How to Hire in Home Health

A conversation with Randy Forrest, home health Consultant 

For our healthcare and hiring blog series, I interviewed Randy Forrest, Lead Healthcare Resources Consultant at SMART, and he shared common pain points, solutions, and advice for home health hiring managers. By reading this blog you will be able to:

  • Empathize with common home health struggles
  • Read solutions
  • Gain practical advice for home health hiring

Chad Harrington

Randy Forrest. Image credit: SMART.

Randy Forrest. Image credit: SMART.

SMART is a home health and hospice consulting group that helps with everything from financial advice to clinical compliance. For example, they help with out-sourced medical coding, billing, and quarterly compliance reviews. They also educate many home health hospital owners, key management, and line-level employees on the rules and regulations under which they work with Medicare and Medicaid programs. 

Randy Forrest is a SMART director and their lead healthcare consultant. Since he consults home health organizations around the nation we interviewed him best practices for home healthcare. 

Relode: What are common pain points in home health with regard to hiring in general?

1. Significant staff turnover. 

Randy Forrest: “A lot of clinicians give home health a try, but I think it’s such a difficult transition, especially if you’re someone who’s been used to working in a hospital setting or even a doctor’s office setting (or even a nursing home facility). In home health and hospice, too, these nurses get out on the road and go to someone’s house. While they’re there in the home, they’re on an island, and sometimes the situations they go to are not very good.”

2. On the job challenges. 

RF: “I’ve had nurses fall through the steps trying to get up somebody’s porch. I’ve had nurses walk into a home where there’s a bed-bound gentleman, who lives alone, has no caregivers around. When someone walks in the door, he just pulls out his pistol from out from under his pillow in his hospital bed. There’s a lot that goes on with home health clinicians. It’s not for everyone. A lot folks give it a try, then just can’t handle that situation. So we see a lot of turnover in that regard.”

3. Competition for top talent. 

RF: “I guess it’s probably like a lot of the other healthcare industries. There’s a lot of competition for these folks.

"In the Nashville area, we probably have 40-50 different home care companies. So you’ve got a lot of companies, and frankly there’s just not a lot of loyalty there. If someone’s willing to pay 50 cents more an hour, or a dollar or five dollars a visit more, clinicians will jump. A lot of turnover.”


R: What are some creative solutions besides cash to solve the high turnover rate? 

RF: “Having a good human resources department who helps with team building within the home care agencies is one thing you can do. Your benefit programs—we find a lot of times, it’s that extra-added work-related benefit program that might help keep someone on tabs. We’ve used things like 401k plans with vesting schedules.”

R: What are other solutions for the hiring process?

RF: “I mentioned earlier that when you’re looking for a nurse, it’s really one thing; if you’re looking for a registered nurse therapist, it’s a totally different ball game.

"Typically what we do in those situations when we’re looking for those type of employees, we really have to go on a national search and get a recruiting company—you actually end up paying some pretty significant fees to flesh these folks out. A lot of these companies have registries of potential candidates for jobs all over the country.

“Recently I was trying to hire a registered therapist in rural Middle Tennessee, and it took a year and a half to find a registered therapist. It was lost revenue for the company, because in the home care and hospice business, you have to have clinicians to do the work.”

“At the end of the day, we found a therapist who was living in the area but was working at a rehab center, an outpatient therapy clinic. We ended up paying him enough to coach him from the outpatient therapy clinic.” 


R: What advice do you give personally to home health agencies? 

1. Find the best hiring resource. 

RF: “Well, I would suggest that home care agencies and hospice entities look for a resource that number one is affordable, but number two, gives a broad perspective of potential candidates—something like what Relode does with your product.

“We have an old standard thing in our industry where we say, 'To find the right employee, you have to make three hires.' Wouldn’t you be so much better off if you were able to get these folks credentialed on the front end so you’re only hiring this person one time, because it gets expensive.

“Just a point of reference, a company that I’ve worked with—about a $25m company—we estimated last year, their cost was about $3.6m for turnover. That gives you good reason to find a better way of doing it.”

2. Conform to compliance. 

RF: “There’s no short cut to compliance. Compliance is an intentional program that you establish, you audit it, you monitor it. It’s a culture that has to be developed.”

“The best advice I give companies today is: Make sure you are in compliance with the federal rules, as well as the state and other insurance rules.

"Being able to retain your reimbursements is a huge key in our industry since the Affordable Care Act—we call it 'Obama Care'—came into place, because a lot of these companies are having a medical review on what they’ve billed to Medicare. Making sure you’re doing it right is key.”

3. Be responsible with commercial carriers. 

RF: “You have to be responsible when you’re contracting with insurance carriers. Recently, I had a company out West—we’ll just leave it at that—who was getting paid $75 a visit for a therapist to go out and see patients, covered by this insurance company. The owner was paying a contract therapist $90 per visit to do the work. Do the math.

"What we told her: 'You’re spending $15 on the front end before you even count your overhead. You might as well just take $15 for every visit you do and just throw it in the trashcan'—that’s what she was doing. There’s a lot of movement in that area. Learning how to handle those outlier type insurance policies and things like that is very important for them.”