Caregivers Stay in the Field Because of These 4 Factors, According to Executive Director of PDHCA
Emilie Bartolucci, Executive Director of PDHCA is here to talk about her journey to the home care industry and why that’s led her to pursue a doctrate in organizational leadership. She’s focusing her dissertation on the caregiver experience and the motivating factors that keep caregivers in the industry. Here’s what she has learned.
Hey, this is Miriam Allred, and you’re listening to Vision | The Home Care Leaders Podcast by Home Care Pulse. My guest today is Emilie Bartolucci the Executive Director of the Private Duty Home Care Association (PDHCA). Welcome Emily. We’re so excited to have you. Thanks for joining us on Vision. Emilie Bartolucci is the current Executive Director of PDHCA. Before she was the Director of Advocacy and Community Engagement for NAHC, the affiliate organization, the National Association for Home Care and Hospice. Before that you worked at Bayada, you’ve also worked in the hospital environment and also hospitality. So really excited to have you Emilie talk to me a little bit more about your background. I know I’ve kind of mapped it out there, but tell us about your background and how you’ve arrived at homecare.
Thanks Miriam. I really appreciate you for such a warm welcome. I, I tell people I’ve, I have sort of this odd background in how I ended up in home care was a happy accident. So I started my career a number of years ago and I won’t date myself, but I started as a CNA in a med surge ICU back in Boston Children’s Hospital. I was pursuing my undergraduate degree and I really fell in love with that kind of work and fell in love with the community that healthcare provided. And I had great aspirations that I was going to go and do great things there, but I ended up moving to Philadelphia with my husband at the time. And when I got to Philadelphia, I wasn’t sure what to do. And I sort of ended up again by accident working for the Ritz Carlton Hotel Corporation.
And I spent a lot of time with them learning about what it meant to be a leader, learning about what it meant to deliver stellar service and really employee and consumer experience. And, but there was this part of my heart that always really wanted to go back into healthcare. And when I had the opportunity to do that in 2012, with Penn Medicine, I jumped on it. I wanted to really marry that clinical hands on aspect of care with what I had had learned from the hospitality industry. And we opened the Penn medicine center for healthcare innovation in 2012. And it was a great opportunity to really get acquainted with all different kinds of care, to get acquainted with the academic side of the world. I ended up pursuing my master’s in public administration at that point thinking, wow, this is a great way that I could work with communities and spent a lot of time working on consumer and really patient and family engagement and experience with them pulling in real time feedback and doing a lot of piloting.
And somewhere along the lines, I ended up working briefly for the children’s hospital in Philly, kind of pulling those same things across, but I got a call of the blue the one day to come and work with Bayada home health care. And they said we really want somebody that has your background, your experience in both hospitality, as well as and healthcare to come and help us develop really what the future of our service delivery, the future of our experience for employees and for our clients and families. And I couldn’t think of a better place to do that. I couldn’t think of a better cultural fit. I couldn’t think of a better company. And I spent about a little over four years there doing that and really getting to work in the different service lines that exist in, in the, the home care realm.
You know, everything from behavioral health, to home health, to hospice you know, personal care services, it was really enlightening and really it really felt good to be able to do that. And you know, through that work, I got a lot more involved in advocacy efforts. My own daughter is a consumer of home care and other home health care needs that she’ll need later in life. And it just really felt like the right place to be. And when the national association came knocking on my door and said, Hey, we would love you for you to come here. I said, yeah, I would love to do that. And I had just started at that point, working on my doctoral work, trying to look about organizational theory and leadership, and I thought, wow, this is the moment where I can really understand at a national level what’s going on. And home care be an advocate, but also learn more to help inform my research on the personal side of things. So this was really for me, it was sort of this really crazy path that led me to kind of where I think I belong at this point.
Oh, I love it from the Ritz Carlton to Bayada, to PDHCA it’s incredible. I absolutely love it. And I’m glad you put in that, you know, that last bit about working towards your doctorate right now. That’s what we’re really going to talk about today. And we’re going to focus on your findings, but to give people context into, you know, the topic and the research, I want to, you know, kind of walk through that a little bit. So tell us about your topic and really why you chose that topic.
Yeah, absolutely. So, you know, it’s funny, the doctoral dissertation process is such this iterative process. And when I walked into it, I really thought I was going to do something around culture and experience. And it turns out that that’s a super large thing to try to create research out it. I probably would have been doing it for the rest of my life and I would have been happy, but I probably would have never gotten anywhere. And so after all this iterative process, I narrowed it down to looking specifically at one specific role in the home care industry. So focusing in on the home care aid role, understanding that this is such a pivotal and important role for the home care industry and really patient outcomes and really in what we need from you know, a support standpoint, it’s a role that is not often looked at from a research perspective, but as we know is so important.
