This article is sponsored by CareAcademy. This article is based on a Home Health Care News discussion with Elias Lee, regional director of talent acquisition at Aveanna Healthcare, Michelle Cone, senior vice president of training and brand programs at HomeWell Care Services, and Michael Slupecki, CEO of Griswold Home Care. This discussion took place on August 31, 2023 during the HHCN FUTURE Conference. The article below has been edited for length and clarity.

Home Health Care News: Tell us a little bit about who you are, what your role is, what Aveanna does.

Elias Lee: We’re a national provider in home care throughout the United States. We specialize in care from pediatrics, all the way up to adults, and we’re in three divisions. We have our home health and hospice, our private duty services, as well as our medical solutions. I’ve been with Aveanna Legacy Company since 2014. I started as a coordinator and moved my way up to executive director, both in home care as well as senior living. I oversee the talent acquisition in private duty services in the Northeast as well as the Midwest and Mid-American markets.

Michelle Cone: I’ve been with HomeWell for about seven and a half years, and I’m entering my 26th year working within the post-acute care continuum. I started out many years ago as a staffing and scheduling coordinator in private duty, and worked my way through the ranks. I am very happy to be able to share this panel with two wonderful experts today. We are in the non-medical home care space. No hospice and no private duty, but we are skilled home health and we do collaborate very well with those community partners.

Michael Slupecki: I’m with Griswold Home Care. I’ve been with Griswold for about four years. They are also a non-medical home care franchise company, but my career has spanned nearly 20 years in this space.

HHCN: When we think about each of your organizations’ approaches to the ongoing staffing gap in the industry, what would you say it all comes down to?

Lee: For us, as an organization, this really comes down to speed to hire. We looked at all of our operational, clinical, people services, HR, and looked at our onboarding process, from when people are applying, to when people are offered, to when people are hired, and then when they’re actually working in the home.

Looking at those various stages and really taking control of what we can control, and make that experience as best as possible for our applicants that are applying. Because we do spend advertising dollars attracting applicants to us, and making that speed to hire process where it’s timely, they know what to expect. They are able to move through the process, and be ultimately in our patients’ home, which is the end goal.

Speed to hire – we pulled a lot of our departments, myself, clinical operations, and sat down and challenged each other to really dissect and innovate our onboarding process. That way we could be a provider of choice for all applicants that are looking to get hired with Aveanna.

HHCN: Michelle, what about you?

Cone: I think when we’ve taken a deep look at how we can really move the needle, the low-hanging fruit of recruitment and Retention is retention. What we wanted to look at is not just the retention of our Caregivers, but retention at the agency level of our key associates. There’s many different studies, both internally and externally, that really show that if we can focus on retention of our schedulers, our HR recruiters, our care managers, our sales and marketing team, that by default positively impacts the retention of our caregivers.

One of our strategies at HomeWell is to focus on giving those key associates the resources, tools, learning, education, and support that they need, so that they can in turn support and advocate and be there for that caregiver workforce.

HHCN: Mike, what about you?

Slupecki: Yes, it’s interesting, because you started at the recruitment, you went to retention at the middle manager level, and I thought of leadership as the answer, and I felt like it starts at the top. Before we look at technologies, and we look at dashboards, I think the first thing we need to look at is the mirror, to make sure we’re attracting the right talent, because A players don’t work for B bosses. It’s about finding those folks in the team that mirror your culture, mirror the way you see the world, and make sure that goes all the way down through the organization.

If you match up those cultural aspects, you keep that retention at the middle manager level, which I think also then drives caregiver retention and recruitment, and everything flows from the top. I always say to folks, “If you’re working on getting all A players, and you’re wondering whether or not so-and-so is an A player, they’re not.” You never wonder about your A player. We really have to look at our teams and make sure we’re optimizing our teams.

HHCN: Michael, what would you say are some challenges, or maybe how do you approach passing down that culture from the top to those middle managers and just making sure that everyone is rowing in the same direction?

