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Is there a single right way to run a home care agency? We sure don’t think so. That’s why we’re interviewing home care leaders across the industry and asking them tough questions about the strategies, operations, and decisions behind their success. Join host Miriam Allred, veteran home care podcaster known for Home Care U and Vision: The Home Care Leaders’ Podcast, as she puts high-growth home care agencies under the microscope to see what works, what doesn’t, and why. Get ready to listen, learn, and build the winning formula for your own success. In the Home Care Strategy Lab, you are the scientist.
Miriam Allred (00:10)
Hey everyone, welcome back to the Home Care Strategy Lab. I'm your host, Miriam Allred. It's great to be back in the lab with all of you. Thanks for listening and thanks for tuning in week after week. It's a pleasure to be in your ear, and I hope you are getting lots of insights and answers and ideas from this podcast. And I always say this, but more than anything, I hope you're implementing what you're learning and taking it back to the team and putting in the work. So thanks again for being here. Today in the lab, I am joined by Kimberly Jones. She is the vice president at Help at Home Senior Care in California and Nevada. Kimberly, welcome to the show.
Kimberly Jones (00:44)
Thank you. Thanks for having me, Miriam. I have just always enjoyed listening to your podcasts. You've been with a couple different podcasts and I've learned a ton from the guests. So I'm really honored to be here with you.
Miriam Allred (00:56)
I love these full circle moments when you've been listening for lots of years and now here you are in the hot seat to share your expertise. I think of you as kind of one of those like under wraps operators that's very much just like heads down doing the work, having a lot of success and definitely walk the walk, but don't get maybe a public stage to talk the talk. And I'm glad I've gotten you to to step up and join me on the show.
Kimberly Jones (01:21)
Thank you. And I love our topic because really my passion as much as I love seniors, my real passion is that people love what they do and have a great place to go to work every day. And so that's what the culture is that we try to create for our staff, but really for our caregivers as well.
Miriam Allred (01:39)
Yeah, we're gonna get into talking about how you all structure pay rate increases for your caregivers. You have kind of like a formulaic approach and it's very straightforward, but it's helps you retain your caregivers for exceptionally long amounts of time. And so we're gonna unpack all of that and you're graciously gonna share kind of the nuances of your program, which is amazing. Before we get into that, let's have you introduce yourself briefly, talk a little bit about kind of your professional history and then also your family life and then getting into this business about ten years ago.
Kimberly Jones (02:07)
Sure. Well my career in my twenties, I was with a office staffing company, temporary help company. And I started there doing staffing. And back in the eighties, you were just using a file folder and applications and orders. It's very different than what we do today, but it's basically the same kind of concept that you're finding places for people to work. And so I ended up with that company having the top office there, there in my twenties.
I just really enjoyed doing that type of work and ended up being the marketing director for the company and was with them for about seven years and I stopped and raised my family. And so I have four girls and I homeschooled them. So I was home for about 25 years. And then I was wondering, what am I going to do now? Do you just go back into the workforce and say, hey, this is what I did after this break? But I wouldn't change it for the world. I'm so glad that I spent that time home with my girls.
But I found out about Help at Home. I met Steve, who's the president of Help at Home, and it was kind of struggling at that point in the history, and they were looking for someone to come in and do staffing. And I said, Well, you know what, I can do that for you, but let me tell you about what I have done and what my philosophy is with it. And he took a chance with me, and it has been great. So I started.
here at Help at Home doing staffing and then became the operations manager and then eventually the vice president for help at home. But a lot of the things apply.
Miriam Allred (03:50)
That's what I was gonna ask.
You know, thirty years ago versus today, are there really the fundamentals of staffing and of scheduling and kinda like that HR piece? Do you feel like it's a lot of fundamentals that are universal?
Kimberly Jones (04:02)
absolutely. I think that people know when you respect them.
And when you're looking out for the best for them and then you treat them with warmth and kindness, I mean, even now I'll be told by people on our team like it's really hard to interact with a caregiver unless you're texting them. And that's really hard and I know that makes me sound like a boomer, but you know, I re I just think fundamentally people are human beings and they and I and I think we're learning things, we're learning ways to interact through
Text. but important conversations I think I always encourage the staff. You need to pick up a phone and have an important conversation so that the tone and all the things that are you're wanting to say really come across in the way that you want to and that communication piece is happening.
Miriam Allred (04:53)
And the pendulum has swung so far that there's too
much technology. And I think people actually crave conversations. And when someone does call you and have a conversation, it feels out of the norm and makes you think twice, but also feels like really personal and genuine. And so I think, you know, we're trying to actually like bring the pendulum back a little bit and have more conversations and have more of that human touch.
Kimberly Jones (05:15)
Right. Things like personal notes. I mean, do people really get tired of getting a personal note in their mail? I don't think so.
Miriam Allred (05:21)
I don't think
so either. So you've shared a few details about help at home, but share share a few more. The company's about twenty two years old. You've been involved for about ten. Talk a little bit more about just some of the context of the company, how many offices, how many office staff, payers, hours, et cetera.
Kimberly Jones (05:28)
Right. Yes.
Absolutely. So Help at Home has been here in Auburn since 2004, so about 22 years. And we've actually been awarded best in home care in Auburn for twelve years. And right after I started, we got the first of our best place to work in Auburn. So we have been awarded best place to work in Auburn for the last eight years. And we started a Nevada location, so it's in Reno, and that was about four years ago and shortly after.
we started the Santa Rosa location. We do primarily private pay. We've been doing VA since 2008, long-term care. So those would be our major payer sources.
Miriam Allred (06:23)
Okay.
And did you say how many how many locations? Is it kind of the the three primary offices?
Kimberly Jones (06:28)
Right, so it's the three
locations with pretty large territories, but the three locations, we have close to three hundred caregivers that are providing care, and then we have about twenty-two office staff.
Miriam Allred (06:42)
Okay.
And you are the vice president. Talk a little bit about your purview. You know, every organization's structured a little bit different and what you kind of oversee. Obviously staffing is kind of like your wheelhouse. Is that take up the majority of your time today? Or are you also thinking about operations and the clinical side as well?
