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There’s not a single home-based care provider that doesn’t have a staffing issue, whether that be in recruiting, retention or both.
In order to combat that reality, BrightStar Care and Chamberlain University are teaming up and launching a home health care didactic course under the latter’s Practice-Ready, Specialty-Focused model.
The Chicago-based BrightStar Care providers home-based care through more than 380 franchised and company-owned locations nationwide. Also based in Chicagoland, Chamberlain University is a private health care and nursing school with 24 campuses nationwide. It has 137,000 students and alumni.
As hospitals became the center of the U.S. health system, home-based care work became stigmatized. Despite the budding, integral setting of care it is, students haven’t always viewed the home as a desired place to start their careers.
BrightStar and Chamberlain are hoping to change that, and will do so through a program that exposes students to all the good and bad that comes with being a home-based care worker.
Doing so, they hope, will not only drive more workers to the home, but also weed out early the ones that likely won’t find a career there – which also will reduce turnover rates.
Home Health Care News sat down with BrightStar Care CEO Shelly Sun and Chamberlain University President Karen Cox to take readers behind the curtain. In the conversation, they discussed the details, challenges and opportunities that come with the program.
The transcript of that conversation is below.
HHCN: First, for the audience that may not be familiar with BrightStar Care or Chamberlain, I do want to get a background on both of you individually as well as your companies. Karen, can we start with you?
Karen Cox: Of course. Chamberlain University is the largest school of nursing in the country, and it’s part of the Adtalem Global Education Group (NYSE: ATGE). Our organization, Chamberlain, has all the nursing degrees.
We have a BSN program that is campus-based and a traditional program in 15 states and 23 campuses. Then, after that, we have 2/3 of our students that are post-licensure, so anything from RN to BSN, MSN, DNP – we have the largest family nurse practitioner program in the country. I’ve been president for five years. Prior to that, for 23 years, I was the CNO and then the COO at the Children’s Hospital here in Kansas City where I live.
HHCN: And Shelly?
Shelly Sun: Sure. I have the honor of serving as founder and CEO of BrightStar Care, an organization I founded about 21 years ago after looking for home care for my grandmother and not having the experience I believe all moms, dads, grandmas, and grandpas should be able to expect.
I started in the midwest with a few company-owned locations, grew and expanded through franchising to 39 states, 400 locations, and now are starting to grow our company-owned portfolio that was about 3 locations about 18 months ago and is over 30 now, as we recognize healthcare is changing rapidly and we need to put our money where our mouth is with new reimbursement mechanisms and Medicare Advantage, as well as important partnerships, such as the one we’re going to talk about today, to make sure that we’re helping our franchisees navigate the labor landscape and the changing payer and reimbursement landscape.
HHCN: You have a partnership that is directly trying to address the staffing problem in home-based care. Let’s first give an introduction of what the partnership may look like. Then, I want to get to how it came about, how you guys were introduced to each other in the first place. Karen, do you want to go ahead?
Cox: Of course. Thank you. You just heard that both organizations are very large and have a scale that is pretty impressive and across the country. We felt like that would be a great partnership, to work on home care together. The reason home care came to the forefront is nursing programs, in schools of nursing, you don’t get exposed to home care. We know that home care is going to be, if it not already is, one of the fastest-growing specialties.
But if you have these preconceived notions of what it is – and believe me, it’s so much more complex than many of our students know – we needed to find a partner who could help us demonstrate that to these students in an organized way, and so we really worked with BrightStar in developing the content.
HHCN: Shelly, why did you think Chamberlain was the right partner for this?
Sun: I think they’re the largest and most respected nursing program across the country. I think it’s great that it is both a campus-based and virtual-based, and able to meet students where they are at their stage of life and stage of journey.
We were looking for how we can help more home health nurses enter the home care workforce, but actually, for when they come, they want to stay. Because, much to Karen’s point, many don’t know what it is and whether they’ll like it or not. It costs a lot to onboard and train new nurses and to have them come for one, two, three months and realize they want to go back to a hospital.
