Payroll Costs Rising from the Labor Shortage

Payroll Costs Rising from the Labor Shortage

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Services are increasingly getting more expensive to provide thanks in part to ongoing labor woes, according to the latest Cost of Care Survey from insurer Genworth Financial.

The national median cost of home care pay shot up 6.17% to $21.50 per hour, or $4,099 per month, from 2016 to 2017. Among other care settings, this is the most pronounced increase. The cost of home care services, including household tasks, reached a median of $21 per hour, or $3,994 per month. This is a 4.75% increase from last year.

Over five years, the median cost growth rate was 2.5% for home health aide services and 3.08% for homemaker services.

This year’s cost increase was particularly notable, says Gordon Saunders, senior brand marketing manager for Genworth’s U.S. Life Insurance division. Overall, the annual median cost of long-term care services climbed an average of 4.5% from 2016 to 2017. It marks the second-highest yearly increase for nursing homes and home care since the study began in 2004.

“We have become accustomed to seeing steady increases in the cost of long-term care services, but this year, we saw a marked acceleration in the cost of home care over previous years,” Saunders told Home Health Care News. “This is based on external factors in the marketplace related to supply and demand: increasing demand for long term care services as our population ages versus shortage of workers and rising labor costs.”

By comparison, the national median cost for a one-bedroom unit in a private-pay assisted living community reached $3,750 per month, or $45,000 a year. That’s an increase of 3.36% from 2016 to 2017.

National median rates for semi-private room nursing home care increased 4.44% and hit $7,148 per month. Also, private room nursing home care reached $8,121 per month, a 5.50% increase.

Labor Woes Crank Up Costs

The labor shortage isn’t the only factor driving up costs, but it has impacted all care settings, says Saunders.

“[U.S. Dept. of Labor] changes have resulted in minimum wage and overtime protections to more domestic service workers who enable individuals with disabilities and the elderly to continue to live independently in their homes,” Saunders said. “Also contributing to the increase in labor costs is the Affordable Care Act (ACA), which requires employers of a certain size to offer some type of health insurance, or pay a penalty.”

For nursing homes, higher labor expenses and tightening Medicare rules have resulted in shorter hospital stays. Instead, sicker patients are sent to rehab nursing homes for shorter stays, driving up costs, Genworth noted.

Room and board for assisted living communities has risen to accommodate residents who are sick, but not sick enough to require nursing home care. Luxurious amenities commonly found in private pay communities also increased costs of care.

What Agencies Can Do About It

This eBook explains the factors driving the labor shortage, and how a two-pronged approach can minimize the costs for agencies.

Download the new eBook and check out the complete library of ebooks for agencies here.

Millennials

Attracting and Retaining Millennials at Your Agency

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According to LinkedIn’s 2015 Talent Trends Report, millennials will comprise half the workforce by the time 2020 rolls around. In less than 10 years, they will make up 75 percent of the workforce. Yet many agencies, despite hiring and retention problems, have not considered the unique opportunities and problems of attracting and retaining this growing segment of the workforce. Who are millennials, and how do agencies make themselves more attractive places for millennials to work?

Who Are Millennials?

There are no precise dates for when the millennial cohort starts or ends, but demographers typically agree that millennials were born between the early 1980s and the mid-1990s or early 2000s.

In reality, there are strong similarities between millennials and the generations that have preceded them: they want security and variety in their career, they want to be stretched and challenged, they want to work for a company of which they can be proud, and they have every intention of being loyal.

But there are many ways in which this growing proportion of the workforce is different. They have strong beliefs and expectations that extend to the workplace.

Where Millennials Want to Work

Data suggests millennials are driving a shift towards the public service sector. In 2010, the Journal of Business and Psychology published a study showing that this age group’s volunteer activity increased almost three times more than the volunteer activity of the overall population between 2007 and 2008. More recently, a 2014 Millennial Impact Report by consulting firm Achieve shows this generation has a high level of interest in public service. Out of the 1,514 employed millennials who were surveyed, 47 percent volunteered for a cause or nonprofit in the past month. The same study shows that 87 percent donated to a nonprofit organization in 2013.

This interest in public service bleeds into choice of work. In a recent Capital One Survey of millennials, 93 percent of respondents think it’s important that their career path that aligns with their personal values. Additionally, a 2013 survey by the National Society of High School Scholars (NSHSS) and a 2011 survey by Universum both show that they prefer to work for companies engaged in the betterment of society.

Political Views

Millennials are the most highly educated and culturally diverse group of all generations. Surveys suggest that their political views are more liberal than previous generations, both socially and economically. According to the Pew Research Center, they are the most likely of any generation to self-identify as liberals, and they are the only generation with a liberal majority. A clear example of this is 2016 presidential election cycle, in which Bernie Sanders was the most popular candidate among 18 to 29-year-olds. In fact, one polling director said of Sanders: “He’s not moving a party to the left. He’s moving a generation to the left.”

Regarding religious beliefs, millennials are less likely to identify with a religion than older generations. A 2014 survey from the Pew Research Center reports that about three-in-ten are unaffiliated with a religion, which is possibly the most of any generation ever recorded.

Use of Technology

Millennials are using technology at unprecedented levels. According to a 2007 survey of students born between 1983-1992, almost all of them owned a computer and a mobile phone. In addition, 76 percent used instant messaging, 40 percent got most of their news from the TV, and 34 percent got most of their news from the internet. This means that, as a generation, millennials are comfortable with technology in all areas of life.

One of the most popular forms of media among millennials is social networking. In fact, a study published in the Elon Journal of Undergraduate Research in 2010 claimed that students who tried to quit social media showed the same withdrawal symptoms of a drug addict quitting a stimulant. Millennials are very active on social networking sites such as Facebook, Twitter, and Instagram. Social media can help them create a sense of belonging, make acquaintances, and remain connected with friends.

12 Tips to Attract Millennials to Your Agency

Employers can take steps to address the needs and preferences of millennials. Consider these 12 tips to ensure your agency is millennial-friendly:

  1. Emphasize your mission. Since many millennials are interested in giving back to the community, encourage them to see work at your agency as an opportunity to do this. Invite them to fundraisers and offer volunteering opportunities. Show them that they can have a positive impact on the world at your agency. This should give agencies a hiring and retention advantage with millennials over other competing employers.
  2. Focus job postings on the greater good. Putting your agency’s work in the context of the global good will help emphasize your mission. Focus your job postings on their importance to the organization and society.
  3. Keeping in touch with millennials is key, whether it’s during the recruiting process or while they’re employed with your organization. According to LinkedIn’s Talent Trends Report, 95 percent of millennials want to hear what you thought about them after the interview. Keep an open line of communication through email or text and provide post-interview feedback opportunities.
  4. Use technology. While older employees may be more comfortable with paper timesheets and schedules, millennials prefer to use technology whenever possible. To appeal to their preferences, post timesheets, schedules, documentation, benefits, and training online. Use automated digital alert systems like next shift reminders, review notifications, or birthday and anniversary greetings to connect with them. Agencies that appear unwilling to adopt technology will not be attractive places for millennials to work.
  5. Be a mentor. Offering guidance is a way to create trust with millennials. To court millennial workers, send regular updates from the hiring manager to people in the application process. If your agency has a mentorship program, call attention to that during the interview process.
  6. Document your procedures. For some, part of the learning process is to learn by doing — to figure out a process that others in the organization already know. But millennials have a different approach to problem solving. They don’t want to “go figure it out” if someone can tell them how to do it more quickly. Set aside the perception that 10 minutes of downloading information is laziness. Allowing them to take it forward will challenge and excite them.
  7. Make work fun and challenging. For millennials, work is supposed to be fun. Keep your employees engaged by giving them more responsibilities so they feel like they are moving somewhere. Millennials love change, so mix it up for them. Also keep in mind that a millennial’s time frame for completing goals is 18 months or less – anything beyond that may not motivate them.
  8. Provide frequent feedback. Millennials enjoy instant gratification, which means they’re always on point to deliver rapidly. As a manager, provide frequent feedback to fill this need.
  9. Promote collaboration and creativity. Both culture and space can contribute to collaboration. In a collaborative culture, managers may encourage staff members to propose new ways of doing things. A collaborative space may be smaller to make interaction easier (e.g. a cozy conference room versus a 20-person boardroom).
  10. Offer individual recognition. While teamwork is meaningful, millennials still want individual attribution. They will embrace the challenge of a single-person task that is part of a larger team project. When they are successful, call them out for a job well done.
  11. Create a work environment that allows a healthy work-life balance. This is one of the things this young generation desires most. Emphasize benefits like PTO. Improving the quality of life both in and out of the office — with social events, benefits, and flexible schedules — will appeal to people looking for more than just a salary.
  12. Avoid an excessively rigorous hiring process. Millennials are informal. Your agency may be weeding out high-potential employees on a regular basis. To avoid this, try to loosen things up a bit. In place of the usual two- or three-round interviews, you can hold professional development classes, host open days, conduct informational sessions, or show potential candidates around the facilities. That way you can let the candidates decide for themselves whether they fit your company’s culture or not.
Biometric Fingerprint Readers

Agencies Speak Out on Biometrics

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14 Agencies Describe How They Use Biometric Fingerprint Readers for Time & Attendance for Staff and Clients

Not long ago, very few agencies would have used biometric fingerprint readers in day programs, let alone group homes. Today, all that has changed. The current range of biometric fingerprint readers are affordable, deliver a quick return-on-investment, and are suitable for use in three- to four-bed group homes. They also have many advantages over other time and attendance methods like PCs and telephone timekeeping.

