Turnover is a concern for ResCare, as it is across the home care industry. But leaders at the large Louisville-based provider also believe that a more stable labor force is an achievable goal, and it is one they are pushing toward.
With annual revenue of around $2 billion, ResCare provides in-home care to about 60,000 each day, across 42 states. Medicaid is a major payor for the company’s home care division, which serves about 22,000 people at any given time. Within this division, about 65% of workers are considered stable, long-term employees.
“The way we look at it is, if we can make 65% stable, we can make 85% stable,” Sonny Terrill, chief human resources officer, told Home Health Care News.
Terrill joined the ResCare team in September 2017. He’s part of a new generation of ResCare leadership, which is focused on taking the company into a tech-forward, more coordinated era of health care. Another of these recent executive hires was Rexanne Ayers Domico, who also joined the company last September, as president of HomeCare and Neuro-rehabilitation.
Domico and Terrill spoke with Home Health Care News about their approach to labor challenges, and how they believe ResCare can win the “war for talent.”
HHCN: Sonny, you were previously Human Resources Officer with insurer Cigna-HealthSpring, and began your career with General Electric. Why did the ResCare opportunity appeal to you?
Sonny Terrill: When I got into health care, I didn’t really know what I was getting into, 15 years ago. What I learned was, dealing with seniors [in the Medicare Advantage population], you’ve got a population you care about, and you want to do your best to make sure they get the best product out there.
When I was working in that senior population, and Cigna bought us and things were changing, we were getting a little more commercial, I wanted to stay mission-driven … the reason I came here is, what I see is an opportunity to give all [our workers] the information they need, the tools they need, the support they need, to be really, really successful, and get all the HR red tape out of the way. Create technology opportunities, hire the right people to come in and lead, and I really think that this can be a great story … With people like Rexanne and others that we’ve hired throughout the organization, we’re kind of changing how people view this industry, and we’re changing the way we operate, and we’re starting to see, just in a short period of time, a change in the direction on turnover, on the brand that we have as a company, the brand that HR has.
We’ve got forty years of success. ResCare’s been doing it great. But I do see that there’s a turn, so it’s exciting. And when you start seeing that little bit of shift in direction, you get up every day with a lot more excitement, a lot more energy.
You mentioned that turnover is moving in the right direction, but I assume it’s still a big challenge?
ST: The truth is this. In Rexanne’s area, which is a large piece of our business, 65% of her caregivers don’t leave. So our issue is really only in about 35%, [driving] that big turnover number … We’re driving toward that, getting a bigger population stable. That excites me. When you hear, “It can’t be done, you’ve just got to hire enough,” I think, if we’ve got that many people who are excited about taking care of our customers, we can get just a few more, a few more, a few more, until that isn’t a black eye anymore. I think we’re going to make [the retention problem] go away, we’ve just got to find the right people.
Rexanne, what were your reasons for joining ResCare?
Rexanne Domico: I started my career in the staffing industry, and then 15 years ago, jumped into the post-acute provider space. I started in home health and hospice, durable medical equipment, and a little bit of pharmacy services. And then I spent a lot of time in the industry doing merger and acquisition work. What attracted me to this role was really the gap that I see in the post-acute space, that doesn’t get filled as much as it should.
We’re very focused on growing but not on growing for growth’s sake. It’s not about billing more revenue and dropping more money to the bottom line. It’s really about serving more people.
Today, on our home care census on any given time we might have 22,000 people that we’re serving. We want to serve 23,000, 24,000, 25,000 because that means that there are people who are getting services who otherwise would truly be going without, and this is in many times a truly vulnerable population that in many cases doesn’t have access to the health care services that they need. By identifying the right people, by getting more and more people to work with us and stay with us, we can provide those services.
We even have markets today where we will get calls from Medicaid contractors who will ask us, how many people can you take this week? And we oftentimes will have to turn them down because we are at maximum capacity with the caregivers that we have.
That’s sort of a heartbreaking call in some ways. You want to be able to say yes and grow your business, but you’ve also got these people who, if we’re not taking care of them, chances are nobody is. To me, that is really what this opportunity was about, to fill that gap a little bit. To reach more people. Not just the Medicare beneficiary. Really and truly, there are many people vying to take care of that [Medicare beneficiary], but there’s not as many people out there vying take care of the Medicaid recipient.
And do you agree with Sonny, that there’s already positive momentum in achieving those goals you have related to the workforce?