Kimberly Jones (07:02)
So at this point I would say it really is taking a look at all of the pieces working together. I have three incredible managers that oversee. we have kind of a different structure. It's not like a branch manager, but managers that take care of the staffing, business development, and finance, and they are so incredibly good and competent and so I would say it's not just in staffing that
That I've involved, it really is taking a look at all of the things working together. We recently put a document together of what the leadership team each was responsible for, and the biggest thing is the culture of the company is that I'm looking at is that that's maintained no matter how large we get, whether you're a client or a caregiver, that that same culture that we've always had from the beginning stays in intact.
Miriam Allred (07:56)
I think that's top of mind for
everyone is how do you maintain that like cultural integrity as you scale? I know this is off topic before we get into the topic, but what type of like analysis do you do to like pulse check your culture? Like are you talking to clients and caregivers or like what do you personally do to kind of like pulse check your own culture?
Kimberly Jones (08:16)
That's a great question.
I do still take inquiries because that's we always want somebody who's a live person to be taking that inquiry right away when somebody is having an issue and are looking for service. but I don't that was a weird transition to make of not knowing every caregiver and every client and what was going on. But like I said, my managers are really, really good at taking care of those things. But I think as we meet, I meet with the management team several times a week and we talk about situations.
We talk as a team every month. We discuss our top 10 clients in each location and what's going on with them, what kind of issues need to be addressed. So that whole sense of culture for the whole team coming together and discussing those kinds of things helps download that. Like if there's something that presents itself that seems like that's not presenting us the way that I really want to, or that's not meeting the need of that client or that caregiver.
caregiver, which really is rare because like I said they're very capable of taking care of those things. But it it helps when everybody's on the same page and you're discussing things about clients. You can tell, you know, I I it's so important to me. that was another thing I I didn't mention is very unique about our company that was important to me from the beginning is that every person has been a caregiver themselves in our organization. So every person who's on our office staff, whether it's personally or professionally knows what it's like.
To provide care. For me, my mom was diagnosed with the type of Parkinsonism that didn't present itself till after she came out of surgery. So one day she's driving, doing great, and that week everything changed. She couldn't walk. All those neurological issues started to present themselves, and I had no idea that was prior to working here, I had no idea what was going on or how to take care of.
care of her and so I learned and I and everyone in within our organization has a similar story. So I think just that respect for what a client needs and also what a caregiver goes through on the daily comes through to our caregivers when we're yes.
Miriam Allred (10:32)
Yeah, you can tell if there's that like genuine empathy, you know, you've either
got it or you don't. You've either lived it or you haven't. I think back to just kind of the the question that I asked, like really tight feedback loops, like like you said, you know, talking about 10 clients every single week, talking about, you know, all of your caregivers, the long standing tenured caregivers, the kind of people in the middle and then the new caregivers, like just putting an increased awareness on all of your people all the time and keeping those feedback loops like tight and controlled.
And then not letting your foot off the gas on any of that. You know, I think as you scale it's easy to let people people and processes kinda start to slip through the cracks, but you've gotta keep, you know, a a finger on that pulse all the time.
Kimberly Jones (11:13)
And having that feedback. So we have a really great system that's called Grade Us that
asks clients and caregivers for feedback and Google reviews. So we have the top number of Google reviews in our industry in our location and working in the new locations to get to that same level. And they're beautiful to read. I mean just really heart-wrenching stories of of people and what they've gone through. So we have that and then we have we do periodic phone calls to clients and to caregivers doing surveys to find out from
them how they feel about things, what they think about things. We're also involved with Caribou who asks a lot of questions to caregivers about how things are going.
Miriam Allred (11:59)
Yeah. And this is a good
segue into pay. You know, it's it feels like it's been a minute since I've talked about like recruitment and retention. And we're gonna hit kind of like the pay angle specifically, but I wanna ask you kind of a a couple of like high-level contextual questions before we get into your program specifically. The first one being around is pay a recruitment driver and maybe the top recruitment driver? We've talked like it has been for like a little while now. And I'm just curious from your experience, does it feel like pay is the top
kind of recruitment driver when these applicants are looking at your job ads.
Kimberly Jones (12:32)
So I would say yes and no, because all of us know no one is gonna stay just for pay, generally speaking. But when you're a caregiver and you're looking through ads in Indeed or MyCNA jobs, whatever, I think that you definitely will choose to go ahead and apply with the companies that have the higher rate. I just think that that's a fact you don't know much else about the company, obviously the tone of the ad, but I d I
I do think that it is a big factor to get people to apply and to bring them in the door, but you better have a lot more backing it up once they're here because that I don't think that that would be the sole reason that someone stays.
Miriam Allred (13:14)
Yeah. And you probably have
a really large like applicant volume, I would imagine, at kind of your size and scale and also your reputation, you know, word of mouth, people hear about your company and want to apply and want to work there. Do you feel like higher pay attracts higher applicants, or is the applicant pool still really widespread, even if you establish that higher pay rate?
Kimberly Jones (13:36)
I am so grateful that we do have a whole lot of applicants.
apply and when we looked at the statistics we interviewed probably only about ten percent of the applicants that applied but when we look at our workforce our caregivers are at the highest level we do in-home caregivers so personal care and companion care but we have over 60 percent almost 70 percent of our caregivers are at the highest level of as we label them within our system
Miriam Allred (14:10)
Okay. That's probably
a qualifying question like on your application. How years of experience is that kind of like your qualifier?
Kimberly Jones (14:18)
No, it's really not. that they have done anything. So we have some great caregivers that were taking care of their mom or you know, their grandparent and they don't have any professional experience. And when you talk to them and interview them, they would tell you, I don't have any experience, but they actually have a whole lot of experience. So to us I think we're looking more at how long do you stay at positions that you've been at previously. I
I have a great caregiver who's now on my staff that was a fast food manager, another one who was running the family pizza business, and they are wonderful caregivers because they come in there and they know how to take care of things and provide really great customer service. So it really does not always come down to that. But like we're about to talk to about, you know, we we've got a lot of things in place to increase the skill level of brand new caregivers.
Miriam Allred (15:16)
Yeah. Okay.
speaking to your pay specifically, do you know what your pay rate is kind of compared to the market? Do you know how your pay rate kind of compares to other agencies in your area?
Kimberly Jones (15:28)
So when I look at the Indeed ads, I didn't see anyone who had a higher starting pay, though there was ones that were similar. But it's kind of hard when you're looking at ads to know exactly what's your eventual pay or your starting pay. looking at the benchmark survey, we were in the top five percent of pay rates.
Miriam Allred (15:51)
Okay.