These interviews will help you learn more about the pros and cons of biometrics in an agency setting. Read the responses from managers, administrators, and employees about how biometrics have worked for their agencies. These providers are using biometric fingerprint readers in day programs, group homes, and at contract job sites. Biometric fingerprint readers are primarily for the staff, but some providers encourage clients to use them as well.

The Ron Wilson Center, Oregon

The Ron Wilson Center is a private non-profit agency in Monmouth, Oregon. A group of parents, students, and concerned citizens founded the agency in 1974. The Ron Wilson Center is now a leader and innovator in providing services to people with I/DD. The agency currently serves about 65 individuals in a variety of programs that include residential services, supported living, and day support activities.

Before setting up biometric fingerprint readers, the Ron Wilson Center was using MITC telephone timekeeping. Loralee Poppitz, the accounting services director, says the primary reason for the switch was timesheet fraud. The agency suspected some employees were buddy punching with the telephone timekeeping system. “With the biometric fingerprint readers in place, we know the staff has to be there in order to clock in, eliminating any chance of buddy punching,” she says.

Loralee tells us that the biometric fingerprint readers have worked out well so far. “It was easier to install them in the homes a few at a time, and it was more cash flow-effective to spread out the expense,” she says. “We registered employees’ fingerprints into the biometric fingerprint readers when they came to pick up their paychecks. We then went to the group homes to catch the few employees we missed.” The agency now has 160 out of 175 employees entered.

As far as power and internet connectivity issues, Loralee tells us that, “We had the internet go down in one of our homes, but not the power. The biometric fingerprint reader still captured the punches. When we got the internet back up, it transferred all the punches.”

Implementation

The agency staggered the implementation in three groups. After purchasing the system in January 2017, they installed the first batch in five group homes in February, then added the second set of five in March, and they are getting ready to do the last six now. “The conversion went smoothly. The hardest part as a larger organization was capturing all the employees,” Loralee says.

She found a clever way to help employees learn this new way of clocking in: “We sent out fliers to the group homes and posted a cheat sheet we got from MITC next to all of the biometric fingerprint readers. This is our third month using it and it seems to be working fairly well.”

The enrollment and training process can be intimidating for some providers, especially larger ones. Many agencies integrate enrollment into the training process. Loralee, for instance, sets up new hires on the first day of training, and they start using them right away. Sometimes, people must scan their fingers twice if they are too cold or wet. However, most people use the fingerprint readers without a problem.

East End Disability Associates, New York

East End Disability Associates (EEDA) is a non-profit organization that provides services for people with I/DD. A small group of parents organized EEDA in 1992 as a grassroots agency. They were active advocates for their children and believed that everyone has the right to fully participate in quality education, medical, habilitation, and recreational services. To that end, EEDA secured funding to create programs that promote life enhancement for people of all ages with I/DD. Today, EEDA provides services to over 700 individuals. The same group of parents that started the organization continues to manage it.

EEDA installed just one biometric fingerprint reader a few years ago. For a while, it was the only one. Now, however, the agency uses fingerprint readers at four locations and is rolling out a new one each month. In total, it plans to use biometrics at 12 sites. Currently, two biometric fingerprint readers operate in day habilitation facilities, two in residential facilities, and one in the main office. The future fingerprint readers will be in residential and crisis house locations.

System Administrator Dan Bogan cites ease-of-use and reliability as the reasons EEDA uses biometrics. The biometric fingerprint readers are easy and quick for the staff to use. “East End Disabilities has many locations where a lot of employees have to clock in in a short amount of time,” Dan says. “There is limited access to telephones at some sites, and while dialing in is quick with the phone, biometric fingerprint readers are faster.” Also, the agency has experienced electrical issues that interfere with its server. If the server goes down, the fingerprint readers store attendance records until the server is backed up. This guarantees that time & attendance is always accurate, even in the case of a server outage.

Implementation

Since adopting the biometric technology, EEDA has created a few new procedures to streamline enrollment for new employees. Originally, employees enrolled in the fingerprint readers at their work sites. Now, HR enrolls them at the main office during orientation, and that fingerprint reader automatically shares the fingerprints at all of the locations.

The implementation of biometrics has been an overall success for EEDA. Dan extols the benefits, saying, “The biometric fingerprint readers are very good. They save a lot of time for employees clocking in and out, and there are fewer missed punches.”

Hands of Heartland, Nebraska

Hands of Heartland is dedicated to growing new opportunities for adults with physical and intellectual disabilities. The agency provides day, residential, and respite services.

Hands of Heartland has been using biometric fingerprint readers since September 2015. HR Director Trina Leech says biometrics have been “a quick and accurate way to get a large number of people processed in and out at the beginning and end of the day.” She also says buddy punching is now a thing of the past.

Biometrics have helped to streamline the agency’s payroll process, too. “Supervisors can quickly identify if a staff member has not properly clocked in and out,” Trina explains. “Previously, we used paper timesheets and supervisors manually calculated time worked for 200 total employees. We’ve saved approximately 20 hours per pay period and we are running payroll twice a month.”

Looking back, Trina says she wishes the agency would have used biometrics earlier. “You wouldn’t believe the difference it’s made in processing payroll. It has significantly eliminated errors. Prior to MITC, we would have 10–15 employees a pay period with errors. I no longer have people coming to my office with issues. It has also saved time for supervisors, who are checking MITC on a daily basis and are able to wrap up any corrections within 48 hours of a pay period ending. This allows them to focus more of their attention on other tasks.”

Trina says the switch to MITC was a worthwhile expense. “It was an investment to go from paper timesheets to time and attendance, but it has paid off. We are now looking to add other modules like scheduling. We hope scheduling will help our ability to control overtime hours and staff to client ratios.”

Implementation

The agency has encountered minimal issues with the implementation. A couple employees had trouble using the fingerprint readers due to skin condition and dexterity. The agency allows those employees to enter their employe PIN numbers instead. One other employee’s fingernails were too long to fit in the fingerprint reader, but she had no problems after cutting her fingernails shorter.

Often, agencies that have had a negative experience with a previous system are wary to try something different. Trina says this was true at Hands of Heartland. Since implementing biometrics, however, Trina found that the most reluctant supervisors are now the happiest. “The supervisors say they have so much time to do other things now,” Trina tells us.

MITC has found that a time & attendance system will achieve higher compliance levels if known and effective policies and procedures are in place. Trina learned this firsthand. “I met with each supervisor to go over the process and helped them with a payroll or two. It was a little bit of hand holding up front but it paid off. A lot of the supervisors are truly caregivers at heart and so this technology is somewhat scary, but they now have the confidence they needed to take off with it. With the supervisors on top of it, employees get on top of it because they don’t want to be the person with several corrections in a pay period.”

The agency also uses incentive programs to encourage staff to properly use the system. “In our day centers, if employees go an entire month without corrections, they get a $10 gift card. That program is going to get expensive soon, but it got us a lot of buy in and we’ve had no problems with new employees,” Trina says.

North Star Community Services, Iowa

North Star Community Services is a non-profit agency serving Northeast Iowa and beyond. Since 1975, it has been helping disabled adults live enriched and empowered lives in the community. The agency provides adult day services, employment services, and supported community living services.

North Star Community Services implemented biometric fingerprint readers about two years ago. Now, 35–40 employees using biometrics in their day programs. While some employees were resistant at first, they eventually came to appreciate the convenience of the biometrics. When the agency had to send some of the fingerprint readers out for repairs, the employees complained about having to use telephone timekeeping. They missed the faster, easier fingerprint readers.

HR Director Bridget Hartman says biometrics have been super convenient for employees. “We have MITC set up so employees’ lunches are automatically deducted if an employee works at least a 7-hour shift,” she says. This means employees don’t have to waste any of their lunch break walking to the fingerprint read on the other side of the building. Instead, HR automatically accounts for a lunch break. In an employee skips a break, a supervisor can override the process.

Also, biometrics have increased payroll accuracy at North Star. She says: “We would recommend biometric fingerprint readers to any agency that has a large group of employees, even if you already have another time and attendance system in place. Our goal was to speed up the amount of time employees spent clocking in and out while getting an accurate record of employee attendance. The biometric fingerprint readers have achieved that goal.”

Implementation

As we have heard from other agencies, long fingernails posed a problem for some North Star employees. But Bridget explains that MITC easily resolved this issue. “Over time, [long fingernails] damage the prism on the biometric fingerprint readers where employees place their finger to clock in and out. We recently had to replace both prisms in our biometric fingerprint readers, but MITC came to the rescue and replaced the prisms in a timely matter without any complications.”

