Brett Ringold, vice president at the Jenkintown, Pennsylvania-based A Long Term Companion, has been named a 2024 Future Leader by Home Health Care News.

To become a Future Leader, an individual is nominated by their peers. The candidate must be a high-performing employee who is 40 years old or younger, a passionate worker who knows how to put vision into action, and an advocate for seniors, and the committed professionals who ensure their wellbeing.

Ringold sat down with Home Health Care News to discuss his career trajectory and centering home care business around the caregivers.

What drew you to this industry?

I started my career in the home care industry in 2010, but my first experience with home care was as a patient. I was diagnosed with Crohn’s disease when I was 12, and during a particularly bad flare-up, my family hired a local home care provider to assist us. 

Fortunately, I’ve been in remission for nearly 20 years. Still, that experience as a patient inspired my passion for home care and shaped our mission to deliver the highest quality of care to families in the region.

What’s your biggest lesson learned since starting work in this industry?

I’ve learned that our professional caregivers are at the core of everything we do.

When I began my career, especially from the perspective of a former patient, I thought our focus was primarily on serving clients and their families. It quickly became apparent that as leaders, our responsibility is just as much about being exceptional employers, because when we support our caregivers, they’re able to provide the outstanding care our clients depend on.

If you could change one thing with an eye toward the future of home care, what would it be?

Better access to care — in terms of having the workforce meet the growing demand for care and ensuring care is available to those who need it.

There’s been a lot of talk lately about an existential caregiver crisis. Many industries face workforce shortages, but few see a growing demand like home care, which only compounds the challenge. Addressing this will require a multi-faceted approach, with workforce development playing a critical role.

Americans are living longer, and especially considering the increasing number of people diagnosed with Alzheimer’s disease and dementia, many will require significant care throughout their lives. Some of this care will be paid for through Medicaid or privately by families, but funding for home care is a pressing issue that needs to be addressed.

Medicare Advantage has not provided the comprehensive coverage for home care that many hoped for. Expanding elder care tax credits and enhancing veteran benefits will be necessary.

Including home care as a standard benefit in Medicare and private insurance plans might be an aspirational goal, but it would be vital to ensuring better access and affordability.

What do you foresee as being different about the home care industry looking ahead to 2025?

The overall quality of care will continue to rise, not just by raising the ceiling but also by elevating the baseline standard of care. Several key factors drive this, including increased investment in our workforce, stronger collaboration across the health care continuum and a growing emphasis on accreditation and higher standards. We’ll see more consistent, high-quality care as providers embrace these changes.

In a word, how would you describe the future of home care?

Bright.

Our industry has evolved so much since I began my career 15 years ago, and I’m very excited about the advancements we’ll see over the next 15 years.

What quality must all Future Leaders possess?

The ability to innovate while staying true to mission. All Future Leaders must maintain a strong connection to their organization’s core values, even as they embrace new ideas and technologies that will continue to drive our industry forward.

To learn more about the Future Leaders program, visit https://futureleaders.agingmedia.com/. 

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At the Home Care Association of America’s (HCAOA) annual conference last month, providers offered a peak behind the curtain on how those determinations take place.

Hillendale Home Care CEO Jesse Walters, A Long Term Companion (ALTC) Vice President Brett Ringold and Michelle Cone – SVP of training and brand programs at HomeWell Care Services – all offered up different perspectives on how they approach compensation.

“What we can do to try to attract the workforce to the home care industry is something that we all carry on our shoulders, and it’s important for us to come together in industry settings such as this and share with one another,” Cone said during a panel discussion. “What we normally see is very ill-defined processes, right? … And we want to be process-driven.”

Based in Burkburnett, Texas, HomeWell is a home care franchise with over 80 locations across the U.S.

HomeWell reevaluates caregiver compensation two or three times per year, according to Cone. Ringold said ALTC reviews compensation “at least annually,” but that that process changes based on circumstance. For instance, during COVID-19, those reviews came quarterly in some cases.

Walters said once per year is the “bare minimum,” too, but that “triggering events” can always change that.

