Ep:46: Senior Helpers CEO Shares How They’re Achieving a 3% Hospital Readmission Rate

Miriam Allred (00:08):

Welcome to Vision | the Home Care Leaders Podcast. I’m Miriam Allred with Home Care Pulse. My guest today is Peter Ross, the Co-founder and CEO of the Senior Helpers. Peter, welcome to the show!

Peter Ross (00:20):

Glad to be here.

Miriam Allred (00:21):

This is a real treat, like I said before. We haven’t met before, but I’ve heard many great things and you’ve been a long-term friend of Home Care Pulse. So I’m really honored to have this conversation.

Peter Ross (00:32):

Thank you.

Miriam Allred (00:33):

So just a little bit about Peter. You started Senior Helpers back in 2004, you really are a national industry thought leader in home care, and you’ve served on the HCAOA national board for a number of years. Anything you want to add to tell our audience a little bit about yourself?

Peter Ross (00:52):

I appreciate the national thought leader part. I do. I do tell everybody that I learned something new in this business every day. So the beauty of home care and the beauty of the industry we’re in is that it’s just, it’s so enlightening on a daily basis to learn what we, what we do as an industry, but also what we don’t know about that we learn something every day. So I think that part’s fun. It’s been a great joy to be involved in this industry for so long. And the home care association market is a great association. I know home care pulse is very close to the HCAOA, and we appreciate all their support. And you know, I’ve had the pleasure of leading that organization for seven years and I’ve been on the board since 2008. So just a great opportunity to work with my colleagues and everybody calls in front of me is like all them friends. And it’s just been a great situation. So I think you nailed the background as well as you can appreciate the kudos, but it’s a Senior Helpers is gonna be a great team as we do as an industry. So it’s never one person. So, but thank you.

Miriam Allred (01:58):

We’re right alongside you with learning something new every single day, this industry is constantly throwing new challenges our way, but that’s what makes it fun and exciting. So today we’re going to talk a little bit about the social determinants of health. Like I mentioned previously, it was a kind of a buzzword before COVID hit, but I feel like it’s kind of swept under the rug a little bit and I think we’re going to see it brought back to life here really quickly. So I thought who better to speak to the concept and where we’re headed than, than yourself. So tell me a little bit about just that concept in general, social determinants of health, how would you define it and how would you describe home care’s impact on the social

Peter Ross (02:39):

Return? Well, I mean the original term came from people. It was really around homeless people. It was really kind of where the term came up originally, where people were at a place to live and a place that, you know, somewhere to eat and to survive. Then I think when it came into home care and we talked about, you know, that, how do we find a way to let people live out their life in their own home and, and takes on a lot more meaning. And I think we’re, it’s a kind of, COVID took over everything, so let’s be clearer. So I think, yeah, everything from, you know, okay. So if someone’s held a hot button of the day, a year and a half ago, well, pandemic trumps all hot buttons. So I think that changed the world in a lot of ways, but I think it also helps social determinants of health because as you could see, a lot of the people that were affected most by the pandemic were folks that were not at home.

Peter Ross (03:31):

They were in facilities. They, you know, they were very disconnected to their family and to their environment. And I think it provided an opportunity to say it was worse, the value of home care where, so then, you know, oh geez, we just want to live at home. Or, oh, we have to go to this facility. What’s the meaning of life and the what’s the quality of life for that. And I think that’s where social determines of health to stick on a new role to say, you know, how do we find a way to make it better? It’s not just I’m living at home, but how am I living at home? You know, what’s, what’s the need. And I think what’s going to happen. Miriam is you have this huge need for data, the social determinants of health, the buzzword comes up through looking at how do we risk manage lives from a health care system or a health insurance perspective or a Medicare situation.

