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Staffing is almost ubiquitously considered the toughest challenge in both home health and home care. A parallel issue that is often considered far less, however, is turnover among executives at the companies that make up the space.
It’s not completely clear whether the trend came to fruition due to COVID-19 itself, or whether it was due to the pandemic’s indirect ripple effects on employers, people and work life in general. But both anecdotally and based on broad data, executive turnover in home-based care has ticked up since 2020.
Sources from the private equity space as well as home-focused consulting firms have separately told Home Health Care News that it is a trend they’ve both witnessed and are playing close attention to.
The question is whether it will slow down in 2022 and beyond.
The notable names that have either resigned or moved on from their posts in the past year include: April Anthony, the former CEO of Encompass Health’s (NYSE: EHC) home health and hospice business; Brian Petranick, the CEO of Right at Home; Paul Mastrapa, the CEO of Help at Home; and Paul Kusserow, the CEO of Amedisys (Nasdaq: AMED).
Those are just a few examples. And in addition to the big-name leaders no longer in their former roles, dozens of high-level executives in other positions have taken part in the re-shuffling that has gone down over the last two years.
For some companies that have seen executive exoduses, filling those holes isn’t always easy.
“When you’re in that position, you’re under the gun,” Mark Kulik, managing director at The Braff Group, told HHCN. “If you have an organization and you’ve got a defined org chart, at that level – the director level and above – you can’t leave those positions over for too long. So you’ve got to go ahead and make a decision and have someone step in.”
At that point, organizations basically have two options: hire someone that is in a lower position but ready to make the jump, either internally or externally, or find an executive in the same role as the vacant one to fill the spot.
And that is where the problem becomes cyclical. As organizations lose talent, ultimately, that generally means another organization in the field is likely to lose out as well.
No matter what route an organization takes, it’s also not an exact science.
“Sometimes that person that you hire that is aspiring to be next up in that position works out and does great. They they learn, they grow,” Kulik said. “Other times, it doesn’t work out for that person or the company. And then you’re back to making a decision, ‘Do I look for the next person to replace the person I just hired six months ago or a year ago?’ It’s just a very tough cycle.”
To make matters worse, providers in both home care and home health are going through industry-altering change in their respective sub-sectors. It’s hard to tackle staffing woes, for instance, if there aren’t the proper leaders in place to take them on.
In home health care, there’s regulation challenges, such as the implementation of the Home Health Value-Based Purchasing (HHVBP) Model and OASIS-E.
In home care, there’s seemingly more opportunity than ever – in Medicare Advantage (MA) and alternative models such as hospital-at-home programs that operators can get involved in. Setting an organization on a new path, though, is near impossible without consistent and strong leadership.
Especially when a new CEO is hired, it can create an onslaught. Those new leaders often want to bring in people they feel most comfortable with, which leaves holes in former organizations and creates turnover in the new one.
“New CEOs, they draft people, they bring the prior bandmates, if you will, along with them,” Kulik said. “And that causes change. And that causes some turnover. So they’re trying to assure that they’re working with the same quality level of performers that they worked with in the past. And when they’re successful in doing that, they bring those people along, and that creates its own set of dominos of open positions. That’s happening in the marketplace, too.”
Theoretically, there is more opportunity than ever in home-based care. It’s an emerging setting, which should be attracting more talent to the space.
In some ways, that’s happening. More executives with payer backgrounds are coming into leadership roles in the space.
At the same time, the work can be tough. Especially during the COVID-19 chaos, that was a cause for burnout.
“There’s several different winds afoot,” Kulik said. “But there’s the issue over work-life balance in this industry. There is no end to the work that is in front of you, there’s always something else to be done.”
M&A’s role in executive turnover
In terms of burnout, the turnover among executives somewhat mirrors what providers have seen with front-line workers.
But the amount of merger-and-acquisition deals that have taken place over the last two years certainly has helped drive that turnover.
“It’s not to say that that turnover is only happening at kind of the the C-suite or the senior management roles, because we’ve seen that up and down the entire management chain,” Eugene Goldenberg, a managing director for health care investment bank Edgemont Partners, told HHCN. “However, I think what’s also driving this is there has been what I would deem to be an unprecedented level of M&A activity over these last 24 months or so.”
Despite a lull in dealmaking in home care and home health in the first quarter of 2022, there have been massive deals – such as UnitedHealth Group’s (NYSE: UNH) pending purchase of LHC Group (Nasdaq: LHCG), among others – that will close out later this year.
And before that, the back half of 2020 and 2021 included record-breaking numbers.
“And as a result a lot of that activity, some of the targets are finding themselves in strategic hands,” Goldenberg said. “And obviously, there’s not always a need for CFOs, two CEOs or two division heads. So as a result, every time there’s a strategic transaction, there tends to be a handful of very qualified and experienced operators that become available once their respective noncompete expires.”
Even Encompass Health’s spinoff of its home health and hospice segment to Enhabit Home Health & Hospice led to many leaders leaving the organization.
And while M&A is often the cause of those leaders exiting, the general turnover of leaders has made it tougher to get deals done in 2022.
“There’s a disproportionately lower level of proven leaders versus open opportunities,” Kulik said. “I get asked quite often throughout the course of the year if I know of a good sales leader, or a good clinical leader, or a good CEO or COO candidate.”
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