For Carol Sampaio, RN, LHRM, it is similar to the type of detective work she has done for much of her career. Before she worked in home care, Carol was a licensed health care risk manager for a Florida hospital and worked closely with Florida’s Joint Commission (JCAHO). Her job was to solve the mystery of why a problem happened and figure out how to keep it from happening it again. Now, she uses deduction skills to keep clients happy.
Carol is the administrator for the Homewatch CareGivers office in Daytona Beach and an important way for her to measure the success of the elderly home care provided by her caregivers is through quality assurance visits (QAVs).
“We want the clients to be happy with the services we provide. We can’t strive for excellence or improve what we do if we don’t check in regularly,” Carol said. “The most important thing is that everyone is on the same page. Everyone knows what’s being provided and it’s at the right level.”
Determining this is not as easy as it seems. Florida requires a face-to-face QAV every 60 days, and initially, Carol was actually going more often. In many ways, it was very helpful.
“When I actually go there, I get to see the whole environment. I get to see the interaction between the people who are there and the family members that are there. Then I can see how I can help them best. I can teach the caregiver how to better help the client,” Carol said.
However, the visits seemed to have some gaps in the information she learned. Often Carol or another nurse would return from a QAV where they were told everything was great. The caregivers would all get perfect scores – no one would report any issues unless they were really egregious. This made both Carol and Daytona Beach office owner John Pringle suspicious.
“The QAV process uncovered problems so rarely that I was convinced the QAVs were not uncovering what was actually out there,” John said.
John then signed his office up for Home Care Pulse (HCP), an independent organization that measures client and caregiver satisfaction for home care agencies. The results confirmed John and Carol’s suspicions. The same clients that reported everything was great during a QAV passed along complaints to HCP.
“Most people will avoid confrontation and will not give honest answers in a face-to-face interview,” John said.
Clients really like their caregivers, and if they say something bad, they worry their caregiver might go away. If that happens, there could be some major consequences. First, if they get a new caregiver, they would have to reteach that person how they like things and let another new person into their home. Also, many times a caregiver is a person’s lifeline to their ability to stay in their home. If the caregiver goes away, that makes their living situation unstable again and the client is afraid of losing that. Finally, a caregiver really becomes like another family member. They don’t want to hurt a family member’s feelings by badmouthing them during a QAV. It’s hard to tell me that I’m not a wonderful person when I’m right in front of you, or that the caregiver is bad when they’re right there,” Carol said.
Because John and Carol want to collect the most honest feedback possible, they had to find a way to circumnavigate this challenge. The answer, it turned out, was as easy as picking up the phone.
“It turns out that while clients have a hard time rating people as imperfect in person, they don’t have that when they’re on the phone,” Carol said.
Clients simply find it much easier to complain over the phone, so she now calls each client every week to check in. This keeps her updated on any recent problems, identifies them more quickly, and gives her more accurate information regarding client satisfaction.
Carol still visits clients’ homes regularly, but she has a different focus while there. She makes sure caregivers have the right skills and she spends more time checked to see that clients receive all the services they need. Once she gets on site, her assessment skills as a nurse kick in and she can tell if something does not look right. She measures a person’s status with what she knows from previous visits to make sure nothing is missed.
“I want to see improvement and if I see a decline in the rating of someone’s ability, I want to know why and what we can do to fix it,” she said.
To Carol, a good QAV does not bring any surprises. She is current on what is going on in a client’s home thanks to her regular phone calls, and to her, the best visits are those with clients who are so pleased that they want caregivers around more often.
“The end result is to have happy clients,” Carol said. “My favorite part is interacting with the caregivers and clients on a one-on-one basis. As people get to know you and rely on you, they can ask you questions and put their faith and trust in you. And when you’re able to allow the client to stay in their home because your caregivers are there - that’s our goal as an organization, and when you’re able to meet that goal – that’s the best feeling.”