And how putting on the spot with this one, how often have you in how often do you increase your base pay rate? Is that typically something you do annually or how how often historically have you increased your your base pay?
Kimberly Jones (16:04)
I would say it's generally annually. We have done it at times when inflation has really gone up or the caregiver pool has shrunk. Like shortly after COVID, it was so hard to get caregivers. So I think we did two pay increases of our base pay during that time. But we generally speaking will do it annually.
Miriam Allred (16:27)
Okay. And I guess the flip
side of that is increasing your rates for clients. Do those two things typically increase together annually or do you have you ever found, you know, that one goes up, the other stays?
Kimberly Jones (16:39)
Generally speaking they go up together.
Miriam Allred (16:42)
Okay. I think that that's kind of the obvious answer. But I think COVID was a good example of like, okay, we might have to increase our pay. I think I heard agencies doing every three to six months just to keep up with kind of the the lack of demand and to attract attention.
a couple more questions. You have built out this like tiered structure, and I'm just curious where and why this was born. You know, there's a lot of different ways to think about increasing caregivers pay rates. When was this idea established and why did you feel like you needed something like super tangible and formulaic like this?
Kimberly Jones (17:15)
I remember when I was staffing and someone called me and I'd been here I don't know a few months and she said, Do you know when I get a raise? I've been here for five years and I have not gotten a raise. And I said, You know, I'm not sure. And and it occurred to me like I really want rates to be a pay rate that someone gets really clear. I think it's important, kind of goes back to that respect point that if I'm and there's so many
Variables in home care. You've got people who have experience with all different areas.
And I and I thought, what do I want to reward? How do I set this up? So we started just thinking what things are important to us in our caregivers. And they are the skills that they bring, whether it's hands-on skills or dementia skills. we also reward people for how long they've been with Help at Home and we reward people for the education that they go ahead and
They don't really have to seek it out, we provide it for them, but they've got to be willing and interested and motivated to take it. So all of those things come into play when we establish their pay rate. But it was born out of the fact that I really didn't want it to be subjective, you know, where you just think, this is a great caregiver, let's give her this much. or here's a person who never calls us, so their rate never goes up. I don't know, but and now there's a lot of legality to it. Like there really has to be transparency in your pay rate.
And that's absolutely going to happen here at Help at Home. If someone came in, they could look exactly at our formula that's set up in each person's profile and tell exactly what pay rate they should be at.
Miriam Allred (19:03)
Yeah. And at the beginning of the conversation, we talked about like, is all of this universal? I think this is a universal concept of how how do employees increase their pay rates? Like, I it's it's ambiguous in a lot of jobs and a lot of roles. And there's obviously kind of like annual reviews and like kind of the corporate world, but even in like hourly jobs, it's like, how can one increase their pay rate? I think that's you know, some companies are doing better than others, but it's like something that a lot of employees wonder and think about, and that's
part of why you've built a very specific program for this.
Kimberly Jones (19:34)
And I think also to add to the professionalism of being a caregiver, that it really is a career path and that there's things that they can do. It's interesting because we offer this and we'll talk about how we present it to everybody and some people are all about it. They are contacting us, can I take my next classes? Can I do this? Can I come and get reevaluated? And other people it's not quite as important to them. And so they don't, but it's it's made available. So if this is a driver for you, you're gonna get a lot of satisfaction.
because you know exactly the next step to take so that you can increase your pay.
Miriam Allred (20:09)
Have you identified
patterns in that regard? Like who who are the caregivers that care about this and do this and why? And who are those that it like doesn't really motivate them or matter to them? Like is it an age thing? Is it an experience thing? Like have you identified any trends or patterns?
Kimberly Jones (20:24)
No,
that's so interesting. No, I haven't.
I know a lot of people do it for the meaningfulness of work. Like home care is something where you just know at the end of the day, you know you've done something meaningful with your life. And so maybe if I was just to pick something out of the air, that would be something where someone is not quite as concerned. Maybe it's somebody who doesn't have to work. But a majority of caregivers do need that paycheck. They're trying to put food on their table, gas in their car, and they want something meaningful that they're that they
can do. And then there's that percentage too that really look at themselves as I walk in that door and I'm a professional, I'm a caregiver, and and they're they feel prepared for the role and they're always looking to learn.
Miriam Allred (21:13)
Mm-hmm. And
we want all of them to feel this professionalism. You know, we want and I think you're headed in that direction is like we want everyone to care about pay, but about knowledge and about experience. And then the pay reflects that. And we want all of them to see this as a career, as a profession, as something that they can improve upon and progress in and see kind of a a bigger path for. I feel like a lot of unfortunately a lot of caregivers are kind of closed minded and kind of just like trap themselves in this bucket, but
Kimberly Jones (21:16)
Yeah.
Miriam Allred (21:43)
It's the employer's job to help them kind of poke their head up and see that there's a lot more out there and that this is a profession and we treat it as a profession.
Kimberly Jones (21:52)
Yeah, I I absolutely agree.
Miriam Allred (21:53)
You said
it a minute ago. How do you communicate this and present this? Because this is also one of the hurdles a lot of agencies face. They come up with these great programs and they, you know, tackle it for like six months and then it kind of fades. But how do you communicate it initially and then how do you keep a top of mind ongoing?
Kimberly Jones (22:08)
well we started with our ads. So in our ads it talks about that you can increase your pay $1.50 an hour within the first six months. So what that allows you to do is take our different certification classes.
You're allowed to take one a month till they're completed. So it's a great way for people to just see right off in the ad. Then when they're being interviewed, a lot of them have questions about that. And of course, what is going to be my starting pay? And we have to let them know. Well, there's several different factors. It will at least be this. So we let them know what the very minimum would be, and then we talk about our whole structure and how it all works. And then when they come to orientation and training and onboarding, they get a handout of
About how it works so they can take that with them. And then, like you said, annually when we do rate increases, it goes out again so that they have it. With the education portion, we're contacting caregivers and saying, Hey, I see that you haven't taken this or that. Are you interested in taking it? So that we're promoting that. But most people are giving us a call and saying, am I past that 30 days? Can I take my next class?
Miriam Allred (23:18)
Is some of that
automated? You know, if their certifications or classes are like need renewing or they have an opportunity, do they get notified and some of that automated so your team's not doing it all manually?