Slupecki: We’re not a huge organization. Our home office structure is only 30 people. We have a very good pulse on those folks. Then, we have eight company-owned locations that are really operated by another 30 people. For an organization our size, it’s really easy to keep the pulse on everything. We do annual surveys. We actually got recognized by Philadelphia Inquirer for best places to work. But, we really read those and make sure there’s nothing crazy coming out of them. About how somebody’s not feeling appreciated, and just being really reactive, but because everybody’s on a first name basis, it’s really easy to see if somebody’s having a bad day.

It’s really easy to understand if it’s so-and-so that needs a little help on the management side, because the two words I always target for, I look for are tolerant perfectionists. There’s a lot of perfectionists out there that are very intolerant.

Tolerance is something that comes with maturity. When we target those people at the mid-levels, we might have to coach them up on accepting the fact that not everybody is a perfectionist, and just working that culture that way.

HHCN: Elias, I wanted to follow up with something you said, which is about the importance of onboarding. I’m curious how the onboarding process has evolved with more technology, and since the pandemic has shifted a lot of that stuff online and virtual. Can you talk about the evolution and changes in the onboarding process?

Lee: For onboarding, I think there’s a lot of data points that, especially for recruitment, we can see the application process and how, when people are applying their experience. There’s a lot more technology from our applicant tracking system to manage that, which is important, as well as, really, implementing systems to make improvements. The technology has been a real upside since when I started off as a recruiter and an executive director and now to my current role. I think utilizing this technology, and pulling the data, and making decisions off of it, has been really beneficial to us to create the best onboarding process to be streamlined across Aveanna.

HHCN: Michelle, anything to add on that one?

Cone: Absolutely. I think the advancement and the expertise that we see with our platforms is very important. We need to, as an industry, make sure that our owner-operators are extracting as much value from the platforms as possible. It’s credit in, credit out, right? You need to make sure that all of our teams are putting the right information in, so we can use that data to direct and provide insights into making strategic business decisions. What platforms are working? What models are working? What sort of recruitment channels are actually working? What are those conversion rates? What do we want to double down on? What do we want to pull back from? How can we leverage our partnerships?

We want to make sure that we’re pulling every single lever that we possibly can, to help us onboard quickly, get those caregivers onboarded, hired, get their background checks, get them placed with a client, because we know that when we’re able to place them with a client quicker, and we’re able to provide as much support, and encouragement, and appreciation as possible in those first 90 days, that’s when the magic happens, and that’s when we see the success rates of retention.

HHCN: Right. Michael, anything to add on that one?

Slupecki: Yes, data is what we all rely on, and I think all of our process improvements are very iterative. We keep trying to tweak things until we’re optimizing whatever it is. From candidate flow to retention. So, just keeping that data and making sure every time you change something, you’re seeing the impact of that.

HHCN: Right. How do your organizations differentiate themselves for recruitment for direct care workers? Michelle, let’s start with you on this one.

Cone: We recognize that while as a franchisor we are there to support our franchisees in any way that we can, we are a caregiver business. That’s what we’re here to do. It’s important to not just recruit, but to attract wonderful caregivers, to be that employer of choice model in our local communities. We’ve also spoken a lot about how important it is to collaborate with competitors in our markets. There’s not an infinite number of caregivers, especially those lifelong caregivers. So, we’re having to explore opportunities to pursue and build our caregiver workforce outside of our traditional model, which is what we’ve leveraged for quite some time.

Michael and I, we were sitting at lunch yesterday, and we were talking about recruitment and retention and how this seems to be on the forefront of everyone’s mind industrywide, not just in the healthcare continuum, and we were joking that this has been ongoing for us as an industry for decades now. As we say in Texas, this is not our first rodeo. We’ve been tweaking and dialing in and trying to completely understand the workforce, and make sure that we’re meeting them where they are. I know even at a corporate level, we understand that without our caregivers, we don’t exist.

We do not have an industry [without caregivers], and more importantly, our clients are not able to age in place at home, which is where they want to be. From the top down, we recognize that the clients may be the backbone of our industry, but the caregivers are our lifeblood. Without them we are not here, and our clients cannot get what they need. We were founded by a caregiver, we are very caregiver-centric, we believe that caregiver recruitment and retention is a marketing function very similar to client acquisition and retention, and we look at it that way.

HHCN: Yes. Michael, what about you?

