Welcome to the Healthcare CEO podcast. Join us as Daniel Fernandez, healthcare leader and patient experience advocate leads dynamic one-on-one discussions with healthcare executives, consultants, and other industry experts. Listen in as they share actionable insights and unique perspectives into the day in the life of a healthcare CEO.
*The following has been adapted from our full-length interview, which can be found here.
Meet Emma Dickison
Emma is the CEO and president of Home Helpers Home Care, President of Home Care Association of America the industry’s leading organization. She’s a certified senior advisor. A certified franchise executive.
Origins of the Business
Daniel Fernandez (DF): Why specifically and how did you get into home care to begin with?
Emma Dickison (ED): I’ve spent my career in franchising. Specifically, in three great industries, but what drew me to home helpers and the industry here is that I have a long history of family caregiving that started when I was in elementary school with aging loved ones that required car at home and at that time, there really wasn’t options like home helpers out there. So, over time, we became very familiar with what the family goes through and selecting individuals to come into the home and provide home care and the level of trust there has to be. When I had the opportunity to join Home Helpers Home Care, I was thrilled. I’m so passionate about the mission which is to be able to enable aging loved ones to live their best lives possible in the comfort and safety of their own home and for me, it’s very personal and it’s one that I have just thrown myself into since 2007.
DF: Home Helpers have a pretty significant reach around the country, is that correct?
ED: Yeah, we do. Currently, we’re serving about a thousand communities in 41 states and Canada as well. We’re continuing to grow. We still have communities that we don’t serve and we are anxiously waiting to expand into those communities to offer Home Helpers Home Care and our exceptional care services in those communities.
DF: Over the last year, caregivers specifically have been sort of thrust into the forefront. They’ve been a hot topic and everyones been talking about them. Nurses, homecare and so on… There’s a study that was released by the Bureau of Labor Statistics that by 2025, there’s expected to be 1.6 million home jobs created for personal care aids, home health aids, and some types of nurses. But, it appears there’s not enough caregivers currently to fulfill those roles. What do you think is driving this imbalance?
ED: So, even pre-pandemic, we were in a full employment economy. It wasn’t just us, it was the entire economy. We were struggling to find top talent. Certainly, the pandemic accelerated that for us simply because home care has played such a vital role in helping to flatten the curve of the pandemic and keep an aging population out of institutional or acute care settings. So, you know, we have accelerated our intent to hire 100% as our offices have been open and have been hiring through this pandemic. We have seen, industry-wide, a breath of fresh air and that we are starting to get a number of applicants that are from the retail and hospitality sectors that are wanting to make a transition into doing something more meaningful and you know we say we have a mission that matters and so we are starting to see some of that career transition. I don’t know whether it’s going to continue after the pandemic and things get a little back to normal, we’ll see, but certainly we know that for an aging population, you know, 10,000 turning 65 a day. As we age, nine out of 10 of us are going to want to age in place, and seven out of 10 of us are going to need services like home helpers. We know that there’s going to be an increased demand — as you noted — on recruiting to this sector, and I think that it’s going to be a multi- faceted approach with both public and private sectors and the educational community to be able to support getting individuals attracted to the industry, then educated, and then, of course, placed.
DF: Posting a job on Indeed or online are just not going to cut it anymore, correct?
ED: Yeah, we’re seeing some really innovative ways that I think all industries and agencies are moving to and I’ve often used the phrase that in the past we’ve been able to fish for talent. Now, we have to go hunt for it. Job boards are going to be a part of our recruiting efforts, however, I think social media is certainly starting to play a larger and larger role. And, I think there is some unique social media content and direct advertising that is critical. I also think the way that people are going to apply is going to be different. I think the companies that make it easier for applicants to find them and submit their information are going to be key. As an example, I know a lot that are starting to use video as their application versus filling out this form or coming in and completing an application. It’s really very simple. You send a video into a link that basically says who you are, what you’ve done, and why you want to be employed by the company you’re applying to. I think those are going to be some new and innovative ways that we’re going to see as we continue to hunt for good talent.
DF: I love the idea of video. Mostly, because I can think of ways to pick up on body language and vocal tonations and things of that nature. Are there other things you’d look for in potential caregivers that may come across during the process?