Kimberly Jones (23:30)
That would be wonderful. Right now, the automation is for the annual trainings and the initial trainings, which aren't even part of this. It's it's just the obviously there's some good education in there, but it's the licensing requirements of every state.
Miriam Allred (23:32)
Okay.
Kimberly Jones (23:49)
But no, it really is. And the other thing that we want to do with it is I want all caregivers to take the dementia courses initially because there is so much dementia. I mean it's like one in nine seniors have dementia as one of their diseases.
But if you have a client that has Parkinson's, I want you to take the training that has Parkinson's. Because once you're taking something and you're applying it to your client, then you're really starting to learn things. But we have several different classes that we offer, so they're not in any particular order other than the the dementia we want everyone to take.
Miriam Allred (24:31)
it. Okay.
Well, yeah, let's spell out each of these. There's kind of four that we're gonna run through. And I'm just gonna I'm gonna kind of mention them here at the start and then we'll get into each one. So there's kind of four ways for care caregivers to increase their pay rate: a hands-on skills assessment, dementia competence evaluation, certification courses, and then also a longevity bonus for how long they've been with the company. So let's start with the hands-on skills assessment. Again, these aren't like novel terms to anyone, but how you approach them and how you kind of score them is different to you. And so that's what I want to get into. So
Kimberly Jones (24:37)
Yeah.
Okay.
Miriam Allred (25:00)
For the hands-on skills assessment, what do what do they have to do and then how are they scored on that?
Kimberly Jones (25:06)
Okay. So for the hands on skill assessment
First of all, every staffing supervisor who does the assessment has been trained in what we want them to look for. So that's universal across the board. If I say this is a level three caregiver or a level one caregiver, we're all on the same page on what that means. But we have a beautiful training room in each of our locations. That's like a studio apartment for a senior with a weighted mannequin, and we have them go in and demonstrate a certain
skills for us. So they're scored on if they're using right body mechanics, they're scored if they're verbally cueing the client. And a lot of people don't think of this, but that they've prepared the things that they need, like for a bedbound change or for doing a transfer. So we're looking at all those things and observing them and scoring them. And so depending on how they score, that will affect where they start out with their pay rate.
Miriam Allred (26:09)
Got it. And so
this is done up front when they first start. Then how often do you re-evaluate this?
Kimberly Jones (26:15)
So they can ask to be reevaluated every three months until they get the top score. And we really try, especially with someone who's a brand new caregiver, to bring them in after they've had a client that's required these skills. So maybe you come to us and you don't know how to do a bedbound change, but your client had slowly decreased in what they're able to do, and you've had to start doing those things. So now we want to make sure. So during someone's annual
evaluation we always make sure have when's the last time you took a skills assessment? Let's go ahead I know you've had this client this client and have you go up to the apartment and let's let's do that so we can make sure you're at the top rate that you can be.
Miriam Allred (26:59)
Okay. And it's
one comprehensive assessment of a lot of different skills, or can you kind of like chunk it up into different skills?
Kimberly Jones (27:06)
It is one comprehensive when it ha comes to the hands-on and then the dementia portion's a different thing. Because there's some people who have all kinds of hands-on skill but they've never worked with dementia and vice versa.
Miriam Allred (27:18)
Okay. How about
how many hands on skills are they testing for?
Kimberly Jones (27:24)
they're doing the transfers, use of gate belt, and bed bound changes. So and then within the bedbound changes are different factors in in how they're working with the client to do those types of things.
Miriam Allred (27:38)
Okay. So it sounds like maybe
four or five. Those are the ones that I've heard. I was just curious if there were more. and is or are all of those required by the state or are they required by the state, or it's up to you to decide to do this?
Kimberly Jones (27:52)
Yeah, so it's up to us. So anyone who says I've had some experience, whether it's in the home with a relative or professionally, we want them to take the skills assessment so we can really view what they're able to do when it comes to hands-on.
Miriam Allred (28:07)
Okay, got
it. And yeah, making sure everyone's kind of at the the same playing field for your company and kind of like your your baseline. So let's let's talk about the dementia competence evaluation. So this is a separate, this is kind of a separate evaluation. what do they have to do for that?
Kimberly Jones (28:23)
So that one was way trickier because the hands-on skills assessment, even though we needed to come up with like variations to make a person a level, whatever they are. With dementia, that was really different. So my staffing manager, Amanda, is excellent with dementia, and so she really took this on as her project. And we came up with the best way to evaluate it is to have a conversation with the caregiver. So in the past, we had just been looking at I'd
ask you when you came into an interview, tell me about what kind of things you worked with with your dementia client. And they would tell me. And so I'd have an idea of what they had worked with, but honestly we realized it doesn't tell me if you're competent in dealing with dementia. It just tells me what you have seen, what you've been around. And so that was our challenge. How do we create something that helps us? We we don't have like just a dementia patient in-house to be able to have that person interact with.
So we just talk to them. We find out, of course, those things, like what kind of issues were you dealing with? But then we're also trying to find out how they handled different things. How did you support that senior who had dementia and this behavior or that behavior was presenting? And did you have other support? Like somebody who's in a facility, they might automatically defer to a supervisor for the harder behavior.
Behaviors. But if I'm in a home, it's you and me, and that's we're gonna have to figure something out. So there's a whole mindset that's behind people who are really good with dementia. They feel comfortable just entering that person's reality and being creative on how they can accompl continue to put that person first and then
You are working towards getting a task accomplished, but the task really is secondary to making sure that you are entering that person's world and supporting them, not adding to their agitation or frustration by what you're doing. so we just have a really good conversation about those different areas. What are the behaviors? How did you deal with them, and what kind of strategies did you use? So somebody who has a real mind for
dementia has several different strategies in their back pocket things that they've been creative and you just kind of see their wheels turn on being creative to to work with someone in dementia and other people feel very much like well I mean I had to tell her that or I had to do that because she was wrong. Like it's it's not it's not about being right or wrong. It's about working with the person. So they sit down and have a great conversation and again this is all of the stuff
Miriam Allred (31:13)
Mm.
Kimberly Jones (31:18)
Staffing supervisors are trained to do this evaluation and then there's a score put on it. And this one in particular, even if you take our dementia training, until you have had the competency evaluation and actually worked with somebody who has dementia, we don't evaluate where you are and what stage of dementia that you're competent to help.
Miriam Allred (31:41)
Okay, those are gonna
be some of my follow up questions. One one just curiosity question. how what portion of your clients have dementia? If you had to ballpark fifty percent, seventy percent, ninety percent?