I think what we saw in this partnership was an ability to expand the number of nurses that have an opportunity to come into home care, but as importantly, a lot of nurses leave the profession. That’s because usually where they start, if it’s not an ideal fit, if it doesn’t check the boxes for what they’re looking for – both in leveraging their license and their education but also the heart of the work that they want to do – the worst thing for the profession in general is that they leave. How do we make sure they have more exposure during their nursing program to all of the different places where they could accept a job?
I hope it’s home care. But if they don’t like home care, I hope it’s not. Having that exposure to it was something that allowed us to really get excited and really lean into the hundreds of hours, many months that our clinical team put into trying to bring a customized curriculum to meet the needs and expectations at a very high level, because they are known to be the best with Chamberlain, we needed to help bring the curriculum.
We know how to do home care, we know how to do home health nursing, but doing that in a way that an adult learner is going to learn and be engaged is different. It’s taking some content, but a whole lot of adaption to get it to something that we both could be proud of co-branding.
HHCN: Karen, you mentioned that a lot of these students don’t know what to expect in home-based care. I think for a long time, there’s been a stigma about home-based care. That you want to be in the acute facilities when you’re younger, then maybe later, you’ll go to home-based care. They don’t recognize that it’s the most exploding setting of care in health care in the U.S. right now. When did this first come on your radar, Karen, as a problem that you needed to address to get more workers ready for this type of care?
Cox: There’s a 30% turnover rate of first-year nurses – that’s a cost strain and a resource strain, and it’s not productive for anyone.
We believe that there are two reasons for that. One is the work environment, and education can’t fix that. But we can address helping them understand where would be a good place to go.
The choices in nursing are broad.
The person who would like to be an oncology nurse isn’t probably the person that wants to be a nurse in the emergency department. Home care, perioperative, they’re all very different. We’re trained as generalists. We can do all of it. We just can’t guarantee you’re going to like it and find joy in your work, which is we know is very important.
This is part of a grant that’s called Reimagining Nursing funded by the American Nurses Foundation, and we were 1 of 10 schools to receive this grant. We started with perioperative care and then moved to home care.
The reason for those first two specialties is, as I mentioned earlier, you don’t get experience in those areas, and if you do happen to, it’s usually bad experience because there weren’t enough patients in the hospital. You went with a home care nurse one day or you stood in the back of an OR one day and not a good way to get people excited. We’ve also felt like, to get career practice-ready nurses to healthcare organizations, we had to teach them about those programs.
This is not a program that’s required. You select, you choose to take the didactic course, which Shelly talked about, and which BrightStar was absolutely the practice expert in. They go through that. If they pass it, then they can choose to take their 96-hour class, clinical class, in the last part of their program, and spend 96 hours in 1 of those 2 specialties with our partners, like for home care with BrightStar.
They get to see what it’s like, what it’s not like, and make a really informed choice. One of the things that we did in nursing leadership, and I did the same thing, for many years, those two areas, we told people you have to have a year of general med-surg experience before you can come.
Well, now we know that every specialty is different, and it’s important if someone has an interest to get them in then, because they may never come back. We have a pretty robust research project around this that we’re measuring results on. Our hope is that we increase the number of people going into the specialty.
I can say with certainty that’s happening. And If you have 96 hours, that’s a lot of clinical hours and exposure to a subspecialty. That’s really where that came from, is really wanting to help our partners. And home care is going to grow. Perioperative has grown, and they have a deficit of nurses, but home care is going to continue to grow, and we just want to be part of that solution.
HHCN: There’s a lot of power in being a home-based care worker as well. In some of the other settings, you really can’t impact the patient’s life as much as you can as a home-based care. I think that’s also a way to get more workers involved.
Sun: I just think that the timing is interesting as well, coming out of the pandemic. I think that we are at a great period of time where legislative policy is changing, and fundamentals around hospitals have had to change because they didn’t have enough beds to take care of everyone when they were trying to deal with the pandemic. It meant that more acuity was being done in the home.