On My Own, Missouri

On My Own is a non-profit, non-residential independent living center in Missouri. Since 1997, it has been assisting disabled individuals in five counties.

The agency has been using biometric fingerprint readers for three years for 26 office employees. Prior to the fingerprint readers, On My Own didn’t have any system for time & attendance for the office staff. CFO Patti Hendrix says, “We wanted an onsite system that guaranteed employees were present.”

Patti found that biometrics reduced overtime throughout the agency. “Biometric fingerprint readers have kept a better control on overtime. We have found employees working when not scheduled and have eliminated those issues. MITC also helps us with payroll.”

When compared to other timekeeping methods, Patti agrees that biometrics surpass them all in terms of ease-of-use. “Scanning a finger is easy,” she says. “It just becomes a habit!”

Implementation

The only issues On My Own experienced while implementing biometrics were isolated cases where the biometric was unable to read particular fingerprints. Patti explains that about five people have consistent problems. But for the most part, the system has been accurate and timely.

In regards to the agency’s enrollment and training process, Patti tells us that, “On My Own has an employee orientation and explains how the procedure works just to give a little detail. We also added a part to the employee training where we require new employees to practice using the biometric fingerprint readers. We include that with the rest of the training on how to use MITC.”

The Arc Baton Rouge, Louisiana

The Arc Baton Rouge was founded in 1950 from a grassroots movement of families working to create services for children and adults who were being denied day care, educational opportunities, and work programs. Today, The Arc Baton Rouge is one of 19 affiliated Louisiana chapters and nearly 700 nationwide. It provides individual and public policy advocacy, residential and housing supports, educational assistance, vocational training, and employment solutions and recreational activities.

One reason many agencies select biometric fingerprint readers is that clients with certain disabilities can use them. This encourages their independence, as Time & Attendance Specialist Jenny Bulkley discovered. “The clients we serve have a wide range of abilities and aptitudes,” she says. “The ones who can use the biometric fingerprint readers love it. The biometric fingerprint readers give them more autonomy. The clients love to come and put their fingerprint on the scanner or enter their employee number, and benefit from the feeling of independence it gives them.”

MITC allows agencies to mix and match timekeeping methods depending on the program. While the Arc Baton Rouge uses biometrics for state contract clients, it uses Door Clock in the vocational program. “We chose to use Door Clock in the vocational program because our clients have greater disabilities,” she explains. “Some have retracted hands or limited intellectual capabilities. These clients had difficulty getting fingerprints to work.” This ability to utilize a mix biometrics, telephone timekeeping, and Door Clock has been a huge advantage for The Arc Baton Rouge.

Implementation

Jenny has found that the biometric fingerprint readers are very easy to use for almost everyone at the agency. “We love that employees don’t have to pick up and call as with telephone timekeeping. There is such a slim margin for error because there is nothing for the employee to enter. With telephone timekeeping, it is possible that employees enter the wrong job or the wrong code. The only issue we have experienced with the biometric fingerprint readers is that they cannot be used by individuals with a hand-related medical condition.”

Though new technology can often cause apprehension, Jenny’s training from MITC reassured her. “Everything was relatively easy. When I first opened the box, it was a little intimidating, but I love working with MITC. The support people are great. I only needed to go over everything in training one time before I had it down.”

Most importantly, biometrics have helped the agency achieve its goals and improve the quality of life for the individuals it serves. As Jenny puts it, “Because biometric fingerprint readers increase the autonomy of our employees, it helps us with our mission of encouraging independence.”

Northern Transition, Michigan

Northern Transitions is a private, non-profit agency in Michigan. It provides a range of vocational rehabilitation services to individuals with barriers to employment. Services include evaluation, supported employment, community placement, and numerous types of employment within the organization for individuals who require a high level of continued support.

Northern Transitions has been using biometric fingerprint readers for about two years. Right now, 50 employees (staff and clients) use them. The main reason the agency chose biometric fingerprint readers over telephone timekeeping was a lack of phone service and internet at their contract sites. The fingerprint readers don’t require internet connection or phone lines; they only need a USB drive so supervisors can download the attendance records.

The agency currently has two biometric fingerprint readers installed. Executive Director Joel Krupa tells us, “One is located at a SourceAmerica contract site at the international border station in Sault Ste. Marie, Michigan. It’s essential to have one there because we can’t have internet there due to regulations. We had a phone line there but removed it since everyone nowadays has cell phones; and we don’t need a phone line for the biometric fingerprint reader to work. Our other location is at our recycling center that we operate.”

The Benefits

Joel says that the biometrics have been easy for everyone to use. “We only had one incident where the person trying to register their fingerprint into the biometric fingerprint reader couldn’t get their fingerprint scanned. We just have that person using their 4-digit PIN for clocking in and out. Other than that, the biometric fingerprint readers are pretty simple to use. The results are less missed/wrong punches being entered,” he said.

Joel believes the agency’s payroll costs would likely be higher without the biometric fingerprint readers. “If you use paper timesheets at your agency, there is a possibility for a lot of inaccurate times. If you had multiple individuals on any given day leaving work at 3:20 or 3:25 when their shift would end at 3:30 and claiming to be leaving on time, it would all add up to a loss. The preciseness of the biometric fingerprint readers eliminates this issue,” Joel claims.

The benefits of biometrics have been numerous for Northern Transitions. As Joel discovered, “The biometric fingerprint readers are efficient for agencies to use. They aren’t complicated for employees to use. For our model, there isn’t internet or any phone lines required. They help eliminate payroll issues. Also, they are cost-effective for agencies to invest in because the price has come down a lot.”

Supportive Concepts for Families, Pennsylvania

Supportive Concepts for Families is a large provider serving individuals with I/DD throughout Pennsylvania. The agency manages multiple programs, including residential and family community living, home-based waiver services, supported living, adult training, behavioral health, and transportation.

Supportive Concepts has been using biometric fingerprint readers for several years now. Mark Kellenberger, Vice President of Information Systems, says convenience was a big reason for choosing biometrics. For example, using a biometric fingerprint reader in the adult training facilities prevents long lines to clock in or out, because the process is so quick. The second reason the agency chose biometrics was to eliminate buddy punching.

Looking back, Mark recalls only one issue with the fingerprint readers: “One of our group homes is on an old Verizon DSL line and the circuit is unreliable. Other than that, the biometric fingerprint readers have worked out and are generally available.”

He concludes that, “In the right situation, biometric fingerprint readers are really worth it. Where we get the biggest return on our investment is at our adult training facility. We have a large number of employees clocking in and out around the same time and the biometric readers are excellent for that type of situation. In the smaller homes, we don’t have a large number of employees coming in at the same time, but having that security factor is vital.”

Implementation

During implementation, some of the supervisors struggled to learn how to enroll employee fingerprints into the readers.  “But that seems to be a non-issue now,” says Mark. “There is the occasional problem of an employee’s finger not being readable, but all things considered, they’re pretty low maintenance.” Employee enrollment was also fairly painless. “Since everything flows into the database, there are a couple of different ways for us to enroll an employee. We can have the employees register their fingers at their work site or at the central office. But recently, we’ve had our employees just scan their fingerprints at their respective work sites,” Mark explains.

Mark says that the fingerprint readers have effected the entire organization positively. “Our people know that we check, so I believe that there is some downstream effect. Employees are aware that we have biometric fingerprint readers installed in some houses, and even though they don’t have them installed in their workplace, they do what they’re supposed to do in regards to being honest about clocking in and out.”

Center for Life Enrichment, Maryland

The Center for Life Enrichment aims to increase the vocational and personal potential of individuals with disabilities in Maryland. Currently, the agency serves over 200 individuals through supported employment, community learning services, day habilitation, and family and individual support programs.

Center for Life Enrichment implemented biometric fingerprint readers about six years ago. It currently uses four biometric fingerprint readers between two stores.

Like many other agencies we spoke to, Center for Life Enrichment was previously using paper timesheets, which was vulnerable to fraud and errors. “This method lacked visibility into when workers were present,” says Executive Director Randy Ferguson “We knew it was possible employees were being dishonest about what time they actually arrived and left for the day. Installing biometrics made the employees’ time indisputable and completely eliminated inaccurate timesheets.”

The Benefits

Once employees began using biometric fingerprint readers, Center for Life Enrichment saw fewer late arrivals. Randy tells us, “Employees can no longer dispute whether they were on time with the biometric fingerprint readers, compared to when paper timesheets were in place. This prevents our employees from being paid for a full shift when they arrived late or left early without notifying their supervisor.”

Aside from a few instances of skin care products interfering with the reader, Center for Life Enrichment has had no problems. Training and compliance have also been simple. “On a new employees’ first day of orientation, we scan their fingerprints into the system. It is a part of the new hire procedure on day one,” says Randy.

Because biometric fingerprint readers are inexpensive, agencies with many users can afford multiple readers. “If an agency has a lot of employees/clients (like our stores do) clocking in and out around the same time, there is a huge advantage to having multiple biometric fingerprint readers. This facilitates faster clocking in and out and prevents employees having to wait in line for their fellow employees to finish,” Randy discovered.