ED: Yes. In the previous, you’d get an application and review the application based on experience and education or tenure in their job. Now, you have the ability to kind of do that a little bit of what you’d see in the first interview. Someone being able to make a good first impression in a short clip video. This isn’t a half hour dialogue, this is very short. Just an introduction. So, you are looking for body language because 80% of our communication is through non-verbal gestures. You’re looking for a presence. What is their confidence level? How are they dressed? Those types of things are what you’re also looking for. Also, how articulate are they? Can they describe themselves, what they want to do, why they want to work for you, and does that passion come through. It’s certainly some of the key things you’re looking for in a video application.
DF: Let’s shift over to the quantitative sort of things. Are there certain things that organizations should be looking at? Metrics, for instance, during the process that are important.
ED: Well, certainly every state has their own requirements about what certifications or training they must have. So, you have to look for that at the individual state level. Other things you’re wanting to pick up on, in my opinion, are beyond the skill. We can teach skills. The things that you’re wanting to try to discern are their work ethic. Are they dependable? What’s their communication skill like — whether verbal or non-verbal? Those are key things that you’re wanting to look for to make sure that they’re a good fit for your organization. I don’t know of any organization that’s not looking for dependability or solid work ethic and some level of loyalty to previous companies that they stick to for a little bit. When you’re hiring as an employer or organization, you invest in professional development at a pretty good rate if you want to retain top talent. So, you want to make sure that somebody is going to take what they’ve learned and then display that in your organization. I know that today, nobody stays with the same organizations like they did when their grandparents were in the workforce. However, you do want to be able to help people and enhance their skills and use them within your organization for at least some period of time. So, those are the things that I think you’re using when you’re evaluating talent.
DF: There have been a lot of studies about caregivers being burnt out — especially in hospital-type settings. Clearly because of the last year of the pandemic, of course. Do you think that’ll potentially drive more caregivers towards in-home care?
ED: We’re fortunate in that we provide care in the least risk and usually most economical setting. We are providing care in a one-to-one ratio, and you do get very intricately involved with the clients that you care for. We have already seen some transition out of facility type care into home care. I think that will continue, however, I just want to reiterate that whether it’s in a care setting of a facility or in-home care, there’s more needed and I encourage anyone to think about the profession as a career. And, we’re also wanting to make sure that we’re taking care of our mental, physical, spiritual, and emotional health too. Any career right now is stressful. I think healthcare is more because of the COVID environment, and I think it’s incredibly important as employers if you want to be an employer of choice to not just pay attention to the physical health but also the mental and emotional health as well. You also want to be able to provide resources to those individuals no matter what care setting they’re providing.
Home Health Care Future
DF: Is enough being done by the government to deliver that in-home care that we’re going to need as we’re aging?
ED: The Home Care Association of America is the largest trade association for the private duty home care we do. And, as you mentioned, I am President of the Board of Directors. I think that in previous years, we have been working really hard with our elected officials to continue to make sure that there’s broad access to home care. You see programs like the veterans aid and attendance benefits which help support veterans and for their spouses — medicare advantage, which is continuing to expand the services and plans that are offering qualified home care services. My last trip officially was marked early March of last year. I was on capital hill and advocating for two particular pieces of legislation to help support home care in the future. One was called the Credit for Carrying Act, and it has been picked back up with sponsorship recently in Washington DC, which would provide a similar type of tax credit for families that are supporting home care — paying for qualified services in the home. The other is the Caring for Seniors Act, which is designed to revise the IRS tax code of 1986 that would now allow qualified home care services to be part of Health Savings Accounts. So, I do believe that in the coming years, our elected officials and communities will be working together to make programs available to help continue to have access to home care. It’s necessary because when you have aging loved ones that go into facility settings, that is generally a very expensive endeavor and the government — state or federal — pick that up, and they’re finding that it’s more economical to allow someone to age in place in their home when safely possible. And, it’s not just a financial decision, although that’s certainly a key driver, it’s also a physical, mental, and emotional decision from the family as well.