Peter Ross (04:21):

So as you look at it’s one thing to live at home, but how do you live at home successfully? How do you find that, that, that secret sauce to make that happen? I think that’s where home care plays an even bigger role than before the pandemic. You know, before the pandemic, about 60% of hospital discharges were going to a home-based setting during the day pandemic and predicted to go after it’s almost 85%. So there’s lot more people now coming home that would normally go into a facility first, before then transit, transitioning to home, which is putting even more pressure on us in home care because those folks are going to higher acuity cases. The reason why they didn’t go home before it hasn’t changed, they have issues. There’s chronic issues or issues they need to rehab, but now they’re going right home. So home care plays it even more important role and making sure they go home safely.

Peter Ross (05:21):

You know, one of the things that senior helpers has done through all this social determinants of health has created a platform called life profile. It’s in a way that reassess the ability for a senior to live in their home safely, and it creates an autonomy score. That’s really fascinating that predicts whether that person will be re readmitted to a hospital in 30 or 60 days. It’s really a powerful assessment tool. It’s an app we have on our tablets that we go into a home or go into a facility. They assess, you know, what’s the opportunity for them to live independently and safely at home. So I, while social determinants of health took a back, you know, kind of the back shelf of everything going on with COVID the issue didn’t disappear. I think it’s been actually heightened by the pandemic. And I think it will continue to be a buzzword that that people will be talking about, you know, speaking about for God years to come. Yeah.

Miriam Allred (06:19):

So let’s, let’s dive in here. Like you said, tracking the data analytics behind tracking the quality of care. That’s I think kind of where some of the hangup is here. It’s hard to measure the quality of care being provided in the homes. You know, it’s hard to track food insecurity or loneliness or social isolation or, you know, issues with transportation on all of those things are playing into their overall wellbeing. So it’s slightly hard to, to, to quantify the quality of care. So it sounds like you guys have a platform or a software that you’re using to help measure some of that. Let’s talk about what you’re measuring and how you’re measuring it.

Peter Ross (06:59):

Yeah. So we’re actually scoring them every 60 days. So we’re trying to understand what their autonomy score is when we first meet them. And then based on putting what we call a smart care plan together, how does that impact that score over time? You know, you know, what are we looking at? We’re not just looking at medical conditions, we’re looking at social, we’re looking at loneliness and, and, you know, and looking at other safety risks in the home it’s not just medical, it’s not just medication. It’s more than that. And then how do you interact with the family? You know, it’s one thing for home care to be there, to help you. But most families can’t afford home care, 24 7. It’d be great. But that’s just, isn’t realistic. So we also also train our families and their family caregiver, because what happens a lot of times is we, you know, we are in the home and we’re doing a good job during the 20, 40 hours a week.

Peter Ross (07:54):

We’re there. But when we leave, the family’s not trained on how to transfer them from a bed to a chair, you know, how to use a hard lift, how to use a pivot poll, how to do those types of things around the home. And that’s when the accidents happen. That’s when a fall occurs. And that’s when, so we have to begin to measure kind of the impact there, and also start leveraging technology into the home to see if there’s ways that we can augment our care with other types of passive, you know, technology that can monitor falls, monitor other types of abnormal behavior that’s going on in there. But data, I always believe I’m a six Sigma graduate data set your free home care policy lives in the data world. And I think, and you’ve been surveying data for a year. So as long as I’ve known Home Care Pulse, so know, and you’ve been surveying clients on how they’re doing and employees and how they’re doing.

Peter Ross (08:48):

So the data has to set you free here. And it has to give you the information more importantly for the safety of the, of the family member, but also as you look to what’s happening in the industry, when it comes to Medicare advantage when it comes to other programs that you’re now part of an ACO or an MCR where you’re, you’re now our risk partner, for instance, with our new partner and our new owner and advocate, Aurora health and health advocate, our enterprises, they have these risk pools and they have these things while home care has never been star rated because we’re not Medicare reimbursed. So yeah, we’d never had to have that data, but it’s something that the industry has realized for the last five years. It was actually a committee on the home care association board, all around data to really try to understand, we’ve gotta be able to get this data so that we can play on this pool.