In addition, employee attitudes have shifted in a positive direction as a result of the biometrics. “Since installing the biometric fingerprint readers, we have noticed the employees previously coming in late and claiming to be on time are now showing up as scheduled. Partial absenteeism (late arrivals) has declined,” Randy proclaims.

Advantages of Southeast Arkansas, Arkansas

Advantages of Southeast Arkansas, provides community-based services geared toward maximizing independence, self-support, and employment opportunities for persons with developmental disabilities in a 14-county service area. The agency manages HCBS, transportation, preschool, community waiver, adult day treatment, therapy, supported living, and family support programs.

Approximately 85 employees use biometric fingerprint readers at Advantages. The agency has them installed in pre-schools and adult development programs. In total, they have six biometric fingerprint readers between four of their center-based services.

When asked why the agency chose biometrics over other timekeeping methods, Executive Director Deanna Doherty says: “We noticed that biometric fingerprint readers were cost-efficient and would eliminate potential problems with time and attendance. Before implementing biometric fingerprint readers, all of our timekeeping was done on pen and paper. Paper timesheets gave employees the opportunity to be dishonest with what times they would write down on their timesheets. The biometric fingerprint readers eliminated timesheet falsification and provide security.”

The Benefits

Deanna says that Advantages has thoroughly enjoyed having the biometric fingerprint readers. However, she notes that, “The only real issue we have experienced with the biometric fingerprint readers is that our employees who do a lot of paperwork often damage their fingers through paper cuts, and employees that work in our cafeteria will sometimes get burns that cause them to have a distorted fingerprint. The biometric fingerprint readers won’t be able to get a clear scan on their fingers. But overall, we haven’t experienced any major issues with the readers themselves”.

Like many agencies switching from paper timesheets to biometric fingerprint readers, Advantages has seen reduced payroll costs. Deanna explains, “We believe that payroll costs would be higher, especially if we would’ve kept our old system of pen and paper in place. The employees were on the honor system for clocking in and out when they started their shift and marking down the actual time they entered the workplace. The biometric fingerprint readers helped us eliminate guess-work for our office staff.”

She adds, “We really enjoy having that extra layer of accountability for our employees and that reliability for our staff.”

Genesis Group Homes, Minnesota

Genesis Group Homes (GGH) offers residential care to individuals with I/DD throughout northwest Hennepin County in Minnesota. The agency has biometric fingerprint readers in 16 group homes, and another location is opening soon. Currently, 150 employees use them.

The agency enrolls new hires in the main office; the system automatically distributes the fingerprints to all the readers so the employees can clock in at any group home.

COO Greg Gunderson says the agency chose biometrics to gain greater accountability, accuracy, dependability, and ease of use. He also said the agency wanted to eliminate buddy punching and shared passwords.

Greg has a couple of tips for other agencies considering using biometric fingerprint readers. “Assure your internet provider has a static IP address assigned to each site in advance. Anticipate a bump in turnover during implementation. We experienced it. Not everyone wanted to be honest about their time!”

Arc of Mercer County, Pennsylvania

For over 60 years, the Arc of Mercer County (MCAR) has helped people with I/DD realize their ambitions and achieve their goals. MCAR provides employment, vocational training, housing, family living, older adult care, transitioning, habilitation, and recreation programs.

Like many agencies, the Arc of Mercer County wanted to eliminate buddy punching, eliminate any possibility of sharing passwords, improve accuracy, make clocking in and out easier, and maximize the speed of clock ins at their day programs.

Katie Bodien, IT Director at MCAR tells us where and how the agency gets the most out of biometrics, saying, “The Arc of Mercer County was one of the first agencies to utilize the new generation of biometric fingerprint readers. We have expanded their use over time. Now we have 25 biometric fingerprint readers installed in day programs and group homes.”

The fact that biometric fingerprint readers do not rely on an internet connection is a prevailing benefit to many agencies. “When the internet goes down, the employees can still clock in and out, and no data is lost,” Katie explains.

ESR Inc., Minnesota & Wisconsin

Since 1964, ESR Inc., a private non-profit agency, has supported adults with developmental disabilities and other special needs by helping them integrate into the larger community and gain meaningful employment. In 2014, ESR’s services expanded to residents of St. Croix County, WI, which increased the number of people they serve to almost 500 each year.

ESR has been using biometric fingerprint readers for time and attendance since December 2016. Koni Thomas, Director of Admin Services at ESR tells us the factors they considered in deciding to use biometric fingerprint readers were staff accountability and ease-of-use. He explains, “Our main objectives were to eliminate buddy punching & timesheet fraud, the risk of staff sharing passwords, and to increase accuracy and speed of clock-in.”

At locations where timesheet security is paramount, such as day programs, biometric terminals are far more reliable than paper timesheets. At ESR, “The employees were using paper timesheets before. Now all 120 employees use five biometric fingerprint readers installed in the day program locations,” according to Koni.

ESR encountered only a few employees who had problems using the biometrics. “There a couple of staff who intermittently have problems with their fingerprints being read. Two staff members have been deleted and re-entered multiple times and now have a PIN set-up to use. We enroll new hires on their second day of employment following the instructions from MITC,” Koni tells us.

Again, Koni discovered that the lack of dependence on an internet connection was a huge advantage in regards to reliability. “The internet sometimes goes down, but the biometric fingerprint readers stay working even without a connection.”

Cornerstone Valley, Oregon

Cornerstone Valley provides 24-hour services to children and adults with I/DD, and manages group homes as well. The agency has been using biometric readers for several years.

Cornerstone Valley first installed biometric fingerprint readers two weeks after it opened. Currently, 60 employees use six fingerprint readers. The agency has five residential locations, and each has its own fingerprint reader. The administrative office also has one for the salaried staff.

Associate Director Carly Smith says the agency had always envisioned using biometrics as its primary timekeeping method. “We knew that the agency would grow. We would eventually want to have employees signing in electronically instead of on paper timesheets. I had previously worked in an agency that used MITC telephone timekeeping, which had worked well for them. When we heard about MITC’s biometric fingerprint readers, we knew installing them would be a fantastic idea. We didn’t want to switch over systems once the agency started expanding. We decided to start with biometric fingerprint readers instead of another system. Apart from the first two weeks of the agency opening where we used paper timesheets, we have always used biometric fingerprint readers.”

The Benefits

As we’ve seen time and time again, reliability is a significant factor for agencies seeking a time & attendance solution. In biometrics, Cornerstone Valley found a dependable timekeeping method, even when there’s no internet connection. “When the internet goes down, the biometric fingerprint readers still work, employees still clock in.”

Smaller agencies like Cornerstone Valley need an uncomplicated time & attendance system. Carly says: “The biometric fingerprint readers are minimally ‘techy.’ I am someone who wouldn’t be too eager on handling a new technological advancement unless I really needed to. These biometric fingerprint readers are on the low end of requiring one to be tech-savvy; which makes them easy to use. We’re a small agency with no IT department to assist us if a complicated system was put into place. Installing the biometric fingerprint readers from the beginning was a smooth process. We have had very minor issues since installation.”

Carly says employees and administrators alike love the fingerprint readers. “They really simplify things for us,” she says. “I know my employees appreciate how accurate the times are, especially when it comes to them being paid down to the minute, instead of their times being rounded. I would highly recommend installing biometric fingerprint readers at any agency.”

Automated Scheduling

Agencies Speak Out on Scheduling

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With restricted funding, labor shortages, and state and federal mandates continuing to pressure providers, human service agencies need to use their limited human and financial resources as efficiently as possible.

Ineffective employee scheduling directly impacts labor costs, productivity, and an agency’s ability to operate within budget. Effective scheduling solutions improve manager productivity and enable managers to make more informed scheduling solutions, while eliminating the inefficiencies inherent to a paper scheduling system.

In this article, agencies across the United States share their experiences using an automated time and attendance solution, how they implement optimal scheduling practices, and the benefits of effective scheduling.

An effective automated scheduling solution can improve efficiency and organization at an agency. Community Living Connections is a non-profit agency founded in 2004. With 300 staff providing community supported living services to approximately 200 individuals in Wisconsin, CLC supports individuals to live in their own homes and participate in community life, providing in-home staff to help with planning, personal cares, medical support, finances, relationship building, and more.

The Senior Scheduling Manager at Community Living Connections, Stephanie Stringer, has seen improvements since automating scheduling practices, “It is liberating to have schedules accessible, accurate, and up-to-date. Employees can check schedules from anywhere, which makes it easy.”

The benefits have been numerous, “I know how important it is for our systems to run well and be up-to-date. CLC can really have flawless transitions between shifts. This helps the employee be less anxious. Employees have said it’s a huge relief to know that they aren’t going to have to work late. Those comments usually come from people who previously worked at another agency or remember how it used to be here prior to MITC with unreliable schedules. Even my boss thinks that MITC and centralized scheduling have given so much consistency and reliability to the function of the agency.”

