First, make sure the need is there
Before you jump into a new mom and baby service, be sure you have a market for the program, suggests Candace Sharkey, RN, MS, executive director of HealthTouch in Wakefield, RI. "We did extensive market research before we implemented the program to make sure there was a need for doulas," Sharkey says. "We knew birth projections for our area, competitors’ programs, types of reimbursement available, and the types of services new moms would want," she explains.
Even with her market research, Sharkey says she was surprised by a few things after the program got off the ground. "We knew new moms would want light housekeeping, help with the babies, help with errands, and help with siblings," she says. "What we did not expect was the number of moms who wanted overnight care so that they could get some sleep. In fact, this is the most requested service," notes Sharkey. "We also have no typical length of stay. Some new mothers keep the doulas for only three or four days; others continue the service for as long as three to four months," she says.
"We average two to three patients at a time on the service, so we do have to float the doula-trained certified nursing assistants (CNA) in and out of other home care services," Sharkey explains. "The challenge is to avoid disruption of long-term continuity with traditional home care patients," she admits. "We don’t assign a doula-trained CNA to a long-term patient, but we try to keep them assigned to a shorter-term patients so that we don’t compromise continuity when the CNA is needed for the new mom and baby program," Sharkey points out.
Although her agency charges $25 per hour for the doulas — slightly more than a standard CNA charge — the program generates more visibility and goodwill for the agency than significant revenue, she admits. "Because this is a service that insurance generally doesn’t cover, we do appeal to a certain income level," Sharkey adds. "We find that many times, the mother or other family member of the new mom will pay for the service as their way of helping, especially if they don’t live nearby," she explains.