Kimberly Jones (31:51)
Well,
I mean the statistic is that it's one in nine have dementia, once they're a senior. I would have to look up exactly how many but it the call for it is huge. I I mean my first thought was that I would say close to fifty percent, forty percent. and that
Miriam Allred (32:11)
Okay. Yeah, because the one and nine stat yeah,
versus like, yeah, your your actual census, I would I would imagine it's higher than that statistic. Okay.
Kimberly Jones (32:21)
Yeah, because those
are the people who need care and observation. They need someone in the home quite often for a lot of hours.
Miriam Allred (32:27)
Exactly.
Okay, so then my question is, there's this there's this dementia competence evaluation. Will you put caregivers on dementia clients before they've had this evaluation, or this is always kind of a precursor to them even starting with a dementia client?
Kimberly Jones (32:45)
Yes, so now that we have it in place and we've had it in place for I think close to a year, we don't unless they they do. So if we've established that a client we have some criteria of what makes up like stage two of dementia, we have it broken down into one, two or three stages with more difficulty in things that you're able to deal with, escalations and those types of things. So
Now if I have a stage two dementia client, then I'm only going to provide a stage two or three caregiver to that client. So
Miriam Allred (33:25)
Got it. Okay. And I'd imagine
when they get reevaluated, do caregivers come to you asking to be put with more advanced dementia clients, or is it the reverse? We need this caregiver to work with this more advanced dementia client, therefore we need to kind of train them and evaluate them to make sure they're a good fit. Just kind of like that matching of like are the right caregivers and the right dementia clients put together?
Kimberly Jones (33:47)
Right.
I I would say probably it's a combination of both, but definitely if I see a caregiver that seemed really good with dementia and we have an opportunity to provide more training for them, they're just never gonna be out of work because it is such an important important skill for somebody to have. So it definitely works both ways. But the important thing is that, you know, in the old days where we would have said, this person
Has experience with dementia, it was such a disservice to not have a deeper understanding of that because if I've only worked with mild dementia and you put me in with somebody who needs a lot of redirection and reassurance and de-escalation, it's going to be so difficult to impossible for that person to be to come away and feel good at the end of the day. But it really is wonderful to see Miriam. There's people
Miriam Allred (34:44)
Mm-hmm.
Kimberly Jones (34:47)
Who love working with people with dementia? It's like a puzzle that they get to piece together, and that is just how their mind works, and they get so much satisfaction at the end of the day for being able to do that. And you put someone else in there whose mind doesn't work that way, and they're incredibly frustrated that this person's behaviors continue to escalate all day, and they're exhausted at the end of the day because it's it's really not their mindset.
Miriam Allred (35:13)
And that's why I think this is
so valuable for providers to hear right now of a dementia competence evaluation to see where their competency is and also their interest is. And then also to identify there's caregivers that are suited for kind of stage one and then stage two and then stage three. And we talk so much about matching and how hard, how difficult it is to put the right clients with the right caregivers. Like dementia is a
key part of that and all of the different stages. You've probably listened to my recent episode with Jim Kimzey and hopefully shared that with your team about like advanced dementia. There is definitely a market and a skill set and caregivers that are equipped to handle advanced dementia clients. And it could be an easy kind of mistake for agencies to make to put these caregivers that again are probably familiar with like mild dementia to then be placed with advanced and they're it's just a bad match and it doesn't work out and the client's frustrated, the caregivers frustrated, the family's not happy. It's a spiral.
Kimberly Jones (36:05)
Yeah, no, it it I think that's one of the most important things that all of us are facing right now. Absolutely.
Miriam Allred (36:11)
Yeah.
I feel like we've we've covered that pretty well. Any other comments on the dementia competence evaluation or things that you learn in the past year of implementing it that you tried something and it didn't work or adjustments that you've made to that?
Kimberly Jones (36:25)
I I don't know in terms of that really, but in terms of just incorporating continued dementia training within our programs, our orientation, we've recently added a dementia experience that we provide for caregivers to really understand what it's like, the frustrations somebody with dementia has with how they see, how they what's going on in their head.
We want to make sure that they have that, you know, and and we use a lot of Teepa Snow education in the presentation. So right from the very get-go, we are incorporating that into our orientation so caregivers get prepared and it piques their interest because not all new caregivers have any idea what the world of dementia is like and how important it is for them to get those tools under their belt to be able to be successful.
Miriam Allred (37:16)
Talk a little bit more about that experiential
one. Is that a tool or a company or a something that you use to provide that experience?
Kimberly Jones (37:23)
Yeah, so a company that we found in the Midwest provides a kit that has headphones that have different noises going on, has glasses that limit the vision, and then some gloves that make manipulating things very difficult. And so we took those and we put together like some tasks that we asked them to do while all of this is going on, so that they
can you have that experience of the frustration and what it's like. you know, if somebody's talking to you at the same time as you're trying to do something, and just how difficult it is. You don't realize the world that they're living in. So it it's obviously just really a drop in the bucket of what people who are struggling with dementia have to go through, but it does give them a lot of empathy and patience, you know, understanding why patience is so important with their dementia clients.
Miriam Allred (38:22)
What are some
of the c comments you hear from the caregivers that go through that? What are some of the things that you've heard them say after doing doing it?
Kimberly Jones (38:23)
Mm.
they just can't believe that that's what's happening inside of a person or that would be so hard or you know, how hard it is to remember even. Part of it is that we give them the instructions of what they're supposed to do while they have the head set in. And so they're having all this noise going on in their head and their concentration is distracted while they're getting a step by step of what they're supposed to do and and they realize how frustrated they get. So you're not surprised when you are with a client.
and they're extremely frustrated with the littlest things.
Miriam Allred (39:04)
Yeah. I just think
of like, you know, these these caregivers that are so good with like advanced dementia. Like they are just like the angels or the salts of the earth. I don't even know the right term, but like we're just so lucky to have them and so grateful and we need more people like that. But it's like a special someone that has the patience and the ability to be able to help, especially kind of advanced dementia clients, because it's really, really challenging.
Kimberly Jones (39:20)
Maybe.
Right.
No, I'll never forget I was in a facility our community where a gentleman with obvious dementia was there and he was just causing havoc and people weren't sure what to do exactly. And this person who worked there who was excellent with dementia came up beside him and said, Richard, you are looking so handsome today. You know what? I would love to have you take me over to the food hall or whatever to to be with you would be such a pleasure.
