There are more than 18 million health care workers in the United States; 80% of them are women, according to the Bureau of Labor Statistics.

While women make up the vast majority of home health care workers, they are a minority in the C-Suite. Only 40% of the industry’s key decision-makers are female.

Homecare is a tough space to succeed in, and while org charts may not reflect it, this industry is loaded with strong, determined women doing incredibly meaningful work — they simply don’t get the recognition they deserve!

Here at HHAeXchange, we’d like to take one small step towards changing that. ‘Extraordinary Women in Homecare’ is a series of feature articles designed to celebrate women who bring strength, passion, and creativity to their roles in the home care industry.

For this edition, we spoke with Chelsea Garcia, Director of Business Operations for Homecare Services & Finance at Ability360. Based in Phoenix, Arizona, Ability360 is a 501 (c)(3) non-profit corporation that touches the lives of individuals with disabilities and addresses the disability concerns of their family members, co-workers, and employers. In this article, Chelsea shares the unexpected path that brought her to homecare, the difference between being a “boss” and being a leader, and the best thing providers can do to retain their caregivers.

How did you get started in the homecare industry?

I had moved from Nebraska to Arizona in 2006 to start a nursing program at Arizona State University (ASU). My mom thought it was important for me to earn my own income while going to school, and being a nurse herself, she suggested I become a caregiver. That way, I could get my feet wet in the homecare industry and stay focused on nursing. As a caregiver, I liked that I could care for individuals with a range of needs, and all I had needed to get started was my first aid and CPR certifications.

I come from a family of nurses; every woman in my family from the past few generations is a nurse. Halfway through school I got pregnant with my son, and his father’s job led us to Las Vegas. I ended up graduating with a degree in medical assisting. I always thought I’d go back to school and finish the nursing program, but it just didn’t happen. I’ve since realized that nursing isn’t for me, and I’m so grateful I chose caregiving.

How did your time as a caregiver impact the way you function in your current role?

It has made a huge impact. Experiencing how things worked on the caregiver side has greatly influenced how I see things on the business end.

The work that caregivers do is so important, yet many of them barely make a living wage. I’ve always believed that paying our caregivers correctly, fairly, on time, without delays, without interruptions – that is what’s going to make their quality of life better. And if we make their quality of life better, then they’re going to make our consumers’ lives better.

This understanding has impacted the way I make decisions on a daily basis, and it’s also changed what I get excited about. For example, when our agency received American Rescue Plan Act (ARPA) funds, I was so excited because that kind of funding doesn’t come around often. Sitting with our CFO and VP of Home Care Services and brainstorming about how to give this money back to our caregivers was so much fun. Giving back is always the first thing on my mind, because that’s what we’re here for.

What makes Ability360 unique from other organizations that offer homecare services?

Ability360 is a 501 (c)(3) non-profit corporation. As a Center for Independent Living (CIL) organization, all our programs are designed with the goals of maximizing independence, encouraging self-sufficiency, and advocating for personal responsibility. We address disability concerns across the board – not only for consumers, but for their families, friends, and employers as well.

Ability360 offers so many different programs and services to advocate for independence. In addition to homecare, our programs and services include individual and system advocacy, information and referrals, employment services, ADA services and counsel, empowering youth in transition, home modifications, social and recreational opportunities, and more. We also have a top-of-the-line sports and fitness center on our campus that was built to accommodate people with all types of disabilities.

The caregiver shortage is a major concern for many agencies. What has Ability360 done to improve caregiver retention?

We are in the beginning stages of streamlining our hiring and onboarding process to make getting started simple and easy for caregivers. We’ve also begun offering E-learning options to our caregivers for their required annual continued education training.

We’ve been lucky enough to be a receiver of ARPA funding and that has made a huge difference as we’ve been able to increase caregivers’ salaries. Just over the last two years, we’ve made a $3 increase in hourly wages for our caregivers, and we’re offering bonuses.

Recently, President Biden signed an executive order to expand access to affordable, high-quality care and provide support for care workers and family caregivers. This is a step in the right direction, but now, we need to ask Congress to include additional funds for Medicaid-based Home and Community Based Services (HCBS) in legislation. Lawmakers and the Biden administration could provide additional guidance on how these dollars could be spent to prioritize higher pay for homecare workers, and State officials could increase reimbursement rates for HCBS providers and encourage them to use the funding for caregiver wages.

Our agency is doing what we can to increase our caregiver retention rates but when it comes down to it, money is a factor that affects everyone, and no one should have to choose between making a fair living wage and caring for a family member.

