rico. McMackin said the Florida chapter will give this state's private duty home care providers an opportunity to work cooperatively on important legislative issues, share resources with other agencies and participate in training and education programs.
Members are also to have access to industry news and information that could affect the way all agencies conduct business.

"Because of the many challenges facing the providers of private duty home care, it is becoming increasingly important for agencies to join together so that we can continue to improve the industry and protect the health and safety of consumers," McMackin explained. "The NPDA promotes strong ethical standards and is dedicated to educating the public about private duty home care."

The NPDA has scheduled informational meetings around the state for private duty home care agencies. In South Florida, there are sessions scheduled at 5 p.m.:

Oct 24, at Atlantis, 6026 Old Congress Road, in Lantana

Oct. 26, at The Sterling of Aventura, 2777 N.E. 183rd Ave., in Aventura

Nov. 7, at Summerville at Regency Residence, 5600 Lakeside Drive North, in Margate

To sign up for one of the informational sessions, call (866) 282-4823 or e-mail

Thursday, October 19, 2006

USA Today Article promotes Home Care & Hospice for End of Life Care

The cover story in the Money section of USA Today for Thursday, October 19, 2006 focuses on the cost of end-of-life care, and poses the question, "Should treatment be provided, regardless of cost or quality of life?"

The story is based on data from the Dartmouth Atlas Project that evaluates variation in medical care across the country. The report shows that the cost of care during the last six months of life varies from $24,591 in the District of Columbia to $12,878 in Idaho. The biggest factor affecting cost is the availability of doctors and hospital beds. Another factor that comes into play is the willingness of doctors, hospital staff, and hospices to talk with patients about end-of-life, what kind of care they want, and where they want to die.

According to Joanne Lynn, a geriatrician who worked for the RAND corporation, "Substantial progress could be made in slowing rising costs if the U.S. health system could find better ways to reduce hospitalization for people at the end of life, such as providing more in-home services."

What can we do as leaders in home care & hospice to get this message out to the rest of the healthcare delivery system? Post your comments below.

Wednesday, October 18, 2006

What's the Best Way To Expand Your Business?

You have a successful home care business. What's the best way to expand it?

You could start up new programs and services. You can start up a new branch in a new location. Or, you can acquire an exisiting business.

One of the best breakout sessions at NAHC (other than mine, :-) ) was presented by Dexter and Steve Braff from the Braff Group. They mixed their typical "growing up brothers back-and-forth humor" combined with solid financial data to give us some real meaty information to consider.

First, Steve identified four specific costs to consider in expanding your business:
  1. The initial capital outlay
  2. The loss you may need to absorb
  3. Lost opportunity costs over time
  4. Use of senior management time and resources

Then he gave us an expanded view of ROI - Return on Investment. To fully grasp the ROI on your expansion strategy, you need to consider:

  1. Profits from the new business
  2. The terminal value of the new business when you exit or sell it
  3. The value of intellectual or human capital that is accumulated in the business
  4. Stock price movement
  5. Arbitrage -- buy low and sell high
  6. Elimination of barriers to entry (CON, Licensure)
  7. Allocation of Scarece Resources

Then he outlined the alternatives:

  • Acquisitions
  • Start up
  • New Program Development

Then brother Dexter came up and ran through several very interesting spread sheets showing the cost of the three alternatives, and the potential return in each of the categories described by Steve.

If you'd like more information on their concepts, go to The Braff Group web site, and then contact Dexter or Steve. I'm sure they'll be happy to send you a copy of their presentation information.

Congratulations to Warren Hebert on Robert Wood Johnson Fellowship

If you see Warren Hebert, CEO of the Home Care Association of Louisiana, tell him "Congratulations."Warren was selected to be part of a very small group of nursing executives to become a RWJ Executive Nurse Fellow.

The Robert Wood Johnson Executive Nurse Fellows Program is an advanced leadership program for nurses in senior executive roles who are aspiring to lead and shape the US health care system of the future. Their mission is to inspire experienced nurses in executive roles to continue the journey toward achieving the highest levels of leadership in the health care system of the 21st century.

The program seeks applications from outstanding nurses in executive roles from health services (including patient care service, integrated delivery systems, health plans, and other health organizations engaged in organizing and delivering health care), public/community health, and nursing education who, along with their employing institutions, are willing to make a three-year commitment to the program. The fellowships are intended to offer participating nurses the experiences, insights, competencies and skills necessary to achieve, or advance in executive leadership positions in a health care system undergoing unprecedented change.

The RWJ Executive Nurse Fellows Program is a national program supported by The Robert Wood Johnson Foundation with direction and technical assistance provided by the Center for the Health Professions, University of California, San Francisco.

Tuesday, October 17, 2006

Here's the Law Governor Romney Described on Monday at NAHC

A landmark bill was signed into law which will allow many more low-income seniors and disabled adults to be able to receive the state-funded home care services they need in their own homes or in the community rather than in nursing homes.

Entitled "An Act Regarding Choice of Long Term Care Setting," the bill requires that low-income elders and disabled (specifically those covered by Medicaid or Mass Health) a) receive pre-admission counseling prior to long- term care placement about home care/community care options that are less restrictive such as home care, adult foster care, or day care.

Should these persons choose home care or community care options over nursing home placement, the funding that would have gone to reimburse the nursing home for the individual's care can now instead be used to pay for home care/community care services.

In other words, the "dollars follow the person" as his/her setting of care changes. Pre-admission counseling about such options will also be provided to non-Medicaid/Mass Health covered elders/disabled persons, but on a voluntary basis.

New state legislation also creates a work force registry to match consumers with caregivers, retains the right of persons with disabilities to have control (hiring/firing) over their personal attendants, creates a council to recruit and train caregivers, provides a network of backup/substitute caregivers, and allows attendants to join unions. This is key legislation as the turnover rates for caregivers is between 40 and 60 percent annually.

source: The Sharon Advocate

Home Health Care Provider Pleads Guilty for Medicare Fraud

I believe this may be the case that Bill Dombi mentioned in his presentation during the opening general session on Sunday at the NAHC annual conference:

LOS ANGELES, CA (AP) -- The San Diego-based owner of California's two largest home health care businesses has pleaded guilty to health care fraud that cost Medicare 40 million dollars.
Lourdes ''Lulu'' Perez entered the plea yesterday in federal court as part of a settlement in which she, her husband and her two businesses repaid nearly 34 million dollars to the government.

Perez is scheduled to be sentenced on October 16th. Prosecutors have recommended that the 53-year-old be sentenced to 46 months in prison, but she could get up to 59 years.
Perez was the owner of Los Angeles-based Provident Home Health Care and San Dimas-based Tri-Regional Home Health Care. Prosecutors say the businesses billed Medicare for work that was never performed.

Former provident nursing director Margaret Tan has cooperated with the prosecutors' investigation. She's scheduled to enter a plea October 23rd.

Delta Health Technologies Announces Strategic Partnership with CellTrak Technologies

Monday October 16, 10:15 am ET

ALTOONA, Penn., Oct. 16 /PRNewswire/ -- As part of its ongoing commitment to bringing reliable software products and unyielding service to home care, Delta Health Technologies has announced a strategic partnership and distribution agreement with CellTrak that will allow Delta customers to transmit clinical data via their cell phones, eliminating paper in the home care setting. Under the terms of the agreement, Delta will make the CellTrak product available to its customers effective immediately, integrating the product with its software.

What other innovations are you seeing in home care technology? Comment below:

Monday, October 16, 2006

Selecting, Hiring and Managing Home Care Sales Professionals

This afternoon, I presented a program on Selecting, Hiring and Managing Home Care Sales Professionals. The room was full, and we had great interaction. Thanks so much to all of you who were there.

Here are some of the points we discussed:

The Role of the Sales "Coach."

  1. Pick the right players
  2. Teach the basic skills
  3. Drill the fundamentals
  4. Push your sales team members to be bette than THEY think they can be
  5. Implement your sales game plan
  6. Maintain motivation & enthusiasm
  7. Provide immediate and ongoing feedback.

Then we talked about the Top Ten Recruiting Techniques in Home Care:

  1. Employee Referrals
  2. Word of Mouth
  3. Newspaper Ads
  4. Web Site
  5. E-newsletter
  6. Direct marketing
  7. Public Relations
  8. Paper Newsletter
  9. Flyers & Posters
  10. Special Events

We Examined the Three Criteria for Picking Great Home Care Sales Professionals

  1. Behavioral Styles
  2. Workplace Motivators
  3. Sales Competencies

We then discussed in detail tools for assessing behavior and motivators.