You think about the stereotype of younger nurses coming out of school wanting to go into the hospital because they wanted to have the thrill, and they wanted to see more.
Well, guess what? The home is as likely to have some of the higher acuity as the hospitals would have, and that hasn’t always been the case. With hospital-at-home programs – we’re participating with some of the large hospital-at-home programs and skilled nursing facility alternatives – and we’re seeing a lot more high-acuity nursing being needed and demanded in the home. This is no longer just infusions and wound care.
More consumers like the thought since they went through COVID, not having to go into a hospital if they could avoid it, being able to receive more and more care – even if it’s higher acuity – in the home.
We’re a member of Moving Health Home, and they did a study. The great majority of those members in that survey felt very comfortable having even higher-acuity types of services done in the home as an alternative to hospital. I think that’s where the industry is going, and we have to partner together and make sure we’ve got nurses that are prepared to participate in that.
Cox: I’d also just like to go back to social determinants of health aspect. The Robert Wood Johnson Foundation released a study two years ago now called The Future of Nursing 2020-2030. It was all about health equity and how there isn’t good health equity in our country, by a long shot. Their conclusion was that, unless nurses play a large role in addressing the social determinants of health, we will have a hard time really impacting health equity.
When you’re in someone’s home, you get to see who they are as a person, and when they’re in the hospital, it’s a transactional practice in some ways. But in the home, it’s about how they live, who they live with, and what’s important to them.
HHCN: Shelly, I want to get a better idea for the audience of just how big of an issue staffing is right now by the numbers.
Sun: Yes, I think that – to continue to grow at the pace that we’ve been growing – which has been double-digit every year since I’ve started the business, we’re going to need 2,000 to 5,000 additional incremental nurses than we have today over the next 3 to 7 years to meet just built-in demand.
That’s outside of the national account program that we support in terms of some of the hospital-at-home and infusion companies, clinical trials that we support as well.
We see this being mission-critical. We can only grow if we have the workforce that aligns with our core values, which means they understand what they’re getting into. They are excited about it. They know they can make a difference.
I agree home care probably more so than any other area, you’re able to see the difference that you’re making in someone’s life and the family’s life on a day in, day out basis, but it’s not for everyone. Having an opportunity to have more and more nurses exposed to see if this could be the right calling and can be the right fit will be critical for our ability to grow.
HHCN: In terms of the curriculum itself, how are you designing it, Karen? What are some of the nuts and bolts of the program?
Cox: The program was developed through a partnership with BrightStar. It goes through what you would do in an orientation as a new nurse, but at a little bit lower level. The idea is that they don’t just walk in, they still have orientation, but it won’t be as long. Everything from just how you assess a patient in the home, the safety in the home, how do you look at what their needs are from start to finish, how you case manage.
All of those things are incorporated. Again, so they don’t walk in and just start bombarding a preceptor, a nurse who’s very busy, with very basic questions. We think it makes a big difference. And even if they take the course and decide not to go with home care, it means that they appreciate what their colleagues in home care can do and are doing for the patients.
HHCN: Shelly, I thought it was really interesting the point you originally brought up, which is that you’re not necessarily trying to push people towards home-based care, because if you did that, it would actually be more detrimental because you’d have an even higher turnover rate. It’s not as if you’re going to be painting home-based care as completely seamless job that doesn’t sometimes get tough.
Sun: Absolutely. I think that was the benefit of this program and having an opportunity to have a hand in the practicums that the nurses would go through with the 96 hours that they would do alongside some of our offices across the country.
We’re also talking to other partners that might be home health agencies that we have a good relationship with and know we’ll do the right thing, and we can agree on what’s going to be done.
I think it behooves the entire home care continuum to be able to have more nurses seen and exposed to it. We are trying to make sure that we have eyes wide open so that we have those that come, stay. The statistic, the 30% that come into nursing and then burnout, and leave the profession, that’s what we have to avoid.
Every single area of health care is going to have a nursing shortage.
