Serving the home health, home care and hospice industry since 1999.

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by Darcey Trescone

There is no question we are headed toward a health care crisis when discussing our aging population. "The U.S. population is aging rapidly. By 2030, 71 million Americans (about 20% of the U.S. population) will be 65 and older. These individuals are at risk for complex health problems, chronic illness, and disability, and they are and will continue to be the heaviest users of health care."1

Management to minimize costly acute care episodes, decrease our overall health care spend, and provide treatment in the home changes the way we need to think as an industry. In 2016, Paul Osterman wrote in Who Will Care for Us?, "Three recent trends in the delivery of health care point directly to an expanded role for home care aides. First is the growing focus on the creation of health care teams, as opposed to the traditional top-down, doctor-focused practices. Second is the increased attention to the management of chronic conditions. The third is a newer interest in managing transitions from hospitals after acute incidents. The importance of all three trends is supported by research-based evidence, and each creates new opportunities for home care aides to play an expanded role."2

Richard Keller, President of All Metro Health Care – a provider of home care services in Florida, New York, and New Jersey and part of the Simplura Health Group – saw the changes in the industry coming and uncovered a link between ensuring value-based care and caregiver retention. His strategy focuses on an empowered workforce that drives better quality care.  

What was the strategy?

"As an industry, we have built a system that is not sustainable based on the growing volume of patients who require and will require services in the home. At the center of the system is a workforce that spends a significant amount of time one-on-one with the patient and is a valuable part of the care team.

"We get out of it what we put into it. Investing in the education and tools this workforce requires can help us get more information out of the home to help improve patient outcomes.

"The role of the home care aide is undervalued, and this is a problem. We do not give enough weight to their perspectives and feedback. By focusing on improving the value the home care aide role brings to the care team; we hope to continue to build and attract a workforce that enhances the patient services we are delivering."

Keller has All Metro's aides enroll in interactive training classes with Ladders to Value, one of New York's Workforce Investment Organizations (WIO). The Workforce Investment Program provides funding through New York's Medicaid 1115 Waiver for initiatives to retrain, recruit, and retain healthcare workers in the long-term care sector.

During this training, caregivers learn critical information regarding the care of patients with specific diagnoses, including chronic heart disease, diabetes, respiratory infection, depression, dementia, UTI, anemia, and electrolyte imbalance, among others.

All Metro also utilizes the early warning documentation tool known as STOP and WATCH to reinforce the items covered during training. STOP and WATCH uses simple language to identify common but nonspecific changes in a patient's condition. The tool is not only for certified nursing assistants but also for other direct care staff, such as housekeeping and rehabilitation, as well as families.

Once home care aides receive the proper training on identifying change of condition, it becomes essential to have a standardized method in place for observing and reporting those changes. Keller worked with HHAeXchange to accomplish this.

Using the HHAeXchange Mobile App, the home care aide is prompted at the time of clock-out with pre-defined questions regarding the patient's condition. The aide can also add non-diagnosis-related observations to track changes such as a patient running low on medication or a malfunctioning medical device, for two examples.

"We get immediate notifications from the mobile app if there are any negative changes in a patient's health based on an aide's response or observation, so the nurse can take action right away if a patient's condition is worsening," Keller continued. "It has also allowed us to identify additional training that the aides may need. We traditionally had one-way conversations with home care aides, and now it is a two-way conversation focused on the needs of the patient and the best way to care for that patient in the home." 

Since August 2019, All Metro Health Care reports that they have avoided escalation on at least forty-four patient cases with this education and tool.

All Metro surveyed their home care aides and found the following:

  • 93% reported that the tool has made it easier to report changes in client conditions.
  • 97% agree that the tool has improved their communication with the office.
  • 87% reported that the tool has significantly improved their involvement in client care.
  • 94% reported that they feel confident in identifying and reporting changes in condition.

"Without a direct care workforce, there is no way to meet the looming need, yet today these workers are poorly trained, poorly compensated, disrespected, and restricted in their duties." Osterman wrote.Keller understands this sentiment. His work continues to focus on positioning his organization and enhancing the roles of their direct care workforce to meet the needs of our aging population.

"We made the initial step simple with the Stop and Watch curriculum and data capture. Now our focus as an organization is to learn from this initiative and continue to scale the home care aide competencies, value, and ultimately their career path." Keller said. "The name 'Simplura' is derived from the Latin word "Better Together," which can be found on our website and drives everything we do.  By sharing our best practices, fostering mutual respect, creating innovative solutions, and offering consistent support, we deliver on our purpose to improve the quality of life for our patients and our employees."

We all believe that the role of the home care aide truly makes a difference in providing care in the home. Paul Osterman recognizes this and asks us for more, "Such high-minded sentiments are rarely acted upon, and the reality on the ground is different: the work of home care aides is viewed with contempt, lack of imagination, and ignorance."Osterman encourages us to release our biases and begin preparing this vital resource for the future. After all, it is the responsibility of leaders in our industry to be the visionaries and protect our home health care aides. All Metro Healthcare’s, Richard Keller is an example of just such a leader.

About Simplura Health Group

Simplura Health Group's origins go back to 1955 when the founding organization – All Metro Health Care – began providing services in Long Island, NY. Since then All Metro expanded across the state of New York and acquired operations in New Jersey and Florida to become one of the largest and most respected home care companies in the country. In 2015 All Metro purchased CareGivers America in Pennsylvania; in 2016 All Metro purchased Multicultural Home in Massachusetts and in 2017 All Metro purchased Independence Healthcare, also in Massachusetts. All three of these companies are among the most trusted names in home care in their respective markets. The brand Simplura is our way of recognizing that we are all Better Together as we continue to manage and grow our existing businesses and expand our family of companies through future acquisitions.

About HHAeXchange

At HHAeXchange, we believe that healthcare should be simple, effective, and transparent. Since 2008, HHAeXchange has been at the forefront of delivering better homecare by helping payers and providers achieve operational efficiency, increase compliance, and improve patient outcomes. Today, we are the leading homecare management software solution for the Medicaid LTSS population. We act as the single source of truth in connecting payers, providers, and patients through our intuitive web-based platform, enabling unparalleled communication, transparency, and visibility.




2 “Who will care for us?: long-term care and the long-term workforce”, Osterman, Paul, Copyright 2017 Russell Sage Foundation.

3 Developed by INTERACT® (Interventions to Reduce AcuteCare Transfers), STOP and WATCH is a vertical acronym that lists conditions that can assist in early identification of patient changes and reduce the risk of avoidable hospitalizations.


Darcey Trescone

Darcey Trescone is a Healthcare IS and Business Development Consultant in the Post-Acute Healthcare Market with a strong background working with both providers and vendors specific to Home Care and Hospice. She has worked as a home health nurse and held senior operational, product management and business development positions with various post-acute software firms, where her responsibilities included new and existing market penetration, customer retention and oversight of teams across the U.S., Canada and Australia. She can be reached at

©2020 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. One copy may be printed for personal use; further reproduction by permission only.