Summary — In-home healthcare is a challenging business, but the owners of EMJ Healthcare in Atlanta have learned how to mitigate the risks and embrace how rewarding it can be. Read how they uncovered their system for success, and made caring for their people — both clients and employees — possible.
Time to read: 9 minutes
Care, comfort and company are all important so people can age in place.
Assistance with bathing, food prep, laundry and cleaning, all the basics, and just the human act of presence. Those are the differences between safe and unsafe, comfortable and uncomfortable, dignified and ashamed, and between content and lonely. They are the difference between losing the life you are used to and getting to keep it, and central to the purpose of in-home healthcare.
Tim and Carolyn Golden, owners of BrightStar Care franchisee EMJ Healthcare in Atlanta, got into the business because of their big hearts. Though that remains an important part of the equation, all of the realities of managing a far-flung, distributed home healthcare business with lots of employees and contractors is a dominant part of their day-to-day.
“You absolutely get into this field thinking you are helping people,” Tim explains. “But ultimately, this business is really about managing people. Thankfully, the end result is still that we are helping people, both our customers and our employees.”
The challenges in running a home healthcare business are many, with employees scattered across broad territories, clients who have difficult health issues, and sometimes even the conflicts between elderly clients and their adult children who’ve booked the care. On top of that, margins are tight, which suppresses wages and can make employee management difficult. But after taking advantage of some lesser-known advice, the Goldens have found business success, allowing them to enjoy the feeling of making a difference for clients and their families more often.
Safety and health checks are crucial to allow people to stay in their homes.
Tim was a banker in 2007 when the sub-prime mortgage crisis melted down the economy. His job became, very suddenly and very completely, not fun. “I just got really tired of seeing people lose everything,” he remembers. “It took a toll, and I needed a complete change.”
It’s telling, then, that he got into a business helping people who have permanently or temporarily lost a lot of their mobility, health and independence, to not lose every last thing. The Goldens’ company helps hundreds of clients continue to live or recover at home, rather than having to move out and into a medical or convalescent facility, or into a relative’s home. That’s a big deal.
When the Goldens set up EMJ Healthcare as a franchise of BrightStar Care, they were the company’s fourth office. It took a little while to get their feet under them, but they were essentially at cash-flow break-even within a year. They’d built up a good roster of full- and part-time caregivers and a decent client base. They were developing a presence in the marketplace. But soon, they’d need to lean on an important ally, one they had on their side from day one without really realizing it.
“People don’t get into home healthcare to become wealthy. They do it because they care about people. They are people with big hearts, and at our agency we can’t help but be drawn to that as a business we want to help support.”
— Brent Jones, Insurance Agent
Speed bumps inevitably hit all new businesses, and one of the larger bumps for EMJ Healthcare was several large workers’ compensation claims reported over a short period of time. It was more than concerning, vexing, perhaps suspicious, and a pain to manage. Was there a safety issue? Or something more? The Goldens weren’t sure, but they did know it was exhausting. And also, expensive, Tim says. “We essentially didn’t take any money out of the business for the first several years.” But that all changed with guidance from their insurance agent.
“I believe wholeheartedly, the specific workers’ compensation insurance situation is the make or break for my home healthcare clients’ profitability,” explains Brent Jones, the Goldens’ insurance agent and principal at West Insurance in northern Illinois. “Where excessive claims or even fraud happens, ‘experience modification’ comes into play, recalibrating premiums to rebalance the premium-to-coverage ratio. And e-mod can really be a killer for business owners where fraud has gotten out of hand. It can also be a way to reduce costs.”
An experience modifier (aka experience mod or e-mod) is a multiplier applied to the premium of a qualifying policy, according to a state-mandated formula, which provides an incentive for loss prevention. The e-mod represents either a credit or debit that is applied to the premium before discounts.
After learning more about the issues EMJ Healthcare was having with workers’ comp claims, Brent provided guidance and Tim learned how to take the problem head-on. He got more aggressively involved in tracking and managing claims, calling adjusters weekly, and he adopted Return to Work policies that reduce “lost time” claim costs. They built in systems to better communicate with field staff and increased training.
EMJ Healthcare also switched their workers’ compensation coverage to EMPLOYERS®, where the Injured Employee Hotline, with 24/7 bilingual nurse advisors, is included in every premium. By having all injury reporting and initial medical processing go through the EMPLOYERS Injured Employee Hotline, claims paperwork is automatically processed, initial care is directed and an accurate record is captured if it is ever needed for later adjudication. Not only does over-the-phone nurse triage improve employee health outcomes and reduce claim work, it can shorten lost time and sometimes may reduce claim or policy expense.
Knowing their parents are being cared for allows adult children to feel more comfort, too.
