Recruiting and retention woes are the obvious, above-the-surface topics when it comes to home-based care providers’ staffing. But the below-surface trends could be just as important, and those are becoming apparent.
For instance, home health providers are having to manage increased PTO usage and decreased productivity from workers. In general, the profile of a worker pre-COVID-19 and post-COVID-19 is different.
“We haven’t seen productivity recover to pre-COVID levels,” VNS Health President and CEO Dan Savitt said at Home Health Care News’ FUTURE event on Thursday in New York City. “And there’s a couple of different things going on.”
The New York-based VNS Health – formerly Visiting Nurse Service of New York (VNSNY) – is a nonprofit home health, hospice and palliative care provider. It cares for over 40,000 patients, a healthy mix between health plan members and traditional Medicare patients. Part of its reasoning for the rebrand is that it plans to expand outside of New York in the near-term future.
“We continue to hear from our staff that they’re just tired,” Savitt continued. “And there’s a capacity constraint, so we’re very careful how we push them, but we haven’t been able to recover. And I think that – coupled with higher levels of unplanned PTO and other related problems – has really continued to constrain capacity. It makes it much more difficult to operate day to day at the same gross margin level as we were before.”
VNS Health is certainly not alone.
Providers are dealing with a dilemma: either they urge workers to be more productive on their jobs and to work more, risking burnout and turnover; or, they allow them more time off, more flexibility, and deal with the short-term losses that come with that.
For Enhabit Inc. (NYSE: EHAB), it has taken the latter route.
“We need to [approve that PTO] in today’s world,” Enhabit CEO Barb Jacobsmeyer said at FUTURE. “If you don’t approve it, they can go anywhere. You want them to feel the support that they can enjoy some family time.”
The Dallas-based Enhabit has 251 home health locations and 100 hospice locations across 34 states. It officially became a publicly traded company in July after spinning off from Encompass Health Corporation (NYSE: EHC).
Enhabit has been open about its employees’ PTO usage. After two years of taking time off out of necessity – due to being sick, a family member being sick, etc. – workers were finally able to utilize PTO for vacation this past summer.
It came in bunches, and Enhabit’s operations felt the brunt of that.
“Summer tends to be a higher usage of time for vacations, but what we experienced was a pretty significant increase,” Jacobsmeyer said. “What was challenging was that you’d have a branch branch director say, ‘But if I let them off, I’m going to have some issues, and I’ll have to turn patients away.’ And you have to make that decision to say they they deserve that time. And if we’re going to keep him for the long haul, we need to let him take the time off.”
The PRN staff that would normally fill in was also taking time away at about the same clip as other staff, so in the end, Enhabit could not maintain its capacity. But Jacobsmeyer was willing to live with that, with the long-term focus being on retention.
Managing through workforce complications
Amedisys Inc. (Nasdaq: AMED) is dealing with a staffing dichotomy.
On one end, it is seeing wage inflation flatten and also seeing a better flow of qualified candidates applying for positions. On the other end, it’s also dealing with certain changes in staff behavior.
“What is starting to develop, and something we’re watching very closely, is that our employees do want more optionality, more flexibility on their schedule,” Amedisys President and CEO Chris Gerard said at FUTURE. “We’re seeing status changes happen at an increasing rate. In some of our markets, we’re having good hiring months, but not increasing our clinical capacity, because some of our existing full-time staff members are willing to forego the health benefits and other things to go to a per-diem or PRN basis.”
That, in turn, brings down clinical capacity. And that phenomenon is especially new, mostly visible in the last year or so, according to Gerard.
“Its a challenge,” he said. “But we need to manage through it.”
The Baton Rouge, Louisiana-based Amedisys provides home health, hospice and personal care services in 38 states and Washington, D.C., and cares for about 445,000 patients per year.
The question it and others are trying to figure out is how to manage through that challenge.
Amedisys has stressed to employees that you can have full-time status and still have flexibility, something it has worked to make happen. It has also built proprietary ways to find out when employees are nearing a point where they may leave the organization in the next three months.
When that system identifies an employee in that situation, it leads to a one-on-one, face-to-face meeting with them to find out what the company could do better to keep them where they are.
“You have to be able to scale, but you also have to be more flexible in how you cater to your staff,” Gerard said. “That’s what we’re doing, just really understanding what the motivation of the employees is and saying, ‘Is there a way that we can fulfill that motivation without changing status or losing access to productivity?’”