Interviewing technique crucial to hiring best aides
Learn to ask structured, situational questions
(Editor's note: In this second article in our three-part series on hiring, training, and retaining home health aides, hospital-based home care agency administrators explain how best to choose candidates for aide positions.)
As the demand for high-quality home health aides heats up, home care administrators must be ever more careful in the way they interview candidates for aide positions. Industry changes are forcing home health aides to perform more functions, so it's important that this low-paid yet important group of people be of the highest quality.
"Industry changes are putting more responsibility on aides. We're doing fewer nursing visits, so aides have to be even better at assessing and charting patients' progress," says Betty Baker, RN, CETN, the director of home care at Alliance HealthCare in Ft. Morgan, CO.
Here are some of Hospital Home Health readers' best tips for making sure your company's screening and interviewing processes help you select only the best quality home health aides.
* Ask candidates to take a written test first.
You can save a lot of time by asking aide candidates to take a written competency test before doing any other type of screening, says Colleen Usrey, the director of Kewanee Hospital Home Care and Hospice in Kewanee, IL. This gives such a good take on the candidate's communication skills that it allows you to see the better candidate easier, she says.
"You really waste a lot less of your time and the job applicant's time by interviewing them before having them take the test," Usrey says.
The writing test she uses is a competency test she gets from the National League for Nursing. (See editor's note at end of article for ordering information.)
* Emphasize work experience.
Ask aide applicants about their past experience early on in the interviewing process, recommends Guylene Griffin, the service coordinator at Amarillo Area Hospital Home Care in TX.
"A lot of people think that if they can't do anything else, they can always be a home health aide. This is not at all the case," Griffin says.
She prefers candidates to have aide experience or experience in a service field.
* Watch out for job changers.
If aide position applicants have a history of changing jobs every two months, that's a red flag, Griffin warns. You need to ask the candidates why they changed jobs every few months. They may or may not have valid personal reasons for this, she says.
"If they got fired, find out why. Often, they will tell you something that will help you understand them better, like that a patient said something about the aide, so her previous employer had to let her go," Griffin says.
* Get a colleague to help with interviewing.
Having a clinical staff member participate in interviewing candidates can help when it comes to thinking of questions that must be asked and to help see how the candidate really is, Usrey says.
* Use an interview worksheet to guide your questioning.
Keeping an interview worksheet in front of you while conducting in-person interviews can help you remember all of your questions, and help lead your questions in directions that will yield the most information from candidates, Usrey says. (See Kewanee Hospital Home Care and Hospice interview worksheet, p. 90.) Agency administrators should have their staff write up a list of questions to be used to guide interviewers, says Linda Weinberg, MSN, the director of Anne Arundel Medical Center Home Health Care in Annapolis, MD. She screened her company's interview questions and had her hospital's human resources department screen them, too, to ensure the legality of the questions on the list.
* Train your interviewers.
Agencies should make sure the staff who will interview aide candidates are well-trained in interviewing, and knowledgeable in the legalities of interviewing, Weinberg recommends.
In her nurses' orientation program, Weinberg has included a section on the legalities of hiring employees, as well as interviewing techniques. She often sits in on the first interviews employees do, and afterwards gives them advice on how to improve their interviewing skills.
* Ask situational questions.
To see whether a home health aide position candidate would feel compassion toward patients, Griffin gives the candidate a scenario of a difficult patient and asks the candidates how they would handle the situation.
"I always give them the example of an elderly woman, a stroke patient who we've been caring for in 12-hour shifts for years, and who sometimes gets aggressive. When I ask this, I can tell immediately by the look on the candidates' faces whether this job is good for them or not," Griffin says.
Either she sees compassion or extreme discomfort in the candidates' eyes, Griffin says. Even if the candidates seem compassionate toward the patient in this scenario, their responses can yield more information about how the candidates would be as home health aides.
"Someone who has their arms folded across their chest and says, 'Oh, I know exactly what to do with that kind of patient,' may be too much of a know-it-all for home care," Griffin explains.
A better candidate would be one who asks questions such as, "Do the patient's medications contribute to her being aggressive?" or "Is there a family member involved in the patient's being aggressive?" Griffin says.
"You want aides to ask questions and not to assume that they know it all. That's part of being observant, which is a key part of the aide's job," Griffin says.
Baker says she likes to stick to asking patient care questions in interviews because this prevents her from inadvertently asking any illegal questions, and also because it gives her a good idea of how a candidate would work in the field. These are some examples of questions she asks:
-- What do you do when a patient says he or she doesn't want a bath?
-- What do you do if you see scratches on a patient's arm or bruises on his or her back?
"This tells me a lot about their judgment and their ability to observe," Baker says.
* Ask questions that show candidates' communication and analytical skills.
Even stock interviewing questions can yield useful information about applicants' thinking skills, Usrey says. These are four of the stock questions she asks:
-- What are your strengths and weaknesses?
"Often, when I ask candidates this, they give a sort of blank response, and I can tell they're thinking, 'Why should I tell her what my weaknesses are?' This is normal. They've never had to think about what their strengths and weaknesses are," Usrey says.
But the way candidates express their answers shows Usrey how well in tune the candidates are with themselves and their abilities, and how well they can communicate this, which is useful because home care aides need to be able to communicate to their supervisors how well their patients are doing.
-- What's the most important thing to you about your work?
"Say you're interviewing someone with nursing home experience. You want to hear that they liked caring for people. But if they say, 'I just want to work during the day,' or 'I just need a full-time job,' then you know what you're dealing with," Usrey says.
