Nurses should know home care finances

It’s not just a mission; it’s also a business

Declining or stagnant reimbursement, increasing overheads, and a hot job market that makes attracting and keeping staff difficult are woes common to agencies nationwide. But when faced with this situation, Jamie Hills, RN, owner of Seattle-based New Care Concepts, decided to meet it head on. By educating her staff on the business of home care, she has cut her staff turnover by more than half.

"Our costs keep rising, and nurses are very hard to find in a strong economy like we have here," she says. Keeping them is even harder, particularly for the medically intensive patients that New Care specializes in. Clients usually require around-the-clock care, Hills explains. The families are already in crisis, and losing a nurse is a stress they don’t need — one that can affect quality of care.

Hills took action last year after the Washington state legislature voted a 3% increase to all state vendors, including home health agencies that took on state cases. But the state Department of Social and Health Services in Olympia usurped two-thirds of that increase, leaving New Care Concepts essentially back where it started.

When nurses and clients started asking questions about why nursing staff weren’t paid better, Hills knew some education was needed. In order to reduce turnover, and perhaps get some added soldiers in her fight for better reimbursement, she started educating her staff on the business of health care during bimonthly meetings.

"I think it is hard for nurses to understand that this is really a business," she explains. Any of the 175 nursing staff who want to attend the all-day meetings are paid for their attendance. The sessions cover general health care business information. Hills explains the New Care budget to staff or discusses marketing and public education. The agency recently had a meeting in which a local state representative came in to talk about lobbying and how legislation is passed.

"Keeping their brains interested in the industry helps keep them loyal to us," says Hills. "We used to talk about clinical issues, or Joint Commission requirements. But now that the nurses are more involved in the business, they contact their senators and representatives."

They are also more likely to be able to answer the questions from clients and their families about home care, Hills adds. "It filters to the family and the client. They better understand that I am not an adversary, but an advocate."

From education to political activism

Hills hopes the nurses will be able to answer questions clients and their families have about home care with more authority because of the educational meetings. In turn, she hopes the families will discuss the topics with their friends and their legislators. "They need to understand that the rates we get drive the delivery system, and if they want good staff, they have to get involved," she says. "I can talk to the legislator all I want, but it hits them more when a family shows up with their child on a ventilator and tells their story, and how changes in legislation affect their lives."

Hills also has given staff and clients prewritten letters to their legislators, complete with a stamped envelope. "All they had to do is sign them," she says. "I hope they sent them out."

The efforts have paid off already. Nurses are more interested in their work, and turnover — which can have such a devastating effect on patient care — has declined by more than half from an average of one nurse per week to about one per month. "The nurses who come to the meetings stay at New Care," she says. "The ones who don’t usually leave within a year. Since we can’t pay people more, we have to focus on other ways to get nurses’ loyalty and understanding."


Jamie Hills, RN, owner, New Care Concepts, Seattle. Telephone: (206) 789-9054.