And she just changed his whole mindset and distracted him a way that was really enjoyable for both of them and all the behaviors ended. And so it's just amazing to watch somebody who understands what to do.
Miriam Allred (40:11)
Exactly. That knows
the strategies, but then can just do them so effortlessly. Like they just roll off the tongue and the behavior and you're just like, wow, what a skill set. But they've been accumulating that experience and then it becomes so natural. Wow. Yeah. Well, I hope I hope everyone listening to this kind of takes this to heart of like how can they do some sort of dementia evaluation amongst their staff? Because this is really, really powerful.
Kimberly Jones (40:16)
Yes.
It's amazing.
I admire for sure.
Miriam Allred (40:36)
Let's transition to the third one, which is other certification courses. And so you've got kind of a suite of training. Talk about what what your caregivers can do and how you attach the pay rate to different certification courses.
Kimberly Jones (40:47)
Sure. So we've been working with Care Academy for a long time and they had a dementia certification that is approved by the Alzheimer's Association. So that's where we started. and that's a ten hour course. And so we started by saying if you guys take us, if you caregivers take this, you'll get paid for taking that training, plus we'll give you a bump in pay because you'll understand dementia. So we started with that, but then they began
to also provide other certification classes in a variety of different diseases that affect seniors and some of them were two or three hours. So we bunched together, we put packages of different classes together. So like our second certification is a stroke recovery, heart disease and respiratory conditions. So that's just an example. So that comes to about an eight-hour class so they're paid for that and then they get a bump. So
There's six different ones. the next one has safety and fall prevention, Parkinson's and diabetes, then there's a behavioral health certification and an end-of-life care. So they have an opportunity to take each of these and get a bump in their pay after they take the clo the courses.
Miriam Allred (42:06)
Okay. And they can
probably do the this at any interval. They could do this all in a week and then they get all of the increase. Is that how that works, or have you kind of like set a timeline? Okay.
Kimberly Jones (42:13)
They can take one a month.
One
certification, a whole package of certifications, so that eight to ten hours of classes they can do one a month because they're doing this on top of their schedules as well. So if they're in if that puts them in overtime, then they're getting paid overtime because we these certifications are really important that they take those classes. And so like I said, everybody starts with the dementia and now we have the advanced dementia, which is something we put together with TPA Snow classes. And
And then if they have a client who has a particular disease that is in this list or they're dealing with somebody with end of life or somebody who has some type of behavioral health issue, then we enroll them in those classes as their second or third. They don't have to be taken in order. We really want them to apply them as much as possible.
Miriam Allred (43:05)
And are those required?
And do you kind of like make it required before they can take on that client? I know that seems like a weird question, but it's like you assign it to them, they have to get it done before they start that shift.
Kimberly Jones (43:16)
There definitely have been situations where that is the case, where it's very important to their family to the family and the level of care that's needed, but for the most part it's people who this is all an optional part of increasing their education and their professionalism and increasing their pay.
Miriam Allred (43:39)
Okay. And so you said there's about
six other certification kind of packages and they can do up to one a month. can you share how much what's the the pay increase for each of these and is it the same for all of them? It's like fifty cents per certification.
Kimberly Jones (43:53)
Right, right. So it's a quarter, but and so they can make a a dollar fifty increase in their rate by taking these classes.
Miriam Allred (44:01)
Got it. Okay.
And this is kind of back to the question of like there's people that are motivated and want to do this and then there's people that aren't. Like I that's what I hear with training. It's like there's people that like it and want to do it and do it. And then there's people that that don't. Is that your experience? There's people that do it. Yeah.
Kimberly Jones (44:08)
Right. Right.
Absolutely. Yeah.
But when we take a look, you had me look at some stats and so I'll look at this, but my top caregivers all have taken every class available. So there's definitely a correlation there.
Miriam Allred (44:28)
Yeah, they're hungry.
Like the people that wanna learn, that wanna increase their profession, like there's like a hunger for it. But then it's like how do you how do you get the rest of your caregivers to want to further your education? Like what type of efforts have you deployed to help them want to do this?
Kimberly Jones (44:44)
Right.
Well, it does come out on a regular basis, first of all, that that list of what's available. And then we
make sure that everyone takes dementia. I mean we really it's not it is an optional situation but we really encourage everyone to take it. And then just periodically my team goes through and contacts caregivers and says, hey I noticed that you're eligible to take another certification clo course. Are you interested in getting enrolled? And for some people, they hop right on it, Miriam, or they call us in advance and other people say, you know, I just have too much going on right now. It doesn't really work for me.
to
be you know required ten hours of training on top of my work so right now I can't. And that's fine with us too, whatever works for that person.
Miriam Allred (45:33)
And what is your training
pay rate? Is it the same as their kind of base pay, or how do you decide what they get paid for their training hours?
Kimberly Jones (45:41)
Yeah, so most training hours are done at minimum wage, but there are some sort situations like Nevada's minimum wage is very low compared to what their hourly rate is, so we changed that so that it's not at minimum wage. But other places it's it's not such a disparity, so that's what it's at.
Miriam Allred (46:03)
So it just kind of depends. Yeah, that
makes sense. Yeah. Say their hourly rate is like, you know, 20 and then the minimum wage is like 10. It's like, okay, that just doesn't feel fair or justified. So you kind of establish that. Okay. let's let's move on to the last one, which is longevity. So you want to reward people that have stayed with you. And I think again, this is another really important one because why people stay. You know, we talked at the start of pay being an attractor, but how do we get people to stay?
And and you incentivize and increase the pay for how long they've stayed. So how does this work? How do you kind of think about the intervals of them staying and how do you increase the pay?
Kimberly Jones (46:39)
So we thought
in terms of the first year we're all about having you take the classes. So if you want an increase in your pay, there's so many opportunities. Take more classes, come in and get your hands-on skill evaluation, work with some people with dementia and take the classes and apply it and get your competency evaluation. So you have all of these ways to get done. But then once you start hitting some milestones and how many hours you've been with help at home, then we start putting
money behind that. So starting with I want to say that it's four thousand hours up to twelve thousand hours there's pay bumps so that they can so we reward them because I mean to replace these caregivers you know if you can find them it's really hard and how much would you pay? So we wanted to make sure that they were all making a a good amount. I mean some of my top caregivers one's been with us for 17 years one's been with us for
thirteen years, you can't replace them. Yeah.
