S3 Ep.1 : How Training Has Changed Over the Last 20 Years, With New Hosts Linda Leekley and Amanda Sternklar
S3 Ep.1 : How Training Has Changed Over the Last 20 Years, With New Hosts Linda Leekley and Amanda Sternklar
As we dive into Season 3 of Vision: The Care Leaders Podcast, new hosts, Linda Leekley and Amanda Sternklar, discuss how training has evolved over the last 20 years, and what care providers need to focus on to provide long-term support for industry professionals.
Thank you so much for joining us. If you are listening to this podcast as a reporting and your favorite podcast platform, and you want to be a part of the action live, you can join us every other Tuesday at 2:00 PM Eastern standard time for vision live, you can sign up for an indication at homecarepulse.com/podcast. You can also subscribe there or subscribe on your favorite podcast listening platform. This is season three of vision, and before we jumped in, we just wanted to introduce ourselves talk a little bit about our backgrounds and specifically talk a lot about Linda’s background, how she came to be the chief clinical officer here at home care pulse and her history with the industry. So thanks so much for joining me, Linda.
Sure, absolutely. And just stop me if I’m going too deep, huh? or too much ancient history, but you know, like, like a lot of nurses, when I became an RN, I was told you gotta work in acute care. You gotta take all this book, learning that you’ve gotten at school and you’ve gotta put it to use in the real world, in acute care, in the hospital setting in order to really hone your skills. Back then the word was that if you worked in community or home based care that you weren’t really making use of all your nursing skills. So I worked in acute care. I worked with oncology patients who were undergoing research treatment protocols and no question, it was challenging work. It was important work. But I often wondered what happened to these patients when they went home. I found it kind of frustrating to practice a and no, no offense to acute care nursing, but for me it just felt like assembly line nursing.
You know, you, you admit a patient, you care for them for a few days, you discharge that patient and it’s sort of a rinse and repeat scenario. So, you know, I, I just sort of was always attracted to a more holistic approach to care. And so I gravitated to home health and, you know, cuz there, you generally care for the same patient for a number of weeks if, if not, not months. Right? Mm. So I spent several years as a visiting nurse and and then my next career jump was into clinical education. I spent some time at the branch level and then became a corporate level clinical educator for a national home health organization. And my main focus, which I loved in that role was to help develop professional home health and hospice aids.
Well, the jump from visiting nurse to clinical educator was, was just sort of a natural evolution within that branch. They needed somebody to to do the work mm-hmm and I was interested I’ve always liked teaching too. So it was sort of a natural compilation of, of nursing and teaching. And then as far as my, my job at the corporate level, well that was and then jumping to, to what I, to starting my own business. That happened. It was outta my control actually it was the balanced budget act of 1997. Before that healthcare was cooking along really growing and then this balanced budget act was passed in 1997 and it drastically slashed Medicare reimbursement amounts for services across the continuum. You know, CMS was looking to save 1.6 billion over five years. So as a result organizations across the us either closed their doors, about 3000 of them closed their doors, or they looked to trim their budgets since education was often viewed as a nice to have I was laid off and you know, that that kind of rocked my world.
I thought my career was cooking with gas and here I found myself unemployed as a single mom with three kids who were approaching college age and I thought, okay, timing well, let’s see, what can I do? And then it occurred to me if I was laid off. And so were the educators across the country, right? Staff development, people, clinical educators, just all let go. And what that meant is that the training had to fall to the busy nursing supervisors or even the staff nurses. And they may have had little time, energy, or even interest in performing that, that responsibility, that role. And I knew that the training for the caregiver’s aids and CNAs would be what suffered. Remember this is ancient history. So the internet was in its infancy. You couldn’t just, oh, let’s do some online learning. It didn’t exist.
And you know, most training was put together in house and that might be some repurposed nursing article that’s given out to caregivers you know, printed Xerox from a magazine and given out to, to caregivers as an in-service or remember this is old days, a VHS tape popped into a machine and, and that served as an in-service or, or training. You know, and I just thought there’s gotta be a better way. So for, for direct care workers to really get consistent quality education. So I, I sat down at my dining room table and gave birth to this business plan for a monthly subscription for caregiver training. And that’s how in the know was born.
I know that in the know has grown or grew so much since then, you know, we’ve talked to so many folks who, who know you from back when, in the know was a physical monthly mailer. How has it changed and evolved since then? And then obviously, how did you come to be at HCP?