Even in an industry based on kindness, compassion and caring like home healthcare, the Goldens learned they weren’t immune to employee fraud. “Most of the people who work in this field are in it for the right reasons,” Carolyn Golden says. “They have a heart for caring for people, and it is a job that works for them in their lives. And then there are a few people who maybe aren’t as pure-hearted.” As much as workers’ compensation protects employees, the Goldens realized it also helped identify those who weren’t truly there for their most important asset: their clients.
When an employee gets hurt in the home healthcare space, it’s not just the business that’s affected. The clients are, too. The majority of EMJ Healthcare’s clients are elderly, and the care their workers provide is often life-sustaining. “It’s common to get close with our clients. So much so that when one of our elderly clients dies, our caregivers will usually go to the funeral and pass our condolences to the family,” Tim says.
When an employee gets hurt in the home healthcare space, it’s not just the business that’s affected. The clients are, too. The majority of EMJ Healthcare’s clients are elderly, and the care their workers provide is often life-sustaining. “It’s common to get close with our clients. So much so that when one of our elderly clients dies, our caregivers will usually go to the funeral and pass our condolences to the family,” Tim says.
Clients and healthcare workers often develop considerable affection.
He mentions a few stories that stick with him: a family who sent a limo to pick up the caregiver for the hour-plus ride to a client’s funeral; another caregiver and client who loved watching baseball together, even making poster-board signs to root their team through the playoffs; a husband dealing with his wife’s early-onset dementia bonding with the caregiver who made both of their lives easier.
For Brent, as an agent, stories like this make the work he does with home healthcare businesses so much more than “just insurance.”
“Home healthcare has unique difficulties as a business,” Brent explains. “The work doesn’t happen under the employer’s own roof. They tend to have broad service areas. Much of the care is 24/7. And the wages are really low for the care providers, affecting everything from retention to transportation, and even to a potential financial incentive to commit fraud.”
Brent has seen cases where claims weren’t handled well, so when he first heard about over-the-phone nurse triage at EMPLOYERS, he made sure that became a standard feature for all of his workers’ compensation clients.
“I’m a believer in the Injured Employee Hotline,” Brent says. “I even hired in workers’ comp coaches and started providing intensive client education about how ‘experience modification’ works. It can have a massive impact on their costs, and they have some control there. As a business owner myself, I thought it was essential that all of my clients understand how all of this comes together.”
Ultimately, he believes businesses pay for injured workers in more ways than one. Managing risks, from creating safety training programs to helping injured workers get back on their feet — and back to their clients who rely on their care and friendship — is crucial.
Looking back on their experiences since opening EMJ Healthcare, the Goldens are grateful for the expertise they had on their side with Agent Brent Jones. “I think workers’ compensation is a great thing as a way to care for people when they need it, but some people may see it as an opportunity,” Carolyn says. “You have to approach it with the right system and tools, because at the end of the day, we need to manage those costs and hassles and stay focused on servicing the clients.”
For Brent, the impact that workers’ comp claims can have on costs underscores the importance of having a system in place for managing those claims. “Being completely consistent in how you deal with it helps pre-manage any possible liability, should there be litigation over a future injury or claim event,” he explains. “An additional upside to telephonic nurse triage is that every call related to a claim is recorded.”
In addition to having a system in place for managing all claims, Brent offers three hints to help home healthcare businesses with workers’ compensation.
Don’t Get Burned — “Every claim needs to be reported immediately,” Brent says. “I tell my policyholders to treat every report of injury like a house fire. With consistent processes and a system in place, claim costs, fraud and staff disruptions are kept to a minimum. And using telephonic nurse triage like the EMPLOYERS Injured Employee Hotline is a great way to smooth the process, mitigate risk and maybe reduce cost.”
Many Happy Returns — “Return to Work is an important part of the system,” Brent insists. “If they can’t return within the insured’s business because of injury limitations, finding non-profits where they can do lighter-duty work, and still be paid by the policyholder, is a lot cheaper than running it through a lost-time claim. And it is a truism in the industry that ‘supervised people heal faster.’”
Shared Values — “Our catchwords at West Insurance are accessibility, responsiveness and accountability,” Brent says. “We look for two things in carriers: financial stability and responsive adjusters. Those are two of the primary reasons we were drawn to EMPLOYERS. They’ve been at it for over 100 years! That’s stability. And because they only do workers’ compensation insurance, their adjusters are specialists who take the calls and they work the answers. That’s what we expect and get from EMPLOYERS as our partner in taking care of workers’ comp policyholders.”
To learn more about workers’ compensation insurance from EMPLOYERS start with these explainer resources, or if you have a question about how EMPLOYERS could help your business, get connected with an agent today. Already part of the EMPLOYERS family? Current policyholders and agents can log into EACCESS for account details. Your agent or territory manager are ready to help answer questions and improve your workers’ compensation insurance experience.