Developmental Services of Dickinson County is another agency that uses MITC. Developmental Services supports over 300 adults and children in a variety of home and community-based service settings in central Tennessee. The agency employs over 280 staff working in eight counties with an annual operating budget in excess of $9.0 million. The agency manages 3 day programs, 30 smaller group homes with 2 beds, and a home and community-based service program.

Barbara Brandon, Team Manager, and Amber Donegan, Payroll & Benefits Coordinator, have improved scheduling practices at Developmental Services. Prior to using MITC, “Managers maintained schedules in excel. Whoever was on call had to flip through pages and pages of schedules and employee information that may or may not have been updated to find people to cover shifts. MITC gives managers more opportunity to see what’s actually going on. We have a weekend supervisor who covers on call shifts. Working with accurate schedules saves a lot of time. We have cut down on wasting time with phone calls and avoid calling people to cover a shift who are already working.”

Centralized Scheduling

Some agencies perform scheduling in a centralized manner, with a dedicated individual or department put in charge of all scheduling concerns. For example, Community Living Connections has a scheduling department overseen by Stephanie Stringer. “In our scheduling department, we have 3 people. I supervise and direct a Scheduling Manager and a Scheduler under me. We roll out schedules 2 months in advance for all employees. Supervisors are each in charge of a certain number of locations, and are ultimately responsible for shifts that aren’t filled at their locations. We meet twice a week with the three teams of supervisors to discuss scheduling and open shifts. I talk with teams monthly at their individual team meetings as well.”

“Overall, centralized scheduling is really a relief and tool that frees people up to do other aspects of their job. We ask employees and other staff not to do certain functions in MITC to allow the scheduling department to be responsible for most updates. This works better for us because too many hands being involved increases the chances of mistakes. I find our department needs to micromanage to a certain extent just to make sure no one makes a mistake that we are unable to track. Some might see it as obstructionist, but it prevents mistakes that would be even more cumbersome to correct,” according to Stephanie with Community Living Connections.

Implementation

Gateway Services started in 1970 in an abandoned schoolhouse in Malden, Illinois, with a crew of three, one program, and $34,000. Today, Gateway has grown to support 10 programs, 2 main locations with day programs, 6 group homes, home-based supports, and a transportation program. During its long history, Gateway Services has had to implement many changes. One of the latest was to implement a new workforce management, payroll, and financial system.

“Our accounting assistant maintains the staff schedules. The schedules are used to ensure everyone has only 40 hours scheduled. This allows us to produce the early overtime warning report. This report gives us the opportunity to minimize overtime. The benefit of putting in the schedules is we can cut staff hours to reduce overtime where we can,” according to Mandi Johnson, CFO with Gateway Services.

Mandi believes Gateway is still working toward the ideal scheduling system. “We didn’t force management to do things,” she says. “In my opinion, schedules should be set up 4-6 weeks in advance with adjustments made as needed. We have one program that won’t do that. They start from scratch every 2 weeks. If we’d have said, “you’re going to do it this way and that’s it” things would have been smoother.”

Time Savings

Developmental Services of Dickson County gained time to focus on other tasks after implementing a scheduling solution. “Using scheduling with MITC makes your life a whole lot easier, especially when you have a lot of employees on the payroll side. I’ve been able to do a lot more accounting work that I didn’t get to do before. I can’t imagine the headache without MITC. MITC is a huge timesaver overall to everyone in administration.”

According to Stephanie Stringer, “When I first joined CLC, 50-60% of calls to the eCell manager were scheduling questions from employees! We found that our paper copies of schedules posted in the houses were inaccurate or not up-to-date. Once we started training and getting staff used to looking online for themselves, calls to the on-call phone were greatly reduced. Keeping schedules accurate and verifying assigned shifts has been much easier. The number of calls pertaining to scheduling are rarely an issue. On-call scheduling questions are seldom brought up as a problem in our bi-weekly meetings.”

“Developmental Services has definitely saved time on the approving of payroll. We have better control of what employees are actually doing as compared to schedules.”

MITC scheduling offers additional features to improve agencies’ operations.

“We use MITC availability selection criteria to help fill open positions. MITC allows CLC to screen or filter for available employees. All of our managers have access. We use MITC scheduling daily,” says Stephanie Stringer.

Self Service

With MITC, agencies have the option to give employees access to schedules. Stephanie Stringer shared that, “Community Living Connections allows employees to view their timesheets and make edit requests. Employees can view and request PTO through their calendar. Employees cannot edit their own information or restrictions.”

Most employees are able to benefit from self-service. “There are a handful of folks who struggle with self-service. It is largely because they are in a certain age range or lacking tech savvy. A good 90% of staff understands how to use MITC and use self-service,” according to Stephanie Stringer with CLC.

Developmental Services also gives employees access to self-service. “Employees use self-service, and the employees that I’ve talked to like having the access to it. Since we’ve started doing scheduling on the web as well, they can see schedules.” Additionally, the agency has 10 clients working for it, and they use client timesheets.

Overtime Reductions

Gateway Services has experienced reductions in overtime since implementing a time & attendance and scheduling solution from MITC. Mandi Johnson, CFO shared that, “Three years ago, overall overtime was 23%. Now it’s down to 5.77%. In the CILA program it is now 11.23%, down from 36% due to using scheduling and early overtime reports. At first, I ran reports and would give mangers notes about which employees were in danger of going over. They would look at schedules and adjust them as necessary to prevent overtime. Now, managers are on the web checking daily reports themselves.”

Scheduling can definitely help agencies reduce overtime. However, the nationwide staffing shortage has made many agencies reconsider their ability to focus on overtime reductions.

According to Stephanie Stringer, “In certain households, when there is a good pool of staff, CLC would be able to control the flow of overtime. It’s a great idea, but with our staffing shortage, reducing overtime isn’t a priority. We are happy to contain it! We’ve weighed whether it’s ok to go with the overtime, decided it is, and we build a percent into the budget to pay for it.”

Barbara and Amber with Developmental Services are in the same position. The agency is down about 30 people, so it has not seen any overtime reductions yet. However, they say: “Overtime might have been higher than what it is today without scheduling. It is helpful to see at a glance how many hours employees are scheduled for to make sure the agency isn’t giving any one employee more overtime than anyone else.”

Ease of Use

There are benefits of an MITC Solution that Stephanie at Community Living Connections had not experienced previously. “I was in a similar role at a different agency doing the same type of work prior to coming to CLC. In that job, all schedules were Excel spreadsheets. I was responsible for having 25 schedules up-to-date and ensuring they were understandable. After starting this job at CLC, I thought “if I’d have had MITC, I never would have left the other job, and it would have been so much better. I have worked with other scheduling systems. We get some mixed reviews from managers. Scheduling can be the scapegoat, and be blamed as the reason people are frustrated.”

She continues, “I prefer just a few people working with schedules as opposed to every single manager. Their real function as a manager is the advocacy and care of clients and the supervision of staff. Managers take these jobs because they want to work with people, certainly not to spend their time on scheduling.”

Help Wanted - Labor Shortage Worsens

Labor Shortage Gets Worse

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An acute labor shortage among home care workers across the country is threatening care for disabled and elderly individuals. Many agencies are struggling to retain employees. Scheduling is also difficult, as as agencies move around a shrinking pool of workers to cover open positions.

The labor shortage endangers a vulnerable population. In Minnesota and Wisconsin, nursing homes denied admission to thousands of patients because they lack essential staff. Patients living in rural ares of New York have injured, soiled, and starved themselves because paid caregivers aren’t available. In Illinois, the independence of developmentally disabled people is being compromised, as agencies experience staff shortages of up to 30 percent.

The emerging crisis has several causes. First, state Medicaid programs are unable fund higher wages. Second, the pool of workers willing to perform this physically and emotionally demanding work is shrinking. These problems portend even worse difficulties to come. Experts warn that America’s senior population will swell to 88 million people in 2050, up from 48 million currently. They will also require more assistance with chronic health conditions and disabilities.

“If we don’t turn this around, things are only going to get worse,” said Dr. David Gifford, senior vice president of quality and regulatory affairs for the American Health Care Association.

Rising Demand, Stagnant Wages Contribute to Labor Shortage

For years, experts have been predicting that demand from a rapidly aging population will outstrip the capacity of the direct care workforce. The U.S. Bureau of Labor Statistics estimates an additional 1.1 million workers of this kind will be needed by 2024 — a 26 percent increase over 2014.

Yet, the population of workers who tend to fill these jobs, overwhelmingly women ages 25-64, will increase much more slowly. After the recession of 2008-2009, Medicaid-funded agencies filled positions rather easily. Now, however, the improving economy has led these workers to pursue other higher-paying alternatives. In response, turnover rates are soaring. Falling immigration and refugee rates may make the situation even worse in the future.

At the same time, wages for nursing assistants, home health aides, and personal care aides are stagnant, making recruitment difficult. The average hourly rate nationally is $10.11. This rate is a few cents lower than it was a decade ago, according to the Paraprofessional Healthcare Institute. Workers in a handful of states are pushing to raise the minimum to $15 an hour.

