There is a very high likelihood that some of your caregivers are working with your clients of the books.
At Sixth Sense Solutions we have worked with all types of caregiving agencies, and we see this problem arise time and time again. Once the caregiver and the client develop trust, they feel more confident in making arrangements to work outside of the agency that helped bring the pair together.
Why They Do It
Perceived on-going value, cost savings, a desire by both parties to “help” each other, etc. A recent example of one of our home care agency clients here in Orange County knows this situation all too well. The client that was under the agency’s care and needed extra hours based on assessments, but instead had decided to reduce their hours. The client and caregiver made outside arrangements for the extra care – resulting in the caregiver working for the client directly on some hours and working for the agency with that client during other hours.
The client gets a “discount,” and the caregiver gets a higher wage – “win, win” right? Well, no.
The Hidden Cost of the Hidden Arrangement
Even though it may not be apparent in your organization right away, there are some opportunity costs and hidden costs related to their “win-win” arrangement. The easiest one to see is the loss of perceived value: that the client is now convinced they can pay the caregiver directly and no longer “needs” to continue to be directly on service with you (or devised a blended model of use).
Another thing to consider is that the caregiver is now using his or her hours to work privately and may be less available for your schedule arrangements, diluting the value of your available labor pool. The new income they are generating for themselves is also an opportunity for them to quit, or continue to cut back on their hours with your agency.
How the Client Discovered His Caregiver’s ‘Off the Books’ Arrangement
One day, there was a call from a local hospital – the agency’s caregiver had had a stroke. All the hospital knew of the patient was their name and that the client who dropped them off (they left their name) and since the client did not have any emergency contact information for the caregiver, they mentioned the name of the agency. The hospital representative called the agency and asked if they had an emergency contact for the patient. The agency was diligent and followed up right away, but noticed the caregiver wasn’t officially scheduled to work with this particular client on that day, and in fact, they noticed that client had significantly reduced their usage and the caregiver hours. That is when they were able to start to put two-and-two together.
How to Stop Caregivers From Working ‘Off the Books’?
Even though you may have a policy that discourages fraternization, these things are bound to still happen. We recently did a survey and found over 95% of caregivers were approached within the first 30 days to work “off the books” in some capacity. It is the nature of consumer behavior in the industry!
But there are some tactics and ways to make your caregivers less likely to accept working for your clients outside of the agency hours. If you are able to address it in a professional, strategic manner you can help extend the time a client is on service. This approach will help maximize the hours they will receive from your agency, allowing you to provide the appropriate level of care and quality you believe is needed.
We encourage you to schedule a complimentary call with Sixth Sense Solutions to discuss this approach. Click here to get started.
About the Author
A dynamic thinker with a great sense of humor, Keith Freeman, MBA, is a Strategic Consultant offering unique solutions to transform healthcare organizations such as hospitals, hospice/palliative, home health, and home care, RCFE/assisted living and skilled nursing facilities and professional healthcare staffing services that support them.