Johns Hopkins Home Care Group Using Education to Combat the Workforce Shortage

Johns Hopkins has earned a reputation as a world-renowned health system, but it’s also on the cutting-edge of home-based care and medicine with its multi-service home care provider, Johns Hopkins Home Care Group.

And one of the provider’s current top objectives: addressing the industry-wide workforce shortage through a number of recently launched programs.

Johns Hopkins Home Care Group falls under the larger umbrella of Johns Hopkins Health System’s Home & Community-Based Services division, which includes four Medicare-certified home health agencies (two adult and two pediatric), two private duty companies, a large home medical equipment company, 10 outpatient specialty pharmacies and three alternative care infusion sites.

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The division also has a robust home care coordination network, a medical model in-home primary care offering, a mobile vascular access program and a remote patient monitoring program.

In total, Johns Hopkins Health System’s Home & Community-Based Services division has 1,600 employees who provide care services to about 170,000 patients a year. In that process, the team travels about 90 trips around the globe per year — or about 2.1 million miles.

Running a home care business within a prestigious health system such as Johns Hopkins is both a privilege and a responsibility, according to Mary Gibbons Myers, president and CEO of Johns Hopkins Home Care Group and president of Home & Community-Based Services for Johns Hopkins Health System.

“It’s a privilege to be with some of the brightest and greatest physicians and clinicians in the country, and a responsibility to live up to that name and high quality of care,” Myers told Home Health Care News.

One thing that separates Johns Hopkins Home Care Group from other in-home care providers is that the organization views itself as a research incubator, according to Myers. It thinks a little differently about everything, including patient care, but also how to best find and take care of its own workforce.

“We really have a tripartite mission of research, teaching and patient care,” she said. “Education is very much embedded in everything that we do.”

It is this commitment to education that has been the main driver behind some of the recent initiatives Johns Hopkins Home Care Group has implemented, responding to the high turnover and low retention rates often seen in the in-home care arena.

In 2018, the average turnover rate in the home care industry reached an all-time high of 82%. Home health industry turnover, in comparison, checked in at an average rate of about 21.23%.

Besides being disruptive, that turnover is expensive, as each home-based care worker lost requires thousands of dollars in training and resources to replace.

Elevating the home

As part of its creative problem-solving mentality, Johns Hopkins is focused on combating the workforce challenge by making the home setting a destination for nurses, who tend to have a preference for working in the hospital setting.

“Most of the education that nurses are getting is centered around acute-care,” Myers said. “We need to work with our academic scholars and try and change the curriculum to focus on the home and community — because that is where a patient is 99% of the time.”

In addition to this, Johns Hopkins is looking for ways to make new graduates successful in the home care setting, as that has not been a focus in the past.

After concentrating on academics and potential new graduates, Johns Hopkins has created an opportunity for experienced nurses to re-imagine their careers by creating a Cross-Continuum Nurse Fellowship program, the first of its kind in Maryland.

The program trains nurses on becoming an expert on care in the home and then allows them to rotate between the home and an acute-care setting.

Doing so improves patient outcomes, according to Myers, because nurses gain a deeper understanding of both sides of the care continuum.

“I do feel like this is trailblazing and groundbreaking,” she said. “Often in nursing, clinicians are looking for something different after a few years in the acute-care setting; instead of them leaving, we want them to come to Hopkins and grow with us.”

Another recent initiative is a Johns Hopkins summer internship program that focuses on exposing nursing students to home health sooner.

The internship program launched last summer and is starting small. It currently has two nursing students that work one-on-one with an experienced nurse in the field.

“Two things are happening: They are getting exposure to the home setting, and it creates the possibility to use these nurses to be our first new graduate residents,” Myers said.

In an effort to create economic opportunity for under-served Baltimore communities struggling with high unemployment rates, John Hopkins unveiled its Health Services Cost Review Commission (HSCRC) grant program in 2015.

The HSCRC grant program trains people to become a certified nursing assistant.

“The city worked with Hopkins and asked what we could do because jobs is a major issue here,” Myers said. “Hopkins, along with the city, came up with this program that focused on individuals who were living in areas affected by high unemployment rates and other socioeconomic factors in order to help residents become gainfully employed.”

Participants who successfully complete the program are eligible to be hired as full-time employees at Johns Hopkins Home Care Group.

“As we look to build a pipeline for nurses, we looked at the personal care level as a starting point,” Myers said. “More and more people are wanting to age in place, which is increasing the demand for these services.”

Preparing for PDGM

Of course, Johns Hopkins Home Care Group isn’t just focused on recruitment, retention and training.

Like most home health providers, the challenges that the looming Patient-Driven Groupings Model (PDGM) could create are top of mind, but due to its history of care for complex patients, the organization feels confident in its ability to thrive.

“We have always taken care of the most complex patients, and most of them require high utilization of nursing services, so we actually believe with PDGM taking a lot of focus on nursing that we will have the potential of a positive benefit,” Myers said.

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