Home Health Providers Balancing Workload Management With Clinician Satisfaction

Hiring for nurses, caregivers, aides and other roles in home health and home care is extremely challenging.

Between keeping up with rising wages due to inflation and the cost of living, to offering adequate training and education to new hires, recruitment and retention is a constant battle for providers.

One area that has risen to the top of the priority list: workload management.


“The top priority is simple, but it’s hard to get right,” Amedisys Inc. (Nasdaq: AMED) Chief People Officer Adam Holton told Home Health Care News. “Our top priority is workload.”

Getting workload management right

The Baton Rouge, Louisiana-based Amedisys is home-based care company that operates in 37 states and the District of Columbia. The company offers home health and hospice, as well as high-acuity services in the home through its subsidiary, Contessa Health.

The primary reason for nurses who voluntarily leave Amedisys, whether within their first year of employment or following the first year, is attributed to workload, according to Holton.


That trend is not just an Amedisys problem either.

In a study published earlier this year by researchers at the National Council of State Boards of Nursing (NCSBN), more than half of over 50,000 registered nurses and licensed practical nurses reported an increase in their workload during the COVID-19 pandemic.

Source: NCSBN

Similarly, a high rate reported feeling emotionally drained, used up, fatigued , burned out or at the end of their rope “a few times a week” or “every day.”

These issues were most pronounced, according to the study, among nurses with 10 or fewer years of experience. That burnout has resulted in an overall 3.3% decline in the U.S. nursing workforce during the past two years.

For home health and home care — where there is a shortage of about 250,000 nurses — that stress is felt all across the country.

In turn, providers are strategically navigating workload management for new and tenured home-based care workers.

“There is a vicious cycle that can exist in our industry,” Holton said. “In talking to peers, the challenge seems to be that most people will leave because of workload, go somewhere else where they probably got more money and face the same, if not worse, workload issues. The core of all of this is fixing that.”

At Amedisys, the onboarding plan is structured in a way that is very intentional and deliberate in preparing clinicians for what they will experience when they start taking patient visits.

A more recent strategy shift, Holton explained, is the provider has started to self-scout itself using retention numbers at care centers that have positive data points and negative data points.

“Where we have low turnover, it’s a positive cycle,” Holton said. “You’ve got a workload that is manageable, creates a better caregiver experience, which then leads to more discretionary effort and better productivity. Where we have care centers where historically there’s been high turnover, it’s this vicious cycle that is very hard to break.”

Part of Amedisys’ workforce strategy plan that’s been at the top of mind for Holton this year has included “overseeding” with clinical hires in some areas to break that vicious cycle that the combination of high workload and turnover perpetuates.

“We have been systematically identifying the biggest pain points in high-volume roles and addressing them through technology, standardizing work and shifting tasks that are better executed by other groups,” Holton said.

What caregivers want

Workload management efforts also include making sure matching a caregiver to a patient is as seamless as possible.

“That all ties in with this idea of matching clients to caregivers,” Bayada Chief People Officer Jeff Knapp told HHCN. “We have to make sure that it’s not only a good match personality-wise, but it’s also matching the needs of the caregiver.”

The Moorestown, New Jersey-based Bayada is also one of the largest home health providers in the country. It has over 360 locations across 23 states and six other countries.

Many of the industry’s caregivers — Bayada’s included — work for three or four different providers at a time to essentially hedge their bets to find a good balance between workload, pay and other benefits.

For providers that want caregivers to stick around, it’s up to their workload management efforts to ensure they can provide the kind of work that will keep a caregiver on their payroll.

“I hear from caregivers all the time that say, ‘I don’t want to put all my eggs in one basket,’” Knapp said. “And for Bayada and our purposes, we would really love for caregivers to put all their eggs in our basket. So if we can do a better job of making them comfortable, ensuring that we’re going to be able to fill their desired work schedule and give them the hours that are convenient for them and their families, then that’s a win-win for everybody. So we are putting a lot of emphasis on that, too.”

In years past, businesses could be much more selective in the way they hire. Pre-pandemic, the employer held most of the leverage. Now that’s changed significantly.

“That’s never really been completely true in home care anyway, but now that’s flipped on its head,” Knapp said. “Our intentional understanding is we have to make it so that we are responding to the needs and the desires of the caregiver and making it easy for them to say, ‘I want to work this many hours a week, but I can only work from between this time and this time and within this geographical area.’ And we have to be able to make it easy for you to do that.”

For Bayada, the strategic shift is instilling some of those guarantees in the caregivers that are already on staff as a retention tool. Knapp said there is “untapped potential” and capacity in the caregiver pool already on the payroll.

“I think there’s a lot of untapped capacity in people who already work for us who are hedging their bets because they don’t have confidence that we can fill those other shifts,” he said. “Or that we can provide for them in the way that they want.”

As providers, proving to caregivers that they can provide a level of security is a big priority.

Technology also plays a role. Bayada is trying to make it easier on caregivers to alter their schedule or find a replacement if a shift can’t be covered.

“In the old days, if you had a sick child or a family emergency, it was a whole thing if you called off and had to wait to hear back and wait for someone to call you,” Knapp said. “Versus now where you can just go on your device and say, ‘Hey, I need help.’ Everyone sees it and covering that shift is so much easier.”

Buzzwords like engagement, satisfaction and fulfillment are thrown around often in home care, but these little differences and changes are what add up in the caregiver experience equation.

“All these things are pieces to the puzzle that make a person stay at an organization because the provider is making it easy to work for them,” Knapp said.

Holton has heard the adage that people don’t leave organizations, they leave managers. Certainly, the manager has a huge impact on the caregiver experience, he said, but in home-based care where there is more work than people that can do the work, people don’t leave managers — they leave workload.

“If you can figure out the workload,” Holton said, “you’re going to keep them.”

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