If you'd like a copy of the slides and handouts from this email, send me an email and I'll send the handout to you.

What do you think about selecting and hiring sales professionals in home care? Give us your comments below.

The Exhibit Hall is a Great Learning Place

One of my favorite ways to experience the annual NAHC Conference and Exhibit is to walk the aisles of the trade show. Each year, I am constantly amazed by the size of the exhibits, the number of vendors selling information technology, and the new inventions that were not hear last year.

This year, one of my focal points was to talk with IT vendors about the capabilities of their systems to provide CRM - Customer Relationship Management. This is a huge hole in the IT infrastructure of home care. Many of my clients are frustated because their home health care clinical and billing software won't interface with their CRM system. I talked with several IT vendors, and no one really addresses this problem. What's your experience? How do you capture data to help your sales and marketing team members focus on your most profitable referral sources? I'd love to hear from you.

Walking the trade show is also a great place to meet old friends from the industry. It has been wonderful seeing people who I've known for the 24 years I've been working in home care. For example, I ran into Mary Kay Perra, who was the Executive Director of the Pennsylvania Association for Home Health Agencies in 1982 when I spoke for a home care group for the first time. She's now living in New Mexico and doing some work with Joie Glenn and the home care association there. I won't go on and list all of the othe wonderful folks I talked with because I'll surely miss someone. But suffice it to say, the exhibit area is a great place to learn what's new in our industry and what's new with old friends.

I was surprised how few people were taking advantage of the show. Talking with many vendors, they were dissapointed with the traffic in their boothes.

What's your take on the Exhibit? What did you observe that others might like to know about? Comment below:

Claude Pepper Awared Winner: Governor Mitt Romney of Massachusetts

Welcome back to the 2006 NAHC annual convention in Baltimore. Today's session opened with the introduction of the winner of the Claude Pepper Award. President Val Halamandaris introduced the award winner, Governor Mitt Romney of Massachusetts.

Governor Romney opened with a fun joke from the speaking business. He said that Val called him and asked if he believed in "free speech." The governor said that of course he did. Val said, " Great, I'd like you to give one." The crowded enjoyed it.

Then Governor Romney gave us four points for being and effective leader:

  • Throw out conventional wisdom and come up with new answers
  • Gather data
  • Analyze the data and develop new perspectives
  • Bring people around you who bring new perspectives

As an example, the Governor described how he approached the problem of the uninsured in Massachusetts.

The Problem: Many people are uninsured, and those who have insurance pay more to cover for those who don't.

The Solution: Get everybody health insurance.

Problem: You can't have the government provide universal health insurance. "If you think health care is expensive now, wait until it's free."

Governor Romney brought together a group of business and government leaders. They analyzed the data and explored new perspectives. They identified three types of people who don't have health insurance. They thought they would find low income, minority, single mothers. Instead they found young, male, working adults. The three types of uninsured:

1. Young working males who qualified for Medicaid but had never applied. The solution was to set up a system to have them apply on the spot when they appeared for treatment.

2. The Middle Income. They make $54,000 to $70,000 per year, but choose not to buy health insurance because it was so expensive at about $400 per month. The solution was to remove insurance regulations that drove up cost and reduce the premiums to around $200.

3. The Working Poor. They make $15,000 to $55,000. The state helped them buy insurance through subsidies. The money came from funds that would have gone to hospitals to pay for care for the uninsured.

The next step was the "Personal Responsibility Principle." This requires every single citizen to purchase health insurance as the state had removed the barriers to coverage. Now, if you show up at the hospital emergency room, there's not excuse for not having health insurance to cover your care.

The state also reduced property taxes and provided tax credits for the elderly people who did not have sufficient health coverage. They also refocused the state mediaid program on providing the "least restrictive care," which enabled many Medicaid recipients to have home care instead of going into a nursing home.

I was intrigued by Governor Romney's examples because they cause me to rethink two main points:

1. The uninsured are not low income, minority, single moms, but rather middle income young males.

2. The concept of "The Personal Responsibility Principle" suggests that the government remove the barriers to buying health insurance, including subsidies for the poor. But then require that everyone purchase healthcare coverage to pay for their care.

What do you think about this approach? Give us your comments below by clicking on the somments button.

Sunday, October 15, 2006

NAHC Celebrates 25th Anniversary

Congratulations to the National Association for Home Care & Hospice for 25 years of significant contribution to the healthcare delivery system in our great country. I've been coming the NAHC conventions since 1983, and it's a delight to be part of the progress that has happened in our industry.

For the next three days, I'll be reporting to you live from the floor of the 2006 Annual Convention and Exhibit in Baltimore Maryland.

I'd love to read your comments about the topics we're covering. After each posting, there's a "comment" button which you can click to add your thoughts and ideas on the subject. We encourage our readers to engage this interactive process by commenting on the BLOG posts.

Thanks so much for your continued support and encouragement. I'd love to hear from you.

Best regards,


Stephen Tweed, CSP
Leading Home Care ... a Tweed Jeffries company


Stephen at

A Leadership Idea to Change our Country

The keynote speaker at the opening General Session of the 2006 NAHC Convention and Exhibit in Baltimore was Jim Clifton, CEO of the Gallup Organization. Clifton believes, as did Dr. George Gallup, that democracy is about the will of the people, which is why it is essential to ask what the public thinks.

Clifton founded an opinion research company after graduating from college, and built it into one of the most successful firms in the nation. Ultimately, he acquired the Gallup Organization in 1988 and turned it into a company with a global presence with 40 office in 20 countries. They're currently doing surveys in Iraq to find out what the people there want from their new government.

One of the interesting ideas that Clifton discussed is based on survey of healthcare employees. Surveys of over 2 million workers found that only 25% are "spirited, enthusiastic, and proud of their work." Most others are "actively disengaged."

What about your employees? How many are "spiritied, enthusiastic, and proud of your home care company?"

Clifton said that most healthcare workers are having a really good day when "they make other employees as miserable as they are. He said, "When you find miserable patients, you'll find miserable employees."

His solution: "Double the number of enthusatic, spiritied, and proud employees."

What can we as leaders in home care and hospice do to bring in more enthusiastic, spirited and proud employees? Give us your comments below.

And for more ideas on recruiting and retaining great employees, stay tuned to Leading Home Care Report and Private Duty Today. Visit our Web Sites at and

Do You Believe in Angels?

Jim Clifton, CEO of the Gallup organization, congratulated Val Halamandaris and NAHC on our 25th anniversary. In his keynote presentation, he told a story about people believing in angles. He said, " I have an announcement to make. There are angels. I've been in the presence of them."

Then he gave us some data from the Gallup Survey.

George Gallup, f0under of the company, 75 years ago crafted the question, "Do you Believe in Angels?"

25 years ago, 50% of Americans answered affirmatively to the question. Today, 80% of survey respondents say they believe in Angels. Said Clifton, "Val, because of you and the good people at NAHC, and others like you, more people believe in angels."

What about you? Do you believe in angels? Give us your comments below:

Coming Changes to Medicare PPS

Mary St. Pierre, Vice President for Regulatory Affairs brought us up to date on the proposed changes to Medicare PPS. CMS wants to create a "more equitable distribution of funds."

Some of the changes:
  • Adjustments to SCIC, PEP, and LUPAs
  • Adjustments to reimbursement for Medical Supplies
  • Revisions to the Case Mix

Case Mix Revisions include:

  • Diagnosis and co-morbidity
  • A "4 equation model"
  • Multiple therapy thresholds
  • Smoothing between thresholds

The target is to have these revisions implemented by January of 2008, which means the proposed rule will be drafted by January 2007, have a 60 day comment period, and write the final rule by July or August 2007. Stay tuned to NAHC or your state home care association for more updates on these revisions.

What are your thoughts on the proposed PPS changes? Add your comments below.

NAHC Legal Update

One of my favorite people in home care in Bill Dombi, Vice President for Law at NAHC. Bill is always on top of what's happening in our industry, and presents the latest updates from the legal front. And, he's fun and funny.

During the opening general session, Bill updated us on :

Coke vs. Long Island Home Care

This is a case where a home care aide is suing her employer over entitlement to overtime pay. The case has the potential of invalidating the "Companionship Services" exemption under Federal Law. The case is being appealed in the 2nd Circuit Court, and may well go to the U.S. Supreme Court.

