Home Care 101: Comparing CDPAP, Traditional Services & Private Caregiver Hiring

Home Care 101: Comparing CDPAP, Traditional Services & Private Caregiver Hiring

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Dennis Gill: Welcome to CareSmartz360 On Air, a Home Care Podcast. I’m Dennis Gill, Senior Sales Consultant at Caresmartz.

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Dennis Gill: Today, we have the pleasure of speaking with Trailblazer in the private pay home care arena, Megan Shergill. As the Director of Private Pay Market Development at BNS Health, Megan has dedicated her career to expanding long-time home care options for New Yorkers, offering them choice.

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Dennis Gill: Quality, and peace of mind through a 130-year strong legacy of service.

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Dennis Gill: With over a decade of direct support experience in the autism and deaf communities, and a background in special education, Megan brings a blend of empathy, expertise, and passion to her work.

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Dennis Gill: She’ll guide us today, through Home Care 101, comparing CDPAP, traditional home care services, and private caregiver hiring.

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Dennis Gill: You don’t want to miss her invaluable advice and her guiding principle. Quoting her, make sure that those that you work for are part of the conversation, not just subjects of the conversation.

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Dennis Gill: So, Megan, welcome to the podcast.

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Megan Shergill: Thank you so much for that warm introduction. I am not worthy, or I feel not worthy, but I really appreciate it.

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Dennis Gill: No, no, definitely you are, definitely you are. And you took out the time today, thank you, first of all, for that also, and for our listeners, so it would be a very educative session, so, and they’ll be learning more about this topic from you.

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Dennis Gill: Okay, so let’s jump on to straight away with our first question for you. So, Megan, what are the key operational challenges agencies face when coordinating CDPAP care compared to traditional services, and how can they streamline those processes?

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Megan Shergill: Well, as many of us already know, CDPAP and traditional home care services are two very different beasts in regard to client experience, operations, the back-end processes, and more recent, more than ever, the expectations of the agency. So, with the new, the recent new restructuring for the CDPAP program, PPL is really the, the most involved in,

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Megan Shergill: really the only entity involved in processing the payroll for those caregivers, those personal assistants. So, let’s start with CDPAP services first. So, the challenges for a subcontractor working underneath PPL for CDPAP services.

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Megan Shergill: You have to first and foremost really consider the client experience, the consumer experience, with onboarding, but also then that personal assistance, that caregivers experience onboarding. Because that’s going to make or break your business, because that’s essentially all that subcontractor is responsible for. So, you have to make sure to maximize your back-end efficiencies and really lean into automation.

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Megan Shergill: technologies but also making sure that your front-forward-facing team, speaking to the clients and the caregivers.

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Megan Shergill: are really salespeople, right? Because families still have choices when it comes to subcontractors, you have to make sure that they all know their book of business.

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Megan Shergill: makes them different and special. So, to maximize profit under these new different, you know, structures and margins, it’s really important that they work essentially with a skeleton crew, and in order to do that, you have to have technology on the back end, you have to have templates at your disposal. I also recommend having really robust trainings and onboardings for, like, new admin

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Megan Shergill: staff, because we know in this industry, turnover happens with the admin staff.

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Megan Shergill: And, of course, with CDPAT, it’s not just about onboarding that client, but that caregiver also has to onboard in tandem together with that client, and

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Megan Shergill: So, really what you need to do is maximize your technology to do the mass emailing, mass texting, mass voicemails, to keep those individuals on track with their onboarding, and giving them realistic deadlines

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Megan Shergill: Because otherwise, you know, their emotions are heightened as it is. They’re not going to finish the onboarding if you don’t keep on them, type of thing.

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Dennis Gill: Thank you for the camera.

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Megan Shergill: to work with those different technologies to maximize that. So CDPAP is really focused on the onboarding, right? But then with traditional home care services, you have not only the full cycle of life, the closing the sale, the onboarding, the staffing and the scheduling, and then, of course, the processing the payroll for the caregivers.

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Megan Shergill: It’s still very similar in regards to leaning into back-end technologies and back-end softwares that are going to make your team shine, and also allow you to work within, you know, the smallest skeleton crew as possible.

