Amedisys, Enhabit, VNS Health all see changing workforce dynamics

Recruitment and retention issues are the obvious and apparent issues when it comes to staffing home care providers. But trends below the surface could be just as important, and these are becoming apparent.

For example, home care providers must manage increased PTO use and reduced worker productivity. In general, the profile of a pre-COVID-19 and post-COVID-19 worker is different.

“We haven’t seen productivity return to pre-COVID levels,” VNS Health President and CEO Dan Savitt said at Home Health Care News’ FUTURE event on Thursday in New York City. “And there are several different things happening.”

Based in New York, VNS Health – formerly Visiting Nurse Service of New York (VNSNY) – is a nonprofit home health care, hospice and hospice provider. It cares for more than 40,000 patients, a healthy mix between health plan members and traditional Medicare patients. Part of his reasoning for the rebrand is that he plans to expand outside of New York in the near term future.

“We keep hearing from our staff that they’re just tired,” Savitt continued. “And there’s a capacity constraint, so we’re very careful how we push them, but we haven’t been able to recover. And I think that, coupled with higher levels of catches unplanned force and other related issues, has really continued to constrain capacity, making it much more difficult to operate day-to-day at the same gross margin level as before.

VNS Health is certainly not alone.

Providers face a dilemma: either they push workers to be more productive in their jobs and to work harder, risking burnout and turnover; or, they give them more free time, more flexibility, and deal with the short-term losses that come with it.

For Enhabit Inc. (NYSE: EHAB), this is the last route taken.

“We need to [approve that PTO] in the world today,” Jacobsmeyer told FUTURE. “If you don’t approve of it, they can go anywhere. You want them to feel the support they can get from family time.

Dallas-based Enhabit has 251 home care centers and 100 hospices in 34 states. It officially became a publicly traded company in July after separating from Encompass Health Corporation (NYSE: EHC).

Enhabit has been open about its employees’ use of PTO. After two years of leave out of necessity – due to illness, sick family member, etc. – the workers were finally able to use the PTO for a vacation last summer.

It came in bunches, and Enhabit’s operations felt the brunt of it.

“Summer tends to be a bigger use of time for vacations, but what we experienced was a pretty significant increase,” Jacobsmeyer said. “What was difficult was a branch manager saying, ‘But if I let them go, I’m going to have problems and I’m going to have to turn patients away.’ And you have to make that decision to say they deserve that time. And if we want to keep it for the long term, we have to let it take time.

PRN staff who normally had to fill in were also taking their time at about the same rate as other staff, so in the end Enhabit was unable to maintain capacity. But Jacobsmeyer was willing to live with that, with the long-term focus on retention.

Management of labor complications

Amedisys Inc. (Nasdaq: AMED) faces a personnel dichotomy.

On the one hand, he sees wage inflation flattening out and also sees a better flow of qualified candidates applying for positions. On the other hand, it is also about some changes in staff behavior.

“What’s starting to develop, and something we’re watching very closely, is that our employees want more options, more flexibility in their schedule,” said the president and CEO of ‘Amedisys, Chris Gerard, at FUTURE. “We are seeing status changes happening at an increasing rate. In some of our markets, we’re having good hiring months, but we’re not increasing our clinical capacity because some of our existing full-time employees are willing to give up health benefits and other things to go to a daily allowance or PRN base.”

This, in turn, reduces clinical capacity. And this phenomenon is particularly new, especially visible for about a year, according to Gérard.

“It’s a challenge,” he said. “But we have to get through this.”

Amedisys, based in Baton Rouge, Louisiana, provides home health, hospice and personal care services in 38 states and Washington, DC, and supports approximately 445,000 patients annually.

The question she and others are trying to figure out is how to handle this challenge.

Amedisys emphasized to employees that you can have full-time status and still have flexibility, which he worked to make that happen. It has also developed proprietary ways to know when employees are nearing a point where they could leave the organization within the next three months.

When this system identifies an employee in this situation, it leads to a one-on-one meeting with them to find out what the company could do better to keep them where they are.

“You need to be able to scale, but you also need to be more flexible in how you respond to your staff,” Gerard said. “That’s what we’re doing, really understanding what employee motivation is and saying, ‘Is there a way to satisfy that motivation without changing status or losing access to productivity?'”

Michael A. Bynum