And so I wanted to focus in on the home care aid, but I also wanted to look at those home care aides that have been in the industry for a long time. So more than five years I wanted to understand why they continue doing this when we know the role is so challenging and we know they’re such high turnover. And yet we have a group of them that seems so committed and will stay five, 10, 15 years or more doing the same thing over time. We know there’s challenges in payment rates for these folks. We know there’s a whole host of challenges with just how difficult the work is, but why are they continuing to do this? And so my research really focused a lot on answering that question. Why would someone choose to continue to work in this role? What are the motivating factors for them to want to do this?
How are they being engaged in a way that others may not be to understand, but also to use that information, to share with the industry overall on ways we might be able to do better on engaging, attracting individuals to this role and keeping them in the role long term. So I did a lot of qualitative research in the sense that I was really looking for stories and, you know, the stories are at the heart of who we are. As human beings, they’re really at the heart that really explains who we are, why we do things. And so I chose to focus my research on a narrative form, meaning I was collecting stories from individuals and then looking for themes within those stories that tied back to that overall question of the why, why are they continuing to do this?
What are those motivating factors? And so I interviewed a number of individuals that are home care aides that have been in the industry longterm, and just ask them to share their story about how they got into their roles and what has kept them there. What are those factors that keep them there, or what are things that are maybe opportunities that they see and really what came out of that was some really special information, things that I had intuitively known from other, you know, conversations and home visits that I’ve had with home care AIDS in this role, but it was so enlightening and insightful to hear it in their own words and for them to talk about and share their story from the moment that they decided to become a home care aid to where they are today and learn what those motivating factors were.
You’re jumping the gun, but I’m so excited and I love the passion in your voice. So before we get into the findings, you’ve kind of talked about the research. Are there any stories, compelling stories that you could maybe summarize or highlight quickly from your research?
Yeah, I mean, so some of the home periods that I’ve talked with you know, they started their careers, not knowing what they wanted to do. I spoke to a home care aide and she’s, she’s been an aid now probably for more than 30 years. And she has always been a home care aid, but she started her career so many years ago thinking she wanted to be a nurse. And she actually went to nursing school and sorry, time getting her degree and doing all of her clinicals. And when she got done with all of her clinicals, this, this thought dawned on her and she said, you know, I don’t feel like as a nurse, when I’m going in my, to my clinical everyday, I get to spend as much time with my patients as I want to. I don’t get to know them.
I don’t get to form any kind of relationship with them. I want to do something where I can have a better relationship longterm and do more for these ones, the patients that I’m taking care of. And so she did a little exploration and she came across home care and she said, you know, I could have been a nurse and home care I could have, I could have went and, you know, did all of those things, but she said, nursing and home care is really episodic. You know, you go in and they want you to do a couple of things and check on vitals, check on wounds. And I, I didn’t want that. I really felt like I wanted to connect with a patient and do more for them and really impact their life. And so she talked about how she made a decision early on that she wasn’t going to be a nurse.
She wasn’t going to do that even in home care. She really just wanted to spend more time. And she said, you know, I, I was working with home care aides and they would tell me how great it was. They would go in and they would spend two or four hours with their clients. And it was, it was incredible. They would learn about their families. They would be able to help their patients reach goals, being able to help them, you know, emulate better. And she says, you know, there’s moments where it sounds so silly where a, a patient of mine might say, you know, and share with me this incredible smile and say, today was the best shower I’ve ever had in my life. You know, thank you. And she’s thinking, well, you know, I gave him a shower yesterday that he said was just as good, but today this is incredible.
And those small moments are things that were so special. And we heard that not just from this particular individual that I talked to, but I heard this from, for mothers who would share that, you know, we got into this, not for the money. It wasn’t the money I got into it because I really felt compelled that I wanted to give back to someone and I wanted to do it in a very, a particular way. It’s not a way where there’s this hustle and bustle of the hospital environment. There’s not this you know, rush to get in and get out and check off some boxes and fill out paperwork. I wanted to use this as a way to really care for someone, provide this kind of personalized service for them so that they could live their lives better. And that’s what we heard echoed in. A lot of the stories I heard from these AIDS was just this profound desire to want to give back to others and be able to influence their lives, which you, don’t, what you find in healthcare. You know, I did that as a CNA, but they’re right. It’s so quick. And it’s so brief. You don’t get that opportunity often to develop that longterm kind of connection and relationship with someone that you do in home care.