Hardest to cover are people with disabilities or older adults who live at some distance from a city center and need only one to two hours of help a day. Workers prefer longer shifts and less time traveling between clients, so they gravitate to other opportunities.

Hard Times in Wisconsin

Some of the best data available on the labor shortage comes from Wisconsin. Here, several long-term care facilities and agencies serving disabled and elderly individuals surveyed their members over the past year.

One of seven caregiving positions in Wisconsin nursing homes and group homes remain unfilled, one survey discovered; 70 percent of administrators reported a lack of qualified job applicants. As a result, 18 percent of long-term facilities in Wisconsin have had to limit resident admissions, declining care for more than 5,300 vulnerable residents.

The situation is equally grim for Wisconsin agencies that send personal care workers into people’s homes. According to a separate survey in 2016, 85 percent of agencies said they didn’t have enough staff to cover all shifts, and 43 percent reported not filling shifts at least seven times a month.

“The words ‘unprecedented’ and ‘desperate’ come to mind,” said John Sauer, president and chief executive of LeadingAge Wisconsin, which represents not-for-profit long-term care institutions. “In my 28 years in the business, this is the most challenging workforce situation I’ve seen.”

Reaching a Breaking Point

Sauer and others blame inadequate payments from Medicaid, which funds about two-thirds of nursing homes’ business. In rural areas, especially, operators are at the breaking point.

“We are very seriously considering closing our nursing facility so it doesn’t drive the whole corporation out of business,” said Greg Loeser, chief executive of Iola Living Assistance. Iola offers skilled nursing, assisted living, and independent living services about 70 miles west of Green Bay.

Like other short-staffed operators, he’s had to ask employees to work overtime, increasing labor costs substantially. A nearby state veterans home, the largest in Wisconsin, pays higher wages, making it hard for him to find employees. Last year, Iola’s losses on Medicaid-funded residents skyrocketed to $631,000 — an “unsustainable amount,” Loeser said.

Wisconsin Gov. Scott Walker proposed a 2 percent Medicaid increase for long-term care facilities and personal care agencies for each of the next two years. However, that won’t be enough to make a substantial difference, Loeser and other experts say.

Due to the labor shortage, it is increasingly important for agencies to have the right workforce management tools to help retain employees and manage the changing schedules of a shrinking workforce. To learn more about how workforce management can help your agencies minimize turnover and improve retention rates, contact MITC.

Pennsylvania Agencies Share their Thoughts on EVV

Agencies Speak Out on EVV in Louisiana

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The State of Louisiana has not had a lot of success with EVV. It previously attempted to mandate Sandata for EVV in 2013 and then First Data for EVV in 2015. It ended up cancelling both. On April 18, 2017, the state announced its third EVV mandate plan.

The state and providers have wasted an enormous amount of money, time, and energy with nothing to show for it. All mandates have involved the state selecting a single vendor. The third mandate offers a state system, but leaves the providers to pay for all the technology with no freedom of choice! The Louisiana approach to EVV was very different than the approach other states took. In Missouri, for example, providers could choose any vendor, as long as it complied with general regulations for Medicaid electronic documentation. Over 600 providers in Missouri have successfully been using EVV for billing and payroll since 2015.

On April 18th, the Louisiana Department of Health released a memo outlining the EVV requirements that will take effect on January 1, 2018. The plan requires providers to use GPS verification via tablets which are kept in the client’s homes. Providers will incur the cost of the tablets and data plans. This memo contains misleading information regarding the use of GPS as it pertains to the Cures Act and the perceived monetary neutrality to providers. According to providers, the memo wildly underestimates true costs and exaggerates savings. As evidenced from the testimony of Louisiana providers in this article, the state has not adequately addressed many concerns with the selected technology and the cost burdens they will place on providers.

In this article Dr. Laura Brackin with Brackin & Associates, along with representatives from Care, Inc., The Arc of Baton Rouge, and Options, Inc. share their thoughts on EVV in Louisiana. Many providers in Louisiana have been using EVV systems for years; they hope their feedback will be helpful to their state and others considering EVV implementation.

The State’s Case for EVV

The Community Provider Association (CPA) represents many providers in Louisiana. In 2015 the CPA wrote a letter to the state outlining questions and concerns regarding the state’s plans for EVV implementation. The letter said:

“The Community Provider Association supports the implementation of an EVV system, as it has the potential to streamline billing and other administrative processes, and reduce waste, fraud, and abuse. However, if the system is not an appropriate system for Louisiana and/or is implemented inappropriately, it will not achieve the desired outcomes and could harm a system that is already on the brink of collapse.”

Brackin is the former head of the Louisiana Office for Citizens with Developmental Disabilities and current President of Brackin and Associates, a disability consulting firm. She represents the Community Provider Association, which has been actively involved with Louisiana’s EVV considerations for the past few years.

“Our team wanted EVV, and felt it would be helpful to providers because a lot of the processes with the state were time consuming and labor intensive. We also knew some providers across the country were billing for things they wouldn’t have been billing for with EVV, either intentionally or unintentionally. That money could be better redirected toward services for individuals and increases in reimbursement rates.”

“Data from 2012 indicated EVV saved states money due to a reduction in ineffective or inappropriate billing. The cost savings could range between 10 and 20 percent. The cost of Louisiana’s largest DD waiver is well over $400 million per annum, which would mean there could be cost-savings of $40-$80 million per annum. Even a more conservative estimate of 5% in cost savings would still yield significant results of $20 million. That’s a lot of money and we need to make sure we’re spending it appropriately in our service system.”

The Vendor Debate

“Several providers in the state were already using an EVV system; however the state wanted to implement a single system for all providers. We did not think this was a good idea. We pushed for the state to allow providers to choose their own EVV vendor from a state approved vendor list. But the state had already made the decision to hire the first vendor.”

“There are several benefits for the state to use an approved EVV vendor list, as opposed to implementing a single EVV system.”

“First, when the state contracts with one entity, it’s very labor intensive for the state. It takes a lot of time and resources for state staff to understand the complexities of an EVV system in order to develop the Request for Proposals (RFP). It then takes time to evaluate those proposals, initiate a contract, and manage that contract. It’s much easier and faster for a state to implement EVV statewide by setting criteria and then approving the vendors who meet that criterion. With the deadline for the Cures Act in 2019, allowing for multiple vendors is the fastest way for states to get an EVV system in place.”

“Another benefit to the state is that allowing multiple EVV vendors means that the state isn’t tied to one vendor. Therefore, if the state has a problem with one particular EVV vendor they can eliminate that vendor from the list without threatening the entire EVV system for the state. Whereas if the state uses one vendor and then has problems with that vendor, they are stuck until they can develop a new RFP, go through the selection process, and implement a new system.”

Cost Savings of a Multiple-Vendor Solution

“Using multiple vendors is also a benefit to the state financially. It takes the state much longer to implement a single system than it does to use multiple vendors. And time is money. EVV saves states money by reducing fraud, waste, and abuse in the system. The longer it takes the state to implement EVV, the longer it takes to reap the cost-saving benefits of EVV. Think of the money the state could have saved over the past four years if Louisiana would have implemented EVV in 2013. We are now four years down the road, facing a state budget crisis year after year, when we could have been saving millions of dollars. It doesn’t make sense.”

“Louisiana is again proposing the use of one state-wide system. However, the state has agreed to build a bridge between the EVV systems providers are currently using and the state’s system. But it is my understanding that providers who are not currently using an EVV system will be required to use the state’s EVV system. The state will only allow exceptions for those providers who are already using an EVV system. That may have changed.”

“Providers initiated EVV legislation several years ago to push the state to move forward with EVV. The bill passed and became law, but implementation has not been what we expected. We’re now considering whether we need legislation to ensure that providers be allowed to choose the EVV solution that works best for them, because that’s best practice.”

What Louisiana Agencies Love about EVV

Some providers in Louisiana have been using EVV systems for years, and they know what works best for them. For example, Options, Inc. in Hammond has used multiple EVV systems in the past. CFO Sue Bush prefers a system that allows caller-ID. The agency once used a system that was not caller-ID based; employees had to enter a 6-digit pin for each client. This caused many mistakes. In 2009, the agency switched to MITC, and the new system eradicated those mistakes.

However, that is not the biggest benefit of the new EVV system. Bush says: “The biggest advantage of using MITC for our EVV system is during audits. Anytime we use MITC and another entity uses paper timesheets and there is an overlap within the state, we don’t have a problem because our records are electronic. That means we get paid.”

Options, Inc. can also automate pay differential calculations and integrate them directly from MITC into payroll. “MITC classifies shifts as different pay types before records are exported to payroll,” says Bush.

Another agency that has seen the benefits of EVV is Care, Inc., which has offices in Hammond, Covington, LaPlace, and Baton Rouge. The agency used paper timesheets before switching to MITC in 2014. Billing Coordinator Bridgette Wilson says EVV is worlds better than paper timekeeping. For example, when clients are admitted to the hospital, Wilson can make sure there is no duplication between administration, admission, and discharge. “We can see that nearly in real-time… Knowing where people are in real time helps you manage your employees.”