Fraud And Abuse

Bill described a case in California where a company pleaded guilty of falsifying claims by having people sitting in a room creating paperwork to document home care visits and episodes that never took place. They entered a guilty plea and already $33 million has been recovered. Several physicians are being investigated and could be indicted.

We all need to be concerned about unsavory characters entering our home care community and giving all of us a bad name with CMS, the OIG, and the citizens of our communities.

Price Waterhouse Coopers Study

Bill described a study that is being conducted for NAHC by PwC to evaluate the methods being used by MedPAC, the Medicare Payment Advisory Committee, to assess the financial health of home care companies by using national margins. The early findings suggest that the methodology being used by MedPAC do not accurately portray the true financial health of our industry.

Bill also introduced the new Deputy Director for the Center for Home Care Law, Denise Bonn.

What do you think about these legal issues? What are your concerns about reimbursement and regulatory issues? Add your comments below using the "Comment" button.

Targeting the Baby Boomers: Innovative Ways to Reach Tomorrow's Private Duty Decision Makers

My NAHC experience kicked off on Sunday afternoon by moderating a panel presentation on how to communicate with Baby Boomers about Private Pay Home Care. The Panel consisted of:

  • Mike Ferris, CEO of Home Care Marketing Solutions, Chapel Hill, NC
  • Bob Roth, Managing Partner of Cypres Home Care Solutions, Phoenix, AZ
  • Pat Drea, Vice President for Operations, Visiting Angels, Haverford, PA
  • Dennis Stack, Founder of America's Life Stories, Phoenix, AZ

I began the program by giving a little background on the Baby Boomers.

Who are Baby Boomers?

  • Born between 1946 and 1964
  • 78.2 million individuals
  • 7918 will turn age 60 each day during 2006
  • They are the children of the fastest growing demographic - the over 85 group
  • They are positioned to inherit trillions of dollars over the next 10 years
  • They are the major influencers for buying Private Duty Home Care

Baby Boomers were influenced by:

  • The Viet Nam War
  • War protests
  • the Beatles
  • Motown
  • Hippies

How to reach Boomers?

1. Create innovative communication and marketing techniques

  • Radio
  • TV
  • Web Site
  • Email
  • Print media
  • Personal Notes

The key is not the techniques ... it's the implementation where innovation is key.

2. Create exceptional customer experiences.

According to Pat Drea, we need to move private duty from being a commodity to being a provider of exceptional experiences for our clients and their children.

Boomers want:

  • Quality of Life for their parent and themselves
  • Not just service, but a solution for their parent
  • Peace of Mind
  • Customized services to meet individualized needs
  • To shift from our product from a service to creating an experience

As an example of how Private Duty companies can help create experiences, Pat introduced two products to create lasting memories for clients and their families:

  • iMemories used DVD video to capture old home movie film, slides, photos, and video in a customized creative memory
  • America's Life Stories is a product that uses audio casettes and an interviewer to create an audio biography of the client for their family.

Dennis Stack presented an emotional story of his own personal experience and how he created this comapny to help Boomers capture the life story of their loved ones.

What are your thoughts about communicating with Boomers? Add your comments by clicking on the comments button below.

Thursday, September 07, 2006

New York State Passes Laws to Promote Home Care

ALBANY---Three measures that will continue to transition New York's health care system by expanding home health care options for New Yorkers have been signed into law by Gov. George E. Pataki.

The first measure would authorize designated nursing homes to provide medical care to patients in their homes and the second measure makes permanent the Access to Home Program which provides financial assistance to homeowners and renters to adapt their homes or apartments to better meet the needs of persons with disabilities.

The third initiative would create a comprehensive, at-home hospice program for children.

"We are committed to advancing initiatives to allow New Yorkers to receive the treatment and support they need in the most comfortable and loving environment possible," Gov. Pataki said. "Important reforms to the health care system I have advanced along with the Legislature are beginning to reshape the delivery of care in New York State. These new measures will advance those efforts by providing these much needed services to these individuals in their own homes."

What's happening in your state to promote home care? Do these state initiatives really have a level or reimbursement that will make it attractive for high quality home care companies to provide these services?

Let us know what you think.

Friday, June 09, 2006

Michigan Physical Therapist Receives State Home Care Award

Canton, Mi---June 9, 2006---Nancy Malone, Canton resident and long-time physical therapist at United Home Health Services, was awarded the Spirit of Caring Award from the Michigan Home Health Association (MHHA) on May 11, 2006 during their annual conference in Traverse City. According to MHHA, this prestigious honor is only given occasionally, as it is reserved for an individual whose contribution to home care is considered to be unique and of extraordinary value.

Nancy was nominated for this award by her supervisor Lynn Lariviere. “Nancy has consistently demonstrated excellence in her profession and leadership qualities. She goes the extra mile in everything she does, including her relationships with her patients”, remarks Lynn, Rehabilitation Coordinator at United. “ Nancy is a wonderful, caring person and an outstanding therapist. She has been such an asset to United Home Health Services. We are so thrilled that she has been recognized with this high honor.”

Stephen's Note: Our research shows that "appreciation and recognition" is the number one characteristic of a "great place to work" in home care. Creating a culture where your leadership team regularly recognizes staff members for their contribution is key to staff satisfaction and retention. Nominating your staff members for state or national awards is one small thing you can do to show your appreciation.

I was at the awards luncheon in Michigan when this award was presented, and I saw the expression on Nancy's face when she received this award. It's amazing what a wall plaque, a free lunch, and some applause will do, not only for the award winning employee, but for the rest of your staff as well.

Monday, May 08, 2006

Picking the Winner

Well ... I did it. Something I've wanted to do for many years. Go to the Kentucky Derby and experience the infield.

Saturday, May 6th, 2006 was a perfect Derby Day, so Elizabeth and I made a spontaneous decision to go to the track. We had a wonderful time experiencing the experience of the experience. We placed a small bet on the ponies. Then we went back home in time to watch The Derby on TV.

And I won! I put a $2.00 bet across the board on the winning horse, Barbaro. And here's the ticket to prove it.

There are some similiarities between winning the Kentucky Derby, and winning in home health care. And it starts with picking top talent. Now I have to admit that I'm not much of an expert in picking top horse racing talent. I just got lucky.

But I'm getting better at helping clients pick top talent in home health care. Particularly leadership talent and sales talent. Much like the handicappers have tools to help them pick successful race horses, we have some tools we use to help home care CEOs pick top leadership and sales talent. If you would like to know more about these talent selection tools, give us a call toll free at 866-209-5101.

And stay tuned to see how our horse does in the Preakness, Pimlico race track in Baltimore on Saturday, May 20th. Posted by Picasa

Monday, May 01, 2006

CMS to Study Home Health Care and Medical Adult Day Care

The Centers for Medicare & Medicaid Services (CMS) have announced the implementation of the Medical Adult Day Care Services Demonstration, which encourages Home Health Agencies (HHA’s) to partner with Medical Adult Day Care Facilities (MADCF’s) to provide medical adult day-care services to Medicare beneficiaries as a substitute for a portion of home health services otherwise provided in the home.

“This demonstration will allow Medicare to assess whether providing medical adult day care services as part of the home health benefit will improve patient outcomes and increase patient satisfaction,” said CMS Administrator Mark B. McClellan, M.D., Ph.D.

There are approximately 2,100 licensed medical adult day care facilities throughout the country providing adult day services that include health care, as well as social interaction and caregiver respite services, to meet the day-time needs of individuals with functional or cognitive impairments.

Currently, Medicare beneficiaries who attend medical adult day care facilities pay out of pocket for those services or they are reimbursed through a third party payer other than Medicare.

The home health agencies that will participate in the demonstration project are:

Aurora Visiting Nurse Association, Milwaukee , Wisconsin
Doctor’s Care Home Health, McAllen , Texas
Landmark Home Health Care Services, Allison Park, Pennsylvania
Metropolitan Jewish Health System, Brooklyn , New York
Neighborly Care Network, St. Petersburg , Florida

What is your take on this project? What impact will mixing home health care and medical adult day care have on your business?

Thursday, April 20, 2006

Are You a Starter ... or a Finisher?

This morning, I read the following in an email from my friend and fellow NSA Past President, Chris Clarke-Epstein. It struck home with me, because in my business I sometimes have great ideas that get started, but the don't get finished. What about you?

