The Value in Team-Based Home Care

Speaker: Assaf Shalvi

So, I personally believe that community- managed home care is the way of the future of home care and this is what we should strive toward. A situation where care management is done by the caregivers on the ground, supported for whatever is not client- facing. 3 main reasons why this is better –– It's better reliability and availability of service, higher quality of service and more cost effective. Reliability, the nurses run the service. They decide what area to cover, who is going to be on the team, which referral sources they want to work with, which clients they would like to accept, who is going to work when, that means that they feel that they own the service. They look the client again and say join us, we will give you a good service, not some transitional care manager in a hospital that the client will never see again. They have to deal with client services issues. Not some client service manager that is the voice behind the phone sitting in the office. And so, they make sure things don't go wrong. They show up, they make sure that the shifts are covered, documentation is done, everything is in place and the service is more reliable. The second reason the service is more reliable and more available is that because there is not so many overhead costs, the nurses get paid in this model about 30% more, we pay in the Swift Shift networks, LPN, 30% over the market rate on average. And same for RNs, to be honest. So that immediately increases the number of hours that are available and more clients get serviced. Finally, our second point is the quality to provide high quality home care. There needs to be care. The caregiver needs to really care about their clients. Now, if you were at work for an agency, you don't choose your clients. You don't choose your teammates. You have no decision making authority or scheduling authority. You can't even pick up the phone to the client in some cases or to your teammates to manage things then you really don't care. And of course you don't get guaranteed hours, no benefits etc. In the community managed model, you own the business, the same nurses provide the care the same clients, so they care. When you care, you notice, you notice, you notice that something changed. There's a slight twitch in the knee when he goes into the bath. Maybe something should be checked. Oh a different look in the eye, not as responsive. Maybe you should talk to the neurologist, talk to the PCP. And this care also means that there is trust. So when the client feels that they need medical attention, they don't call 911 and go to the hospital. But they call the nurse team, which can go and assess the situation and get the PCP, the primary care physician involved if needed. But it prevents hospitalization and it provides a quality outcome and it doesn't exist without care and you can't care about the client when you don't have any authority, any responsibility, any guaranteed guarantees for pay. And when you're treated like a commodity. And the third is cost effectiveness. I mean home care, or health care, is expensive. And home care is the silver bullet that's supposed to save all these institutional cost of hospitals and skilled nursing facilities. But the reality is that almost 40% of the money that goes into home care actually doesn't go into home care. It goes into covering the salaries of people that sit in the office. It goes to cover the hundreds of thousands probably of square foot of home care offices across this country that were mostly sitting empty for a year. It comes to cost a lot of functionaries and M&A executives and marketing executives and board of directors, which has had nothing to do with the actual delivery of the care. In a nurse- managed model –– there's no such thing. The nurses provide the care, technology with a very small layer of back office employees are there to provide some support. But you know, 75, 80% of the funds go to the people that actually deliver the care. So for the taxpayer who's you know, already paying 4 point something trillion dollars a year for health care in America. And he's looking at 10,000 people joining Medicare every day and going through surgeries and having to get home care and other services. Looking at the prospect that every for every dollar that goes into healthcare, 40 cents goes to people that have nothing to do with the care of the clients. It's crazy. I looked at the prospectus of Aveanna, and I saw that the salary of the CEO there is about 70 times the salary of the nurse and if he doesn't show up to work one day, probably none of the clients will ever notice. Think about it. So higher reliability and availability, higher quality of care, much more cost effective. I think that anybody that cares about home care wants to see this as the model of the future.