Yeah it, it changed a lot, you know, as you say, it was a monthly mailer, like a physical hard copy in the beginning. And then it went to floppy discs. We put the information off of floppy and mail that out, and then it was a CD rom that we mailed out and then it was email and then finally it was online learning. So that part of the business changed a lot and the business grew over those two decades. And then in 2020, I was lucky enough through various circumstances to HCP. And in the know we’re both working with a particular visionary investor. And he said, Hey, there’s a lot of synergy with your companies. How about if we merge? And so that’s what happened. And I am just thrilled to serve as chief clinical officer at, at HCP and oversee the expansion of our training library and work with so many wonderful healthcare organizations across the continuum.
And I know we’re certainly very excited and very lucky to have you through, you know, being in, involved in training for so long. I’m sure that you’ve seen so much change in the industry and the ways that we think about training and professional development. Can you talk a little bit about some of the changes that you’ve seen over that time?
Sure. you know, I think there’s, there’s definitely been a change in the perception of continuing education and how important it is for all healthcare professionals. Just one example, when I moved from Minnesota to North Carolina, I was kind of shocked that North Carolina had absolutely no continuing education requirements for nurses. So when I came to renew my license, you know, I just signed up and there was no, no continuing ed. Now that changed about 10 years ago in North Carolina. And it has in many other states as well. There’s still just a handful that, that have no CE requirements for nurses. When you think about it professional development in healthcare, it started with physicians, you know, they were the ones seen as, as needing that professional development and it trickled down to nurses and then it trickled down to direct care workers, but you know, the wheels on the healthcare wagon and sometimes turn excruciatingly slow, as we all know.
Right. Mm-hmm just one example from sort of ancient history though, did you know that most nurses were not allowed to touch a stethoscope or a blood pressure cuff until the 1960s physicians didn’t think that nurses had the skills necessary to take vital signs? And I know that sounds like a long time ago, but it, when you think of the history of healthcare, you know, only in the last 60 years have nurses held that that role, you know, of, of taking vital signs. And then now that’s passed down to caregivers in a lot of settings, right? Yeah. up until the 1980s, you know, most caregivers, nurse aids, home health aides, and so on, they were just trained on the job by other people in that role. There was no, there were no schools, there were no no training standards at all. Mm-Hmm .
And so thankfully, you know, over these past few decades, the, the federal standards for training CNAs and home health aids, they are well cemented throughout the us. And 21 states even require more than the federally mandated 75 hours of classroom training. But the, the nice thing about that standardization is that, you know, that a CNA trained in say, Iowa is going to be tested on the same knowledge and skills as a CNA in Colorado and a CNA in Tennessee, you know, it’s, you just have that sort of confidence in, in what people are, are being learn trained on.
For the industry. Exactly, exactly. So, you know, in the last few decades, I’ve definitely seen an increased emphasis on training and that’s proven out by the number of training companies that currently exist. When I started in the know there was only one other competing company. And so if you look now for how many are out there, right? Yeah. You know, that, that training became sort of a aha. We do need this mm-hmm
Of course it sounds like we’ve, we’ve seen a whole lot of change, especially in terms of numbers, in terms of expansion. And I think a lot of what we’ve spoken about is it’s good that we’ve had that aha and that, that kind of needs to continue to happen. But on the flip side, what, what changes haven’t you seen and why are we still having these kind of conversations
Over 20 years later? Right. Well, that’s a great question. it’s those slow moving wheels yeah. But, you know, unlike the training for CNAs and home health aids, the training for non-medical caregivers is still not standardized. You know, as you know, Amanda, it, the training ranges from zero requirements in some states to more than 75 hours in other states. And so, you know, I think until, or unless CMS gets more involved in non-medical home care that disparity in training hours is gonna continue. And that means that, you know, you don’t have that comfort level of consistency, a non-medical caregiver in Iowa may be learning completely different things than a non-medical caregiver in Colorado or Tennessee mm-hmm to use that same example. I think another reason we still have these conversations is that the level of respect for direct care workers is still not where it should be.