Fantastic example. I just love that. And I think as an industry, we, we need to tell the caregiver story a lot more often. I’m just, my wheels are turning in my head like, wow, we need to like team up on a podcast that’s all about these caregiver stories, you know, highlighting the amazing things that happen every single day with these direct care workers. So, so absolutely love that. I’m sure there’s so many more stories that you could share, but let’s really dive into the meat here, which are the findings. You kind of hit on it before, but let’s talk about what are the factors contributing to the longevity of these caregivers roles? What were some of the findings that you found?
Yeah, it’s you know, I agree with you, there is just such something special about hearing it through their own eyes, through their own perspective and, you know, time and time again, talking to these home care AIDS and listening, I spent a lot of time just listening and doing a lot less talking. And what I found was some really common themes that emerge across all of their interviews, no matter where they came from, what part of the country, how old they were, how long, you know, was it five years? Was it 20 years? Was it 30 years that they’ve been in their role? All of them really honed in on four major, major themes. And one of them that you heard me mentioned was around relationships. So relationships were the primary key driver for many of them wanting to get into their roles, but also to continue working in their roles.
We heard a lot of it being around the patients and families themselves, so that connection that they had. But I also heard all of the AIDS talk about the connection that they had with their colleagues. And although one of them that I interviewed had a really, really profound connection with their peers and really felt like they had this support system and they supported each other so that they could then in turn support their patients and families. What was interesting was the one individual that shared that he didn’t have that kind of support system from his organization mentioned how much he was looking for it. He was a caregiver that had come into the role really to kind of help a family member and ended up working in the role permanently because he loved it so much and felt really connected and empowered, not just to care for his family member, but to also care for others.
And he talked a lot about how he is seeking and looking for those opportunities to connect with his colleagues from an emotional standpoint and mental standpoint for, for support in that area. But also just to learn from each other and have that comradery. And so those kinds of relationships being able to on the patient and family side, as well as with colleagues were so profound and continuing for them to stay in this role long term. Other things that came up were around recognition. So recognition was super important and we all kind of feel that in our roles, but for these home care aides that shared their stories with me, they felt it was so motivating and connecting when they got recognition, no matter how small from their clients and their family members. So, you know, the same thing that the example I shared about the shower, you know, how fantastic that was.
They’ll show us share stories about how, you know, when they come into the home, their client greets them with this big smile and wants to tell them about what they did last night and wants to tell them about, you know, their daughter who’s doing this, that, and the other thing or sharing stories about what they did when they were growing up. And it, it was one of those that recognizing being recognized for what they do and how valuable and important is by their patients and families was extremely motivating. And also, you know, you talk about that recognition, they get from their peers or from their organization. And so, you know, they talked a little bit of how it’s really great when someone tells me, you know, you did a fantastic job with this client, or they say, Hey, you really helped me out with some additional training on, you know, using a Hoyer lift.
I hadn’t used it in, you know, a couple of years and you stepped in and you helped me do that and supported me in that. I really, I appreciate you for that. And so it was really this peer to peer recognition of the value of what they provide and the knowledge that they have that was so important to them. And what the other interesting piece I found was is they really felt it was important for society overall to recognize them for what they were doing. And I asked a few of them to elaborate a little bit more on this, and they would share that, you know, when they, someone asks them what they do in their roles you know, and they say, they’re a home care aid. They say, Oh, well, what does that mean? What, what, what do you do? And, you know, they’re, they’re talking about they’re providing, you know, supportive assistance or you know, they’re providing meals or companionship, and they’re doing all these things and people will say, Oh, okay, well, that’s nice.
You know, isn’t there something else you want to do? They feel like society needs to understand more about how integral this role is, how important it is these families oftentimes, you know, as a caregiver for them, they are the only ones that are coming in and making sure these individuals can live independently and live safely. And, you know, not everyone recognizes that. And you know, when they talk about that, they say they need to record nice that what we do is important, what we do is valuable and that, you know, the rest of the world needs to understand that not value and someday maybe if they can see how valid, well we are, maybe they’ll be able to pay us what we’re worth and what that value is. And so they record ignite is that this is a segment of the home care industry and health care overall that is severely underpaid for what they do.
