NIC Notes

Insights in Seniors Housing & Care

By: Jane Adler  |  July 18, 2019

Collaboration vs. Competition:  How to Work with a Home Health Agency

Seniors Housing  |  healthcare

Home health and home care providers are often viewed as competition for the senior living industry. But collaboration with outside agencies can create a better resident experience and extend the length of stay. 

What follows is an interview with Sarah Walmsley, national director of strategic partnerships at Bayada Home Health Care, Moorestown, New Jersey. She is the head of business development for Bayada Senior Living Solutions. The Q&A provides a good roadmap of how to collaborate with a home health provider and make the relationship work.   

Q: Tell us about Bayada Home Health Care. 

Walmsley: We are one of the top home health providers in the country with revenues last year of about $1.3 billion. We offer a full range of services including skilled home healthcare, hospice, private duty care, behavioral health, staffing, assistive (personal) care and habilitation services (for those with intellectual/developmental disabilities). We recently added hospital management services to develop joint ventures with healthcare systems. Bayada was privately owned for 40 years, but last year it became a nonprofit organization in order to ensure its long-term continuity,  

Q: Where does Bayada operate 

Walmsley: Bayada provides care in 22 states and in six countries. We have 330 offices and just reached a milestone of caring for over 1 million customers since 1975.   

Q: How many senior living communities do you work with?   

Walmsley: Our Senior Living Solutions division is providing care or contracted fitness classes in over 1,200 communities across 14 states operating out of 37 offices. Since the division was launched in 2012 we have experienced an 84% increase in senior living census growth. Senior Living Solutions currently compromises 30% of our home health practice. We serve about 5,000 residents. 

We are currently the provider of choice for over 300 assisted living/independent living and CCRC communities. That bucket of business is growing about 20% a year.  We enjoy deep trusted working relationships with the healthcare team of these communities and we work collaboratively to implement customized programming and interventions.  The end result is that we achieve remarkable results in metrics such as resident satisfaction, increased length-of-stay and rehospitalization rates that consistently are under 8%. 

Q: Are your service offerings growing?    

Walmsley: We added hospice services in 2017 and fitness services in 2015.  Fitness is growing 50% year-over-year based on customer demand and we are adding new class types and offerings, such as Parkinson’s disease and memory care specific classes. We have over 4,000 residents participating in classes each quarter and provide over 21,000 classes a year.  We added hospice care because senior living owners and operators wanted one provider.  Senior Living Solutions Hospice has seven offices in three states and now makes up 15% of Bayada’s Hospice practice. We project that within five years, our senior living hospice services will be represented across our home health and therapy markets.  

Q:  What’s the best way to establish a working relationship?  

Walmsley: There are essentially three best practices we have learned are necessary to have an optimal working relationship. First, agreeing on expectations and what success looks like is paramount when initially launching a new relationship.  We have found the most effective way to do this is by following an integration plan we create which incorporates engagement, education and trust-building activities with residents, care providers and leadership early on. It also provides a roadmap to phase in all the services we offer to prevent confusion or disruption to the community. Second, customization is key.  As we know, no two communities are the same, each has a different culture and unique needs.  Our model at its core is based upon an established communication and execution framework centered on the delivery of our key servicesWe meet with each key stakeholder to build out their optimal model. Modifications could be as simple as providing our outcome data meetings on days when there are fewer meetings or when the physician is present to create a fitness class for residents with Parkinson’s disease.  Third, quality assurance measures must be established for a collaborative care model to work. Setting success and accountability measures upfront ensures a good working relationship. At a minimal, outcome data should be shared and discussed monthly to identify if hospitalizations could have been prevented and to put in interventions to prevent future issues.   

What should senior living providers expect from a home health company?  

 Walmsley:  First and foremost, providers should look to align with a company that echoes their own mission and values. During the vetting process, they should ask to see their quality metrics (hospitalization rate, SOC rate and CMS 5-star ratings for quality and customer satisfaction), determine what scope of services they offer across the continuum and ask them to explain their proactive approach. Ask how clinicians are trained. A senior living operator should insist on a one-point person for their community who oversees the daytoday operations.  Lastly, the selected provider should be included in their referral source’s preferred networks. It makes sense to align with a provider that understands the senior living landscape.  

Q: What does the home health company expect?   

Walmsley: We need to establish deep collaborative relationships. The community leadership and healthcare staff should look at their healthcare provider as a collaborative partner and trusted advisor and provide time to review outcomes and strategize tactics to reduce adverse trends. The community leadership should be honest if there are concerns and both entities need to be open to figuring out what each can do better to enrich the lives of the residents.  

Q: What is the financial arrangement?  

Walmsley: Home health services, including hospice and physical therapy, are reimbursed by the resident’s Medicare and private insurance.  Our fitness programs are customized for the community and the operator pays us directly for the program. In some cases, we lease gym space from the operator for our physical therapy program.   

Q: How do you handle workers coming in and out of the building? 

Walmsley: This is the pain point I hear about every day and that’s why people are calling us. We provide a dedicated team so the community always receives the same nurse, physical therapist, occupational therapist, speech therapist and social worker. The executive director knows who is coming into the building. A program manager is assigned to the community as their point person.  They own the relationship. We provide regular updates on who is on the service, how many visits the resident received, progress, discharge date, and other details. We have an electronic medical records portal to chart updates.   

Q: Do you need office space in the building? 

Walmsley: We don’t need office space. It is rare that we rent office space. We do in cases where we have a relevant enough census that would mandate us to have onsite staff on a day-to-day basis and the distance is too far from our office, then it makes sense.

Q: Are teams assigned to more than one building? 

Walmsley: We typically work in communities of 50-400 apartments. If a lot of residents require services we assign a team and backup team.  Most teams are working at 2-3 buildings.  Our mission is to keep patients from bouncing back into the hospital.    

Q: Do operators sign a contract? 

Walmsley:  We have a service agreement that maps out the communication and execution framework.  It includes a collection of best practices that if implemented will result in positive outcomes.  

Q: What percent of residents pick Bayada as a provider? 

Walmsley: Of course, residents always have a choice. The majority work with the recommended home health provider unless they have a prior relationship with another provider. Residents are usually looking for guidance. And they want to stay in their apartments as long as they can. We hold resident meetings to explain our services, answer questions and share our results 

Q: Do you work with physicians and other healthcare groups? 

Walmsley: Under healthcare reform, hospital groups, doctors and skilled nursing facilities are creating their own networks. Quality outcomes matter in a value-based payment system and that is our focus. We are in a lot of these preferred networks which is a reason why the senior living operators want to work with us. They know we have a seat at the table. It makes sense. For example, we have transitional care managers to ensure the resident makes a safe transfer from the hospital or skilled nursing center back to the community. A busy nurse at a community does not have time to call social workers to find out about med changes, check the paperwork, and be there when the resident arrives. We are a great value-add.   

Q: What’s ahead for collaboration? 

Walmsley: The silos are coming down. It’s exciting. We are talking to each other as true colleagues. We share the same goal to keep residents healthyHealth care systems, payers, insurance companies are looking for quality care at a lower cost. But they don’t think of assisted living as healthcare even though the sector is managing an elderly, frail high risk population. We need to work out more creative models of care.