Peter Ross (09:42):

Yeah, we, we, we were told years ago that home care at your nonmedical non-skilled, I think that’s totally false. I’ve said that for 10, 15 years now, we are part of the healthcare continuum. We are skilled and our caregivers are trained. You know, we do things to make it better for people, but you’ve gotta be part of that healthcare continuum. We gotta start talking their language. We have to be able to integrate with the health system and the EHR systems and all the things that are happening so that we can share that data, you know, home health is a great partner to us and, but they’re trying to I’m in it and I’m out, right? So when I go to a home, I’m there to check vitals, I’m there to make sure the medication set up. If they have a G-tube or a feeding too, I’m there to help with that, but I’m gone, I’m gone.

Peter Ross (10:30):

I’m not there to help with activities of daily living, grooming, bathing, eating, taking, you know, taking their actual medication. It’s great that it’s there are they taking, you know, so all those things, we actually augment that that’s where you see a change, a condition, you know, and that in that particular senior, I had a good, good friend and board member, a geriatrician who used to say, you know, seniors have bad days, but when is it a really bad day? So those are some of the things that home care can point out and be you know, I think a, a real benefactor to the healthcare continuum to let them know kind of what is truly happening. Cause we’re actually there with the family. You know, unlike people that are just visiting or doing a telehealth visit, we’re actually there. Ooh,

Miriam Allred (11:16):

You’ve covered a lot that I want to get a little more granular on really good insights there. And I’m excited to talk about kind of that seat at the table and how data’s going to get us there. But, but I want to backtrack a little bit and get a little more granular on this approach that you’re taking in this. You said it was kind of app based that you’re using. So you mentioned the care plan, which I’d imagine is kind of at the intake, but then you mentioned that 60 day milestone. Can you get a little more specific on just kind of those milestones, how you’re tracking it? You said it’s app based, but it is inside of your scheduling software. We get a lot around that question.

Peter Ross (11:52):

So our app, we track over aria stuff. That’s being done. We tracked nationally. So we track the scoring. We track results. We look at the care plan recommendations. And, but every office, we teach them on how to look at what that score does. The score tells you as they are right now with no intervention, what’s your chances of being readmitted to a hospital. Then we can actually do some levers. We can pull some buttons we can push that says you interject homecare. If you interject DME, do you interject family caregiver? We can raise that score up. It’s like a fuel gauge. We can go from a quarter tank to a three-quarter tank. And now you’re, you’re out of the, out of the danger zone. You’re in the green, not the red anymore. So we then look at that after we put it in the care plan, cause we expect Miriam for that to go up.

Peter Ross (12:51):

Now, everybody was just like people in our industry think we’re dealing with end of life. People are just getting older and sicker. I totally disagree. I believe that we’re able to interject into augment some things for them and provide the things. So that gives them a purpose, but actually can improve their score 60 days from now, if we’re doing our job right, and we’re interacting with the right care plan, we’re pulling the right levers. We’re pushing the right buttons. There’s no reason why this family member can’t get better. There’s not, there’s no reason why we can improve on that quality of care and improve on the quality of life, which quite frankly is more important. So that, that person sees that, oh, I was able to do this. They hadn’t, they were in the hospital for a reason. You know, what, what can we do to keep them out of there? I mean, 400,000 people a year Miriam, dying in the hospital for not the reason they went in.

Peter Ross (13:49):

The last person you want to put in there is a frail senior. So we want to keep them out. My friend, a geriatrician used to say that an ER visit for a senior is a 30 day sentence away from home because no year, our department in the country has been sued for admitting a patient. So that’s what happens. So we need to keep them home and keep them safe. I think telehealth has grown tremendously during the pandemic. That’s awesome. You know, more people can see their doctor and technically that’s what you’re doing. And by the way, the funny part of tele-health most tele-health visits are just verbal.