Our executive management team is almost 50% people who have been here and are very solid in their roles, and 50% made up of new people who bring new ideas of health care. I think that has brought somewhat of a new energy to the team, and we’re looking at innovative ideas to serve this population, figuring out how to be more efficient, and more attractive to a workforce that we really need, and it’s probably the thing that I talk about the most. I think in some ways there’s a war for talent and it’s not going to go away.
How do you win that war, and get the top talent to work for ResCare?
I personally don’t think it’s all about money, I don’t think it’s all about benefits, I think a lot of it is about culture and meeting those people where they are and finding innovative ways that they want to work for us.
If it’s through things like, it’s easier to get your paycheck with us, it’s easier to pick up an extra shift with us, it’s easier to get through the hiring process with us, it’s more fun when we’re on the other end of the line and we’re trying to get you out to someone who needs help. Whatever the case may be, that’s what we’re after. Some of those things are tangible and some of those things are culture, and I think that’s what we’re trying to shape and do.
Circling back to what Sonny said about getting to an 85% stable workforce, how do you do that? Is it through this combination of tangible and intangible things?
ST: One thing that I’ve found, when I’ve tried to figure out what’s different about ResCare, when you talk to our caregivers … they were drawn to it because of experiences in their past, with a family member, a friend who had needs. We have to be a difference-maker for that employee. How great is the employee experience?
One of the things we’ve found in this industry is being paid quickly. Can we go to daily pay? [We are looking for] things that aren’t out there for that workforce, that we can do.
We hire 200 to 300 people a week in Rexanne’s area. When you’re hiring that number of people, your problem is fixed in about six months if you’re hiring the right people. We’re backing up and saying, we’ve got the hiring problem solved, we want to make sure that a large percentage of them, these are people who truly want to do this for a living. Once we identify the right people, they stay. Hiring is not really our problem. We can win that war …
So, on the front end, make sure you hire the right people, and then as Rexanne said, make it easy. It’s not hard, but everybody makes it hard. And every state has different requirements. In some cases, we have to train them for two weeks. So, make sure that’s easy. Make sure it’s online just enough but has just enough human touch, make sure it’s understandable, it’s easy to get to, there’s not connection problems. You’re thinking, “That makes sense,” but you wouldn’t believe the problems people have just to get hired and just to get enough hours.
One of our top professionals, he has his own security business, but he has a big heart for doing this. He’s figured out, I can run my business, but I want to take care of this person, so we stay flexible … How can we get the best people in here? We’re listening to everything … Where some industries haven’t changed, and they’re saying, “I’m the employer and you’re going to do what I say,” we’re backing up and saying, “This is a place for you to serve, we want to make it convenient for you.” That’s the shift in mentality.
People say, oh yeah, that’s the millennials. No. There’s a large population of people my age who are out there doing this, but they want that flexibility. They want that to be accommodated. Why can’t we do it?
RD: We see a lot of different types of people who want to work in this business—a lot of young professionals who are finishing up CNA certifications, and then we also have a lot of retirees who just want to fill some time. The average caregiver who works for us in home care works about 23 hours a week. So, we don’t have a lot of people who are trying to make this a 45-hour a week career.
I was in Columbia, South Carolina, and there was a lady in the lobby filling out an application. I introduced myself to her and asked her why us, why are you here? She said she had heard about us through a neighbor. She lives in a 55-plus community. And she said she really wants to give back.
I thought that was really a testament, because that’s an interesting group, and you’ve got to have opportunities for that group of people that are different than the 23-year-old person who just finished CNA school. We’ve got to communicate with those people differently. We have to respond to them differently. Because we need every one of them. With the 23-year-old CNA, we’re communicating through our smartphones. The retiree, in some cases we’re communicating through our smartphones, but we’re also picking up the phone, calling, emailing, we’re doing different things.
But paying a competitive wage has to be part of the equation too, for recruitment and retention?
RD: And I think we are competitive on the pay scale. We’re competitive market to market. We spend a lot of time and energy understanding what being competitive means. In some markets, that’s vastly different than other markets. Medicaid is a state by state program. Every state does not pay as well as the other.
Sometimes, it’s about a step program so that people who have been with us longer, we reward that performance. Sometimes it’s a quality program. People who bring in better results have the opportunity to make more money. We do a lot of innovative things for referral bonuses. We do a lot of contests and things, you put your name in a hat, you know, we’re trying to be as creative as we possibly can.
