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Home health agency's success is questioned

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Posted on January 31, 2019 |
By John Flowers



MIDDLEBURY — The new managers of Addison County Home Health & Hospice (ACHHH) are proud of their record in taking the New Haven-based nonprofit from the brink of financially insolvency in 2016 to more modern operation that in fiscal year 2018 posted an almost $900,000 financial cushion in an era of Medicaid and Medicare funding shortfalls.

But some current and former ACHHH employees believe the agency’s financial resurgence has come with a less collegial and more authoritarian management style that they said has resulted in many workers — some of them with more than two decades of experience — choosing to retire sooner than they wanted to, or moving on to other health care jobs.

“(Management) chose not to listen to what the staff were saying,” said Diane Dunsmore, who worked more than a quarter-century with ACHHH before resigning last April. “This is an organization without a history of staff going to the board (complaining) about stuff. This didn’t happen.”

A person claiming to have direct knowledge of ACHHH personnel provided a list of 44 people she claimed had left the agency since December of 2017. Agency leaders dispute that claim of 44.

At least one person who has left is considering taking legal action against the agency. The person told the Independent that they were fired last September after refusing to sign a “non-disclosure and non-solicitation agreement.”

That agreement, among other things, prevents the employee from sharing any information about ACHHH clients, service pricing, care techniques, training material or “trade secrets,” among other things.

The former senior employee — who requested anonymity because of her potential lawsuit — said she declined to sign a 5-page non-disclosure agreement because it was written with legal terms that she wanted a lawyer to vet.

She said the non-disclosure form epitomized a new working culture — more akin to a for-profit corporation — that she believes has alienated many past and current employees.

“They run things a lot differently than it used to be run,” she said during a phone interview. “It’s turned into a toxic work environment.”

An environment she claimed makes employees afraid of expressing criticism, for fear it might end their job or result in demotion.

It was during the spring of 2017 that the ACHHH board hired Tim Brownell (pictured) as its new CEO. Brownell joined the agency after having spent more than 25 years serving in various management roles with other home health and hospice organizations throughout the country. He had most recently served as divisional director of Hospice for Community Health Systems, a large hospital system based in Franklin, Tenn. Prior to that, he was vice president of business operations for a large multi-state pediatric and adult home health care company called “Loving Care Agency,” based in New Jersey.

He succeeded former ACHHH Executive Director Sherry Greifzu, who moved to Connecticut to be closer to her family. Greifzu took the helm on an interim basis in December 2015, following the resignation of former Executive Director Larry Goetschius.

Brownell assembled a new leadership team that includes CFO Patrick Rooney and Human Resources Director Liz Gregorek.

FINANCIAL HARDSHIP

They inherited an organization with significant financial problems; the ACHHH ran a $485,700 deficit in fiscal year 2015 and experienced a $503,106 shortfall in fiscal year 2016.

So in 2015, the agency had less than nine days of cash on hand, a term used to describe how many days an organization could operate with no money coming in. In 2016, the agency had less than 10 days of cash on hand, according to Rooney.

New leadership put in some new programs and financial protocols that Rooney said resulted in ACHHH having 28 days of cash on hand by the end of June 2017, and around 80 as of end of last October.

“It was a substantial turnaround,” Rooney said. “Our debt ratio has gone from 48 percent in 2016, to 22 percent in October of 2018. The balance sheet has been more healthy than it’s ever been, and the agency has financially right-sized itself to the point where it could absorb certain slowdowns in business or other financial repercussions that may occur.”

Rooney believes many in the community might not know how close ACHHH came to closing its doors.

“(ACHHH) took almost $1 million in losses over two years and was really hovering on the brink of not only insolvency, but disappearing from this community,” he said. “In the last two years, we’ve been able to capture all of that back and continue to post solid gains.”

Brownell acknowledged not all employees bought into the agency’s resurgence plan, which called for some major changes to its business plan.

“Tough decisions isn’t always about cutting staff; tough decisions is sometimes about changing processes,” Brownell said.

Those new processes, according to ACHHH leaders, include a new electronic medical records system (EMR) that supplants a less efficient paper-based system, and a new computer program that allows home health workers to build patient-care plans. So when they go into a home, ACHHH staff can conveniently access data confirming the patient’s care regimen for that day.

“This is something new to them,” Brownell said. “(Records) were on paper for the longest time. They tried an EMR in around 2014, but it wasn’t good and they stopped using it. A lot of people become intimidated by computers. The EMR system is that. But everyone who has bought into it, loves it.”

Another recent change: Electronic mileage tracking. A worker’s schedule is loaded into the program, along with the route, which can be monitored down to the last mile. In addition to ensuring that only work-related miles are reimbursed, the program can flag — in real time — the closest employee to the most seriously ill client.

“As a home health agency, our people are out there all the time on the road,” Rooney said. “This program has saved us around $10,000 a month and you can imagine that at $10,000 savings a month, if there were certain individuals who may have been taking advantage of the program, that it’s not going to be very popular, because that supplemental income — right or wrong — is no longer there.”