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Megan Shergill: And same thing, knowing your pitch, knowing what makes you different, and really having different, like, lines of support to be prepared for really any operational problem that comes your way. You have to invest in very strong team members who are experts

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Megan Shergill: in that role. And I always say, hire people that are smarter than you, you know, or who can, like, kind of fill in the voids where you can’t, where you can’t shine. That, I think, is the key to success.

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Megan Shergill: Hello? Yep.

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Dennis Gill: I also learned a new thing for you. When I’m hiring my team, I’ll take care of that thing.

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Megan Shergill: Right?

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Dennis Gill: Okay, and what are the biggest challenges in expanding private pay offerings, and what strategies are proving most effective in overcoming them?

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Megan Shergill: I mean…

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Megan Shergill: Have we seen the New York market? It is competitive, competitive. There are a lot of options out there for families, whether it’s just, you know, gray market caregivers who are just trying to sell themselves to be that private caregiver, or a regular home care agency, or even a licensed home care agency.

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Megan Shergill: There are some things that you can do to really set yourself up for success and be, seen as different compared to some of those bad apples out there. Customer service, first and foremost. You know, if you don’t… if you don’t have that set up well.

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Megan Shergill: Then what are you even doing in those systems, right?

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Dennis Gill: Customer service. Right, right.

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Megan Shergill: response times, because as I mentioned before, for clients and families navigating short-term or long-term home care services, emotions are already heightened, right? They’re already at a time of crisis, and they needed services yesterday.

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Megan Shergill: So, to be responsive, to be accessible, to be credible, and to have, like, this great reputation is key, and how do you do that?

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Megan Shergill: So, with my experience,

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Megan Shergill: proving yourself as an expert in the industry, and not just talking the talk, but walking the walk. Having lived experience through different situations and scenarios for families, like… like your beautiful intro mentioned, I… I actually started my career working direct care with children with developmental disabilities, like autism and the deaf community.

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Dennis Gill: committed, yeah.

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Megan Shergill: Yes, and so I have this lived experience of, I know exactly what it’s like to change adult diapers, and to offset, you know, like, you know, not ideal behaviors, and all those things, and working with goals and care plans. So because of that, I have this level of, like, empathy that allows me to connect with the families that I support, and I’m sure, you know, there’s ways that all of us

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Megan Shergill: in, like, a sales or an education role can find commonalities with the families that we support, and that is key to be a differentiator, because you have to be memorable. These families are shopping around.

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Megan Shergill: If you sound like just another call center rep, and you don’t have inflection in your voice, and you’re not pausing to actually hear them tell you their story, then what are you even doing? Like I said.

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Dennis Gill: in the field. But also.

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Megan Shergill: Yeah, but also operationally, as much as you can, if the organization can be competitive when it comes to the rates that we offer for the home care services. Of course, we’re all working on very thin margins, but to the point that I made before, leaning into technology and back-end processes and statements of process and having all those things very clear allows you to then reduce your overhead

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Megan Shergill: So to speak, to allow you to reduce the rate that you quote people. And then also having a very robust caregiver pool.

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Megan Shergill: is optimal, because at the end of the day, you have to staff the case, right? You have to be able to say yes to everything coming your way, so that, that, you know, that means that you have to have a very strong talent acquisition team, you have to be very visible in the community that you serve. Again, you can’t just talk the talk, you gotta be out there.

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Megan Shergill: So what I like to do is I like to, be a part of the community center events.

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Megan Shergill: I love to be asked to be on, like, expert panels and conferences, because it’s in the community that I serve where I hear of the problems that people are facing, and then

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Megan Shergill: by… by just my… my character, I’m a problem solver. You know, like, I… I’m like a bulldog. Once I get my… my teeth into that problem, I won’t let go until we solve it. Wow.

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Dennis Gill: Pretty sharp, pretty sharp on that part.

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Dennis Gill: And just continuing with this question only, that what’s the difference between hiring a caregiver privately versus through a licensed home care agency?