Slupecki: We have something interesting because of our history. Along with our for-profit franchise business, we have a not-for-profit foundation, and it’s named for our founder, Jean Griswold. Coming out of the pandemic, when we were really struggling to find caregivers, we came out with marketing initiatives to drive people into the industry, and at the same time, we pivoted the mission of the foundation to be focused on caregiver advancement, through scholarship grants. We did a great job on fundraising, and this year we’re giving out $100,000 in scholarships.

It’s not just Griswold’s caregivers. Any caregiver can apply, at every level of the continuum. We’ve done a lot of scholarships for folks to achieve their CNAs, but also people pursuing LPNs, RNs, and even a medical director, that started her life caring for her grandmother and stayed in gerontology. She found us, put in an application, and we gave her a scholarship. So, we’ll take donations from anyone.

The company donates the time and energy to keep it going, and then because of the branding, we certainly use it as a unique differentiator for the recruiting process.

Lee: For us, the differentiating factor for the work for us is our accelerated home health aide program that we’re offering in the state of Pennsylvania, which we were able to partner with CareAcademy on. It really accelerates that process to certify the needs in our Pennsylvania markets. One thing that really stood out was reducing the time frame. Whether it be administrative tasks, or candidate idle time, we were able to reduce that by 50%. Another thing which was huge for us was marketing this program as an accelerated program – we’re able to attract new caregivers into our company, and into our home care space. That was huge for us.

Partnering, and strategically in Pennsylvania, where we have preferred Medicaid payers having competitive wages, having a program that is digestible, was a good match that we were able to make. We took this program, and we were originally piloting it in Philadelphia, before we streamlined across Pennsylvania. We saw some great stats. One statistic was 94% of the folks that started the coursework, were completing it. It wasn’t that people were starting it and then they were ghosting us. Especially recruitment, there were no ghosts. 94% of real people were getting through it.

91% of the folks that took the final exam were able to complete it and pass. So, a high success rate on the final exam, high success rate on people, and our caregivers getting through the program. It’s been a huge success for us for the direct care workforce. As of Tuesday, we did get approved to take the program that we’re implementing in Pennsylvania and move it to Delaware. Delaware is our next market, where we’re going to take the revamped accelerated home health aide model and bring it to Delaware to service the Delaware communities and patients that we have there.

Our accelerated home health aide training program, which is very exciting, and now we’re offering and strategically matching it where we have our preferred Medicaid payers is our next vision for that.

HHCN: Going back to collaborating with competitors, do you have any examples of that?

Cone: Much like Michael, we’re a small organization, and so we hear intimate stories from our franchise business coaches who are working with our franchisees on a daily basis. In many of our markets, our franchisees are sharing stories with us, where they are collaborating with other competitors in their communities, and not only sharing the caregiver workforce, but also clients. Maybe they can’t take this client in a certain amount of time, maybe it’s outside of their territory, maybe that need is best served elsewhere.

So, where we typically may have lived in silos in the past, you’re seeing those really broken down more so now than, in this post-pandemic landscape, than we’ve ever seen before. We are a big family. This industry is a big family. There’s not a Griswold versus a HomeWell versus a FirstLight. We are all very collaborative. We want to share best practices. We want to see what we can do as a whole, to make this workforce attractive, to make sure that we’re recruiting and retaining the absolute best workforce possible for all of the clients that were involved with. So, the collaboration that we’re seeing now is better than we’ve ever seen before. I know that personally, I really welcome that, and I’m excited to see that.

HHCN: Michael, what about you?

Slupecki: We’re seeing the same thing. It’s really about taking care of the client, and sometimes our offices don’t have the staff to take care of a client, and they don’t want to just turn them away if they’ve developed almost like a partnership with another provider they trust. So, they’re not just sending them back out to Google, they’re actually referring them to competitors that they trust.

HHCN: Elias, anything to add on that one?

Lee: For us, there’s definitely a lot of partnerships when it comes to staffing, and also just transparency in tools. I have had CEOs in conversations where, “Hey, we’re leveraging this tool.” Just transparency and just sharing information, I think that’s been really helpful on both ends.

HHCN: Right. What sort of groundwork has to be laid in terms of determining what teams to involve and how to get their buy-in?