-- What did you like most about your last job?
"If they say, 'I liked taking care of people and making sure they were clean and comfortable,' then you know you've got a good candidate," Usrey says.
-- What did you most dislike about your last job?
"The good answer is, 'I had to take care of 20 patients at once, and I couldn't spend enough time with them.' The bad answer is, 'I didn't like my supervisor,' or, 'They just picked on me all the time,' " Usrey says.
If you get the bad answer, consider this to be a red flag, Usrey says. Of course, you have to ask why the candidates didn't like their supervisors, or why they felt their supervisor picked on them.
"It might be that aide wasn't good at taking directions. But if you let the candidate explain the conflict they had with a previous employer, you might see that it's not a bad thing," Usrey says.
For example, they might explain to you that their supervisor told them to chart that they did certain care when they actually didn't, she says. It is possible that the candidates were good aides and just happened to be working for poor-quality employers. But chances are also good that the candidates were hard to work with, Usrey says.
* Focus on how candidates answer questions.
Some people interview well, even though their skills or comportment as an employee aren't good. Some candidates will promise to go to the moon for an interviewer, then slack off once they get the job.
"They always tell you what they think you want to hear, but you don't know if they'll actually do this once you hire them," Usrey says.
To see through a candidate's answer when you think they're only telling you what you want to hear, pay attention to the way they answer it, Usrey advises. Does the candidate hesitate before answering? Even if a candidate answers a question well, Usrey asks herself if the candidate really answered the question, or just used impressive language to talk around the question.
* Check applicants' attitudes.
"If they have an 'old people are cranky' attitude, I don't want them to work for me. Compassion is crucial. They have to have that," Griffin says.
* Explain the responsibilities of being an aide right away.
Talk to candidates about their responsibilities and what to expect from the company, Usrey advises. This will ensure that the applicants know what they're getting into, and it gives the interviewer an opportunity to observe the candidates' responses to the type of work required of aides, she says.
These are some of the aspects of the home care aide job that Usrey explains to potential aides:
-- Aides are responsible for their case loads and must let their supervisors know as soon as possible if they cannot see a patient at any time.
-- They must maintain close communication with the nurses who are responsible for the aides' patients.
-- Hospice aide positions require more household chores.
-- Lifting is required for all aide positions.
-- Because the job requires traveling, aides must have reliable cars and will incur expenses to the car, in terms of mileage, and wear and tear.
* Ask your hospital nursing supervisors about their former aides.
If you hire aides from your hospital, you can talk to their supervisors about the aide and get some good information about their work habits, Usrey says. (For more information on reference checks, see p. 93.)
This is one way to get around the problem of former employers not giving anything but employment dates verification when you do background checks.
When Usrey does get a home care aide job applicant from the hospital, she calls the applicant's supervisor and asks questions such as these:
-- Is the candidate reliable?
-- Does he or she call in or check in with supervisors a lot?
-- Does he or she come to work when expected to?
-- Do you feel you can trust him or her?
The hitch to talking to hospital aide supervisors is that the hospital nurse aide supervisors can get frustrated that home care is siphoning off good aides and tire of giving you advice about the aides you're thinking of hiring. Usrey tries to assuage them by sending home care aides or candidates who want to work weekends to the hospital to work as aides because the hospital has many more weekend hours available than the home care department has.
* Listen to your employees' opinions of aide candidates.
The home health aide grapevine can work to your advantage when you're interviewing a new aide position candidate, Baker says.
"Often, if I'm interviewing someone new, the aides offer their ideas about an applicant. I have only 22 employees, so there are no secrets here. If my aides think an applicant is really good or not good at all, I hear about it," Baker says.
The grapevine has worked well for her. In four years, she has only hired one aide that didn't work out, she says. And the only problem with that aide was that she was young and not used to the autonomy of home care, and since then has become an excellent nurse aide in the hospital, Baker says.
* Do a 90-day evaluation.
Hiring aides with a contract that contains a 90-day evaluation clause gives you an out if aides turn out to be less satisfactory than they appeared to be when you interviewed them, Baker says.
"They can interview so well and simply fall to pieces once you hire them," Baker says.
After their first 90 days on the job, Baker has her nurses go out and do a field skills test with aides to evaluate their ability to care for patients. The nurses report their findings back to Baker, who then evaluates the aide's conduct in these and other areas:
-- absenteeism;
-- sick days used;
-- tardiness;
-- patient complaints about the aide;
-- scheduling abilities.
Baker then uses all of these evaluations to decide whether to keep the employee on.
"I tell them upfront when I hire them that I'm going to evaluate them in 90 days and that I'll be looking at these areas of their performance," Baker says.
Trust yourself
* Pay attention to your gut reactions.
"Much of my decision about a candidate comes down to how I feel about the person," Usrey says.
The way she feels about a candidate is influenced by these factors:
-- Is the candidate respectful to her?
-- How did the candidate talk about his or her previous jobs?
-- Was the candidate enthusiastic?
"About once a year I slip up and hire someone that my gut said wasn't right for the job. I regret it every time," Griffin says.
[Editor's note: The National League for Nursing provides a written competency exam for home health aide job applicants, as well as other testing materials. For more information, call or write the League: 350 Hudson St., New York, NY 10014. Telephone: (212) 989-9393.
In addition, the theme of the next Home Care Aide Association of America conference is hiring and staffing.] *
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