How do we make sure that we align the nurses with what they want, what their interests are, and where they’re going to thrive so they stay? Whether that’s in a hospital, that’s in a nursing home, that’s in a med-surg area, that’s in a step down, that’s in oncology, or it’s in the home? Any of those are great. What we need to do is reduce that 30% down to 5% to 10%. By having more exposure to more specialties during nursing school, hopefully in time we will do that. I think this is a great start.
Cox: What happens, too, is that organizations – and rightly so – throw money at it, and money’s important. Nurses want to make a good living.
But if you offer a big sign-on bonus to work in home care or perioperative care, people may do it for the bonus, but only do it for the bonus period of time a year, 18 months, and then you’re back to square one. Whereas if you do it in a reverse order, BrightStar can see who’s interested, who’s going to do a good job, who wants to work in home care, and then they can talk about potential jobs and what some of those benefits might be.
HHCN: Are there certain goals that the two of you have put forth that you really want to meet?
Cox: The first thing is that wherever there is a campus for Chamberlain and in the same vicinity, a BrightStar location, we want to ensure that we have an ongoing pipeline of students that take this course and then choose to spend time, that 96 hours, in home care.
That, to me, is really the basic goal, and then the other things follow it. Are those that come better prepared? Do they stay past the first year, and are they thriving? Are they enjoying what they’re doing?
I think that’s number one. Number two is to increase the number of nurses who are in home care, but more importantly, I think with the social determinants, with our move to value-based care, is that more nurses, in general, will understand what home care does and what home care can offer somebody that they’re working with.
HHCN: We do have a question in the chat. Do graduates get placement at a BrightStar location?
Cox: We work first with BrightStar, but we also have some other organizations that they work with, and, they do get placement. So far, we haven’t had a problem with that, but we’ve just started the home care part of this program. It was not a problem in the perioperative area. They get that placement and then it’s up to the organization whether they want to hire them or not.
HHCN: Then, Shelly, what are you hoping to get out of the program?
Sun: I think we got to crawl, walk, run. I think we’re trying to make sure that we have the curriculum that meets the expectations, and we establish ourselves as a great partner to Chamberlain as they get feedback in the classroom.
Then, as we think about those that are signing up to do their 96 hours, that we are able to match them with our BrightStar Care offices, with registered nurses, that they’re going to be able to spend time with them. And we’ve really thought through thoroughly, not just 96 hours, but 96 hours that are really giving them great exposure as a day in the life, so that they can go through supervisory visits, assessments, a care plan. How do we look for change in condition? What is the data capture that is critical to be able to get out ahead of and look for evidence-based care protocols based upon diagnoses that are going to improve care and make us a valuable member of the care continuum?
I think our short-term goal is making sure we’re a great partner, making sure that we’re able to offer meaningful, impactful practicums for those that are signing up for them and staying out ahead of that.
Then, if we’ve done that and done a great job, that we’re able to select and retain those that are exposed to our brand through both the co-branding in the classroom. That there’s an increase in this pool of nurses that we’re going to need over the next three to seven years to meet our growing demand.
HHCN: Another question from the audience, I think this is an interesting one. From a personal home care perspective especially, do either of you hope this will shift the perspective that home care is non-clinical care only?
Cox: Absolutely. There’s an opportunity for us to say, “Here’s what you would go through in that program. Here are some of the things that you’re going to see. Here are the opportunities that you’re going to have after you go through this course.”
The other thing that we’re starting to do more of is in our community health rotation, and it is to send students to home care agencies as part of that because then, that’s yet one other exposure. They may want to work in pediatrics, and that’s it, but they then know what it’s like in home care.
Sun: I think this is an opportunity to change that position of nursing students. I think there’s a broader context of those that still see home care as potentially non-clinical. I think for a large amount of the industry that is not Medicare Home Health, that still is true because they largely don’t have nurses day in, day out. I think it’s hard to look at home care as a one size fits all.
If you don’t have dedicated RN directors of nursing that are overseeing things from the start of admission, and identifying if there’s been a change of condition, to me, you are not really operating at the level where you are delivering high-quality clinical care.