You know, from my first day as a nurse, I recognized how hard the nursing assistants in the hospital worked and that if we worked together as a team, we would learn from each other. Mm-Hmm . I mean, I, you know, when I was a fresh nurse, I wasn’t gonna come in there and say, because I had a degree, I knew more than these nursing assistants, who’d worked for 20 years, you know, on a unit. So I’ve always had deep respect for, for the knowledge and skills they bring, whether it’s at the hospital or nursing home, home health, hospice, home care. I do think that the level of respect got a bump during COVID mm-hmm mostly due to the exposure that a, the caregiver role got in the media mm-hmm , you know how that was, you know? Yeah. Suddenly people were realizing that, oh, you know, people wanted to stay home.
Right? Yeah. Wanted to age in place. They didn’t wanna have to go to a hospital or nursing home where they would more likely run into COVID. And these brave heroic caregivers faced the pandemic head on and kept providing care to their clients and patients in their homes. And so my hope is that it’s not just a temporary bump that we forget about mm-hmm , you know, but in general, I think the world of healthcare has still not wrapped its arms totally around non-medical home care. You know, even though in my opinion home care is the cornerstone of the healthcare continuum. If you think about it, home care can be considered pre acute because it helps people stay out of the hospital. Completely never go to the hospital as they age. Yeah. If they just need assistance at home and can manage that way and they stay outta the hospital.
Awesome. It can also be considered postacute for people who have come out of the hospital, had some skilled home health and no longer qualified, but still need help to stay at home. And what other aspect or, or segment of healthcare can consider itself, both pre acute. And post-acute, you know, so I think the more that payer sources recognize this deep value of home based care, and they start paying for it as a benefit, then I think there’s gonna be this domino effect on how we perceive direct care workers and the vital work. They perform
You talked a lot about how care staff really haven’t received the level of respect and recognition for their positions that they truly deserve, especially. But not exclusively during, you know, COVID 19 and the pandemic. I imagine that can present a pretty big obstacle to keeping care staff invested in their jobs. I know that we’ve obviously talked pretty extensively here at HCP about caregiver shortages about employee recruitment and retention. What do you see as some of the biggest obstacles aside from what we’ve already discussed to keeping caregivers invested and how do we improve on that? How do we improve the professionalism of care staff? And especially non-medical caregivers,
Another great question, Amanda, you know, I mean the elephant in the room is pay right? Pay is, is key care staff in all roles deserve a fair wage for a job well done, you know, at HCP, you know, that we hear every day from administrators who are struggling to compete with the salaries offered by fast food restaurants, retail stores, or other entry level jobs. One thing I think in my opinion would really help is to change the perception of the caregiver role from that of a dead end job to one with a career ladder, you know, turn the tables and, and help caregivers understand that those fast food or retail jobs might be the ones that are dead end. And that home based care offers, lots of opportunity. Career ladder is gonna look different for and a career ladder is the way to do this, I think, but it’s gonna look different, different people, right?
Mm-Hmm some caregivers love what they do. They don’t want to move on to an office job or move on to nursing school. They just love being a caregiver. They need a career path that, that steers them toward being a lead or a senior caregiver on your team, or a mentor of newly hired caregivers, some a, a ladder that respects their knowledge and skill level over time. Other caregivers might be interested in changing roles and they would welcome a career path that leads to, you know, a home based office staff role or, or to nursing school. Mm-Hmm you know, I think a along with the career path, I’m gonna, I’m gonna blow that horn again. There needs to be more respect for the work that caregivers perform, every communication from a healthcare organization, whether it’s a blog, a social media post, or a job ad should emphasize the respect that that organization has for direct care workers. That’s just so key.
I know you and I have talked about talked a lot about how that’s really important for recruiting and retaining staff, but on top of that, I think it’s important for your clients to see as well. Cause you’re not treating your, your care staff as professionals. What are they expected to do
When it comes to really keeping invested caregivers and other care staff how can agency owners identify and reward staff members who are invested in growing their skills long term, whether that’s, you know, remaining a caregiver and, you know, moving up towards a, a senior or a lead caregiver or whether that’s a more office-based position,
You know, in, in my opinion a key task for administrators is to start the discussion on day. One of, with their employees of home care, being a career for example, analyze job postings, do your job postings read like this is a dead end job, or do they come across like this? This is an entryway to an interesting career. Do you include questions in your interview process around the idea of a career? What are your applicants looking for,
Yeah, well, you know, I’m sure there are some administrators or office staff folks who would say, well, you know, these applicants just seem interested in a quick job that offers some quick money. It doesn’t feel like a career to them, but I would say before you count anybody out, make sure that you’ve done your job, that you have painted the picture for them of what a career in home care could really look like. And I encourage every organization to put a career ladder in place that has clearly defined rewards as each milestone is reached. Make sure everyone on your staff, including those applicants that they know what they would need to accomplish in order to step up to the next rung on their career ladder.