Miriam Allred (47:42)
Yeah. And they're sh they're worth so much to to your company.
You think of, you know, not like dollar for dollar, but you think of how much money they've made your business. Like they are worth every penny, financially. Be a little bit more specific. You mentioned kind of the four thousand hours to the twelve thousand hours. So once they hit four thousand hours, that's when they qualify for this.
Kimberly Jones (47:50)
Yes, absolutely. Right.
Yes, so that's the first time they would qualify for a longevity bonus at a center.
Miriam Allred (48:07)
And then up
to the twelve thousand. Yeah, what what are the increments? Like at four thousand, six thousand, eight thousand, or what how how what are the increments to keep getting rewarded?
Kimberly Jones (48:14)
Yes, it's it's something like that. I don't
actually have it right in front of me at this moment. But yeah, so there's there's
milestones that they hit. So that's all part of that paperwork that they get annually to see. And access care tracks it for us. So in AxisCare which is what we use for scheduling, it shows how many hours you've worked and so that's what we go by. And it even had a feature where you could import. So we used to be on another system years and years ago. I was able to import those hours to these long-term caregivers and make sure they got credit for every hour, whether they were in AxisCare or not.
Miriam Allred (48:49)
Got it. Okay. And to
make sure I I really understand. I'm just thinking, how long does it take a caregiver to get to four thousand hours? Like w any idea of how long that typically takes? Okay. No, that's that's okay.
Kimberly Jones (48:58)
No, I know that I I put it together. I could get out my calculator now. But you know, if a caregiver
is working, I I wanna say that it's at two years. Or a year to two years, depending on how much they're working.
Miriam Allred (49:09)
Around the two year mark.
Okay. Okay. Yeah. I I guess and it's so different because caregivers' schedules are so different, you know, full time versus part time versus, you know, sixty eighty hour weeks. And and so kind of like a two year timeline makes makes a lot of sense. and you mentioned that you have had caregivers stay with you for ten plus years and I'm sure you have lots of conversations with them beyond pay and just kind of a you know, like a heart for the work.
What else do they share with you as to why they stay with your company?
Kimberly Jones (49:45)
I would say f when I think of those two women in particular, it really does come down to the clients. I mean they they're they especially one of she's at every function that we have, every party, she's always coming and bringing cookies and with her daughter and but really I think when they
Find those clients that they're just very attached to, they love the work, they can't imagine doing something else, that that's really it. But I've also got to say I I hope part of it is they know that how they've been treated this whole time, you know, how much respect we have for what they d what they do. We try to encourage, acknowledge all of those things to our caregivers because we really do respect what they do so much.
Miriam Allred (50:32)
Mm-hmm. Yeah, this is just
reminding me of I've I've talked quite a bit on the podcast about like focusing on those longstanding employees and not forgetting about them. We talk a lot about caregivers kind of in their first 90 days or their first year. And I've talked more about kind of the long-standing. I think it was Becky Reel had kind of an email out this week about like the 60% in the middle that have been with you for more than a year, but probably haven't been with you more than maybe three to five years. There's kind of this like bulk of your employees that have probably been with you in that, you know.
one to three year range and what are you doing for them? You know, that group of people are like also indispensable and they're the ones that can kind of fall under the radar and can kind of like slip out the back door. How do you think about kind of that middle group and and retaining them?
Kimberly Jones (51:17)
You know, we we started recently with caribou.
And they have a wonderful program where it's kind of gamified different points. the fact that people are clocking in and clocking out, they're getting points or rewards. Plus every time we talk to a client that tells us that someone's doing something good, we go ahead and put some more rewards into their pot so that they can some things are redeemable for cash and then other things are redeemable for tickets. So we have a big drawing
Every single month for a top winner, a second place winner, and I think eight third place winners, so that people are just being acknowledged for doing the things that they do every day. And then there's a feed that it's attached to Caribou so that you it acknowledges people by name, whether it's their birthday, anniversary, them receiving awards. So hopefully that's getting to them. But it is a big challenge. I mean, I think.
I think in this industry everyone is facing that challenge. Your workforce does not work in your office. You don't get to go by them and talk to them. They are out there doing what they do with clients and it is a big challenge to be able to to make sure that they know that they're seen and heard.
Miriam Allred (52:39)
And it's really a multi-pronged
approach. It is increasing the pay. It is the handwritten notes. It's the phone calls from your office staff. It's caribou that's doing automated rewards and recognition. I I really think you say it's so complicated and challenging for all of us. I think it has to be a multi-pronged approach, and there's no silver bullets here, and there's really no shortcuts to culture and recognition. It's like you've got to be doing a little bit of everything. And the really challenging thing is you have to do
Kimberly Jones (52:43)
Right.
Miriam Allred (53:06)
You have to do whatever that employee wants and what resonates with them, which is why you have to take a multi pronged approach. Some people will like, you know, the public recognition on caribou, some people will like the handwritten note, some will like the phone call. And so you can't do any one of them. You have to do a little bit of everything, which is why it's just challenging. But how do you motivate your team? Because your team is the one executing on all of this. How do you incentivize or motivate your team to make sure that this is top of mind for them? Because
We haven't even talked about, you payroll and billing and all the clinical stuff. Like their priorities are so convoluted. How do you make sure that recognition kind of stays at the forefront of all of your office teams' minds?
Kimberly Jones (53:45)
I mean, I think that absolutely that's a challenge, but when you talk about again that our team has all been caregivers and the amount of respect they have for what caregivers do, I think really motivates them to make sure that the people in the field know that they're appreciated and that they're heard. And I I purposely have also
I don't wanna say overstaff my staffing team, but I hear where people try to run in home care and really f
You know, I hear things like, does each staffing supervisor have three thousand hours or something? Which for us that I mean that's just way too many hours per person when we're talking about developing relationships and making sure that we're dotting I's and crossing T's. So that is a place where we definitely will spend more in our budget to make sure that I have ample staffing coverage. because it's the core of what happens every day. So they have that opportunity and the time to
Do that.