And the more that we can share kind of those stories and get that recognition globally for them from society, the more that they will feel really good about what they do, but also be able to say that others feel good about what they do to you know, the other two aspects that really came into this from motivating factors were that social good aides talked about the reason they got into this and the reason they stay doing this is because they feel the responsibility, this great responsibility to their patients, to their families, and really society to ensure that these individuals have what they need. They talked about it almost as if it was this higher purpose or this religion, you know, they don’t talk about the tasks that they’re doing. They talk about purpose. And we see that as such a valuable piece. Largely when we look at our workforce, as all of our employees, how important it is to contact, connect individuals, to purpose, and these home care aides already have that connection.
And so the more we can cultivate it, the more we can do to just strengthen that connection, the more motivated they’re going to be to want to continue in this work. Other things that they talked about that were really motivating for them and engaging for them were this idea that this is a role that allows them to have a lot of flexibility and choice. So these are things that are coming from their organization, and it’s like this big popery of things, this flexibility and choice in the role that they have and their ability to choose their own hours flexibility and choice in the kinds of clients that they work with. Really things around the ability to learn and grow within their organizations, things that are planned, they might be like rituals or connections that really connect them from a community standpoint, this sort of social belonging standpoint, making them feel connected to each other and their organization.
These were all things that as an organization leaders and mechanisms can be created to foster and foster that kind of engagement with them. And they talked about what their organizations do, and it made so much sense that the reason they stay working in these difficult, challenging roles is because of the relationships and the recognition and that kind of purpose that they have. But also because their organizations are doing everything that they can do to support them, to support them in their roles and connect them to one another really even creating more of that social connection relationship building that is so, so important.
Wow, everything that you shared is just great. Just a couple of follow-up questions. The first around recognition, you talked a lot about just, you know, that verbal recognition, whether it’s from the client or from a peer, did you see any other trends as far as preferred recognition goes?
Yeah, it’s a great question. I think, you know, it was funny. I had thought when I went into this, that I might hear them talk about recognition as a monetary type thing, or you might hear recognition as an award type thing from their organizations or from their clients, maybe from feedback they might’ve gotten through surveys or otherwise that was present certainly, but what was more valued for them were more of the, you know, the actual, give me an example of what you did and this is why you’re being recognized or why you’re being valued coming from different segments. They talked a lot about recognition happening in other ways too, around, you know, some of them gave examples of recently during the pandemic. There was one individual that said my organization sometimes will in the morning, I’ll get an email from them that says, Hey, on your way to work today, I know you’re headed to this client’s house.
Please stop at this particular coffee shop and have a coffee and breakfast on us. As a thank you for everything that you’re doing. Cause we know that you’re working so hard. They talked about those little kinds of surprise and delight things that came in just to recognize them for all their hard work that they’re doing, whether it be through these organized events, whether it be there was an example of something called a Monday morning meeting that one organization does and every Monday morning they all get together. Right now they’re doing it virtually of course, but they would get together. And they would talk about the day and the business kinds of things, but then they would a be able to do kind of shout outs for one another and talk about what, you know, their peer might’ve done well or what maybe they heard from a client about somebody that did well.
And they would shout them out. And the Monday morning meeting as this place of, you know, sort of communal recognition, but then that recognition would continue over social media. I would continue with, you know, they might receive a surprise gift card in the mail. They might receive some kind of award on a quarterly basis or an annual basis. So there was lots and lots of different ways that they talked about recognition. But what was funny was that the most valuable pieces of recognition almost seemed to be the smallest. It was this, you know, this small, really genuine gesture of a thank you, have a smile, have a, Hey, this really fantastic was really the most valuable to them and salient to them. And that’s what they talked about more often than,
Yeah, I love that perspective. And it’s so refreshing to hear, I think, agencies here, other agencies, you know, providing all these monetary rewards or recognition and they feel, you know, for some, they can’t pay as much or they can’t provide, you know, all these monetary forms of recognition, but like you’re outlining, it’s, you know, it’s simple and it’s the small things matter that verbal affirmation and that verbal recognition goes a long way. And I think it’s just refreshing to hear because, you know, budgets are tight and sometimes you can’t provide everything that you want to provide, but it’s so important to realize that just that verbal affirmation or recognition is so powerful. So I love that perspective. The other question, this is a big question and kind of putting you on the spot. But you talked a lot about the social good and getting our communities to recognize the social good that these caregivers are doing. I’m sure you’ve given that a lot of thought and the pandemic has put home care kind of under the spotlight. And I think that has brought about a lot of advocacy and awareness, but what more can we do, you know, as individuals, as an industry to radiate that concept of social good?