I really like what you’re saying here, because I think that they likely do see a lot of applicants who are just looking for a job that they can start really quickly which is fair and, and understandable. Right. But by setting out that career letter ahead of time they can identify folks who, if they weren’t in a position where they were really struggling and needed a job, that they could start quickly, you know, you can start from the ground up really building the idea of a long term career, even if they’re coming in just looking for, to get started working quickly,
Right? And the, you know, the two things are not mutually exclusive, right? I mean, they can start the job quickly and still you plant that seed that, that it’s a career. And, you know, part of that certainly includes investing in the resources that you need to, to have a career ladder. And one of those is a quality training program. I mean, I’m gonna, you know,
Beat that one, you know, but you can develop it in house. You don’t have to partner with a company like HCP. We have it already for you to go, but if you wanna develop it in house and that works for, for you, you know, anything, just make sure it’s a quality training program. Don’t use the, you know, nursing magazine articles or, or
And you know, be sure to conduct regular learning needs assessments to what are your employees most interested in learning if you don’t ask them, you’re never gonna know if the training program that you’ve put together is targeting their learning needs.
That makes a lot of sense. I really love something that you and I had discussed when we were talking about this episode where you referenced caregivers and other care staff participating in training as making an investment in their own career. Mm-Hmm . And I think that’s a real shift in thinking that could help a lot of agency owners and training managers with getting their care staff to complete that training. How can, how can those training managers, how can those agency owners encourage care staff to invest in their own career?
Yeah, I mean, is I’m, it can be challenging because you, you can’t, you can’t shove a career down someone’s throat, but I think it’s crucial to try to paint the picture again, of, of the career that somebody can have in home based care if they put in the effort and you want the picture to be really inviting. But also realistic. There’s no point in, you know, making it sound like it’s all, you know, roses yeah, there, there’s gonna be times when being a caregiver is just playing hard work. It won’t always be fun, but the impact that a professional caregiver can have on people’s lives and on their community at large, it just can’t be measured. So I think one of the key things is to find out what drives your specific employees, for example, are they motivated by an internal mission that they feel to help elderly people age in place, maybe they’re attracted to the science behind the work they do. Maybe they love the therapeutic relationships that they build with their clients. And that’s what attracts them to, to the, the work, or they have an interest in a particular aspect of care, such as Alzheimer’s disease or end of life care. You gotta find out what’s motivating each individual employee, and then build on that.
I was really struck by what you said about nothing can have a bigger impact on community when we were in person. I was having a discussion with our team about how folks are starting to think about work. Someone mentioned seeing specifically on TikTok a big shift in have a lot of, especially younger workers, having more of a focus on work life balance, and specifically some of what we’d both seen was around investing more in community and maybe less in just career progression. And I think there’s a really big opportunity for agency owners and, and other folks to show that being a caregiver being within this industry is a way of investing in your community and building a career. But being able to merge those two in a way that’s really difficult with most other positions because you’re out and you’re in the community and really working directly with folks.
I, I have heard and read that the, you know, youngest generation now entering the workforce is they’re sort of comparing them to the generation of, of world war II in that they want more than just a job. They, they want a mission. They want to be called to really make a difference in the world. You know, for some might be climate change or whatever their particular, you know, mission is they, they want to do more than just you know, clock in nine to five, let’s say mm-hmm . So I think you’re a spot on with that. You know, that, again, that’s part of this big picture that each agency needs or organization needs to paint of what their organization is all about and kind of going along with that, you know, some of you may be familiar with the, the book first published in 1970, but it has had many, many reprints including recently what color is your parachute mm-hmm you know, the, the career guidance that it gave back originally in 1970 was kind of groundbreaking at the time.