Slupecki: I think like a lot of folks in the franchise space, if you have company-owned locations, those become a little bit of your testing ground, because you can tell them what to do, and make them do it, as opposed to having to use influence and arm-twisting with franchisees sometimes. It also prevents you from distracting franchisees with something that may not work, or may not be operationalized. We did some remote monitoring piloting. We’re currently actually, today, kicking off one of the caregiver engagement apps being kicked off back at the office.

The other thing, too, is one of the benefits that people often neglect to see on a franchise network is the idea sharing that comes from the franchisees. The Big Mac didn’t come from the franchisor, it actually came from a franchisee. We want to make sure we have our ears open, so we don’t miss the next Big Mac in home care from one of our franchisees.

Lee: We have a lot of pilot programs to make sure that we’re pulling in the right stakeholders and ensuring that we have the right input for these programs. Especially for our expedited and accelerated home health certification program, pulling in our clinical leaders, getting their feedback, pulling in our HR leaders and our operational leaders, so to get buy-in, really just pilot and partnerships, and really putting the pilot in an area where you’re going to blow it out the water. Not just do it at a low-level, pick an area where the pilot is going to succeed your expectations, and everybody’s all in versus, “Oh, this is just another program or pilot that we’re doing. I think that’s really important.

Cone: Over the past year, we’ve also leveraged, what we call our ‘host locations’, which is our HomeWell operational success team, and they work very collaboratively with our corporate team, including our franchise business coaches, and we have many of these strategically across the US, where these franchisees are like, “We’re running a very tight model, a very successful model.” We have all of the roles that are very fleshed out.

We want these new owners, these owners that maybe would like to come out and visit on site to see what a successful operational location looks like. They want to host those owners, and have them welcomely, like Michael said, you see that collaboration and sharing of best practices across the system. Some of these owners will say, “We want to do that. Have these folks come out and spend a couple of days with us.” That’s our opportunity to also test with some of those owners.

They’re more, typically, again, very efficient and effective in their business models, and very successful in their local markets and are willing and open to try certain things that maybe as a launch, it’s a little bit of a struggle. They’re still trying to get their legs up under them and understand the business model. That’s also been very welcoming, and we’ve seen success from that as well.

HHCN: What about adopting new technology platforms? Are there any upfront efforts you recommend relating to expanding some of those initiatives?

Lee: Expanding some of those initiatives, I think the important thing is figuring out where the pilot, or where the area makes the most sense, and scaling up. We were able to look at Philadelphia, create a pilot there, and now all of our offices in Pennsylvania are streamlined on the same process of how we onboard and train and certify home health aides. I think that is a huge initiative, and a big pointer to focus on.

HHCN: Michelle, what about you?

Cone: This year we launched our proprietary learning management system, our learning lab. Again, with that focus of giving our agency owners not only tools and resources that they need to be successful, but those key roles – those HR recruiters, those schedulers, those care managers – the tools that they need to be successful in their role, which again, will help with retention. We rolled that out to all of those that were in the opening phase in January, and rolled it out to the full system in April. At the end of the first 90 days, we had a 93% adoption rate, which in franchising, is very difficult to do.

That, I think, really leads to the program’s success, which I know our learning team is very excited about, and we’re going to extract as much data as we possibly can as we continue to flesh out that learning lab. We also are rolling out our communities of practice for each key role, where we’re bringing our schedulers together across the entire franchise system quarterly, and allow them a time with a facilitator who’s a subject matter expert, whether that’s a franchisee or a corporate team member, to come together and not feel like an island unto themselves.

You have a scheduler in one state who feels like their hair is on fire and they’re the only one that’s going through what they’re going through, but they’re not. There’s many other schedulers across our organization that are feeling the exact same thing, feeling and going through the same struggles, challenges, and successes that they are. We’re knocking those out each quarter. We’ve had our care management communities of practice. I facilitated the sales and marketing communities of practice just a couple of weeks ago.

We’re getting ready to roll out our scheduler and the HR before the end of the year, and then we send out surveys to our franchisees and to those that participated, to get that feedback so that we can continue to tweak and make it as effective as possible for those that are taking an hour out of their day to participate. Then continue to encourage follow up and sharing and best practices and reach out to each other offline, outside of this more structured opportunity to come together. We’re seeing great success, and our survey results have been just phenomenal.