Obviously, I’m in the franchisor space of non-medical and medical. I think a lot of the industry is still non-clinical because they might have an RN that they pay per diem to do an assessment, and that nurse is never part of the care oversight and care management.
It’s hard to say you’re offering a really high-quality ongoing clinical care model if there’s not a nurse part of the ongoing equation. Our model does and has always had a nurse as part of the entire care journey. That’s why we volunteer to be Joint Commission accredited, and I think ultimately why we had the honor to be selected by Chamberlain to be their partner.
HHCN: What are your thoughts on ultimately scaling this program?
Cox: Well, first of all, we’ve scaled it for perioperative. We’re scaling it for home care. The next thing that we will do is develop a toolkit for other schools of nursing. If this never goes to any other school of nursing, we’ve not been successful. We want others to engage in this, but we know that because of our scale, we can do that.
We don’t want them to look at what’s required to do this and say, “Well, I don’t have time to do that,” but really put together a toolkit and be a resource to them to say, “Here’s how you can do it.”
They may not have the volume. But there are about 1000 schools of nursing that grant the BSN degree in the country. If you even had 200 of those granting the BSN degree involved in this program, the impact would be amazing.
HHCN: I do want to ask another question from the audience. They’re curious, how many students have come to BrightStar to complete the 96 hours thus far?
Sun: It wouldn’t be applicable yet because they have to go through the coursework. They have to go and pass that, and then they have to raise their hand and say that they want to continue on to the 96-hour program, the practicum. Right now, we’re working in lockstep as the classroom experience is starting in I think seven different campuses. We are also building out what the 96 hours look like because we don’t want to just put it to a franchisee office, or a company-owned office across the BrightStar network and have different nurses get different experiences.
How many living room visits should they be in, how many different types of patient populations, pediatric, adult, geriatric, different types of complexity of the geriatric care, whether Medicare Advantage is involved or not, all the different types of assessments that need to be done.
Going through all of those in supervisory visits, wound care infusion, we really want it to touch on a lot of different things that they would be exposed to on a typical day in, day out basis. As soon as the program ends, then we will be ready for the 96 hours of practicum for the students that are electing to participate.
Cox: We start this every three months. We have eight-week sessions. One session, they’ll be doing the didactic, then they’ll do the clinical, but this is ongoing. As we’ve said, the first rotation of students is really going to be important because they’re going to go right back to their friends and colleagues in the program and say this was a great experience or it wasn’t. The other piece that we’re working on are the preceptors. In home care, because there haven’t been a lot of new graduates, they’re not used to what students are like. You work in home care because you like to be independent on one level, and you work with a team on another level, but you’re not used to having someone by your side all day long. Making sure that preceptors know this is how they’re going to get more colleagues and have more support just in general is important.
Sun: And to set their expectations, just like we’re trying to set appropriate expectations of those that we might want to enter the home care workforce. We’re not trying to get people to join just to leave six months later. Same thing. I think we’re trying to be very intentional about what are the skills, personality traits, and expectations of preceptors so that we get a good match between them and the students going through the practicum.
HHCN: Fantastic. We’re running up on time here, but Karen or Shelly, anything else to add, last thoughts on the program, or a call to action?
Cox: I’m just excited by the partnership and by improving both the image of home care and the pipeline of clinical nurses going into home care. I think in terms of a call to action, I think nursing programs, schools of nursing need to find a way. This is no longer just a fringe piece of care.
Sun: I will echo the partnership. I think many talk about the labor shortage and the impact it’s having. I think it takes special organizations like Adtalem, with Chamberlain nursing schools, to be able to say, “We’re going to do something about it. We’re going to go get a grant, we’re going to put in the work, we’re going to find a good partner.” It’s been an honor for BrightStar and our clinical team to be a part of something that hopefully has impacts for decades to come through Karen’s vision and leadership. I couldn’t be happier to see our brand co-branded with a very well-recognized and respected name like Chamberlain.
HHCN: Karen and Shelly, thank you so much.