And the idea was that job seekers need to understand themselves first and figure out what they most love to do. And then they should look for organizations that inspire them and jobs that fit those strengths. So if you think of it, in terms of that, I have, I have two action steps for administrators out there first. In, in my opinion, it’s really crucial to make sure that your organization is inspirational and that your own home care journey illustrates your passion for the work you do. Why did you get involved in healthcare? Do your employees know what motivates you to get out of bed every day to do this work? If the leadership of an organization is not inspired, the staff working in the field, won’t be either,
Exactly, exactly. And that front and center in your recruiting, expressing it, right. Find it, and then express it over and over to your team. The, the second thing I would say is to offer career guidance as part of your employee orientation, and then thereafter at each performance of Val for each employee, think about it. This may well be the only career counseling that some of your employees have ever had ever. So to continue that metaphor of, of, of painting a picture, use every opportunity you have with your employees to add more color and depth to this picture, your painting of their career, what their career could look like. So that, that vision of their future career in healthcare motivates them to invest in themselves.
And finally, to kind of bring it full circle for any healthcare administrators who still think that employee education is simply nice to have like when I was let go so many years ago, then that you can just strike education from the budget when times are tight. Consider this quote by author and management expert, Michael above. He says, if you believe that training is expensive, it is because you do not know what ignorance costs come that have the loyalty of their employees invest heavily in permanent training programs and promotion systems. I agree a hundred percent with this sentiment. So instead of framing, employee training as an expense in your budget and an optional one at that. Yeah. Think of it as an investment in your company, it’s equity in your company, your employees and your patients or clients.
And I know it doesn’t happen overnight. Look, I’ve been doing this for, you know, 25 years and, you know, it takes time, but, but if each administrator, each organization can try these steps and really put put, put them into practice, I think it can, can help with a sea change.
Here’s hop, Hey, Amanda, you know, you and I are gonna be sharing podcast duties from now on. So in the spirit of this particular podcast, I’d like to learn more about your healthcare journey and, and what inspires you? What brought you to HCP? What inspires you every day?
Yeah, absolutely. So I joked that I’ve been healthcare adjacent for a long time. I grew up with a clinician for a parent. I worked in patient registration at a medical practice in both high school and college and eventually landed an employee benefits technology for a while. I also got quite far along in undergrad and a health science society and policy minor before realizing I couldn’t really make it work with my class schedule. But the classes I did take, which included things like sociology of medicine and the science society and policy around specific specific medical practices it just left me with a really deep desire to both learn more and then to someday affect change in the industry, especially again, after those sociology of medicine classes for both employees and the populations that they serve, the classes that blocked me from finishing that minor were both business and English courses.
Because I’d at the same time discovered a deep fascination with marketing or I’d learned that a lot of what I was already doing for free which was creating video and written content bringing awareness to both causes and authors and other things that I cared about through social media and planning events for those authors, as well as some other causes was a career that I could pursue and something I could keep doing after college and managed to also feed myself and, and have a career . So, like I mentioned, I worked in employee benefits for a while. I also worked with some other technology companies but when I heard about an open position at HCP, it kind of felt like something clicked and like everything was kind of coming back together. While I’ve been here and learning from you from other members of both our clinical team and, you know, other folks at HCP who have been in the industry for a long time that’s kind of only strengthened and I’ve both learned more and, and that passion to create change has grown.
And I’m really excited to be able to use the skills that I already have to identify with HCPs, why going back to that and, and really make a change in, you know, home care, home health hospice, and all the other industries that we serve.
Now, we’re lucky to have you and your skills to help bring awareness you know, to, to the industry and, and to help us express at HCP. We are lucky to work for a company that is so devoted to its mission. And you know, not everybody can say that we want to, to serve the home based care industry and make sure that anyone who wants to age in place can do so. And you know, it gets us all up in the morning. Right?
Couple of housekeeping things. Like I mentioned before, if you’d like to join us live, if you’d like to be one of the folks sitting in and asking your questions live, you can go to homecare, post.com/podcast to sign up for homecare live or to subscribe, to get these episodes delivered right to your email inbox. You can also subscribe anywhere your podcasts are sold or anywhere you’re already listening. Linda, if folks wanna get in touch with you, is there good platform or, or other method of contacting you? Smoke signals, carrier pigeons,
All of the above. For those who use LinkedIn, I’m on LinkedIn, I’m on Facebook. I can’t say I do TikTok much. Although my granddaughter keeps pushing me to try it. But it could also email me my email address is my name, [email protected]
And I am on LinkedIn as well as Amanda Sternklar. I can also be reached at [email protected] I am on TikTok though. I mostly post crochet and other handcraft videos there working on a, a more personal marketing TikTok, but not far enough along to say it on a recorded podcast yet. thank you all so much for joining us and we’ll see you again in two weeks.