"According to the gurus at Home Depot, the majority of home improvement projects are abandoned when they're 90 percent complete. By this time, homeowners frequently are fed up with their projects and anxious to move on. That unfinished 10 percent, however, typically comprises the finishing touches that make the project took polished and professional."

Is this behavior you recognize in your self? Are you leaving some 10% finishing work undone that makes people view you as less polished and professional than you really are? Are you willing to challenge yourself to change?

Chris Clarke-Epstein, CSP
Everyone gets a choice about change - endure it or lead it.
Want more insights about change?

Home Care Information Network Introduces Web Seminars by Stephen Tweed

Tom Williams, Home Care Information Network CEO and publisher of Home Care Automation Report, announced Monday that his company has released 11 web-based seminars from Stephen Tweed. According to Williams, this brings the total number of on-line seminars already available on HCIN to 25, just a month after launch of his video streaming venture. “We launched HCIN in mid-March with our special offer on Lisa Selman-Holman’s Coding seminar series and our Revised HHABN seminar, and we are pleased to add Stephen’s sessions to our expanding content library. Stephen is a very popular speaker at state and national conferences, and home care executives will now be able to conveniently view his seminars at the office or home.” A complete listing of current and upcoming HCIN seminars, including excerpts from each speaker, is available at

Teaching administrators to expand, Stephen Tweed is CEO of Louisville-based Leading Home Care and is past president of the National Speaker’s Association. He has produced eleven seminars for HCIN that are available as individual modules or as part of his Private Duty or Planning seminar series. “Stephen’s seminars address a number of very timely topics,” Williams said, “particularly for home care companies that are trying to grow their business or expand their presence in the rapidly growing private duty market.”

“We already have 19 ‘partner states,’” Williams commented, “and we expect our special pricing to association members in those states will influence them to try HCIN. Once they try video streaming, I am certain they will like it.”

Williams has reason to speak with certainty about the reaction he expects from busy home care executives and staff. He reports that his most recent survey reveals 100% viewer satisfaction and that nearly two-thirds of viewers report that they prefer a video-streamed seminar over a live event. “The number one factor folks cite for their high level of satisfaction is the convenience of viewing a seminar when and where they want to,” Williams notes, “free of air and hotel expenses.” He added that viewers also appreciate being able to pause presentations or view a particular portion of a session multiple times.

©2006 Stony Hill Publishing - Reprinted with Permission

Tuesday, April 18, 2006

AARP Survey Says Seniors are Satisfied with Medicare Prescription Drug Plan

A new survey released by AARP finds that most of the elderly who are enrolled in the new Medicare prescription drug coverage program called Part D are satisfied with the program.

The elderly advocacy group says 78% of those enrolled in Medicare Part D say they are satisfied. The findings are somewhat surprising given all of the reports of Medicare beneficiaries having problems with the enrollment process.

AARP Director of Health Strategy Cheryl Matheis explains, "Before Medicare added a drug benefit, more than half of those in the program either lacked drug coverage or had inadequate coverage that did not protect them from high out-of-pocket costs. The new plans fill a critical need for affordable prescriptions drugs".

As of March 2006, over 27 million of a total of 42 million eligible people are enrolled in a new Medicare drug plan. Of those surveyed who had prescription drug coverage before 2006, 63% reported their new Medicare drug plan is either better or as good as their previous coverage.

Only 17% said their new coverage is worse than what they had in 2005 and in prior years.

What are you finding with your home health care clients? Are they enrolled in Medicare Part D? Are they satisfied with the coverage? Let us know what you are seeing by adding a comment below.

See the Survey Report from AARP:

Wednesday, April 05, 2006

Massachusetts to Require All Residents to Have Health Insurance

Legislators in Massachusetts passed a bill yesterday that will require all individuals in the state to have health insurance coverage, just as motorists in most states are required to carry auto insurance. The new bill is designed to reduce the state's 550,000 uninsured to zero within three years.

Here are some of the key points in the bill:

  • Employers who don't provide insurance will be charged $295 per worker per year
  • Individuals below the federal poverty line of $9,600 in annual income will receive free coverage
  • Insurance will be subsidized for those up to three times the federal poverty level
  • The program will cost $316 million the first year and climb to $1 billion by the third year
  • All but $125 million will come from state and federal funds already earmarked for healthcare
  • After the third year, individuals who refuse to buy coverage will lose their state tax exemption . . . about $150 per person
  • Monthly premiums will be about $200 per month for a single adults

What do you think about his concept? Add your comments below.

Here's my take on this.

I think this is a great concept that needs to be pursued. Part of the problem with the healthcare system in America is the lack of personal responsibility. Our employer paid health insurance system has created an entitlement mentality where the Americans believe they are entitled to the best health care money can buy, but without having to pay for it out of their own pockets.

The problem with this is that WE DO PAY FOR IT.

We pay for our health care services in the form of:

  • The additional raise in wages or salary we didn't get last year
  • The additional healthcare premiums we pay to cover those who don't pay
  • The additional out-of-pocket co-pays to cover those who don't pay
  • The additional cost of products and services we buy to cover the cost of health insurance for the employees who make those products and deliver those services
  • The additional state taxes we pay to provide Medicaid for the low income residents of our state
  • The additional hospital costs to pay to operate emergency rooms that treat everyone who comes in whether they have insurance or not.

The list goes on. There are many ways that you and I pay for the health care of others who don't have insurance.

In my view this concept of requiring all residents of the United States to have health care coverage is the best alternative to a nationalized healthcare system. It's a monumental undertaking with loads of challenges. But it's an idea that is worth considering.

What Will This Mean to Home Health Agencies?

For one thing, it may mean that we'll have to provide health care coverage for home health aides and non-medical caregivers who are not currently insured. That's a good thing, but expensive.

It may mean that there will be more dollars available to provide home care services for people who do not now have access to our services. The bad news is, we'll have to do business with more insurance companies at low reimbursement rates.

Let's watch and see what happens in Massachusetts. In the mean time, let us read your comments below.

Monday, April 03, 2006

Home Care Workers form Cooperative

One of the hottest topics in home care today is the issue of "consumer directed care." This is a process whereby home care consumers hire and pay their own caregivers. There is a large and growing workforce of independent caregivers who market their own service to clients.

Now, there's a create new approach for independent caregivers. A group of caregivers in Appleton, Wisconsin, have banded together and formed their own cooperative. A cooperative is a legal entity whereby the members are also the owners. This business model is widely used among farmers who bring together the fruits of their labors and market them cooperatively.

Well, these creative caregivers in Wisconsin have formed Circle of Care Cooperative. According to Cheryl Detrick, Executive Director, the turnover of caregivers at Circle of Care is only 2% per year as compared to 60% for some home care companies. The President of the five member board of directors is Jean Stark, a CNA.

Circle of Care Cooperative was formed in 2004 with a grant from The U.S. Department Agriculture. Detrick said 41 independent caregivers out of a possible 220 working in Outagamie County have already joined the co-op, where wages are typically $2 to $3 more an hour and benefits including health insurance, vacation, holiday and sick pay are ultimately possible.
"Nearly 40 percent of home care givers do not have health insurance," Detrick said.
"Members pay a one-time fee to join that can be spread over two years at $12/month, and they also get business profits," she said.

For more information, visit their web site:

Friday, March 31, 2006

The Cost of Elder Care Going Up

Older Americans in need of care face rising costs in Home Health Care, Assisted Living Facilities, and Skilled Nursing Facilities. A survey of 9,000 assisted living facilities, skilled nursing facilities, and home health agencies conducted for Genworth Financial, Inc. showed the following:

  • A private room in a skilled nursing facility costs $71,000 per year, up 2% over 2005
  • A private one-bedroom unit in an assisted living facility is $33,000, up 7% over 2005
  • The average hourly rate for a home health aide is $22.15, up 19% over 2005
  • For homemaker services, non-certified, licensed providers had hourly rates averaging $17.73, versus $16.84 a year ago.

Alaska and New York remained the highest-cost regions for nursing home care, while Louisiana, rural Missouri and Kansas were the lowest-cost regions. Cost of care in urban regions is, on average, 17 percent greater than in non- urban regions -- a 5 percent increase over last year's regional findings.