I think, you know, it, it is a big question and I think it’s a really important question as someone that has done a lot of advocacy for this industry and specifically for this role within the industry I think there is so much more that can and should be done. And I think it does start a little bit with the story telling, you know, as, as owners, operators and leaders in this industry, we all inherently know what value home care aides and home care has. And, and certainly the pandemic has, has put up spotlight on that. And rightfully so, but I think we need to do more of sharing what we know outside of our own sort of small world, you know, it goes back to sort of this idea of when someone asks even myself what I do, and I say, I work in home care.
They say, Oh, that’s so nice. You work with hospice patients. And, you know, they talk about their grandmother that was on hospice and that, and I start to explain that yes, home care is about hospice and palliative care and end of life support and services, but it’s so much more than that. And I think what really, for me talking to these AIDS and hearing their stories really highlighted for me is the fact that we need to do more storytelling and more stories sharing. You know, the whole reason that I chose to go on a narrative journey for my research was that I really believed that in order to understand and gain perspective and insight into this area, to answer the questions that I was looking to answer, I couldn’t do that unless I was able to highlight their experience through their own eyes to give these individuals that haven’t in the past, had a voice really predominantly in, in research or in the media or just in, in the mainstream world, give them this platform to be able to share their stories and give them a voice collectively and individually, I think we need to do a lot more we know this, but we need to do more of it.
And we need to ask them to share because they’re so willing, they’re so willing to share. And when given the opportunity we need to do more of that, and those stories will really help to fuel advocacy around our, and our ability to really influence what’s going on at a congressional level at a, at a pay level at a support level for these individuals. So the more that we can do that as leaders and the more we can create those opportunities and avenues for sharing of that and sharing what the impact is of that. I think the greater impact overall we can have with our advocacy efforts and really getting the support that this role needs and really showing society what it means to be a home care aid. As you’re talking, I’m, I’m taking my own notes. And, and personally, I feel like my takeaway here is I just wrote down own my role on this industry.
And I like what you said. I think it’s up to each and every one of us to take that extra minute to explain what we do or explain the industry. And sometimes it can feel frustrating or get annoying, but I just think owning our role in owning this industry and advocating, you know, in our daily conversations with people, I think that will go a long way if we all, you know, take the initiative and do our part. So I love that to kind of wrap up, we’ve covered a lot of really great information, but I want to kind of end with how this is kind of a broad question, but how we can act on this information that you’ve shared, you know, what advice or encouragement do you want to give to providers with this information that you’ve found and they’ve shared today?
Yeah, I think, you know, this is something that I think a lot about, you know, you never want to do research in a vacuum. You never want to do just research for the sake of doing research. You want it to have an impact. You want people to be able to take action on it. And if I could give any advice about what to do next for providers, I think the first thing I would tell them is open your hearts and your ears to your staff, your home care aides, to those out in the fields and give them those opportunities to share their story, be collaborative with them, involve them in the planning of the work that affects them, really bring them in to what’s going on because they can be your greatest asset, your greatest value. And so, you know, have those moments with them.
So, you know, that, that’s kind of the first thing. I think the second thing is really think about things within your own operation that you’re able to do that can help to cultivate relationships, even further that major key driver for your aides help to cultivate that recognition. And, and really that kind of connection of social belongingness and community for them connect that for them and really strengthen that for them and in any way that you can. And, you know, we talked about it, doesn’t have to be expensive. It’s really about the little things, the deliberate things that you can do. And I would just encourage you to do more of that. And the more we can do that the more they’ll want to stay. There’ll be the more they’ll be motivated to want to stay. And hopefully we’ll be able to attract others to this industry.
There’s so many individuals out there that I think if they knew what home care was and what value it had and how special it is as part of the healthcare continuum and really special to each of us, as, you know, individuals interacting with each other, humans interacting with humans, I think this could be something really beneficial for your business overall, but really your employee engagement and really for the future of this industry. So really look to your employees as a way to inform you and collaborate with them on your next steps.
Emilie, thank you so much for taking the time for everything that you’ve shared. It has been so wonderful. Just so that our listeners are aware, you’ll be defending your dissertation here in the next couple of weeks. So really best of luck with that. Hopefully we can kind of stay up to date and continue to hear how things go, but really like you outlined for providers, we can take action today. You know, this is great information, but we’ve got to put into practice. So thank you so much for joining us today.
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