HHCN: Michael, what about you?

Slupecki: I think anything we do. We come up with a thesis, or what are we trying to achieve? What are we going to measure and what are we going to define success as after we implement it? We’re kicking off a caregiver engagement tool. We already have measured what we need to see in a reduction in turnover to achieve an ROI. It’s really about looking at that 60, 120, or 3 to 6-month target to see if we achieved what our original hypothesis was. Just make sure you know what you’re trying to achieve before you go out and spend money. No offense to the sponsors.

HHCN: There are so many caregiver engagement applications these days. What has the response been from your frontline workers, and how has it helped your operations?

Slupecki: Like I said, we’re just kicking it off today. We’re coming off of a rebrand we did last year, and we came up with this thing called Tokens of Appreciation. We were originally trying to roll it out almost manually. This helped us base the idea we had around the Tokens of Appreciation. Again, we’ll be able to measure, hopefully, in 60, 120 days, if it’s achieving what we’re hoping for it to achieve.

HHCN: Elias, anything to add on that?

Cone: We really listen to our franchisees. They’re the ones with boots on the ground. As often as we bring great ideas to them, they bring very great ideas to us. We had a franchise owner that was using the CoachUp app, and you guys that are working with Mission Care Collective may be using that as well. We’ve seen great success with that. Making sure that we’re rewarding and appreciating those caregivers in a way that that app allows it to be very user-friendly.

They can see how close they are to gold. They can go ahead and cash in those rewards to receive certain items that they’re excited about. We’re seeing great success. Again, just really leveraging partnerships, whether it’s through CareAcademy, or Mission Care Collective, or any of our other corporate partnerships, we really want to take advantage of those when we hear those franchisees bring those opportunities to us.

Lee: For us, we have the Aveanna heartbeat interaction. We’re a national company, and as we celebrate wins in certain states, just having everybody, whether it’s a CEO, whether it’s the VP of Sales, having that community. We’ve implemented good feedback, similar to Michelle and Michael having a reward system, and we’re trying to build off of that. Just leveraging our size. It’s a community, and not, “You’re in the Northeast or you’re in the Midwest or West Coast,” but having that community has been great. Caregivers doing a great job, getting a message from our CEO or from our leadership team really makes an impact.

Seeing that direct communication, and it’s really a simple message. We all text people, so having that communication and correlation, makes an impact, and we just need to be consistent with it. I think that’s the thing, is just being consistent with that outreach.

HHCN: Just looking ahead, maybe to the next few years and just the success and longevity of the home healthcare industry, what would you recommend to your peers?

Lee: My suggestion would just be, find innovation, and or create it. One of our core values is innovation, and looking at every aspect of what we do to not only meet the demands from our referral sources, but ultimately grow. I think the innovation part from all aspects, from all departments, looking over quarterly, monthly, to improve, is really just my suggestion to grow and be at the forefront in this industry.

HHCN: Okay, right. Michelle, what about you?

Cone: I think we’re going to continue to see data and AI really rise to the occasion. Particularly when we’re looking at cost efficiencies, reducing redundancy, particularly in the back office. I think there’s a great opportunity there. When we see those repetitive redundant tasks by schedulers or recruiters, what can we do to bring that together and reduce some of that? I think AI and technology, moving forward in the next few years, we’re really going to see opportunities for that, to also make sure we’re increasing the bandwidth of those team members that are with us. That capacity management that we’re constantly speaking about.

From a caregiver perspective, continuing to focus on those first 90 days. Oftentimes, our caregivers say they want so many hours, or they’re looking at this or that, but are we having a conversation at that first paycheck? Is this what you want? Is this where you need to be? Because if not, we know they’re going to go elsewhere. Just extracting as much value as we can out of technology, and what insights can we glean from that to make strategic business decisions.

Slupecki: I’m going back to my original comment about just optimizing your teams, because I totally agree with innovation, but the business graveyard is full of innovative companies that couldn’t execute. To execute, you first have to have the right people on the bus, and then focus them with the right tools and challenge them to be innovative, but always start with building the right team.

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