For more information, see the full report at:

Home Health Pioneer Saves Lives Telling Her Story

This past week, I was working with a new home health care client in Grand Rapids, Michigan. I went early on Sunday evening to have dinner with long time friend and client, Sharon Buursma. Sharon was the CEO of the VNA of Western Michigan for many many years and then moved into senior level executive positions with Spectrum Health. Sharon was a founder of the Michigan Home Health Association, and an early leader in our industry.

In February 2004, Sharon suffered a heart attack in her home, but the symptoms were so unusual that most people would not have recognized them. Only for the grace of God, and the fact that Sharon had just two weeks before read an article about the symptoms of heart attack in women, that she was able to get herself to the hospital and be treated.

Sharons story is so compelling that others who have heard it have shared the information with friends and relatives. Over our dinner, Sharon told me of at least four other woman whose lives have been saved because of hearing her story and being able to take quick action in response to a heart attack. She's become a "poster child" for the American Heart Association and their efforts to inform women about the affects of heart disease.

Please take a moment to read Sharon's Story. Then pass it on.

Home Health Care Agencies who offer FREE pre-operative safey checks may be in violation of Federal Law

Several months ago, a listener in one of our teleseminars on home health care marketing asked a question about the legality of offering FREE pre-operative home safety visits before a patient has surgery. This is a technique that has been used by a number agencies and has resulted in increased referrals.

This question has been answered by an Advisory Bulletin posted by the U.S. Department of Health and Human Services, Office of Inspector General. The posting was in response to a request for an advisory opinion submitted by a large national home care company that was not named. The requestor provides FREE preoperative home safety assessments for patients scheduled to undergo orthopaedic surgery.

In the Conclusion of the Advisory, posted by Lewis Morris, Chief Counsel to the Inspector General, he says,

"Based on the facts in your request, ... we conclude that the Arrangement may constitute grounds for the imposition of civil monetary penalties under section 1128A (a) (5) of the Act. We also conclude that the Arrangement potentially generates prohibited remuneration under the anti-kickback statute... "

Friday, March 17, 2006

Private Duty Home Care in Assisted Living Environments

Want to grow your Private Duty Home Care business? Consider working closely with Assisted Living Facilities to provide on-site care for their residents.

Another of the breakout sessions I saw at the National Private Duty Association conference in Atlanta was this one by John Bowling, PhD, Vice President of Silverado Senior Services. John's company operates senior living centers in California, Utah, and Texas, and John has responsibility for their private duty home care operations. I met John last year at NPDA, and then again yesterday morning in the Fitness Center at the Hyatt.

He gave us some interesting information about the need for home care services in conjunction with senior living centers:
  • From 1990 - 2002 the number of residential care beds increased from 20.9 per 10,000 people to 35.6.
  • The actual number of beds increased 97%
  • The number nursing home beds declined during that same period from 66.7 to 61.4 per 10,000 people.
  • 47.2% of the population over the age of 85 have some cognitive impairment
  • 76% of people with cognitive impairment live at home
  • 25% - 45% of older people living in a retirement center or ALF have chronic pain
  • 45% to 85% of nursing home residents report pain that is often untreated
  • 10% of people over 65 and 50% of people over 85 experience Alzheimers Disease
  • The annual cost of caring for Alzheimers patients exceeds $100 billion

John explained why you may not be getting as many referrals from ALFs as you might expect. They have some fears such as:

  • The fear of poor quality of care reflecting on the ALF
  • The fear of losing control over the staff
  • The fear of losing control over communication
  • The fear of being "exposed" for things not being done "right" or "well."
  • The fear of losing residents to private home settings.

In order to overcome these fears, you need to build trust, open communication, and mutual cooperation with the administration and staff of the ALF

John gave us some examples of terrific opportunities for Private Duty Home Care to work with ALFs:

  • Move-in transition and stabilization
  • Assistance with dimentia care
  • Quality of Life enhancement programs
  • Change of Condition assistance
  • Post-hospitalization / recover assistance
  • Helping the client access events and opportunities outside the ALF

For more information, visit the Siverado Senior Services web site:

Home Health Care Consultant Running for End of Life

One of my favorite people in home care is Jeannee Parker Martin, President of the Corridor Group. Although you might technically consider us competitors since there are a few things that her company does that we do at Leading Home Care, we're really good buddies who share a love for home care and hospice. We trade referrals and cheer each other on.

I'm cheering Jeannee on this month as she trains to run The Big Sur Marathon on April 30th as a fund raiser for The National Hospice Foundation. I was one of the early adopters of this idea who sent my donation check in early. I hope you'll do the same.

Here's a link to Jeannee's Run To Remember web page where you can read more about the event and make your pledge online. Join me and others who don't run much any more to cheer on Jeannee and her team of Runners for Hospice.

Thursday, March 16, 2006

The Positive Impact of Home Health Care in a Retirement Community Setting

This morning's opening general session at the National Private Duty Association conference featured Mary Harrison, Senior Vice President for Life Care Services, LLC. Life Care Services is one of the country's leading planners, developers, and managers of senior residential communities throughout the United States. One of Mary's responsibilities is leading Life Care Home Health Services which provides home care to residents of Life Care Communities.

In her presentation, Mary gave us some interesting and useful data that will help us work more closely with Continuing Care Retirement Communities (CCRCs).

  • In many markets around the country, 10 to 19% of age and income qualified persons reside in retirement communities.
  • In areas like Baltimore, Philadelphia, SE and SW Florida, up to 30% of age and income qualified persons may reside in retirement communities
  • These percentages are expected to increase as retirement communities offer more life style options.
  • Independent rental retirement communities have an attrition rate of 30 - 50% annually
  • Assisted Living Facilities have an attrition rate of 50% annually
  • Rental Retirement Communities cost $2,500 to $3,500 per month depending on the size of the units, and provide 1 - 2 meals per day, housekeeping, and transportation.
  • Continuing Care Retirement Communities have an entrance fee ranging from $90,000 to $1 million depending on the size of the unit, plus a monthly fee of $1,500 to $4,000 for the first person and $750 for the second person. Monthly fees depend on the size of the apartment and the extent of assisted living or skilled nursing facility coverate.
  • 10-15 % of residents in upscale retirement communities will use home health care at any given time.
  • The concentration of clients and hours in one specific location allows for greater flexibility, higher productivity, and better supervision of caregivers.

For more information on Life Care Communities, visit their web site at

Wednesday, March 15, 2006

Home Care Marketing to Die For without Killing Your Budget

A Live Update from the National Private Duty Association annual conference in Atlanta

Want to grow you business 400% in four years without spending a fortune on marketing? You'll want to know more about a powerful presentation by two fabulous women who own and operate a tremendously successful Private Duty Home Care business.

Tricia Menoni and her daugher, Angie Landmesser, own and operate Partners in Senior Care in Chicagoland. They just presented an awesome program on how to market your home care business without killing your budget. I've known Tricia and Angie for several years. They attended our Academy for Home Care Leadership several years ago and applied many of the lessons they learned.

What I love most about them is their "just do it now" action orientation. They create ideas, try things, keep doing what works, and stop doing what doesn't work. They grew their private duty and geriatric care management business from ZERO to $4,000,000 in just 3 1/2 years. What a track record.

Here are five marketing rules they shared with us:

1. Steal from the Best

They keep a bankers box in their office. Whenever they see a great marketing idea, they put a sample in the box. They are constantly working ahead to adapt the marketing ideas of other companies into simple yet powerful things they can do to promote their company.

2. Don't Sell Ice to Eskimos

They empasized that you need to know your customer and find ways to focus on their needs. "Future customers responde to the familiar," says Angie. "You need to know if you are going to be selling at the 'kitchen table' or the 'board table'."

3. Marketing Isn't just Materials

You need to have active marketing techniques that get your information and materials into the hands of people who can buy what you are selling, or who can refer to you. It begins with your own employees. Make sure your own caregivers have your material, know what you are promising, and deliver what you are selling.

4. The Reese's Pieces Rule

"Leave little ways for clients to find their way back to you."

5. You are Known by The Company You Keep

Align yourself with comparable home care companies. If you are actively growing your business, you will not be able to handle all of the inquiries and referrals you get. Make sure you know who you are referring the overflow to. Your reputation depends on it.