If you look at the amount of increases that our company gave last year, it’s a big number, and a lot of that is not at the support center level, a lot of that is at the field level. One of the biggest challenges that we have, and for the industry, is municipalities or states that say, we’re taking minimum wage to this number. And maybe that number is a dollar or two dollars more than the pay rate today in that market, yet the government Medicaid program hasn’t moved what they’re willing to reimburse for services. So that’s the gap that we’re always pushing on and trying to fill.
Sometimes these vulnerable populations are not really considered when those decisions are made, and that can be problematic for us. Where we have to give up margin to be competitive in a market, to get the services provided, that’s what we’ll do.
Considering that Medicaid rates are often not generous, how do you manage, financially, to increase wages and make investments into improving culture and the employee experience?
ST: We are trying to drive as much waste as we can out of what it costs to run the business.
We’re moving to a new, shiny building down the street because it costs half as much as this. It’s a new building, but a much smaller space. This building has served its purpose, but trust me, one of the values [CEO Jon Rousseau] brings to the table is, we’re going to look at every dollar we spend, to make sure that we’re taking the taxpayers’ money and taking care of people. So every dime is spent in the right direction. There’s no executive toys and perks.
You look at systems upgrades. Man, that costs some money. But look at all the waste it drives out. So a lot of our conversations are, we’re going to spend this, but it’s going to get us, long-term, a more competitive edge … I would say half my meetings today are around how do we spend money wisely.
You mention systems upgrades. I know ResCare has invested pretty heavily in tech, such as monitoring systems for people’s homes, through the ConnectedHome initiative. Can tech also help alleviate some labor pressures?
RD: It’s a huge differentiator. I’ve been in this position, where you’re a working professional with aging parents. A lot to times, the first thing that someone will say is, my mom or my dad needs 24-hour care. Most people can’t afford 24-hour care, but they can afford a tech solution that allows them to supplement that care in the home. Maybe we need to be in the home four hours or six hours, but if we have tech in the home … someone is calling to check, we have the ability to talk to that senior in their home, we know who’s at the door when the doorbell rings.
There’s a gap that we fill that I think is very economical and an answer to a big problem that a lot of people have. And maybe at some point they do need 24-hour care, but most of the time, we’re able to take care of that person all the way through. And if they engage home health and hospice services, we can still assist and take care of that person.
I know ResCare also has a workforce solutions division. What is that?
RD: That’s the original business the company was in. It’s a job corps function. It’s us having contracts with the government to provide services to put people back to work. It’s a very motivating part of what we do … We’re often able to work with workforce in certain markets, to get workers to see clients on our cases. And sometimes we don’t, they don’t cross over what we do at all. So, it’s going into communities, winning a contract to help people get work.
So it’s not always home care or even health care specific?
RD: Not always.
Rexanne, given your mergers and acquisitions background, what do you make of all the consolidation happening in home care and home health lately?
RD: The industry is always changing … I think it was encouraging when we saw the move for the managed care company, buying Kindred. It says managed care is paying attention to what we do in post-acute services, and I think they’ve always paid attention to a certain level, but that was a new industry move that’s encouraging. I think the consolidation is going to continue.
While there are a lot of companies out there, there’s still not huge market share that any of these companies have. I believe that all health care is really local. Yes, we’re a big company, but when I’m in Winston-Salem, North Carolina, I’m worried about how are we providing services in Winston-Salem, North Carolina. And the needs there are very unique, compared with Linwood, Washington. So, I think that all health care is very local, and event hough the bigger companies are doing more acquisitions, it’s what they really know how to do. How do you gain some back office efficiencies, but then you’re back out in that local market?
Sonny, do you agree?
ST: I think the local piece is where we’re ahead of the game, and all these bigger players are trying to figure it out. When I was with Cigna, one of their mottoes was, go global, go deeper. Going deeper was, in the markets you’re in, go as deep as you can. We’re already there. When you go to Somerset, Kentucky and you see that model, it’s Somerset, Kentucky-built. When you go to Seattle, Washington, it’s Seattle. This company, we’ve already figured out that local is the right way.
RD: A good example of that is, in the first few weeks of Sonny’s job, he went to Seattle, Washington, and our Seattle branch, we have pods by nationality.
ST: You’re sitting there at the table and each of their supervisors speaks five languages … and in Somerset, Kentucky, you can imagine it looks different. But they’ve figured out what works there. What we’ve done is give them the flexibility to run their businesses and give them the tools to do that.
I believe managed care is coming our way … by managing care and being close, that’s how you drive the cost down. That’s where I think the industry is going. [The consolidation] is not going to change us a whole lot. We’re going to keep doing what we’re doing, and just do it better.
Written by Tim Mullaney