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Megan Shergill: Sure. So, I mean, again, I have lived experience when it comes to, like, hiring a caregiver privately. We actually did that for my grandmother when she was diagnosed with dementia many, many years ago, where, you know, we just… we did a word of mouth, we found a private hire, and that person acted as the live-in caregiver for my grandmother. And there’s certainly pros to that, because you can develop a rapport with that person.

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Megan Shergill: And, they feel like a part of your family.

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Dennis Gill: But again, from my lived experience, at some point, that caregiver starts asking for more and more money.

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Megan Shergill: And you don’t have, like, this mediator, or, like, the supervisor, or this case manager in between the negotiations, or if that person called out, or, you know, is not flexible with the schedule that’s needed, that’s a challenge.

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Megan Shergill: So when you’re working with a home care agency, or specifically a licensed home care agency that’s governed by the Centers for Medicare and Medicaid, there’s a certain level of care and, like, standards that you have to hit, this bar, this threshold. So you have, when you’re working with a whole… with a licensed home care agency, you have this whole

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Megan Shergill: interdisciplinary team.

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Megan Shergill: Starting with the educator, you know, potentially someone like myself, who educates the families with all their different service offerings and all their different options, and then helps them navigate the right pathway to… for their… for their purpose. And then you have, of course, the HST supervisor, or, you know, that scheduling coordinator who schedules that home health aide, but again, acts as a supervisor for

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Megan Shergill: for any, you know, not ideal behavior, like if that caregiver’s on her phone, or showing up late. And also, that, that scheduling coordinator can also send a replacement if needed, or just restaff permanently if needed. And then, of course, we have our field nurse supervisor who develops the care plan, which is essentially a how-to guide so that everyone’s on the same page of what the expectations are for that caregiver.

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Megan Shergill: that client, working within that home. And that’s something that you’re not going to get when you hire privately.

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Dennis Gill: That’s a great one.

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Megan Shergill: market.

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Dennis Gill: Yeah. Right.

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Megan Shergill: Who’s developing that care plan? Maybe the client, maybe the family, but who’s keeping them accountable, you know?

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Dennis Gill: There’s no track of that, there’s no track of that, yeah.

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Megan Shergill: Exactly! And then, and then lastly, of course, …

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Megan Shergill: you know, we would process the payroll, which, like, you know, offsets the burden from the family. And of course, every caregiver under a licensed home care agency has to be trained and certified either as a PCA or an HHA, so that’s another level of peace of mind and reassurance for families that you’re not necessarily going to get with a gray market hire.

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Dennis Gill: Yeah, right he said, right he said. And, according to you, what does a robust continuity plan look like when a caregiver cancels, or a client’s need changes suddenly?

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Megan Shergill: Well, essentially, you have to have a very…

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Megan Shergill: robust team behind the scenes that knows exactly what the crisis plan is when a caregiver calls out last minute. So, if you have the right team set up for success, you have a team member who is responsive, you know, to that initial phone call, but also adaptable, flexible, and willing to think outside of the box.

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Megan Shergill: Meaning, even if you can’t staff that preferred shift to, like, an 8 to 4, can you at least get someone there

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Megan Shergill: For, like, the prime time when the family or that client really needs the services. Maybe get someone in by noon to work, like, you know, noon to 6, something like that.

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Megan Shergill: also leaning into technology, like, you know, softwares that allow you to not only find the geolocations of available caregivers that are, like, immediately available, which, I mean, 10 years ago, we didn’t have that. So, like.

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Megan Shergill: time to be in home care for people. So doing, like, a geolocator to see who’s available, and then mass texting, sending out mass voicemails, mass emails, alerting them, or even if you have different softwares, you can even send them, like, a ping through, like, a certain system or an app.

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Megan Shergill: Letting them know of, a case availability, so doing that.

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Megan Shergill: But then also, having different lines of services within your business, like VNS Health does in regards to, we have RNs, we have social workers, we have a whole behavioral health team, a, like a VA team.

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Megan Shergill: So, depending on that client’s unique situation, if there’s, like, a need that we can’t supply, like if, God forbid, we can’t find, a caregiver to, to go in to restaff that shift.