There are five more rules, and loads of powerful tips and techniques. We'll share those with you in a future publication. In the mean time, visit their web site at:

Stay tuned for more updates from NPDA, and visit their web site at:

Tuesday, March 14, 2006

Certain diagnoses fare worse under home health PPS

Medicare beneficiaries with renal failure, pulmonary disease, and multiple sclerosis have experienced higher rates of hospital readmission and more visits to emergency departments when receiving home health care since the implementation of the home health prospective payment system (PPS), according to an OIG report. Although there has been little overall change in hospital readmission rates and emergency department visits following home health PPS implementation, findings of higher hospital readmission rates and more frequent emergency visits among certain beneficiaries have led the OIG to state that continued monitoring of home health care quality would be prudent.

Quality of care concerns.

The PPS for Medicare home health care services was implemented in 2000 in response to rapid growth in home health spending under the previous cost-based system. Because the PPS directs that home health agencies receive a unit of payment for a 60-day episode of care, some feared the PPS would decrease the quality of patient care by creating a financial incentive to limit patient visits. For this reason, CMS, the Government Accountability Office, and the Medicare Payment Advisory Commission stressed the need to monitor outcomes of care. After implementation of the PPS, the OIG analyzed claim data to detect increases in rates of hospital readmission and emergency department visits, which are indications of poor quality of care.

Investigation results.

As a result of its investigation, the OIG found that the overall hospital readmission rate for home health beneficiaries discharged from hospitals remained at 47 percent and the overall rate of emergency department visits for home health beneficiaries discharged from hospitals increased only slightly, from 29 to 30 percent. However, the investigation showed up to a 5 percent increase in readmission rates for beneficiaries with certain diagnoses, including renal failure, multiple sclerosis and pulmonary disease. Rates of emergency department visits for these beneficiaries also showed up to a 4 percent increase. Although results show that the PPS has not led to increased overall use of hospital and emergency department services, higher levels of use among certain groups of beneficiaries creates a need for continued monitoring. In written comments, CMS agreed with the OIG findings and noted plans to use the investigation results to assist in monitoring the performance of home health care.

Source: OIG Report OEI-01-04-00160, Jan. 24, 2006

Find Physicians who work in Home Health Care

Want to make contact and build relationships with more physicians who work in home health care? Take a look at the web site of the American Academy of Home Care Physicians. This professional society provides information, education, and networking for physicians who work in, around, or about home health care. Many of them have medical practices where they actually make home visits.

One of the things you will find of particular value is their AAHCP House Call Network. This is a list of physicians in home care organized by state and city. Take a few minutes to look at this site and find the home care physicians working in your service area. You may find a great relationship and a new source of referrals.

The organization also provides education for home health agency medical directors, information for nurse practitioners, and a caregiver assessment tool. Take a look. It seems like a valuable resource for home health care leaders.

Wednesday, March 08, 2006

Creating Exceptional Customer Experiences in Home Health Care

Yesterday, I was in western Pennsylvania presenting a seminar for a young, rapdily growing home health care company. It was their annual "Customer Service Day." Once a year, they bring their whole home care team together for a half-day seminar focused on customer service.

They're already doing a lot of things right as evidenced by their rapdid growth. Yet they recognize that they can still grow and improve, so they brought me in to help them go to the next level of customer service.

I presented our program, Devoted to Caring: Creating Exceptional Customer Experiences in Home Care to a delighted audience.

It's not enough today to provide good service. You need to examine the total customer experience. It begins with getting your team members to discuss the question, "Who are our customers and what do they expect from us?" Then, you need to examine each of the contact points where your customers come in contact with your company ... your "moments of truth."

Now ask the question, "What do our customers experience at each of the moments of truth in our company?"

In our seminar yesterday, we examined the moments of truth for our four customers; patients and their families, physicians, referral sources, and third party payors. We discussed what each type of wants from an effective home care company, and what they experience in our company.

There are four elements of an experience:

  • Esthetics - What does the customer experience with the five senses - sound, sight, touch, taste, smell?
  • Engagement - How is the customer engaged personally in the home health care experience?
  • Education - What does the customer learn during the experience?
  • Entertainment - What happens to the custome that is FUN? What's the entertainment value of the home health care experience?

What is the customer experience in your home health care company?

Non-medical Home Care aides the elderly during time of natural disasters

When catastrophe comes calling, seniors and family caregivers are among the most vulnerable, according to the American Red Cross and Home Instead Senior Care, the nation's largest provider of non-medical home care and companionship for the elderly.

"We saw firsthand during Hurricanes Katrina and Rita how seniors could be at greater risk than other demographic groups," said Victoria Melvin, preparedness expert for the American Red Cross. About two-thirds of the 623 victims of Hurricane Katrina identified so far from the New Orleans area were over 60, according to the Louisiana Department of Health and Hospitals.
"But it's not just hurricanes. Natural disasters impact seniors and their families in various ways throughout the country each year," Ms. Melvin added.

"At the local level, we know that a disaster can be deadly for some seniors because of physical and other limitations," said Gary Leiter, owner of the Home Instead Senior Care office in East Providence and East Greenwich RI. "That's why we're always ready to help seniors prepare for any kind of emergency that could threaten their health or safety."

Some recent examples, according to Home Instead Senior Care:
  • A CAREGiver in Indiana rode out a killer tornado with a senior in her home, comforting her until the danger passed.
  • When a massive blizzard hit Colorado, a CAREGiver traversed dangerous streets to make sure an older adult had everything she needed to survive.
  • A Home Instead Senior Care franchise owner and his CAREGiver team canvassed New York City checking on their senior clients when a blackout shut down.
  • During Hurricane Katrina, a CAREGiver drove a senior client with Alzheimer's disease to Georgia for two weeks to escape the onslaught of the storm.

Thursday, March 02, 2006

What if you went to work and ...

Elizabeth and I went to the last University of Louisville home basketball game this evening. It was the final home game for our sole retiring senior, Taquan Dean.

Before the game, Coach Rick Pitino led a celebration of Taquan and his family before the sold out crowd at Freedom Hall. He began by saying ...

"What if you went to work every day and you had an employee who
  • shows up early every day
  • never calls in sick
  • gives you 100% every day
  • when you give him credit, he passes it on to his team mates
  • is a leader on the court and off

This is our team leading player, Taquan Dean."

The coach never mentioned his won and loss record, his record as the all time three point shooter a U of L, or his other statistics. He focused on Taquan the person.

As we listened to Coach Pitino talk about his retiring player, Elizabeth said to me, "There's a story for your BLOG." This is not a sport story. It's a leadership story.

What would it be like if you have a home health agency full of Taquan Deans who ...

  • show up early every day
  • never call in sick
  • gives you 100% every day
  • when you give them credit, they pass it on to their team mates?

You'd have a superstar home health agency.

It's possible. It starts with recruiting and selecting the right players. Developing a clear game plan. Teaching and coaching your home care team. Measuring performance every day and giving immediate feedback. Being their biggest cheerleader.

I know many of you get upset with me when I use sports analogies in my presentations. But I find there are real lessons to be learned form championship sports teams. So get over it already! Quit taking yourself so seriously. Have some FUN! and Play to WIN!

Thursday, February 23, 2006

The Physician Perspective: What Doctors Really Want Before Sending You Patients

He did it again! My good friend, Dr. M. Tray Dunaway blew them away with the opening keynote presentation at the Home Health Line Power Referrals conference in Las Vegas today. Dr. Dunaway is a surgeon from Camden SC who now helps physicans improve their coding, and home health agencies that want to build relationships with physicians.

Tray has a powerful speaking style that includes original songs that he sings during and in closing his programs. He also is able to communicate in very creative ways how we can better understand the needs and wants of physicians.

He used the metaphor of the relationship with your spouse in understanding how to get closer to doctors. He talked about the first date, follow up dates, going steady, getting engaged, and marriage.

He suggested:
  • Strategically choose the physicians you will seek out
  • Be choosy. Don't go after everyone
  • Create two lists: Must Haves, and Relationship Breakers
  • Identify the top quality candidates
  • Learn to recognize the "diamonds in the rough"

Dr. Dunaway made many other powerful points:

  • "Facts tell - emotions Sell"
  • Clinical excellence is assumed. They buy based on how good you are at who you are and how you make them feel.
  • With regard to quality data on Home Health Compare: "If you don't provide your own value interpretation, someone else will do it for you."
  • Clinical Excellence + Customer Service Excellence = Success in a long line of referrals
  • Physician time is your biggest obstacle. Physician information overload is your second biggest obstacle
  • A Physician's behavior is determined by his or her "Emotional Intelligence."