“We look at the compensation strategy as a holistic strategy,” Ringold said. “Yes, what you pay per hour, you have to make sure that you’re competitive. But, for us, it’s total compensation, it’s a robust benefits package, affordable and comprehensive health insurance, a great menu of supplemental insurances, very advanced PTO and sick time paid time off. We also use overtime as part of our compensation strategy as well, because our caregivers love to work a lot of overtime.”

ALTC is a home care provider based in Jenkintown, Pennsylvania.

Ringold added that him and his team vigorously look over home care industry reports to make sure their offers are in line – or above – industry standards.

But part of the process is also taking into account what’s going on at the local market level.

“There’s such an opportunity for us to improve our processes and our touch points, and it’s not always pay related, but you do absolutely need to make sure that you’re not underpaying based on your local market,” Cone said. “That’s the first thing we need to solve for.”

Walters also added that a greater understanding of the local market can help in negotiating with applicants. He mentioned that an applicant may suggest they’re getting paid $30 or more per hour at a nearby agency, but his team’s market research knows that’s likely not true.

“If I have a new staffing manager or new recruiter coming on board with the team, part of their training and development is understanding the market,” Walters said.

Based in Walnut Creek, California, Hillendale provides home care services in Northern California.

In regards to the aforementioned “triggering events” that may cause Hillendale to look at compensation more than once in a year, those are often numbers based.

For instance, if Hillendale is not hiring 25 caregivers in a month, Walters knows him and his team should take a closer look at what’s happening.

“That’s usually it, I’m looking for signs that something’s slowing down, or something’s changing,” he said.

And, although the local market may change from month to month or year to year, Cone emphasized that strategies should be set with a long-term view in mind.

“Design your comp structure with the end in mind,” she said. “What is going to lead to the desired goal for your organization? And I think, again, pay is going to be incredibly important. I think we have to look outside of the obvious, though, which is just, ‘If I pay you more, you’re going to stay with me.’”

Caregiver compensation is generally directly tied to billing rates in home care. The client is charged about double what it takes to pay the caregiver per hour.

But as both have risen over the past few years, home care provider leaders have started to consider how that business model could be altered in the future.

“If I have like 60, 70, 80 core clients that want to age in place for a long time, I’m looking at those clients, and I’m looking at those caregivers, and the average length of stay,” Walters said. “Historically, for us, it’s been like six to eight months. And it’s 50% margin. But what if in the future, it’s 18 months, 24 months at 40% margins? If I’m able to build alignment on what I want and what the caregiver wants, can I pay those people much better to maintain clients on a long-term basis? Does that change the unit economics in our business?”

Those are the sorts of questions providers are going to have to begin asking themselves. Home care isn’t getting cheaper, and hiring caregivers isn’t getting easier.

The sales side

Some of the questions Walters asks himself as he’s going through his compensation strategy are: What do I want at my most selfish? What does the salesperson want at their most selfish? What does the caregiver want at their most selfish?

“I try to find where people are at their most selfish,” he said. “If I can get them to tell me where they are at their most selfish and that aligns or intersects with where I am at my most selfish, then I hire that person.”

That strategy is particularly applicable for salespeople. They may want to be in home care, but caregivers are less likely than salespeople to be motivated strictly by compensation.

Leaders taking the time to talk to their workers about what they want, though, is generally always productive.

“As somebody who has shed plenty of tears in this business, I want my team to cry in the shower once per quarter,” Walters said. “I want them to show back up on Monday and figure out how they can do better.”

There are, indeed, ebbs and flows in the home care business.

That’s true for compensation and revenue, too. One thing that Ringold cautioned against was being unthoughtful about handing out raises.

“If you’re not giving out performance-based [bonuses or raises], I highly recommend you put together a strategy,” he said. “But there’s only one direction, it’s only going to go up. You can never have pay go up and then decide next quarter to take it back down. That’s never going to work. So, you have to be really thoughtful about how you’re going to approach performance-based pay.”

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For the most part, the home care industry tends to have a “the customer is always right” attitude toward clients.

Even so, some instances arise where agencies have to take the drastic step of firing a client. And when this happens, agencies must navigate the process carefully.

It’s important for home care agencies to be able to recognize the difference between a client that is merely challenging and one they need to discontinue services with.

One example of a challenging situation, but not fireable offense, is when a client asks for something that falls outside of the agency’s services lines, according to Brett Ringold, vice president at A Long Term Companion. He recently wrote about this very topic for Careswitch.

