In 2018, the Right at Home location in Sioux Falls, South Dakota, nearly doubled its business in terms of hours with clients and became one of the only home care agencies in the state to earn the gold seal of approval from the Joint Commission.
Despite hitting its stride, sailing hasn’t always been this smooth for the five-year-old business, which had trouble getting off the ground, owner Tony Mau told Home Health Care News.
“There were many times in the first three years I was like, ‘I don’t know if this is going to work,’” he said. “Even a couple years ago, I was thinking I might have to get another full-time job just [to] keep this office running. Then the tires finally hit the ground, you get that traction and it just took off.”
Today, the franchise location, which offers medical and non-medical services, covers 8,000 square miles, serving about 200 clients with about half as many caregivers.
With a 10.8% profit margin and a well above-average caregiver retention rate, Mau attributes the agency’s improvements to top-notch communication between caregivers, clients and office staff.
Points of difference
The Right at Home agency’s improved performance came after Mau worked to step up communication by strengthening the processes around it.
For example, back before business was booming, he implemented a change-of-condition program. After every visit, caregivers now use an electronic system to log their clients’ status, noting changes in condition, whether a client is struggling to walk, developing a rash or anything in between.
The goal is to be proactive rather than reactive, he said.
“When they record that, it goes right to my nurses’ desktop so she can start monitoring that,” Mau said, noting that changes in condition usually prompt a visit from one of the location’s office nurses. “If we feel like [condition] is degrading, then we will get them to their general practice doctor instead of them waiting for an ambulance to come and rolling them to the ER, and that’s been a pretty big difference maker.”
Besides strengthening communication between field and office staff, Mau also moved to increase communication between clients, caregivers and himself as the agency’s owner. To do that, Mau turned to Home Care Pulse, a home care research and solutions company.
Currently, Home Care Pulse surveys 10% of the Right at Home agency’s clients and 10% of its caregivers every month. Mau then uses the insights gained to better inform the business.
“Our entire staff sits down once a month and goes through this report and says, ‘Where did we fail here?’ ” he said. “‘What can we do to fix this?’ It’s not rocket science. It’s attrition, and after a while, things start improving. You put different processes in place. You try to make things a little better one small bite at a time.”
The incremental strategy has worked: The location was recognized as a 2017, 2018 and 2019 Provider of Choice and Employer of Choice by Home Care Pulse, which bases its results on feedback and satisfaction ratings from clients and caregivers. It was also named a Leader in Excellence in 2017 and 2018, also by Home Care Pulse.
With about 20 competitors in the Sioux Falls area, agency differentiation is especially important to the Right at Home agency’s success, according to Mau, who previously spent 22 years in the telephone industry as an operations executive.
High-quality care and the need for all-around communication is what got Mau into the home care industry to begin with, he said. Similar to many home care agency owners and operators, Mau entered the space shortly after his mother-in-law needed home care services in 2013.
“I did a bunch calling around looking for people to see if they could come and help her, and I didn’t get the questions answered that I was looking for, and I had a hard time finding people,” Mau said. “I basically told my wife I’m quitting my six-figure job, and we’re going to go start this business. After I picked her up off the floor, we got this up and running.”
Tackling challenges
Operating out of South Dakota — which spans more than 77,000 square miles and has a population of about 870,000 — means that challenges come with the terrain. Namely, those challenges include weather and travel, according to Mau.
“If it’s negative 29 [degrees], cars don’t like to start in that weather,” he said.
To provide care throughout his agency’s vast territory, Mau’s strategy is to employ caregivers across the entire 8,000-square-miles coverage area — not just those from Sioux Falls. That way, he can pair caregivers with clients who are geographically close, granted their personalities match.
When caregivers do have to travel, they’re paid hourly while driving, in addition to receiving mileage between clients. Many agencies do only the latter.
While unrelated to Mau’s agency, Medicare-certified home health agencies operating in rural areas have long been supported by a small reimbursement bump to offset inherently steep travel costs and sparse patient populations. But the Centers for Medicare & Medicaid Services (CMS) is drastically reshaping those rural add-on payments over the next several years, with some home health agencies on the hook for serious financial hits.
For example, in Vermont, 10 home health and hospice agencies say they will lose significant funding as a result of recent changes to Medicare’s rural add-on payments.
Caregiver, client satisfaction
For November, December and January, the Sioux Falls Right at Home location had an average turnover rate of about 11%. Meanwhile, 63 of the company’s 100 caregivers have been with the company over a year, Mau said. Both figures are impressive when compared to the 66.7% national median caregiver turnover rate.
Mau’s strategy in bolstering retention has been to hire caregivers pursuing the job as a second, part-time career. About 90% of the location’s caregivers are age 30 or older and about 65% are part-time, Mau said.
Apart from hiring older caregivers, Mau also strives to create a healthy work culture, one where he invests his time in getting to know each of his employees.
“I know all 100 of my caregivers. I know all 200 of my clients. I called them on their birthdays. I have a conversation with them so they know who I am and who my staff is,” Mau said. “I think it plays a pivotal role.”
Additionally, schedulers call all the clients and caregivers every two months to check in, and the company also sends employees to meet with clients before pairing them with a caregiver to facilitate the best match.
All in all, the strategy seems to be working: Currently, 156 of the locations’ 200 clients have been with customers for more than a year, Mau said.
What’s next
In the year ahead, Right at Home in Sioux fall is looking to ramp up its referrals and level out its revenue mix, which currently skewed toward state-funded Medicaid clients.
To make it happen, Mau plans to add another member to its marketing team. He also recently hired an employee to focus entirely on social media marketing — where most of the location’s marketing budget goes.
Additionally, Mau hopes its December accreditation from the Joint Commission will boost business, earning the agency more referrals.
“I felt like we were getting big enough I was losing touch of some of the little things on the edges, and it’s all about continuity of care for me,” he said. “I expect we’ll get some traction with hospitals because of it.”
Thrive is a HHCN series that explores the successes, struggles and strategies of home care owners and operators on the local level.
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