He then focused on identifying and communicating with "Opinion Leaders" in the medical communityl. The most efffective mode of chaning physician behavior is academic detailing to physician leaders.

For more information, visit Dr. Dunaway's web site:

Also, visit our web site to order a copy of a brand new audio CD program on Building Relationships with Physicians, with Stephen Tweed, CSP and M. Tray Dunaway, MD, FACS, CSP.

Leverage Telehealth to Earn More Referrals

Liz Powell, COO of the VNA of Western Pennsylvania presented a very effective program on how their agency has used telehealth in increase referrals, improve patient outcomes, and grow the bottom line. This was a delightful program for me because VNA of W. PA. in Butler, PA was my second home health care client when I started working with home health agencies back in 1982. (The first was the VNA of Venango County in Oil City, PA)

Liz Presented a Step-by-Step case study of how they did it:
  • Set Goals
  • Select the right system ( VNA uses HomMed)
  • Implement a Home Health Model
  • Work out the logistics
  • Develop Marketing Strategies to Assure Success
  • Allocate Funds for Marketing
  • Define Target Markets
  • Create Marketing Materials
  • Select Target Markets

The results of their program:

  • Referrals to the agency increased by 22%
  • Home Health PPS visits per episode decreased from 19 t0 11
  • Nurses were able to carry larger case loads
  • Census increased with the same number of nursing staff
  • ER visits decreased 61.7% for CHF patients
  • Rehospitalizatin decreased by 65.9% for CHF patients
  • The agency made an amazing financial turnaround

For more information on this program, visit their web site:

Online Referral Machine: Harness the Hidden Power of Your Agency's Web Site

Brendan Killackey, President of Progressive Technology Partners is the guy to revitalized the web presence of the VNS of New York. Brendan presented some key points about how to optimize your web site to drive referrals:

  • Move beyond brochureware. Most visitors come online to be sold. They come 24/7. One of the most active times is Monday morning when they get to work after spending the weekend with an elderly parent.
  • Bring traffic to your site with SEO - Search Engine Optimization
  • Text is the fundamental element of bringing people to your site ... NOT grahics.
  • Text is page-specific, and SEO is about optimizing individual pages of your site.
  • Text is HTML based - not image based. Only text is indexable by search engines.
  • Use keyword search to find the terms that people are entering into Google and Yahoo!
  • A site map is a list of links to all pages on yoru web site. It helps search engines index all of your pages.

For examples, visit the VNSNY site:

Stay tuned to this BLOG as we introduce you to "Web-Centric Marketing and Recruiting" for home health agencies, coming soon from Leading Home Care.

Hospice Heats Up: Critical Sales Strategies to Promote This Unique Service

We're still at the Home Health Line Power Home Health Referrals conference in Las Vegas.

The final breakout session today was presented by Polly Rehnwall, from Salt Lake City. What a refreshing, somewhat irreverant presentation on some totally new ways to increase your Hospice Census.

Polly focused on growing your Census by generating referrals and converting referrals. Conversion is a big issue. Many hospices are able to get the referrals, but fail to convert them to admissions. The Best programs are able to convert 75% of their referrals to admissions. Although Polly says that many agencies sanitize their conversion numbers by not counting all of their inquiries.

Polly suggested focusing on three key targets: Long Term Care Facilities, Consumers, and Patients and families.

Some key points on marketing to LTC Facailities:
  • Have a "Real Nursing Home Program."
  • Make routine visits to Hospice patients in nursing homes during evenings and weekends. That's when families are there, and they're the ones who really benefit from your visits.
  • Set up preferred provide agreements with ALFs.
  • When making a visit to a facility as this question: "Is there anyone else I can help you with today?"

Some key points in marketing to consumers:

  • "Inquiries" = admissions until proven otherwise
  • Beware of sanitized conversion rates
  • To every caller say, "Tell me about it." Find out what they are experiencing.
  • Schedule a home visit regardless of the circumstances. You can't admit someone if you don't schedule a visit.

Some key points in marketing to families and patients

  • Avoid "eventness" when a family learns of the diagnosis. Don't get caught in the vortex
  • Take small steps
  • Give them direction
  • When you get a "yes" answer, shut up!

You look at these bullet points and ponder. What does this all mean? This was the most interesting, thought stimulating program on business development I've seen in a long time.

To learn more, contact her:

Polly Rehnwall, Inc.

Salt Lake City, UT

Daily Update from the Home Health Line Power Referrals Conference in Las Vegas

I'm writing to you today from Caesars Palace in Las Vegas where Home Health Line and Decision Health are sponsoring their bi-annual Power Home Health Referrals conference. I was the opening speaker yesterday at the Pre-conference Workshop on the topic, Building Your Marketing Referrals Dashboard. About 120 home health care CEOs, CMOs, CFOs, and CNOs along with some sales reps and clinical liasions came out a day early to pick up some advanced techniques on growing their home health agencies.

It was great fun kicking off the conference, describing the Marketing Dashboard, sharing our Top Ten Techniques for Highly Effective Home Care Marketers, and giving away some FREE prizes. For a summary of the key points of my program, click on the link to see the February 22, 2006 issue of Stephen Tweed's Leading Home Care report. (Give us a day or so to get it posted on the web site.)

One of the things we gave away is a copy of our brand new CD set, Building Relationships with Physicians, featuring my good friend and fellow speaker M. Tray Dunaway, MD, FACS, CSP. Dr. Dunaway was our guest expert on Building Relationships with Physicians during four different teleseminar series that we provided in 2003 and 2004. We have combined the four different CDs into one new set and it's now available on our web site at

Over the next two days, I'll be adding additional posts to this BLOG to give you some insights on the programs provided by the speakers at the Power Home Health Referrals conference. You can join us for the next conference in Orlando in May. Here's a link to the brochure:

Interactive & Innovative Training for Home Care Professionals

Michael Giudicissi ( MG to his friends) is Vice President of Busines Development for Heritate Home Care in Albuquerque, NM. A talented speaker and experienced home care sales manager, Michael gave the group some hands-on , down-to-earth tips on how to train sales professionals in home care.

Do You Know Who is Representing You? Most customers will judge your company by your representative. They make their initial judgement in 15 - 20 seconds, their long term judgement in the first 2 minutes, and it can take up to 20 "touches" to reverse an initial impression.

You cannot execute an effective sales training plan unless you know what training your staff needs. Spend time in the field with your sales force. Assist in making calls but don't do it for them. Evaluate each call after it's over and decide on training needs.

You NEED an IBS. Not Irritable Bowel Syndrome ... but an Initial Benefit Statement. This is a 15 - 20 second statement that sets the stage for the call and gets the sales rep 2 minutes to present your program. The IBS is concise, confident, informational and talks about why a referral sources is likely to be interested in what you are selling. It needs to be well prepared and flawlessly practiced.

Role Playing is a valuable training tool. In most cases, role playing is harder than the actual sales call. It involves drawing up realistic sales scenarios and giving your sales reps the opportunity to "play the roles" as they learn to think on their feet, respond to difficult questions, and handle rejection. Michael suggests having your sales reps practice by presenting to clinicians to get feedback on their presentaitons. He also recommends videotaping the sessions and providing instant self-review.

In closing, Michael shared "The Final Secret."

  • Show up
  • Be courteous and professional
  • Be ready to do business
  • 80% of your success in just being there
  • The other 20% is in the training
  • and Finally ... Ask For The Business!!!

You learn more about Heritage Home Healthcare & Hospice at

Star Liaison of the Year: Talent Search Winner Shares Success Secrets

We worked with Home Health Line and Decision Health to promote their Star Liaison competition to find the best home health agency business development reps. I was also invited to serve as one of the judges for the contest. Two candidates were selected as the Star Liaisons. One was invited to speak at this Pre-Conference workshop, and the other will be in Orlando in May for that conference.

The first Star Liaison is Penny Shadinger, RN, Program Liaison with Alacare Home Health & Hospice in Albertville, AL. Alacare is one of the largest home health and hospice agencies in Alabama, and is a leader in using technology to communicate with and monitor patients.