Miriam Allred (54:50)
Yeah, keeping a more
flat org chart. because you're right. Someone actually just said that on a a phone call that I was on earlier today. you know, I don't know if it was like 10 or 15 years ago, it like one care manager to maybe 10 or 15 clients, and now it's one care manager to 40 to 45 clients. Like that is kind of the volume and the nature that we're up against. And and just with the cost of living and the cost of everything, like proportionately it's almost like a one to
forty ratio with clients, but it sounds like you all have prioritized keeping those ratios down as much as possible to keep quality as high as possible.
Kimberly Jones (55:24)
Absolutely.
Miriam Allred (55:26)
last question here, Kimberly. talking about pay, have you found we've already kind of hit on this, but just wanted you to share any other kind of statistics here. Have you found that increasing pay has had a direct impact on your retention or on your turnover? Like can you kind of attra attribute higher pay to longer, longer retention?
Kimberly Jones (55:47)
Well, like we've talked about, there's so many factors that go into it. It would be really hard to narrow it down that it is up to pay. But I think if you're not paying people, they can't stay. In this economy, like I said, I mean they need gas in their car, they need food on their table. If you don't pay them a wage where they feel
That it's respected for the position, then you're you're you are going to lose them. But I took a look at our statistics and it was 66% of our caregivers have worked for us two years or more. So I think that that's a fairly high amount of time for in-home care to have that type of statistic. And within that group of caregivers, 78% have taken at least some of
The certification courses. 51% of them have taken all of the certifications that are available. And our highest paid caregivers, the average longevity of our top 20% of highest pay is six and a half years with help at home. So I would say to me that is keeping them.
Miriam Allred (57:07)
Yeah, I hope that was useful for you to pull those statistics because well
Kimberly Jones (57:09)
It was. It was great.
I'm so glad you asked me to do that.
Miriam Allred (57:13)
Well, honestly, 66% having stayed for more than two years, that's a, that's a huge accomplishment. My mind goes to, okay, how do you get them to stay three years? Like what's what's the drop off, you know, at two years? Like, is there, you know, like what are the reasons? like once you know these numbers, it's like, okay, let's take a harder look at what are some of these drop off points? Why are, 51% doing this, not this. Like those statistics really help you further analyze, what's happening and why.
Kimberly Jones (57:43)
Yeah, people are complex but at the same time we're all kind of the same. You know, we wanna be recognized, we want our work life to be valuable within the scheme of our entire life. I mean who wants to show up to someplace for more hours than you get to be in your home and not have it be enjoyable and feel valued and what you're doing is valuable.
Miriam Allred (58:09)
Yeah. One one more question, Kimberly. You're so passionate
about this, about professionalizing caregivers. And so I just want to put you on the spot of how you think about this as an industry. Guaranteed, you're kind of heads down in your market and your territory and you kind of know what people are thinking. But you listen to this podcast and you hear what other operators are in your area think and say, We've come, I feel like a ways in a good direction of professionalizing caregiving. But I think between you and me both, like,
There's still ways to go. Like we've still got a ways to go before caregivers are formally recognized, before this is formally recognized as a profession. What's what's lacking? Like, what do we still have to do to not I don't know, get us over that kind of like finish line? There's not really a finish line, but like to get us to the point where we feel really good about like where caregaming is at as a profession. Like what what are we lacking and what what yet do we have to accomplish?
Kimberly Jones (59:00)
I I'm I have definitely heard people speak on I think on your podcast too, Miriam, about that we really need to understand who that workforce is that is our caregivers and what their needs are. And I
I think a lot more understanding of them. Does anybody want to call off? No. But I also don't want to be that person who has, you know, my car breaking down, I have three kids in school, I'm trying to make all the ends meet and I'm I'm I'm
I'm not given any grace. If that happens and I call you, then somebody's angry with me or I lose my job or I mean we try to be really understanding of who the individual is who is the caregiver and what their day to day life is. I think just having respect for that, not that we tolerate someone not providing care, obviously. but I think that and then us approaching
Who our clients are and what they need and having a really good understanding. When we go out, we've we've put some systems into place pretty recently where when we do our assessments, we have found a way where we are able to download so much information into the caregiver. And I realized for a long time we went out and we got a lot of information about a client, and then we found a caregiver who was able to do what was needed, but I don't think that caregiver always knew the same information.
That we had just spent a whole long time getting provided. And so we have a system in place now where a caregiver has the ability to read all of that information. And so that how much more do I feel like a professional when I'm reading all of these notes about this client and what's important to them and what's going on? I didn't just get a little paragraph text to me about what a client needs. No, I have access.
To a very extensive care plan about this client. And I have the responsibility of now going in as a professional and providing that care to that client. So I think that's huge. The more we treat them like a professional and it as a profession, the more professional that person is going to feel. Like I said, you know, to have I I think I I talked about this, the number of caregivers that are at our highest level, which for us is a level three caregiver.
it was almost 70%. so we have a lot of people who are going in and feeling like, you know, what I do is a profession and I have a certain skill set that I'm bringing to the table.
Miriam Allred (1:01:51)
Yeah, I love all of that.
Like realistic expectation setting, I think is a big thing. And then treating them as professionals. And that's probably it's it's a two-way street. It's the employees, but also the employers. And if we don't treat them as professionals, then we shouldn't expect that type of behavior and performance in return. And so it's really a two way street. And and that's where I do feel like we're getting better. You know, there's really like yourself, really great home care organizations that have an
incredible workforce that see themselves as professionals. And it's just that, you know, that cliche, that rising tide lifts all boats. Like the whole industry we need to get to that point where everyone, employer and employee, sees this as a profession. And I feel like we're inching our way there. And I hope in my lifetime and my own, you know, career, it's like we we feel like we have accomplished that. because that's really what we're all working towards.
Kimberly Jones (1:02:45)
No, I think you absolutely have done that, Miriam, by bringing people on and we all get to glean from what their passion is, you know, what what they've gone in to accomplish within home care. And it is.
Miriam Allred (1:02:59)
I'm just trying to yeah, just trying to
do my do my little part. But thank you for sharing. Like these, these, qualitative evaluations that you have shared. This is for everyone across the country to hear this and replicate a version of this in their own company. Like this is how as an industry we professionalize caregiving, we all do a little bit better. And so I just want to say, Kimberly, thank you for sharing so graciously everything that you've shared today. We'll include some more details in the no in the show notes and also your contact information so people can reach out and ask more questions.
but thank you so much for your time. We'll go ahead and wrap here.
Kimberly Jones (1:03:29)
you're welcome. Thank you so much, Miriam.