Communicate clearly when closing a service
Closing a home health agency branch office or an entire service line is more than just a business decision. The action affects a wide range of people with whom close relationships have developed over the years, so the timing and type of communication is important.
When Prairieland Home Care closed a rural branch office in 2007, there was a clear timetable and a lot of information given to staff members, patients, and referral sources, says Linda Leone, RN, president of the Fargo, ND-based agency. The board of directors made the decision to close the branch office on a Thursday in June. "On Friday, the day after the decision was made, we mailed letters to referral sources informing them that we were closing and would not accept any more admissions starting on the following Monday," she says. Admissions that were already scheduled for the weekend were accepted, she adds.
Also on Friday, Leone drove to the branch office to meet with staff members and tell them that the branch was closing. "We had prepared packets of information that included how to apply for unemployment benefits, their COBRA paperwork, and information about their pension and annuity plans," she says. "Even though we had been talking with staff members about financials for the office, the actual announcement that we were closing the office was a shock, because no one had wanted to believe that it could happen," she explains. Leone made sure that everyone had information related to their personal finances in hand so that when the shock wore off, they could see what they needed to do. In addition to explaining the reasons for the closing, which had nothing to do with the quality of care or with the staff, Leone described the timetable with the Sept. 30 closing date. "I pointed out that we would begin layoffs, based on seniority, throughout the period as we discharged patients and census dropped," she says. It was important to be very clear about the timetable, so that employees could properly plan for unemployment or look for other employment, she adds.
Identify options for patients
Letters to physicians and patients on service also went out immediately, says Leone. Patients who were scheduled to be discharged prior to the closing date of Sept. 30 received a letter that informed them of the closing, but reassured them that their discharge date was prior to the closing, so their care would not be affected. "We did have three patients who were going to require service beyond our closing date, so they received a different letter that explained their options and that offered our assistance finding another provider," she says.
When the service you are closing is a private duty service, the most difficult part of communications is with the patients, says Mary Newberry, RN, BSN, director of home health and outpatient services at Riverside Home Health Care in Kankakee, IL. "Patients were informed by letter as well as many informal conversations during which a nurse sat with the patient to explain the decision to discontinue private duty service and help the patient understand the options for another provider," she says. Patients were upset, because even those that just saw an aide once or twice a week for a few hours thought of the aide as a friend, she says. "It was very emotional; it was as if we were divorcing," she adds.
The most important part of communicating with patients is not to avoid them, says Newberry. "Some patients require a lot of your time and a lot of talking to get past the anger that you are leaving them," she says. "Also, be honest about the reasons you are closing the service," she says.
Newberry's agency gave the 32 existing patients a 30-day notice about the discontinuation of service, so staff members had lists of resources and community options to discuss with each patient, she says. In addition to options such as Meals-on-Wheels, other private duty agencies, church-based organizations, and other community groups, names of their private duty employees who were willing to continue private duty care for patients on their own, were included. "Be very careful not to endorse or recommend any individual, because you don't want a future negative experience with the aide or nurse to reflect on your agency," she says. Be clear that the patient's arrangement with an individual is between the patient and the caregiver, and not affiliated with the agency, she adds.
Leone's agency only had three patients that would require care beyond their closing date. "We had two patients receiving regular B12 injections," she says. "We found clinics for them to go to for the injections and arranged transportation for one of the patients," she says. The other patient found transportation without the agency's assistance, she adds.
The third patient was a self-pay patient who did not require skilled visits, so the agency helped her find a nurse in the area who would come to her home.
Don't forget to let employees in other offices or departments know what is happening and why, suggests Leone. "There was some fear in our other two offices when the announcement was made about the branch closing," she admits. "Employees were asking each other 'How can this happen?' and 'Will it happen to us?'" she says. Leone and her chief financial officer informed the branch that was closing and the other North Dakota office at the same time, and then Leone went to the Illinois office to talk to the staff.
Throughout all of the process, remember that people and their personal lives are involved, says Leone. "Be honest and tell them exactly why you made the decision and what you can do to help them."
Closing a home health agency branch office or an entire service line is more than just a business decision. The action affects a wide range of people with whom close relationships have developed over the years, so the timing and type of communication is important.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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