Penny did a wonderful job of describing her company, her service area, and how she goes about bringing in a substantial percentage of her company's total referrals. Penny discussed:

  • Giving Personalized Service with phone, fax, personal intake or online referrals
  • Being a True Team Player in working with clinical staff and other team members
  • Educating referral sources
  • Staying connected to referral sources
  • Using your car as your office, and how to prepare for each sales call

You can learn more about the programs and services of Alacare at

Legal Landmines: Top Home Health Agency Marketing Mistakes

The final speaker for the Power Referrals Pre-Conference Workshop was Lis Zink-Person, Esq. President of Pearson & Bernard in Covington, KY. Liz is a long time friend and well know attorney for home health agencies. Liz helps her clients avoid run-ins with the law in the areas of Mediare Fraud and Abuse, avoiding violations of Antikickback statues, and the Stark II law.

Liz shared with the group her "Top Ten Marketing Mistakes That Can Lead to Trouble."

1. No Marketing Policies - You need to have clearly written policies that guide your clinical and marketing staffs in what they can and cannot do in the way of business development in your company.

2. Buying Referrals from Anyone - Liz pointed out specific aspects of Antikickback law and Stark II that make it illegal to buy Medicare or Medicaid referrals.

3. Problem Relationships with Other Providers - Be cautious in developing business collaborations, joint ventures, or vendor relationships with Physicians, Hospitals, Assisted Living Facilities, and others who are in a position to refer patients.

4. Failure to Use Safe Harbor - 42 CFR ~ 1001.952 provides Safe Harbors to protect legitimate business relationships which would otherwise violate the law. These include arrangements for equipment rental, space rental, personal services, management services, discount buying groups, and employees. You need to protect these legitimate relationships with clear contracts, stated duties, and Fair Market Value rates.

5. Freebies to Facilities - You cannot provide FREE services to Assisted Living Facilities, Skilled Nursing Facilities, or Hospitals such as educational programs or discharge planning services. You also cannot rent space or a work station in an ALF or SNF at more than Fair Market Value rates.

6. Patient Inducements - It is a HIPAA restriction that prevents giving gifts to patients that may appear to be inducements to receive Medicare or Medicaid services. An OIG special advisory limits non-monetary gifts to $10 per gift and $50 value annually.

7. Untrained and Unsupervised Sales Force - Train your sales force and anyone who is involved in marketing on your established standards of conduct, and the rules and laws which govern inducements to make referrals.

8. Over-Incentivizing Marketers - It's OK to pay an incentive or bonus to Bona Fide W-2'd employees, but Liz cautions you not to let your sales reps get carried away with what they will do to get a referral in order to get that bonus. Pay for legitimate, legally compliant new business.

9. Skimping on Compliance - Non-compliant marketers are trouble. Audit referral sources and other employees to make sure your marketers are operating within the bounds of legal activity.

10. Believing the Government - OIG, FBI, and Government attorneys get promoted for successful fraud cases. Don't become a "notch on their belt."

For more information on the legas do's and don'ts of marketing home health care services, you can contact Liz at:

Liz Zink-Pearson
Pearson and Bernard
Covington, KY

Monday, February 20, 2006

Survey Shows Preference for Non-Medical Home Care

Ashland, MA (PRWEB) February 20, 2006 -- Non-medical home care tops the list of preferred options for those seeking elder care services, according to the latest data gathered by ElderCarelink, an elder care referral service which spots trends and identifies growing elder care management needs. For those seeking elder care services, 54% preferred in-home care to assisted living and senior communities for seniors primarily between the ages of 75 and 84.

The numbers are consistent with growing trends for elderly to be cared for in the home rather than in nursing homes and assisted living centers. Using non-medical care can support families in their care efforts and support seniors in continuing to live independently. Utilizing home health care and personal care providers can be more cost effective as well. Elder home care services often include meal preparation, personal care services such as grooming and dressing, household services and transportation, according to the ElderCarelink survey.

“The trend toward caring for our seniors in the home is evident as concerns about quality of life and reluctance to turn to dependent living situations such as nursing homes or assisted living grow,” said Robert F. Brooks, Chief Executive Officer of ElderCarelink.

Getting to 'Yes' With Older Clients in Non-Medical Home Care

Our friend, Colleague, and Co-author Mike Sullivan sent us this article on how to sell your services to older clients. You'll find this extremely valuable:

Getting to "YES" with Older Clients

By Michael P. Sullivan

Older clients make decisions largely on the basis of intuition and gut reaction. Here's how you can tailor your presentations about non-medical home care to gain their approval.

Whether we like to admit it or not, the aging process changes us.
As with the senses of vision and hearing, our ability to process information decreases with age. The ability to process information accurately, completely, and quickly peaks in the early 20s and then declines. At age 40, on average, 50% of the inborn level of fluid intelligence-our ability to quickly and accurately process information-has disappeared; by age 60, on average, about 75% is gone.

But the good news is that we compensate for the loss of fluid intelligence with a second form of smarts: crystallized intelligence. That is our life knowledge-what we know from experience. The ability to use that form of intelligence does not decrease with age. In fact, we know more with each passing year.

For providers of non-medical home care, this means we have to handle older clients somewhat differently than we do their younger children. Older clients will understand what you have to say, but you've got to present it in a way that suits their stage of life.

Why older clients resist

If you were to be asked what two plus two equals, you would immediately know the answer, virtually without conscious thought; that is crystallized intelligence. On the other hand, if you were asked what 231 multiplied by 963 equals, you would not immediately know the answer, and neither would most other people.

They would have to process the information consciously in order to arrive at an answer. That is fluid intelligence, and with age, starting for many people in their mid-40s, they would make errors in processing and might arrive at the wrong answer.

Give older clients the right information

You will never get a recommendation accepted with clients unless they (1) get enough information and (2) feel comfortable with the amount of time they have to process it. "Enough" will vary for each person, and it is defined in two ways: by quantity and the kind of information the client wants.

Think about the information requirement like this:

People need different amounts of information to feel comfortable making decisions. Information is like water: some people need a glass and others need a gallon.

We regularly work with clients who want to know every conceivable detail, while others simply want top-line information. It's your job to figure out how much each individual needs.
People need different kinds of information. Older clients generally don't want very many numbers because they require fluid intelligence to process. Older clients typically need other kinds of information.

Once you have determined their information style, aid older clients using their crystallized intelligence-their experience-as it applies to the investment issue under discussion. Discuss your recommendations in terms of their life experiences. Get to know clients so that you can tailor recommendations to their lives.

Give older clients more time

At age 17, an individual's ability to process new information accurately, completely, and quickly is about at the peak. At age 60, that capability is very, very low. Yet, 17 year-olds have many more accidents driving automobiles than do 60-year-olds. Why?

The answer, of course, is experience. For the 17-year-old, every potentially dangerous situation is new. He has to think about it and then react. For the 60-year-old, every potentially dangerous situation has been seen many times over. He doesn't have to think about it; he can just react based on his experience, which has been hard-wired into his central nervous system.
Similarly, an aging investor who uses his life experience will usually be able to make a good decision. But, that often requires the advisor to help him connect that experience with the subject at hand. Make time in your meetings to do that.

Older clients make intuitive decisions

The upshot is that you must remember when you're working with older clients that they will substantially base their decisions on experience, which manifests itself as intuition and gut reaction. It's basically a chemical reaction!

When the brain hears a proposition, its neurotransmitters automatically kick in. Chemicals, like dopamine, transmit nerve impulses. When the input is positive-whether it's more money or a delicious meal-dopamine circuits are activated to different degrees. The amount of "yes juice" an individual produces in response to any individual reward is a function of his or her past experience and biology.

7 Quick Tips

Life experience is an amazing teacher, and older clients have a lot of it. So when working with them to meet their financial goals, keep these tips in mind:
1. Don't rush seniors into a decision.
2. Check in often during the conversation to make sure they are with you.
3. Ask them how much they need to know.
4. Don't inundate them with extraneous information.
5. Don't focus on numbers if it's not their style.
6. Show respect for their life experience.
7. Tie your suggestions to their life goals.

Remember that in non-medical home care, you're selling peace of mind, quality of life, and independence. Tap into the intuitive decision making of your older potential clients.

Mike Sullivan is a well-known consultant/trainer specializing in selling to the affluent 50-plus market. He has worked closely with Leading Home Care as an expert on selling to Bank Trust Officers. He is co-author with Stephen Tweed of "Increase Your Income Selling to Bank Trust Officers and Other Trusted Advisors."

His consultancy, 50-Plus Communications Consulting, provides value-added materials focused on sales to Baby Boomers and older customers principally through sales managers of financial institutions. For more information, call Mike at (704) 554-7863, e-mail him at or go to his website