Peter Ross (14:28):

You would think that wouldn’t be the case, cause we’re all in the zoom world today, but it’s kind of interesting how that actually works. So yeah, I think it’s, the data is such an important part to have that seat at the table. One of my friends in the Home Care Association of America always used to say, ‘if you don’t have a seat at the table, you’re on the menu’. So, you know, you’ve got to find a way to have that, but the data gets you a seat, the table everybody that you work with within a managed care environment, whether it’s the payer or the provider they have to see value in what you’re doing. You know, the home care association put out a value of home care report several years ago that we’re updating now, but what’s really is the value of what we do. How, how does it impact the health of that person, but more importantly, the cost of health care for that person.

Miriam Allred (15:17):

Yeah, that’s, that’s what I wanted to hit on. I love what you’re saying. Kind of boils down to two concepts that home care is the solution to keep them out of the hospital. A, which is a huge priority, but B improve the quality of life and home care is perfectly positioned to address both of those issues kind of around the social determinants of health. So I love that. That’s what you’re saying that this kind of boils down to, I want to address kind of the caregiver side of this. I love this concept of pushing buttons and pulling levers and identifying that, you know, kind of upfront. I can only imagine that that helps give direction and clarity to the caregiver, whether it’s a family, caregiver, or a caregiver that senior helpers is providing, you know, what outcomes are you seeing on the caregiver front? You know, are they more fulfilled because they have more purpose and understand what they’re going in the home to do, you know, speak to some of that?

Peter Ross (16:10):

Well, I mean, the beauty of a smart care plan for us is that, you know, think about trying to make a cake without a recipe, right? So you could be there to just be there, or I get, you know, trust me, you wouldn’t want me to try and make a cake without probably even with a recipe, but let’s just say I had one. Yeah. Having a good, smart care plan gives the, the, the caregiver confidence that they’re doing the right things for this, this, this client that needs a desperately, they’re getting the instructions for getting the recipe for quality of care. And that’s what we’re really trying to do. I think a lot of times in our industry, we, we didn’t spend a lot of time educating the caregiver, you know, as something I saw early on and said, no, this is not who we are going to be at senior helpers.

Peter Ross (17:02):

And I think we’re not, we’re moving that way as an industry as well. We’ve got to do a better job of preparing our caregivers, whether it’s training them, whether it’s giving them really good care plans. And when we do reviews, we review the care plan with a caregiver and usually our director of care, which is usually an RN to really understand, are we making a difference? You know, we have a great care plan, but something changes in second week. Yeah. We don’t want to sit there and go, okay, let’s keep doing the same thing. No, we’ve got to tweak that care plan. Let’s find a way to do that. But I think the more you have a more prepared caregiver, what has the ammunition or the tools to do the job? I think you have that ability to, to impact the quality of care. So having a great app to say, Hey, we can pull these levers and push these buttons, but then there’s no care plan on the other side. Yeah. Then good luck making the cake.

Miriam Allred (18:02):

Yeah. They work in tandem together. Let’s talk a little bit about outcomes. I might put you on the spot a little bit to see, you know, you mentioned you’re tracking kind of hospital readmission rates, and you’ve got some of these specific data points, outlined, any chance you could share kind of where you are at and where you’ve come over the last year.

Peter Ross (18:22):

Only if you can promise Miriam that our competitors are not listening. They’re my friends when I said that earlier, but I think the, you know, we’ve been looking, we did a couple of white papers around our life profile and what we call micro social determinants of health, really getting into the details of what social determinants of health really would be. In our study, we did, it was a 3% hospital readmission when using this, this profile system to make sure that they’re safe at home. And that compares to a, probably an industry average can, I can argue back and forth anywhere between 18 and 20%. So we’ve been pretty successful at really introducing these care plans with the right levers, the right buttons to ensure that we keep them out of the hospital moving forward. But I think you’re seeing as an industry, everything is going into the home and I don’t mean home care.