The Arc of Baton Rouge also prefers EVV over paper timekeeping. Business Manager Karen Monroe says: “Our data is accurate now that we are using MITC. It resolves problems we encountered spending hours and hours on paper timesheets.”

The Costs of EVV

Wilson worries about how the EVV mandate will affect agencies. She says, “The state plan is going to be a problem for everybody that has a payroll process. EVV changes your payroll process; it’s not just time & attendance. How will payroll and time & attendance work together in the state’s solution? I don’t see how the state is going to do that.”

Louisiana estimates the cost of EVV will be non-existent to the state in the long term. A 2014 studying claims that “the savings of implementing a statewide EVV system will more than offset the associated costs of implementation and administration” [1]. Additionally, the April 18th memo states that the “EVV system already in place for center-based, vocational, and transportation providers and utilizing smart devices with internet access is at least cost neutral, and in many cases will represent a cost savings to providers.”

Wilson disagrees: “I don’t know where they get the idea that agencies won’t incur any costs. The tablets are a cost, and my experience is that there isn’t any administrative savings with EVV. I don’t know where the state got those ratios regarding time spent on data, but they aren’t accurate for Care, Inc.”

Bush says the state’s proposed solution is based on faulty logic. “The LDH is saying that we can get rid of people who process billing because the automated system will eliminate data entry. What the state doesn’t recognize is we still have to do all the quality control by matching daily logs with billed shifts. The state’s system doesn’t eliminate anything as far as we’re concerned.”

Wilson agrees: “Fundamentally, implementing EVV did not result in a staff reduction; it changes the work. In my experience, implementing EVV does not generate a cost savings from eliminating positions.”

Agencies Take Issue with the Smart Device Requirement

Following the release of the Louisiana Department of Health Memo (LDH) on April 18th, questions remain regarding the required use of technology and the cost burden placed on providers. Mostly, providers are unhappy that the state wants to require smart devices for EVV.

Wilson is concerned about this requirement. “Who replaces a tablet when a client’s grandchild comes and breaks it? Who is accountable for that piece of equipment? Many people in rural areas don’t have Wi-Fi or computers. How do I, as a provider, get Wi-Fi in a home where there isn’t any?  [The memo] says data plans, and that the provider will pay for them. I don’t see how that is going to work.”

Wilson knows exactly how much it would cost her agency to purchase the tablets: $68,000 for the initial purchase alone. “The state also estimates the tables will last for three years, which doesn’t seem realistic. The $68,000 does not include data plans, replacement hardware, or tracking the hardware.”

Bush agrees, especially if the state restricts EVV to smart devices only. “The cost would be ridiculous. There is no way we could absorb the costs for providing tablets to 150 clients in addition to the data plans.”

Brackin points out that the administrative burden is also worth considering, especially when turnover rates are high. “It will be extremely time consuming for providers to issue smart phones to DSPs, train DSPs on how to use the smart phone for EVV purposes, and then ensure that the smart phones are returned when the DSP is no longer employed. A lot of providers have expressed to me that there are DSPs who just quit without returning anything,” she adds. “Who pays for that?”

Single-Vendor Problems

Bush is also concerned about the plan to integrate the state’s EVV system with payroll. “Our payroll is very complicated with shift differentials. How are our records going to be imported into a payroll system? How are we able to ensure people are paid correctly?” She thinks Missouri’s EVV model, which allows providers to select their own vendors, would be a better option.

Monroe from The Arc of Baton Rouge hopes the state does not go to a single provider. “There is no way our in-home services could go to the state provider because it cannot provide us with the information we need on the backend. I’m talking about things like the payroll reports and other items MITC provides, like tracking training and leaving messages. It just doesn’t have that ability. It would cost us more money if we used the state program, because we would have to hire someone else to convert data for payroll purposes and tracking training.”

Bush also has concerns about the GPS accuracy of the state’s technology. When an employee clocks in from a landline phone, caller-ID guarantees the employee’s location. If an employee clocks in from a mobile device, someone needs to check the GPS coordinates. That gets tricky when employees pick up clients from various locations. “It could be anywhere. It’s all over the place. I think it would be way more difficult,” says Bush.

She says the messaging capability of the state’s technology is another issue. With MITC, employees must listen to automated alerts before clocking in or out over the phone, or they receive them on the web portal. If her agency must use another system that does not support these alerts, the agency’s communication will suffer.

Lessons Learned

Monroe hopes that as the state considers how to proceed it listens to Louisiana providers. “I think EVV is great because there is so much fraud going on. There just needs to be a single way to streamline EVV and get the state on board to allow providers to know the parameters. Providers need to be able to choose our own vendor and get the information as we need it. Going to sole provider, I can’t see how that would work.”

Brackin has advice for other states based on her experience: “Decide what the state needs from an EVV system, develop a list of approved EVV vendors, and then allow the providers to choose their own system. Providers are all different. Some offer only one service to a small number of individuals; others may operate in multiple states offering multiple services to a large number of individuals. As long as the EVV vendors all meet the state requirements, a state should be able to give providers the flexibility to choose the EVV system that works best for them.

Brackin advises other states to start advocating now for the right to choose different vendors.

[1] http://new.dhh.louisiana.gov/index.cfm/faq/category/105

Strong Job Posting

Four Tips for a Strong Job Posting

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A strong job posting is a crucial part of an organization’s hiring process. As the economy improves, organizations are growing more concerned with attracting and retaining talent. In a 2015 study, Travelers created a Business Risk Index Summary. This study found that organizations were more concerned with talent acquisition then they had been the previous year. 53% of businesses surveyed said they worried about attracting talent. Additionally, 14% of organizations felt that organizations were not prepared to cope with the challenges presented by employee acquisition and retention.

Attracting the right employees takes planning, but is something any organization can do. Here are three tips for more effective job postings.

1. Make Sure the Job Title is Descriptive

Indeed.com found that job titles that were descriptive, such as “Marketing and Events Coordinator”, got significantly more traffic than those with less descriptive names, such as “Marketing II”. Make sure the job title both accurately represents the position and avoids generic labels.

2. Have a Realistic and Thorough Job Description

Make sure the job description makes it clear what you expect from a strong applicant, including qualifications, certifications, or availability. The description should include the tasks that the hired candidate will perform on the job.

If you’re looking to hire a person who can lift 200 lbs, be aware that some organizations often use “feminine” language when creating certain job postings. Words like “nurturing” and “caregiving” are often at the forefront, which may not be the image you’re looking to project.

Similarly, avoid emphasizing education or experience requirements unless they are necessary to the position.

3. Make the Online Submission Process Simple

Be clear about required materials, including information on resume format, references, or salary requirements. Make it as easy as possible to submit (ex. allow attachments instead of requiring employees to fill out an online form with information redundant to their resume).

4. Mention Any Non-Pay-Related Perks of the Job

Make sure the post presents your organization in a favorable light and gives the applicant a good idea of company culture.

Pay is not the only factor for employees when considering a job (or changing jobs). If your organization allows flexible schedules, the ability for employees to apply for opens shifts internally, or a strong benefits package, be sure to emphasize those facts in the job posting.

Staffing Survey

Agency Staffing Survey Reveals Acute Labor Shortage

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MITC recently conducted a staffing survey of 137 agencies employing nearly 40 thousand people across the United States. The results showed a severe shortage of direct service professionals (DSPs). As they struggle to deliver vital services to a vulnerable population, agencies are looking for ways to hire more employees and retain the ones they have.

Across the board, from smaller agencies with less than 50 employees to the largest providers with over 2,800 employees, agencies reported an excessive number of open positions, primarily for DSPs. The average agency employed 320 people when fully staffed and had 25 open positions (nearly 8 percent). The total number of open positions was over 3 thousand.

The Hidden Costs of a Labor Shortage

An employee shortage is not just inconvenient; it is costly. For example, agencies have responded to the shortage by authorizing more overtime. Of the agencies who participated in the survey, 65 percent reported overtime was higher than they wanted.

Overtime is not the only cost of the labor shortage. Turnover costs money, both directly and indirectly. Direct costs include overtime, lost billing if services cannot be delivered, recruitment activities, and fill-in staffing. Indirect costs include lost productivity while managers are busy interviewing and training new employees. Less obvious, but no less costly, are the negative impacts to staff morale and performance, which can lead to diminished quality of client care. Among the survey respondents, turnover rates varied quite a bit. For example, agencies in Maryland, New York, and Pennsylvania reported turnover rates under 10 percent, while some agencies the Carolinas, Indiana, and Illinois reported DSP turnover rates as high as 80 percent. This is not surprising, since the states with the lower turnover rates are able pay about 20 percent more for DSPs.

As if the shortage isn’t difficult enough, agencies also reported problems with the quality of applicants among those who are available. Common problems were applicants who failed drug or background checks, had no relevant skill sets, failed to complete training, had poor concepts of attendance responsibilities, or did not show up for interviews/training.