EMPLOYER RELATIONS

Tim Hanson — Dunsmore’s spouse who worked more than 30 years at ACHHH before also resigning last April — said he believes employee-employer relations have gone down as the profit margin has gone up.

He and other past and present ACHHH workers lamented changes that include:

•  Workers allegedly fired for refusing to sign a non-disclosure agreement.

•  Employees allegedly being cautioned after criticizing changes put into place by new leadership headed by CEO Tom Brownell.

•  Newly installed technology — including a computer program measuring employees’ work-related mileage — that some critics said challenged the trustworthiness of workers.

•  Employees allegedly being led out of the ACHHH office the moment they’ve been fired or tendered their resignation.

“I think the board has a fiduciary responsibility to the community to have the agency be viable,” Hanson said. “And year after year after being in the red… is wearing and tiring. And if someone says, ‘I can fix that,’ and that is the focus, then you get this kind of for-profit mindset that drives decision making in a different way than it used to.

“I think the board watched things go from red to black, and I would assume felt vindicated, in a sense that at least now, the agency was making money,” Hanson said.

He claimed agency leaders are not cutting employees as much slack during personal emergencies.

“Home health was not a perfect place before the changes, but it was essentially ‘kind’ to people — especially in times of need,” Hanson said, noting his colleagues were able to cover some of his shifts when his then-significant other was afflicted with a brain tumor.

Dunsmore recalled that ACHHH management similarly eased her workload when she suffered a major equestrian accident around three years ago.

“It was a very kind place,” Hanson said.

It was during a staff conference in early 2018 that Dunsmore and Hanson said they realized how much the working climate had changed.

‘HOSTILE ENVIRONMENT’?

Several workers at the conference asked questions challenging the administration, raising issues such as employee retention. It became clear at that gathering that the administration didn’t appreciate criticism, according to Dunsmore.

“After the staff meeting, people were called in and written up for speaking their minds,” Hanson recalled. “They were admonished for their behavior.”

Hanson said the ACHHH board got wind of employees’ dissatisfaction and set up a mediated meeting between employees and management. Around 15 employees showed up to air grievances, though the couple believes others stayed home out of fear for their jobs.

“Some people used the words ‘hostile work environment,’” Dunsmore said of feedback at the meeting. “We felt we had lost the culture we had loved so much.”

There were no board members at that meeting, according to Hanson.

An employee who spoke up at that gathering ended up being let go five days later, according to Hanson.

The ACHHH personnel policy precludes managers from speaking about specific employees.

Dunsmore and Hanson resigned shortly thereafter, on April 9, 2018. Hanson cited more than a dozen other nurses who have left ACHHH during the past year and a half. Dunmore and Hanson are both Registered Nurse generalists, though Hanson focused on hospice care and Dunsmore was an IV specialist.

“We would have worked there forever,” Hanson said of the couple’s satisfaction prior to 2017. “We miss the collegiality, the feeling of safeness, the trust and the ‘We’re all in this together’ (atmosphere), as opposed to an ‘us versus them’ mentality.”

BETTER THAN AVERAGE

But managers of the agency argue there hasn’t been a “mass exodus” of workers from ACHHH, and that the organization’s turnover rate is far less than the industry average.

Rooney pointed to a Dec. 6, 2018, article in Home Health Care News that places the national average for home health agency turnover last year was 21.23 percent. The current turnover rate at ACHHH is around 12 percent, which Brownell called “extremely low.”

ACHHH currently has 124 full-time, part-time and per diem employees, according to Gregorek. That number has remained fairly steady in recent years, she said.

“With all the Visiting Nurse Associations we have human resources meetings and we have the fewest open positions,” Gregorek said. “We have the fewest number of travelers.”

Rooney, at the time of the interview, said ACHHH had only one traveler in its employ.

Gregorek said she doesn’t believe employee morale has been suffering, though she — like Brownell — acknowledged some people have left because they weren’t on board with organization changes.

“When someone has been in a job in a company for a long time, they don’t have exposure to how other businesses run,” Gregorek said. “So when something changes for them, some take it on the chin and run with it, and some don’t. It’s all in one’s perception.”

Brownell cited patient feedback as proof the agency is on the right track.

“If the morale was down and miserable, our patients would be miserable,” Brownell said, adding ACHHH hospice recently received a “5-Star rating” from its Medicare customers based on a patients survey. “And that’s something we hold in high standard, and that our nurses hold in high standards. That shows the communication piece between administration, staff and patients is flowing, and flowing in the right direction.”

Rooney said 46 percent of ACHHH patients are Medicaid recipients, and 42 percent are on Medicare.

Bryan Young, leader of the ACHHH board promised he and his colleagues have heard employee complaints. The board was slated to discuss that, and other issues, at a meeting on Wednesday, Jan. 30.

“It’s something of great concern to the board,” Young said.

Reporter John Flowers is at [email protected]

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