I mentioned I had a long history of family caregiving. My grandmother had her fifth stroke when I was a senior in high school. They started when I was in fifth grade. As a family, we have a pretty large, extended family, so we made the decision to keep her home. This was 40 years ago and she lived at home for 18 and a half years before she finally passed away. Had she gone into a facility care, which would have been the norm at that time, she wouldn’t have lived another 18-years. She would’ve lost her will. She did live 45 days in a facility. Her care had gotten to that point and she gave up. By being able to be at home, she still had family dinners, family holidays, neighbors that visited with her, she still had a very active life even though she was wheelchair-bound. So, I think about those things and know that our communities across the country and elected officials are working hard to find solutions. Will they come as fast as we need them to? Probably not. We all know that anything in Washington DC typically takes a long time to get done, however, there are so many people working on it, and they have a better understanding of it. I’m very optimistic about the future.
Future for Assisted Living Facilities (ALFs) & Skilled Nursing Facilities
DF: There’s already been a decline in the number of ALF’s. Do you think that will continue to decrease?
ED: Going into the pandemic, facility occupancy in general, whether that was a skilled nursing facility or assisted living facility, was already in decline. I think that given this pandemic, we did see additional residents coming out of facilities where the families could bring them home. I do think that will continue as there’s more access to care. Every survey of seniors that I’ve seen is that they want to age in a place. They’ve been asking the overwhelming majority of people that wherever they are living, at the age of 65 is where they think they will pass. They’ll live out their years in that home or place. So, I do expect that there will continue to be a decline.
DF: What does home care look like in five to 10 years?
ED: I think home care will continue to be an integral part of the home health care continuum. I believe strongly that there will be some wonderful technologies out there to support that. We’re already seeing some of that. I think home care companies that are going to thrive will be those that will be able to embrace that technology and bring it as a solution into the home care continuum that continues to allow our loved ones to age in place. I think that it’ll be a much bigger part of the entire home health continuum and the healthcare continuum overall. We have the unique insights that we are with clients on a regular basis before they get to any type of acute care setting. And, we can see those changes and get resources in place sooner. So, I think we’re going to leverage technology, and I think there’s going to be more clients living in their homes much longer.
DF: Do you have a favorite book?
ED: I love to read. I enjoy reading a great deal, and there’s much I could recommend but the one that most comes to mind at this very moment is The Boys in the Boat by Daniel James Brown. He wrote about nine young men who attended the University of Washington back in the 1930’s and how they came together as a rowing team and unexpectedly won the 1936 Olympics. There’s more to the story, but it’s how you come together as a team and focus and get committed.
DF: Do you have a favorite quote?
ED: “If you don’t like change, you’ll like your relevance a lot less.” It’s from a book called Change is Good, You Go First. It’s a marketing book, but that quote has stuck with me since I read it years ago and I think it’s indicative of how every company has to have the spirit of innovation to be able to remain relevant. You can’t just sit on what you know now. The other one I learned is from my father and he always said, “There’s doing things right and sometimes you have to do the right thing.” We should all know how to do things right, but sometimes you have to go above and beyond what’s right and just do the right thing.
DF: What has the last year taught you personally?
ED: The value of relationships and the value of being present. While we can’t be present maybe you and I might have at one point gotten together in the same city and done this. There’s a way to do that and so for me, it’s about knowing how important the relationships that I have are and about being present in those relationships. Also, the ability to slow down just a little bit. Before the pandemic, I was on the road pretty much every week and now I have the ability to reach more than I ever have. So, I’m really enjoying that.
DF: This is where I give you, Emma, the stage. What advice would you give to healthcare executives listening to this? Maybe some advice or information.. The floor is yours.
ED: For anyone who is running a home care/health care agency out there, I say grind, grace, and grit. You have to embrace those three. I’d also say don’t be afraid to make changes. Do research, innovate, and make those changes. Because what has got you here is not going to take you where you’re going to go in the next five years. If you aren’t proactive and you aren’t actively involved in the industry, whether that’s the Home Care Association of America, private duty healthcare, or whatever association is relevant to your industry, get involved from an advocacy standpoint and from an industry standpoint. That is going to be critical for home health and the healthcare continuum in the coming years. I’d also say make sure you’re surrounding yourself with important people. I have four people that I surround myself with — a cheerleader, counselor, challenger, and chaplain. Those four individuals are key as you think about decisions you’re making and if they’re right for your organization and all of the stakeholders within the organization.
Learn More About How Emma and Other Healthcare Leaders Are Shaping the Future of Healthcare
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