Nursing Summit 2019

Vision for Equality hosted an immersive, daylong brainstorming event titled, “Nursing Summit –
Challenges and Solutions” on July 11, 2019 in Philadelphia, Pennsylvania. The meeting’s goal
was to collaboratively define issues related to Pennsylvania’s home nursing industry and
constructively recommend how to overcome concerns related to capacity, accountability,
training and policy.

During the event, a diverse group of nearly 80 parents, guardians, advocates, health care
providers, academics and state policymakers united to hear testimonials from families enduring
the current nursing shortage, engage in an industry panel discussion and collaborate in
solution-based focus groups.

The series of nine, in-person testimonials provided the audience with an eye-opening, firsthand
account of the daily struggles and chronic hardships endured by families of the disabled. Issues
common among the testimonies included:

- Unfilled nursing shifts, passing the necessity of care onto parents, families or guardians
and ultimately straining or inhibiting their ability to work.
- Last-minute nursing callouts with no replacement, again passing the necessity of care
along to parents, families or guardians and grossly affecting their personal and
professional schedules.
- Poorly trained and unreliable home health care professionals.
- High turnover rates among home health care professionals.
- Lack of accountability, oversight or a compliant communication structure for parents,
families or guardians to report poor performing and/or unreliable home health care
professionals.
- The necessity to “take care into their own hands” due to lack of support from home
health care providers.
- General feelings of helplessness and isolation among parents, families and guardians of
the disabled.

Videos of these family testimonials are now available to view via this link:

Family Testimonials

Immediately following the family testimonials, the audience’s attention shifted to a panel
discussion featuring academic, legal, health care and policy representatives from various
organizations, including: Office of Developmental Programs, Pennsylvania Health Law Project,
Philadelphia Coordinated Health Care, Bayada Home Health Care, Act Home Health Services
and Drexel University College of Nursing & Health Professionals.

Key Takeaways

-There is an overall negative stigma associated with the home health care industry; that
current and aspirant nurses would be better served by careers in hospitals and private
practices. As such, industry professionals feel there is a need to “change the narrative”
at both the professional and academic levels to elevate the home health care profession
over the long-term.
- Home health care pay is considered subpar to other industry opportunities – potentially
influencing the above-mentioned negative stigma.
- Bayada revealed that though their staff received a $5.00 rate increase a few years ago,
their missed shifts only dropped by 3%.
- It was suggested that a rate increase for night and weekend shifts may make the work
more appealing.
- Home health care nurses have reported the following concerns: dealing with pests in
client homes, being afraid to work in unsafe neighborhoods and the long commutes
required to reach certain clients. All of these issues may also be contributing to the
above-mentioned negative stigma. It was suggested that the state could potentially play
a role in providing funding to eliminate pests, secure homes and parking areas and ease
transportation burdens for home health care nurses.
- Unlike hospital environments, home health care professionals “fly solo.” There is no
team around them. Therefore, the complete responsibility of care falls upon the
individual nurse or care professional. This fact may intimidate or dissuade potential
recruits from entering the field.
- It was questioned whether RN’s, LPN’s and CNA’s are being used appropriately; that
care needs should be met with the appropriate service level.
- There is an overall lack of training or instruction for home health care in academic
institutions, and if there is an elective course or area of focus, it typically centers around
pediatrics, not the adult population.
- It was suggested that a track specific to home health care could help to change the
narrative and increase training at the academic level.
- It was suggested that a state-backed student loan repayment program could positively
incentivize nursing graduates to enter the field.
- Individuals and advocacy groups are encouraged to connect and partner with academic
institutions to speak directly with students either in-person or via live, web video services. It is felt that this interpersonal connection could help to educate students about the home health care field.
- Some providers stated that they are blocked from speaking at certain nursing schools
due to the school’s affiliation with a competing nursing program.

Action Items

After the panel discussion, the audience was segmented into ten action-oriented focus groups.
All groups were asked to develop and present solutions to the following three questions:

Question 1:
How do we build partnerships between nursing programs and families?
Question 2:
What can we do to shift the narrative and cultural view of home health care?
Question 3:
How do we ensure accountability of nurses and agencies to provide high level care?

Here are the focus group’s recommendations for each of the three questions:

Question 1:
How do we build partnerships between nursing programs and families?

- Advocacy groups and schools should proactively partner to bring families, their struggles
and needs directly to the students, either in-person or via web video services like Skype.
- Agencies and families should proactively partner with schools to establish clinical
internship programs. These internships could serve as a pipeline for the industry while
simultaneously introducing students to families.
- Create a home nursing track at nursing schools to groom students for the industry.
- Create a required course for people with developmental and physical disabilities.
- Agencies should hold career days at nursing schools and invite families to join their
recruiters at their company tables.
- Schools could hold conferences, similar to the VFE nursing summit, where families can
testify before an audience of students, hopefully inspiring them to work in the home
health care field.
- Schools and agencies could create family advisory boards and nursing advisory boards to
continue the dialogue on these issues.- Schools could make it a requirement for nurses to take a course about home care of
people with developmental and physical disabilities.

Question 2:
What can we do to shift the narrative and cultural view of home health care?

- Create a statewide TV, print, radio and web advertising/recruiting campaign describing
the current nursing shortage and the career opportunities in home health care.
- Launch a statewide PR campaign highlighting positive interactions between home health
agencies, nurses, families and patients. This can dovetail with the above advertising
campaign.
- Create a recruiting campaign that emphasizes that the home is the future of health care;
that people don’t want to say in hospitals and that students would be wise to move
their careers in this direction.
- Put together a website and a series of videos that show home health care in multiple
environments. Use this website and video series as a training and recruiting tool across
the state. This can also be a forum to highlight good nurses and agencies.
- State sponsored scholarships, loan repayment programs or tuition assistance programs
could be a significant incentive for students and graduating nurses to enter the field.
- Nursing agencies could create an advocacy group to visit nursing schools across the
state and thereby avoid regional competitive blockages that are keeping certain
agencies from entering medical school.
- Support classes for interpersonal communication and cultural training for students
entering the home health care field.
- Increase ongoing education and training for home health care nurses.
- Engage parents, guardians, families and exemplary nurses in the recruiting and advocacy
processes. They are your biggest asset.

Question 3:
How do we ensure accountability of nurses and agencies to provide high level care?

- Rather than assign an individual nurse to a home, agencies could organize nurses into
service teams for patients. This team-model would encourage a group of nurses to
develop a schedule or care for a patient and have an immediate pool of coworkers to call upon to cover shifts. These teams would then be rewarded / incentivized on a monthly basis for their coverage percentage.
- Develop a consistent, statewide regulatory board to monitor, grade, and when needed,
reprimand, poor performing nurses and agencies. Organizations should also be
monitored to ensure they’re not taking on cases they cannot effectively serve.
- A supervisor should visit and observe nurses during work shifts. This would provide
oversight as well as create a structured communication process directly with families.
- An industry standard reprimand process should be put in place to avoid problematic
nurses jumping from agency to agency.
- Compensate or pay families when a nurse calls out or an agency fails to cover a shift.
- Develop proactive, quarterly nursing reviews that involve family input.
- Involve families more in the agency hiring and interview process.
- Employ personality assessment when hiring nurses as well as when pairing them with
families to ensure they’re a proper fit.
- Nurses should be required to meet families and the patient prior to being assigned to
the home.
- Establish an online visit verification / log in process tied to nurse performance.