Automatic use of aides increases costs

Tools manage use of staff vs. contractors

But this is how we've always done it." Whenever you hear this phrase, take a close look at the process to which it refers. The staff at Visiting Nurse Association of Greater Philadelphia did and the close look resulted in a process change that resulted in a $400,000 savings over an 8-month period.

"We noticed that we were higher than the norm for home health aide days per patient according to the National Hospice and Palliative Care Organization benchmark survey," says Josh Sullivan, business manager of hospice services for the agency. After questioning staff members about the use of home health aides, Sullivan discovered that it was routine to order home health aides 7 days a week for all patients. "This was a practice that had been in place for years, and no one had evaluated it before," he explains.

After researching the industry standards for use of home health aides, a list of questions was developed to determine the appropriate level of use of aides for the nurses, says Sullivan. The hospice director worked with the nurses to explain the need for a change and to show that not all patients required 7 days a week of aides to produce the same outcome, he says. "We did get pushback from nurses because they were concerned about quality of care and they saw a decrease in aide days as a decrease in quality." By basing their protocol on national standards and by evaluating each patient on a case-by-case basis, managers were able to demonstrate that quality of care would not be affected, he adds. "We did proceed slowly because we didn't want to immediately cut back on aides for patients who already had them for 7 days a week," he admits. "We were sensitive to their needs and met with patients and their families before any changes occurred."

Another side effect of the evaluation of the use of aides was the discovery that many of the aides scheduled to work were contract employees, says Sullivan. "Schedulers were calling contract personnel before employees in many cases," he says. Although scheduling contractors was easier in some cases than working out employee schedules, it was not cost-effective, he says. The problem with contractors was a minimum charge they required and a lack of monitoring of their hours, he says. "We can schedule an employee for 1 hour and they work 1 hour, but a contractor might work, and charge us 2-8 hours, regardless of what we scheduled," he says.

"I developed a scheduling tool that enables schedulers to easily see what employees are available and how many contractors are being used," explains Sullivan. "We now have a firm rule that you can't go over a certain number of contractors in a month," he says. The contractors that are approved by the hospice have all agreed to work in 1-hour increments and not to charge for more unless scheduled for more, he says.

"We also hired some more aides to our staff to make sure we could meet our patients' needs," says Sullivan. Although there is an expense to hiring and training new staff members, it is worth the investment because you know that the aides are trained, motivated, and able to provide the quality care your hospice expects, he adds.