What is it about your job that motivates you to come to work every day?

I love the company that I work for. I love our mission statement, and I love our values. I also have a large team that I am responsible for. As I’ve worked my way up in the company over the years, my biggest priority has been to develop and lead a team that has a heart for what we do. It’s easy to look at my department and think all we do is crunch the numbers or handle EVV Data. Afterall, people in the financial world aren’t typically known as the most warm-hearted or caring individuals. But I don’t simply want to create a fantastic EVV process and procedure – I want to develop team members that really love what we do, why we do it, and the people we do it for.

One of my favorite quotes is, “Most leaders focus on finding the right strategy, the best leaders focus on empowering the right people.” My team motivates me every day to get up and come to work. I want to make sure that I’m not just doing my job, but that I’m also helping my team grow.

What unique characteristics should HCBS executives possess to make them successful?

I think HCBS executives should possess the independent living philosophy – they must understand that we don’t want to institutionalize our consumers, and that we want them to feel as independent as possible. It goes back to quality of life. We want consumers to feel like they have a partner, someone that’s advocating for them and helping them be as independent as possible.

I also think it’s important for HCBS executives to possess great leadership skills, and by that, I don’t mean be a boss and tell your staff what to do. There’s a big difference between being a boss and being a leader. Leaders develop leaders, and part of being a leader means that you listen to your staff and hear their concerns, even if you think you might know better.

What are you most proud of that you have accomplished in your career?

Up until about 2019, Ability360 operated entirely on paper timesheets for payroll. Our organization has been around for nearly 40 years, and in that time, our processes hadn’t changed a whole lot. Doing away with a process like paper payroll and transitioning it into an electronic system was no small feat.

I’m also very proud of my team. I have a very large team within the organization, and I think all my team members enjoy coming to work. Financial and administrative work is not the most fun thing to do. The fact that they are happy to be here, that they like working together as a team, and that they have a heart for what they do – not just what they do for the money, but what they do for the people – I’m very proud of that. I’m very proud of my team.

Why is it important that people with disabilities have control over the services they receive?

It’s critical that they have control over their services because they’re the only ones that know what they need. They’re the only ones living that experience. I can’t imagine being someone with a disability and relying on someone else to tell me what kind of care I need, what I need to do today, what time I need to wake up, or what I need to eat. For people with disabilities to be as independent as possible, it’s important that they can decide their own care. I see it as a human right.

Where do you see the homecare industry going in the next five to ten years?

I definitely see it growing – potentially doubling – within the next five to ten years. Right now, I don’t think the homecare industry is taken as seriously as it should be. I think over the next few years, there’s going to be so many more people, so many baby boomers, that will need the service, that at a certain point people will have to listen. They’ll have to understand that there are individuals in their homes who can’t rely on medical services, and you can’t just throw them into a nursing home. In order to make sure that they’re cared for, you have to fund those programs, and you have to offer more services. I also envision a lot of changes being made as far as consumer self-advocacy and what consumers can and cannot decide for themselves.

What do you think needs to change about the HCBS industry?

I’ll always go back to money and education. If you have anyone around you with a disability, or someone who is elderly and aging, it’s easy to look at them and assume they can get help – that there are tools that can help them, that they have money that can help them, that there’s a nurse that can help them. It’s easy to look at them and think everything is fine and they’ll be taken care of, but in reality, that’s not the case. I think more education about the HCBS industry would drive more people to advocate for funding.

Who do you look up to in your professional life? Any role models?

One of my role models is Ability360’s Vice President of HCBS, Penny Fore. She took a chance on me as an office employee and gave 110% of herself to making sure that I had everything I needed. She gave me the best advice while I was moving up. She taught me the fundamental rules that I teach my team now – she advocates for the people, for the consumers, for the caregivers, and for the work our agency does.  

Another person who I look up to in my professional life is Craig Groeschel. I listen to his leadership podcast all the time. One of his fundamentals is that you can’t lead people by being a boss. You have to listen to people. To be a great leader, you have to be willing to be led to a certain degree. It doesn’t matter how long you’ve been a leader or what position you’re in, you can always learn from the people you’re leading. To be a great leader, you have to be willing to make people great.

I’ve always told my staff, my goal is to make you better.  I want to empower them to do their job better even than I can do my job, and to make them the best versions of themselves. I don’t care what my position is, if I can help people be the best versions of themselves, then that’s what I want to do.