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 do not get the recognition they deserve!

Here at HHAeXchange, we would 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 Vicki Hoak, Executive Director of the Home Care Association of America (HCAOA). As the industry’s leading trade organization representing homecare agencies and their suppliers across the country, HCAOA strives to provide member agencies with practical resources to enhance operations and margins, while improving training and quality within homecare. In this article, Vicki opens up about her personal relationship to homecare, what excites her most about the industry, and the pandemic lessons every provider needs to take with them into the future.

What brought you to the homecare industry?

Prior to serving as the CEO of the Pennsylvania Homecare Association (PHA) for 20 years, I had spent most of my career in the communications and marketing field as a government press secretary for health and human services. I loved it, but after doing that type of work for so many years, I wanted to not only be the spokesperson and write the messages, I wanted to be accountable for the implementation and execution of projects and activities as well. The state home care association afforded me that opportunity to develop, implement, and execute a variety of efforts that could have a tremendous impact on in-home services in PA.

What excites you most about homecare?

The endless possibilities of homecare and the tremendous growth that we are experiencing now and will likely be experiencing over the next decade. Homecare is not just post-acute care; it can also be preventive and custodial. I think we’re just starting to realize the plethora of different services that could be provided by a homecare agency. Home modifications and maintenance, specialized dementia services, family caregiver support groups, pet care, and concierge services are areas that are potential new service lines if not by the agency, then through partnerships with other companies.

What are some of the biggest challenges facing homecare providers today?

There are many, but the most pressing challenge is the critical shortage of homecare aides who are lifelines for so many people, from the young man or woman with a disability, to the 85-year-old widow – all of whom want to remain in their own home, living as independently as possible.

This country, and our industry specifically, must come together to develop a plan that addresses the needs of this growing population and defines the necessary steps to respond not only to their medical needs but also housing, transportation, and socialization.  

This is an unprecedented time. We are on the edge of a pandemic that has changed the way we live, and while tragic, it has proven the value and benefit of caring for people in their own homes. Homecare has proven to be safer and although clients are isolated that challenge is not nearly as detrimental as being in a large facility. We, as homecare providers, must respond by demonstrating the value we bring to the health care system. Specifically, we must prove that personal care – helping clients with their medications, providing nutritious meals, monitoring conditions and assisting with ADLs – can not only reduce and prevent costly hospitalizations, but also assist individuals in maintaining a healthy lifestyle.  

What do you believe is the most important quality for an agency owner to possess?

Tenacity and compassion are key. This is not an easy business and to do it right, it takes a very strong person who is focused, committed, and truly believes that “there is no place like home.”

Which lessons from COVID-19 should providers take with them into the future?

First and foremost, communicate! During the height of the pandemic, our member agencies were communicating with their caregivers and their clients frequently, making sure everyone knew what precautions we were taking to protect not only our clients, but our caregivers, too. Offering training on COVID, providing the necessary PPE, reminding everyone that agencies had their back were messages being communicated on a routine basis. HCAOA even had a slogan, Protect and Prevent, which focused on the five main measures homecare agencies were taking, including frequent hand washing, monitoring for symptoms, etc.

All this emphasis on communications resulted in homecare agencies having the highest level of both caregiver and client satisfaction in 2020 – right at the height of the pandemic.

The second lesson is: be ready to pivot. I think back to last March, when the pandemic was declared and how our association’s leadership came together and realized that we had to help our member agencies change the entire model of homecare delivery to address COVID-19. We immediately established a Medical Advisory Council that developed protocols for homecare during the pandemic and provided training on the use of PPE and answered agencies’ questions around CMS guidance. It was a fast-paced time, but we learned great lessons including the value of having an emergency plan and to continue to build and maintain a leadership team that is committed to providing care no matter what.    

Do you think we will continue to see an increase in homecare services, even once the pandemic ends and the world returns to normal?

Absolutely. People are rethinking care for their loved ones and like a former CMS official said, we are questioning this country’s overreliance on nursing homes. Policymakers and other health care providers are recognizing the benefits of caring and treating people in their homes, which is evident in projects like the Hospital at Home program and the SNF at Home pilots. This of course will also require sufficient government funding for in-home care.

What was a career-defining moment for you, as a woman in homecare?

There were many moments, but the most significant was when I became the client. My mother moved in with me following her stroke and lived with us for four years. We hired a homecare aide to take care of mom while I was working, but every evening and weekend, I was the caregiver. My mother was my heart and the journey of caring for her was one I will always cherish, yet it was difficult and at times overwhelming. When I reflect on that time, I hold onto the memory of every night helping mom into her bed (slip sheet and learning the right transfer technique from wheelchair to bed were a must!) and to this day, three years later, I can still feel the comfort I felt back then, knowing that she was safe here in our home instead of at a facility. And thanks to wonderful professional caregivers and my family, we were able to keep mom home with us until she passed away on hospice care.

What inspires you to do your best work?

My inspiration is doing whatever I can to make certain that others have the same experience I had with homecare and my mother. That means advocating for better understanding about what homecare can provide, keeping it affordable, fighting for better wages for our direct care workers, and of course, elevating the profession of our homecare aides who are so valuable to the well-being of this country’s older population.

What do you think is in store for the future of homecare?

In the future, I believe our agencies will be called upon to demonstrate the value they provide to clients and the health care system. We will be asked to meet performance metrics that will evaluate our care and how it contributes to reducing health care costs and improving individuals’ well-being. HCAOA is already working with our Data Committee to conduct a pilot program on collecting standard performance data and it is incumbent on our industry, to agree to certain standards instead of waiting for others such as government to impose these requirements. We should be in the driver’s seat because providers understand what indicators show good care while also being sensitive to overly burdensome data collection.

Do you have any advice for those new to the homecare industry, or an agency owner just starting out?

My advice would be to take time to make certain this is the right field for you. Talk with agency owners, understand competition, study the environment and forecast, and know the obstacles such as recruitment and retention of workers, scheduling, and financing. Once you have done your homework and understand the challenges and opportunities, you will be ready to take on a new career that has so many blessings!

Vicki Hoak was recently quoted in the New York Times article, “For Older Adults, Home Care Has Become Harder to Find.” Click here to read Vicki’s thoughts on the caregiver shortage and how providers can respond to the growing need for homecare services.