“We have a client handbook and a very in-depth agreement that really explains from the get go who we are and what we’re here to help with,” Ringold told Home Health Care News. “Then we have an intake process where every client talks to a relationship manager, and we tell them about ourselves, what we’re able to do, and what we’re not able to do. Many times the challenges arise after services start, and then the client, all of a sudden, is asking for things outside of your scope of services.”

A Long Term Companion is a Jenkintown, Pennsylvania-based home care agency. The company serves five counties in Pennsylvania, and three in New Jersey.

Oftentimes, clients asking for services outside of the ones A Long Term Companion offers are looking for medication administration.

“We perform medication reminders; we don’t do any medication administration,” Ringold said. “After services begin, some families will insist we administer medication. If there’s something we’re not allowed to do, we’re not going to bend the rules to accommodate and please a client, because that puts our caregivers in jeopardy.”

Another example of this are clients that take advantage of the company’s light housekeeping offering.

“We want to make sure the client is cared for and that their home is tidy and well kept,” Ringold said. “But the family essentially looks at us as a cleaning service for the entire household. We have very strict guidelines in our handbook of what light housekeeping means. We’re not there to clean up for the whole family; we’re not there to do yard work or gutters. If we’re asked to do so, we ask our caregivers to call in immediately, so we could intervene from the office and reset the expectations with the client and their family.” 

Still, these instances do not typically end with an agency discontinuing services with a client.

In fact, these situations create the opportunity for an agency to remind a client of their agreement and the company’s scope of services, and they allow the agency to set clear expectations and boundaries moving forward. 

“If you’re communicating regularly, that goes a long way in identifying the kind of small issues that you could mitigate before they create a bigger issue,” Ringold said.

When it comes to firing a client, the issue isn’t always so “black and white,” Sherry Peach Walker, vice president of client services at Family & Nursing Care, told HHCN.

“We don’t have a black-and-white policy manual that lists everything that we fire clients for doing,” she said. “It’s a very nuanced thing where we want to check and really assess from client to client what their exact experience is.”

Based in Maryland, Family & Nursing Care is one of the largest private-pay home care providers in the Washington, D.C., area. Currently, the company delivers over 40,000 hours of care per week.

The clients themselves, and their involved family members, can often factor into an agency’s decision about whether or not to move forward with them.

“It all comes down to the client, to the responsible parties and family members, and if there’s professionals involved, and how do they deal with it,” Walker said. “How do they work with us to make for a better solution? I think the tough places are really when we don’t have a responsible party, or if the client is not capable of making certain decisions, then that makes it very difficult to be able to safely provide the care that’s needed.”

When firing a client is right

Ringold and Walker both stressed that there are times when firing a client is a clear “no brainer.”

“Lack of payment and caregiver safety are two very easy ones that we have terminated people for,” Walker said.

Similarly, caregiver safety is also top of mind for Ringold.

“If the client’s environment is not a safe environment for the caregivers, we have no choice but to do everything we can to ensure our employees’ safety,” he said. “If a client is abusive that is [a situation where] we don’t have to give advance notice. Because again, we’re protecting the safety of our employees.”

When a home care agency determines that the company needs to part ways with a client, it’s important to be familiar with the state regulations regarding this.

“In Pennsylvania, for example, there are actually very clear cut guidelines on how you could fire a client,” Ringold said. “For instance, you must provide at least 10 days’ written notice; it can’t just be verbal, and it has to be given with ample time, so that client can find another provider.” 

Ringold noted that there’s an exception made when a client has created an unsafe or abusive environment or if they’ve failed to pay the agency. In these cases, the agency can terminate the relationship immediately.

During the firing process, the agency should be in constant communication with the client. The firing process is also easier for agencies that have a clear service agreement with clients, according to Ringold.

Additionally, whatever the agency does should be documented in the client’s file.

Ultimately, Ringold believes that home care agencies should make sure they’re doing everything they can for their clients without endangering their caregivers or overall business.

“In a service industry, you want to do everything for the client, you want to provide exemplary care, but the client isn’t necessarily always right,” Ringold said. “You have to really not jeopardize your values and your core principles.”

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