Ways to Improve Retention and Hiring Rates

Almost all agencies participating in the survey have already taken steps to improve their hiring and retention rates. These steps include:

  • Better applicant screening to concentrate resources on those most likely to stay
  • Annual review of retention and on-boarding process
  • Improved, more organized on-board training
  • Working with local colleges, such as nursing schools
  • Emphasizing total compensation value, rather than hourly rate
  • Developing career ladders
  • Referral bonuses and new hire bonuses
  • Graduated pay scales
  • Early access to benefits
  • Mentoring/buddy programs
  • Contests and awards
  • Employee appreciation days and events
  • Monthly staff newsletter
  • Shift differentials
  • Profit sharing

In addition to these things, agencies can focus on several areas to increase retention and attract workers.

Follow Good Scheduling Practices

One of the biggest complaints employees have is lack of advance notification for schedules. Poor scheduling or last minute changes can cause conflicts with your employees’ home lives. A DSP will be much less motivated to show up if they are constantly being rescheduled, especially at short notice. Frequent rescheduling leads to a culture of frustration and uncertainty in your workforce, and it encourages absenteeism and turnover.

When scheduling employees, it is important to track their preferences and restrictions. This will help you avoid calling them in to cover shifts they can’t take. Capture these preferences during the new hire process. Also, allow enough time between shifts for employees to rest, and avoid calling employees who have just finished a shift back in. Also, planning for holidays well in advance can avoid disruption and lead to better attendance.

Good scheduling practices, together with an accurate time & attendance system, help your agency track frequent offenders who regularly show up late, leave early, or call in sick. These employees set a bad example to others, causing lower productivity and more overtime.

Of all the agencies that participated in the staffing survey, 42 percent are considering new scheduling systems. Additionally, agencies reported that they had already changed some of their scheduling practices by:

  • Investing in new scheduling software
  • Allowing flexibility in how different sites schedule staff
  • Introducing rotating weekend shifts (one on, one off)
  • Creating more full-time positions
  • Increasing the number of part-time staff
  • Creating scheduler position(s)
  • Monitoring hours to ensure employees get breaks
  • Scheduling longer shifts on fewer days
  • Using salaried staff to cover open shifts

Empower Employees Through Self-Service

Employee self-service refers to a system that gives employees a certain amount of autonomy. For example, an online self-service system allows employees to see their schedules, who they are working with, which shifts are open, their PTO balances, and more. This saves time for you and your staff. It also reduces the amount of phone calls and emails between you.

Another popular self-service feature is an automated text or email alert system to remind employees about licenses, training deadlines, upcoming reviews, and more. An alert system can also send birthday and anniversary greetings or HR updates. It can improve communication between employees and managers, too, by sending notices when PTO is requested or approved. Using text/email reminders to notify employees of their next shifts can also reduce absenteeism and helps motivate employees. On the same token, including a digital checklist to assign duties helps employees know what they are meant to do; this is especially helpful if an employee is covering a shift for someone else.

Recognize Excellent Employees

Employees like to feel like their hard work is being rewarded. To do this, make sure your agency provides clear career paths for DSPs. Give them written guidelines on what factors will help them advance, such as good attendance records. Reward hard-working DSPs by gradually increasing their responsibilities. A DSP who has advanced from an entry-level position to a manager role is more likely to be loyal than one who has done the same job for years. For this reason, try to promote from within your agency workforce, rather than recruiting outsiders.

Also, employees want to know where they could be headed and how they can get there. Annual reviews or mid-year check-ins are one obvious venue for these discussions, but also encourage workers to come to HR with career questions and wishes throughout the year.

When excellent employees leave your organization, conduct exit interviews. You may even consider asking longer-tenured employees why they stay. Ask questions such as: Why did you come to work here? Why have you stayed? What would make you leave? What are your non-negotiable issues? How about your managers? What would you change or improve?

While there are no quick fixes for overtime or turnover, making a few key changes can increase caregiver retention and help alleviate the challenges agencies face by caregiver shortages.

U.S. Department of Labor - Managing FMLA

Avoid These FMLA Pitfalls

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Employers should never take a leave from dealing with the Family and Medical Leave Act’s (FMLA) requirements. The FMLA entitles eligible employees of covered employers to take up to 12 weeks unpaid, job-protected leave in a 12-month period for specified family and medical reasons. It guarantees continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Read about these common FMLA pitfalls.

1. Untimely FMLA Requests

When an employee takes extended leave, managers sometimes fail to tell HR right away. This can be disastrous, because an employer cannot retroactively implement FMLA leave. If a manager waits a week to inform HR, it could delay the start of the 12-week FMLA period. This means an employee could end up taking more than 12 weeks of leave, which would impact staffing and productivity. To effectively manage FMLA, an employer must take proactive measures to properly enter and account for leave time.

Agency Workforce Management allows employees to request FMLA like any other benefit time. If the manager fails to act on the request, Agency Workforce Management reminds the manager and notifies HR. Employees do not receive pay for these hours, but the hours are tracked.

2. Failing to Keep Track

Another common mistake employers make when managing FMLA is failing to keep track of an employee’s use of FMLA leave, particularly when it is intermittent. As a result, an employer might give the employee more FMLA leave than he or she is entitled to. Employees can take FMLA leave in as little as 15 minute increments, so a robust, accurate system is crucial. Agency Workforce Management allows organizations to record each employee’s FMLA leave. It tracks total hours allowed (480), hours taken, and hours remaining.

3. Missing Required Notices

Employers sometimes fail to provide required notices to employees. FMLA requires employers to provide four notices to employees seeking FMLA leave:

  • A general notice. This is a permanent notice that employees are always able to access, such as a poster on the wall or in an online employee portal.
  • An eligibility notice. When an employee requests FMLA leave, the employer must give the employee a written acceptance/denial letter within five days of the request.
  • A rights and responsibilities notice. Every time an employer gives an eligibility notice, the employer must also provide a notice detailing the employee’s rights and responsibilities.
  • A designation notice. This is a written notice that an employee’s leave is approved/unapproved under FMLA.

Employers must stay on top of these notices to comply with the law.

4. Providing Overly Broad Coverage

Sometimes employers provide FMLA leave in situations that are not covered. For example, if an employee has not worked an appropriate amount of hours in the past 12 months, he or she is not eligible for FMLA leave. An employer can easily lose track of this if employees use a paper-based time & attendance system. If an employer allows unauthorized FMLA leave by mistake, and the employee later experiences a qualifying event, the employer may deny additional leave. In this case, the employer would be violating the law unintentionally. If the employee realizes this, the employer could face legal ramifications.

5. Accepting Incomplete Certifications

In some cases, like when an employee is suffering from a severe health condition, employers require a certification to prove an employee needs to take leave. However, employers sometimes accept incomplete certifications that are incomplete. For example, an incomplete certification may not state the frequency and duration of the intermittent leave.

6. Enabling FMLA Abuse

The FMLA is ripe for employee abuse. Some employers find themselves with large numbers of employees with certified intermittent leave. Those employers need a plan to keep all employees honest with respect to their use of FMLA.

7. Overlooking the ADA

Employers sometimes fail to realize that a serious health condition that requires 12 weeks of FMLA leave may also constitute a disability under the Americans with Disabilities Act (ADA). Even after 12 weeks of FMLA leave, the ADA or state law may require more leave as a reasonable accommodation.

8. Not Having FMLA Policy

Employers can choose to implement FMLA leave on a rolling 12-month period or within a calendar year. Every organization should have a written FMLA policy that addresses this choice. This way, the employer can choose whichever option is most advantageous rather than leaving the choice up to the employee. Typically, the 12-month rolling option is best for organizations. If using the calendar period, employees can stack leave during the last 12 weeks of one year and the first 12 weeks of the new year.

9. Failing to Train Supervisors about Managing FMLA

Untrained supervisors might not handle FMLA requests appropriately, and may actually violate the law. To avoid legal ramifications, organizations should train all supervisors about managing FMLA — even those ones who do not typically administer leave.

Agency Workforce Management FMLA Solutions

Agency Workforce Management solutions help organizations manage FMLA requirements in every situation.

  • Employees can request FMLA from any location using any internet-enabled device. FMLA requests go to the employee’s manager for approval. On approval, non-payable records go through to the employee’s time and attendance records. If the employee is scheduled to work, their shifts are automatically re-opened.
  • Thereafter, either the manager or HR can document any additional leave the employee takes. If a manager fails to respond to the employee’s request promptly, the manager receives an automated reminder. The employee does not receive pay for these hours but the hours are tracked. Agency Workforce Management also maintains a complete history of FMLA requests.
  • Employers can establish a balance of the allowable hours, and Agency Workforce Management automatically updates these hours by FMLA transactions. For example, if the employee has taken 200 hours the remaining balance would be 280 hours. Agency Workforce Management keeps a detailed record of all transactions.
  • If the employee requests more than 480 hours of FMLA, the request will be blocked.
  • HR can enter the 480 hours into the employee record when the FMLA time commences.