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!