Celebrating 40+ years of service to the Metro Atlanta Community

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The Changing Landscape of Home Care

Personal Care turned 41 this year.  I observed my 35th year as an employee and my 33rd year as an owner.  That, my friends, is a lot of history.  You would think that I would have long ago abandoned using superlatives, such as “the most,” “the worst,” “the best.”  For the most part I have.  This pandemic, however, I have to pray is the WORST.  I pray this is the bottom of bad for our company.

Libba Fairleigh, my retired business partner, used to publish a quarterly client newsletter, fittingly called “Connection.”  We took turns writing a column called, “From Where I Sit.”  What I write about today—the changing landscape of homecare—is my perspective and mine alone.  I offer it for your consideration.

Personal Care was one of the first companies to operate in the field of home care, and for the first ten years of our existence there was no regulation or licensure.  We were pioneers in that effort, along with a few other locally-owned companies.  We also helped develop curriculum for the Certified Nursing Assistant (CNA) training that many caregivers now receive.  For a few years we ran our own CNA school at a nearby church, as we worked to certify all of our employees.

Atlanta’s homecare market is now dominated by a number of national companies who either own or franchise local offices.  Many times, we were urged to consider franchising.  Libba and I declined that opportunity then for the same reasons we have resisted acquisition today.  Our business model is relational, based on knowing and caring for our employees, who in turn know and care for our clients.   Our efforts are towards person-centered care.

In the office, as a team we strive for equilibrium between clients and caregivers, but we are rarely in balance.  Historically we have had either too many caregivers or too many clients.  We talk in terms of “good” problems—too much work, and “bad” problems—too little work.

In 2008 when the recession set in, our work bottomed out.  We had CEOs of big Atlanta companies discontinuing care and taking in extended family members as caregivers for their aging parents.  For a few years we were stuck in a “bad” problem.  We worked to reinvent ourselves, offering shared staffing at a couple of facilities where we had excellent working relationships.  Shared services offer clients the opportunity to pay for services in 30-minute increments.  It is hard work to staff and manage, but it served to teach us more about care delivery, and to pull us through those tough years.

Since that time, we have had mostly “good” problems, thankfully, generally having more work than we could do, but stretching to serve as many as we possibly could.  The labor market is always difficult when you set the bar high for your employees.  We have prided ourselves on being an employee-centered company, offering above-market pay rates and benefits such as a retirement plan, time off, interest-free loans and health insurance long before other companies. We have celebrated the graduations of numerous employees who have attended nursing school while working for us and moved on to work in hospital and medical practices.

Until recently we only hired through referral.  We never advertised or recruited, and we had a steady stream of applicants.  The labor market was tightening before Covid hit.  Now it is akin to climate change—accelerating at a pace that will force major changes in how we do business.

Most of our older employees, many of whom had been with us 20 years or longer, opted to retire.  All employees who worked two jobs (or more) had to make a commitment to one job only, which meant we kept some great employees and lost others.  Lack of child care options and chaos with what the schools could do to keep students in school and engaged, caused another cohort to choose their children and families.  In the first 90 days of the pandemic, even though we still had more work than we could handle, we had 20 people leave.  We were still trying to meet the commitments we made as if the world had not changed, except for the fact we were Covid testing, dealing with Covid exposure and contact tracing, sourcing PPE, pulse oximeters, and thermometers, and working on transportation since those options had also disappeared.

In May 2020, we reached out to you and asked for donations to bonus our caregivers for their heroic commitments, which we did in June.  Little did we know that we were only on the cusp of a health crisis that would become much more serious and darker.

We are entering our 21st month of the Covid era.  Shortly after the Food and Drug Administration fully approved the Pfizer vaccine, Personal Care mandated the vaccine.  To my knowledge no other home care company has done so, although many of us will be subject to expected OSHA regulations that will soon be released and require mandatory vaccinations for companies with 100 or more employees.

Our company has shrunk 23%.  In February 2020 we employed 191 caregivers.  Today we employ 146 caregivers, and sadly we anticipate having another 8-10 leave as of November 1.  Many of these employees have been with Personal Care over 10 years.  I personally have had tough moments as a business owner.  As I wrote at the beginning, I pray this is the toughest one, because saying good-bye to beloved colleagues and friends because of difference about vaccination policy is one of the hardest tasks I have tackled.  While our caregivers love overtime pay, they are tiring because they are overworked, and as a company, we are stretched.

We have watched our industry colleagues impose fee increases three to four times in a year.  We are raising our rates again effective November 1, because we are now catching up to the labor market.  I think we will probably have to evaluate our billing and payroll rates twice a year to make sure we are doing all we can to recruit the best caregivers.  We are now partnering with several CNA schools, offering signing bonuses, and education vouchers, and hoping to creep back to our “good” problem space.

As companies like Personal Care face rate increases because of salary demands and the increased cost of employee benefits, more people are considering hiring privately.  If you are interested in more information on hiring privately, and the pros and cons of it, feel free to click on this link for an article we published a few months ago.

As always, we appreciate your business, your patience, your prayers.

Kind regards,

Martha Clinkscales