Peter Ross (19:18):

We’ve always been there. I mean, you’ve got a hospital at home, you got assisted living at home. You got skilled nursing at home, every buzzword today. And all, by the way, the overarching, you know, elephant in the room is social determinants of health. That’s why everybody’s flocking to the home. So, you know, that’s why it gets lost in the translation because the buzzwords today are hospital at home. The buzzwords are, you know, bumbumbumbum. Yeah, yeah. But the real reason is social determinants of health. We want to make sure they can, they can survive and thrive in the home. And I think that’s, you know, that’s, that’s where I think as an industry is so dynamic to be part of what we’re doing today, but we have to be able to back it up. So we’re constantly tracking data. We have dashboards, we have KPIs. We look at it’s, you have to, you look at our you know, we look at kind of what our clients think of us, obviously, Home Care Pulse knows much about that as well. What our caregivers think of us, we’re always constantly looking at ways to improve because it’s an interesting business, right? You have all these employees, but there’s no employee meeting. You know, they’re all out in the, out, in the, out, in the community working 24 7. So how do you make sure that you have a distributed workforce is doing all the things you want it to do?

Miriam Allred (20:41):

I love that. Let’s talk about this seat at the table. I know that’s kind of a known concept to many, but maybe not to also. So you are using data to earn a seat at the table, you know, at a local level, but also at a national level because you’re a national organization, but how specifically, or what data have you specifically taken to a referral source or to a potential partner and said, Hey, this is what we’re achieving. And you know, what was their response? Any scenarios that you can talk through there?

Peter Ross (21:08):

Yeah. We’ve had hospitals under our life profile program that everyone that’s over 73, that’s discharged, they’ve got a life profile assessment that would show you some pretty, pretty powerful things. So I think they’re, they are taken back that a home care company has this kind of a tool. That’s the first thing they say to us. I think they also understand that we’re serious, that we’re not, you’re not your average home care company. I don’t mean to say that home care is average, but you know, most home care companies, we, and I was like this initially too. We kind of shied away from the clinical side. For lots of reasons, we w we weren’t supposed to be clinical. But I think that was a mistake on a lot of parts. That’s why we adopted chronic care management as a company for Alzheimer’s and dementia.

Peter Ross (21:58):

And Parkinson’s earlier than anyone else, that’s also why we adopted our assessment tool to really be able to sit down with a hospital, with a provider, with a payer and say, this is what we do on every assessment that we’re doing. We track how they do, we track the score. We sh this is the kind of detailed we go to. You know, and th this is one of the big reasons. I think that advocate Aurora made their acquisition of senior helpers was because we were like this, and that’s a lot what they are in, like when it comes to their advocate of our enterprise group of aging independently, their whole focus of whole person health. So I think that’s really kind of one of the things that got them excited, but yeah, we were doing that long before their acquisition.

Peter Ross (22:46):

It’s just that now we have resources with them to actually bring them life profile, even to a higher, higher plateau of more data. Because now you’re working with a healthcare system, that’s had data for 30 plus years. So now you’re able to look at lots of different things that add to that, but it does get you to the table. It does prove the point. The other thing it’s going to be real interesting as we go forward is with social determinants of health, with value-based care, it’s, who’s willing to take a risk. You know, it’s a risk reward here, you know, going away from fee for service to value based care that’s been talked about for a long time, it’s in the process of happening. Probably not as quickly as some people would like it to be. But I think that having the data, you now have a seat at the table to talk about risk sharing. You know, if I do a really good job, I actually get paid more, right. If I don’t do a really good job, I should not get paid this more. So, so there’s very few companies out there, especially in home care that wouldn’t like to have that conversation today, but we need to start. I mean,

Miriam Allred (23:52):

Yeah, really great points. And I love what you’re saying about the risk involved. I think smaller agencies may shy away and say, Hey, we’re not equipped to do such things, but what you’re saying is we’ve got to step up and prove our worth inside of the continuum. And it’s going to take risk. It’s going to take data tracking. It’s going to take, you know, earning that seat at the table, which takes time. And isn’t easy. So love, love all the feedback there. I just, I know you’ve kind of hit on it here with this last question, but tell me a little bit about this acquisition that took place April one. And then also just any other observations of what’s next in this industry over the next year?

