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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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