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Megan Shergill: We have this whole ecosystem that we can reach out to to say, you know what, but this is a veteran, what other supports can we have as, like, this informal support in place?

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Megan Shergill: to get them the care that they need today, type of thing. And also, you know, the educators or, like, the salespeople, the outreach team that are in the community should really have this whole rolodex of other support systems in place

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Megan Shergill: You know, like, in regards to, like, a Meals on Wheels, or, or, like, you know, other different supports. Companion-level agencies.

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Dennis Gill: Like.

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Megan Shergill: you know, even if they didn’t need personal care that day, or, like, they could just, suffice with a companion, I would reach out to someone that can get a companion in there in the home immediately. So, it’s just really important to have, like, this outside-of-the-box mentality when you’re thinking of solutions. I think that’s… I think that’s the biggest thing, honestly.

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Dennis Gill: That’s the biggest thing. Yeah, because I’ve been also into this industry for the past 6 years now, as I told you, and I have seen the operational systems change day by day, according to the requirements, what they are in the market, like, basically, specifically for the open shifts that you were talking about, and, like, finding out a very

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Dennis Gill: apt caregiver for every shift, matching the skills and attributes. Yeah, so the systems does help in that part, and the agencies have to be up in there with the systems that are out there in the market.

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Megan Shergill: And it’s not enough just to say, oh, I tried. Like, no, no, no, let’s get someone there. It’s possible.

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Dennis Gill: Definitely, definitely. And, lastly, Began, your principle is make people part of the conversation. So what practical steps embed that in assessments, goals, and weekly check-ins?

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Megan Shergill: Yeah, this really stems from having a very client-centric approach, which I admittedly learned, when I was working direct care with children with autism and other developmental disabilities, because a lot of them

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Megan Shergill: you know, you may be… you may look at them, like, initially and gloss over and say, like, oh, like, what can they really contribute to the conversation? No, they’re there.

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Megan Shergill: They know exactly what’s going on, and, you know, having a diagnosis or a disability like any of those very special individuals could happen to any of us, really at any point in our lives.

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Megan Shergill: So I always lead with, like, a sense of empathy, and always thinking of, like, what would I want, you know, how would I want to be treated, and wouldn’t I want to be a part of the conversation? So…

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Megan Shergill: that starts from the initial education, at least from my perspective. When I’m educating families about all the different lines of support and services that we can offer families, I make sure to say, you know what, are we able to get that client on the phone as well? You know, can we get that client on the Zoom, even if that client is not verbal, just to have that client sit there, because I want to know what are their goals.

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Megan Shergill: What are their fears?

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Megan Shergill: What are their, what brings them joy, but also what brings them anxiety? And how do we alleviate that, proactively for the family? And then, of course, once services are set to start.

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Megan Shergill: it’s important to have them involved in the care planning development, because they’re the ones receiving the care. And I don’t know about you, Dennis, but I am not the same Megan that I was 3 or 5 years ago, so it’s really important that as an organization, that we remain

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Megan Shergill: Determined to check in with that client, and of course the family as well, to see, you know, what adaptations we need to make to their journey, to their care plan, to their needs.

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Megan Shergill: Because either, you know, sometimes diseases progress, or diagnoses progress. Sometimes there’s improvement, that’s the best case scenario. And we want to make sure that they’re always feeling fulfilled, no matter what stage of the journey that they’re in.

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Dennis Gill: And obviously, if you were… if you’re seeing any positive changes, it does feel pretty good from inside also. I may not be able to feel that, but I can… you can explain that more, that if anything, if there’s a good progress, so obviously, you’ll be happy from inside.

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Megan Shergill: Oh, I always say, when I speak to my friends and my family, that I have the best job, because I see that immediate, or I receive that immediate gratification, because I see, you know, the immediate response of the support that we offer people, and how it changes people’s lives.

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Dennis Gill: Great, great, great. Good to hear that. So thank you, thank you today. Megan, thank you for sharing your expertise with us, and it was lovely talking to you, and to our lovely audience today. Thank you for tuning in, and until next time, I’m Dennis Gill, signing off. Thank you.