Recruiting in a Crisis: Why Home Care Agencies Are Overhauling Their Onboarding Programs

Over the years, training and “upskilling” in-home care workers has been a key strategy to improve retention for providers struggling with turnover. But as the COVID-19 public health emergency continues, providers who are actively recruiting will now have to navigate new obstacles when preparing recently hired caregivers to work in the home setting.

Since mid-March, some states began mandating shelter-in-place orders and implementing social-distancing measures as methods to slow the spread of the coronavirus.

Such preventative actions made it more difficult for in-home care providers to recruit and train workers, but it didn’t stop those things entirely.

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“We have a lot of clients that continue to need our services,” Kim McGraw, vice president of HR, talent acquisition and client care services at FirstLight Home Care, told Home Health Care News. “We want to be in a position to provide that care, so we’ve continued to recruit throughout COVID-19.”

Cincinnati-based home care franchise company FirstLight operates in more than 30 states, providing companion care, personal care and dementia care services, among others.

The franchise system has hired between 450 to 500 new caregivers per week over the past several weeks in order to meet the increased demand for its services, Jeff Bevis, co-founder and CEO of FirstLight, previously told HHCN.

FirstLight isn’t alone in its recruiting efforts. In April, Brookdale Senior Living Inc. (NYSE: BKD) announced plans to hire 4,500 health care workers — with 10% of the positions in the company’s home health and hospice segment.

When it comes to training, FirstLight has worked to shift existing processes into the virtual realm, according to McGraw.

“We do training virtually,” she said. “We have a learning management system that helps us do this. This helps us not only train the caregivers, in general, but also in specific things that are most relevant to COVID-19.”

The COVID-19 emergency has resulted in many providers leaning on some form of virtual training. CareAcademy — a Boston-based training platform for home care professionals — recently saw this first hand.

“We’ve seen agencies really have to reimagine what it takes to train and scale their workforce, turning to us [more often] and relying on us,” Helen Adeosun, founder and CEO of CareAcademy, told HHCN. “We’ve had a number of … hospitals [also] reach out to us for help supporting their direct care worker opportunity. We are seeing companies who have never even considered training technology do so in this moment.”

In March, CareAcademy made one of its training courses publicly available. To date, the class has over 80,000 views.

“Thousands of people have completed certification through that publicly available class,” Adeosun said.

In addition to online courses, some FirstLight owners doubled down on training by having new caregivers connect with company veterans.

“They’ll have the [new] caregivers go through the courses and then set up a call with a [our current] caregivers and then have them dialogue, in terms of what they learned and how they can apply it,” McGraw said. “This allows for a virtual element, but it also allows the owners and trainers to have more of a direct line and an opportunity for interaction with the new caregivers.”

During the COVID-19 emergency, FirstLight began emphasizing additional topics during its training of new caregivers. Those topics included a focus on hand hygiene, infection control for health care professionals and self-care practices.

From a compliance standpoint, some in-home care providers must follow local, state or federal policies on training new hires. On its end, the Centers for Medicare & Medicaid Services (CMS) has made a handful of moves to waive regulations around training.

In April, for example, CMS announced a number of blanket waivers, including the postponement of the 12-hour annual in-service training requirement for home health aides.

At the end of March, CMS provided flexibility around the Conditions of Participation (CoPs) related to on-site home health aide supervision, allowing caregivers to complete this remotely.

Plus, under the CARES Act, the 14-day home health aide in-person supervisory requirements are waived.

For Selfhelp Community Services, the coronavirus brought recruiting to a temporary standstill in March. When Selfhelp Community Services eventually began recruiting again, the organization turned to digital tools like Zoom for interviews, Amy Leshner Thomas, the organization’s vice president of home care, told HHCN.

When it comes to training, Selfhelp Community Services hasn’t fully made the move to virtual services. The organization still partly utilizes in-person training.

“The Department of Health hasn’t approved any total online training,” Thomas said. “We’ve done a lot of the functions in an online capacity, but we still have a skeleton crew of staff. We’ve had situations where we make sure that only one person at a time comes, or we’ve done small orientations where we never have more than a few people in a room. They are socially distancing and wearing personal protective equipment (PPE), and we’ve taken their temperatures at the door.”

Founded in 1936, Selfhelp Community Services is a Manhattan-based nonprofit organization. The organization has a home care services line that serves over 1,000 clients, as well as a Medicare-certified home health agency.

Additionally, Selfhelp Community Services offers New York State Department of Health-approved home health aide and personal care aide training programs. As a workforce investment program, the Selfhelp Community Services training programs serve caregivers throughout the state — not just the organizations’ caregiver hires.

While Selfhelp Community Services potentially looked to move its personal care aide training program online, this proved challenging.

In May, the organization slowly began to return to in-person training while making sure to adhere to health department guidance, according to Thomas.

“We did it like an experiment,” she said. “We had two training rooms that meet the square footage requirement to train 20 students each. We had these folding doors between the rooms, we opened the folding doors, and a class that would have fit 40 students and we worked with 13. We had plenty of space to social distance, and only took small groups of three or four students into the lab portion.”

While Selfhelp Community Services does some aspects of training online, Thomas stresses that it will never be a complete substitute for hands-on training.

“Think of your own grandma,” she said. “Would you really want an agency to send someone to care for her that they only knew through online training? I believe a lot of the class can be taught online, but how do I evaluate what the person is learning, if I can’t see how they interact with people?”

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