Peter Ross (24:34):

Well, we were very, very happy. I’ve gone through three transactions with senior helpers and, you know, not one has been a strategic transaction until now. So I think, and all the, all my friends and, you know, some of the interviews I did after the acquisition was announced I think showed the world that, you know, home care is here. You know, we’re, we were just acquired by the 10th largest healthcare system in the country. You know, I could tell you five years, four years, 10 years that would have been a pipe dream of anyone in our industry, because we just were kind of, we were the forgotten people in the home. Oh yeah, they’re good. Yeah. Yeah. They’re good. They’re not paid by Medicare though. They’re good. Yeah. They’re okay. Yeah, it’d be nice to have. Yeah, that’d be great.

Peter Ross (25:23):

Now we’re here. Now we are a part of a healthcare continuum that we actually can control from start to finish. I think that’s really exciting, but I think it opens the doors up to lots of other home care companies to say, look, there is an opportunity here to really play a role and the advocate of our team at advocate or enterprises and Evercore health have been phenomenal of how they’ve wanted to work with us and to try to look at synergies. And and I, I think we’re just scratching the surface so far at what that all can be. But it, to me it’s just really exciting and it just brings a lot more resources. It brings a lot more credibility to the industry as a whole that we’re now, you know, part of a healthcare system. I mean, think about that as a home care company.

Peter Ross (26:13):

Now that, you know, sends a message that I think to the world, that home care is here to stay. I think you’ll see more transactions in the next year or two. When you come to strategic partners, there’s lots of organizations trying to have a seat at the table in the home, and we’re in the home of thousands of families every day. So how do you find a way to get there while we’re, we’re a vehicle for that to happen? You know, just like other organizations are in the industry. So I think you’re going to see over the next year and a half home care continue to go bonkers when it comes to demand. I think one of the challenges we have as an industry, as caregivers you know, we, I think we’re doing amazing and we would be doing some more amazing if we could get any check and we want where we’ve been training them from scratch.

Peter Ross (27:00):

You have a great program. We do internally with senior helpers that train people, never caregiver before, but at the same time, I think until we get this unemployment to run out, then September, then we hopefully would get a lot of people coming to work and wanting to work. But even beyond that, even before the pandemic, this industry had to hire 1.3 million caregivers, you know, over the next six years. So that was with zero unemployment back then, because you had 3% unemployment, that’s zero unemployment. So how do you find a way to fix that? Wages need to go up, what to families kind of forward? So all those things are things I think over the next year, a year and a half the org, you know, the industry is going to have to figure out you got to find more people to do the work.

Peter Ross (27:47):

How, what are ways that you can actually make that happen? I think is, is really going to be how people perform over the next year and a half. You gotta be able to get, you know, senior hoppers was recognized as a great place to work for the third year in a row, national only national home care company to have the recognition. So we got to find a way to make caregiving a destination. You know, I’ve said for years, and I’ve gotten yelled at many times that, you know, I like minimum wage going up, you know, and everybody at my home care industry were like, what? You gotta be kidding me. But no, we’ve gotta find a way that caregivers can make a living wage. We gotta find a way cause you won’t have the turnover, you know, home care policy. Does your study over a year? You know, your key threats to rest of the industry. I think the last four years has been caregiver shortage. You know, we know we have to find a way to make it a destination, just not a stop along the way. And you cannot trigger as leading one company for another company for 50 cents an hour. You’ve got to find a way to make a difference. So I think over the next year and a half, that has to be solved in some way.

Miriam Allred (28:55):

Peter invaluable, these insights, you are the perfect person to address a lot of these times.

Peter Ross (29:00):

Well, let your listeners decide whether it’s the perfect person or not, but I appreciate the comment and it’s a pleasure talking to Miriam.

Miriam Allred (29:09):

Thanks for listening to this episode of Vision with Peter Ross. If you’d like to learn more about how Home Care Pulse Experience Surveys can help your agency earn a seat at the table, visit our website, homecarepulse.com and check out our solutions pages. Thanks again and we’ll see you next week!