Duett Podcast with Nancy Kemp and Natalie Ellis of CICOA
Intro 00:00
Welcome to the Duett podcast.
Cody Pittman 00:12
Welcome back to the Duett podcast. And again, our goal here is to talk to experts from the home healthcare industry and share that info with our community. My name is Cody Pittman and I am the CEO of Duett and joining me today from CICOA is Natalie Ellis and Nancy Kemp. Nancy, tell me about yourself.
Nancy Kemp 00:28
So I am a care manager trainer at CICOA Aging and In-Home Solutions. I've been working there for about six and a half years. I became a trainer about four years ago and I just enjoyed teaching and training. And I get the privilege of having interaction with a small amount of clients as well. So I get the best of both worlds in that. I have a bachelor's in Social Work from Taylor University. So I really like being able to use my social work degree at CICOA. And that's a little bit about myself.
Cody Pittman 01:05
Natalie, what about you?
Natalie Ellis 01:06
I am Natalie Ellis. I've been with CICOA for, May will be six years. I'm also a care manager trainer. And I started as a care manager and moved up to the trainer position about four years ago as well.
Cody Pittman 01:25
Okay, and remind me what area is CICOA? I know there are 15 AAA's in Indiana. And CICOA is what area?
Natalie Ellis 01:32
So we're area eight. And so we cover Marion County, Hamilton, Hendricks, Hancock, Boone, Shelby, Johnson and Morgan.
Cody Pittman 01:45
Okay, cool. Cool. What brought you into the home healthcare industry or AAA's?
Nancy Kemp 01:52
I was an intern with my senior year of college with area six, which is in the Muncie area. And I worked with that area agency for about a year. When I moved to Indianapolis, then I had some other jobs in between, and then was looking to get back into social work. And as the CICOA graciously hired me after not being in the field for over 10 years. So I really enjoyed being in the home healthcare industry, and really helping those people that want to stay in their homes as long as possible.
Natalie Ellis 02:27
So I went to Ball State. And when I graduated, I kind of took a year off and took care of my grandmother. She moved in with my parents, and I took care of her for about a year. And then I was just kind of looking for a way to help people. And I found CICOA. And I just loved working there. And I love everything that we do. And I just feel like I was meant to work there. It's kind of how I always feel.
Cody Pittman 02:58
So both of you said something, at least something along the lines of helping people and keeping people at home and getting them the care they need. Tell me a little bit about like, functionally, how do care management teams work?
Nancy Kemp 03:10
Yeah, at CICOA. We have different departments that take care of different parts along the way. So we have the Aging and Disability Resource Center where people call in, they can get resources, they can can get connected with services. And then after that, if they are found to be eligible for services, they will have a visit with field options counseling, or they will be given options of what type of services are available, what programs are available. And once they get through that, and they are in need of ongoing case management, then we have a Flourish Care Management department that right now has 16 teams divided into quadrants that cover our eight county area. So we have people that are close by that that can go either in person for home visits, or over the phone to help meet those ongoing needs for those individuals.
Natalie Ellis 04:05
And we do four home visits a year, some of them over the phone, some of them in person, because of everything with COVID. And we always have our ongoing care managers will call their clients every month to check in and see if they need anything and of course the clients can call before then. But if they haven't heard from them in that month, then they will call to just to check in make sure that all their services and everything are going well and they don't need anything else.
Cody Pittman 04:39
What what does the relationship look like then when a client is receiving services, they have a provider, what's the relationship look like between client, care manager and provider.
Natalie Ellis 04:55
So we do call the providers or the providers you know are all was open to call us to if anything's going on with that client. Or if we talk to the client, and let's say that they want some more hours, then we will call the staff at the provider and see if they have staffing available to be able to increase, or whatever they're needing. Maybe they you know, need grocery shopping now, then we want to ask the provider, you know can they go out and go grocery shopping? Or can they take the client with them to go grocery shopping or anything like that. So we do have a relationship with with that. And then, of course, in any kind of situation where maybe there's an issue going on, then we can go out and do a home visit and have the provider there with us. So we can all kind of be on the same page and know what's going on.
Cody Pittman 05:53
So it's a team. A full team. Once you kind of continue to work together to make sure clients getting what they need, as well as sounds like a little bit of mediation in some situations, but also long, essentially, long term planning, it stays together.
Nancy Kemp 06:07
And it's also confirmation that they're utilizing the services that are authorized. Because sometimes there's not a, there's a lack of communication or miscommunication between the care manager and the client and the provider, that they didn't know, those hours were authorized, or there was an increase, because we didn't communicate that information. So just making sure that that individuals usually using the services that they have authorized, or if they don't want to anymore, we make sure we change that.
Cody Pittman 06:39
We're going to shift a little bit. What part of the job brings you the most satisfaction?
Natalie Ellis 06:46
I think for me, I just love to help others. So I feel like finding the right services, or, you know, even just like if someone needs like a wheelchair, or walker or anything like that, like I feel like once I can help that person get those things and get maybe you know, an aide provider to come in and help them or, you know, get a bathroom modification or something like that, I just, I love to like, see that their quality of life kind of increase, you know, because they're maybe more independent with having maybe a bathroom modification, or they feel more satisfied with it, being able to have someone there to help them and they can, maybe they don't like to take showers because they know they don't have the aide and they're, they're afraid they're going to fall. And when we can get someone in there for that I feel like, that's just, it's just, it makes me happy. Because it's just like, I helped you get that, you know.
Nancy Kemp 07:46
I agree with that. And I think what I've enjoyed more recently for some of the long term clients that I've had, that they seem to be going steady, and things are going well. It's just getting to know them as people, you know, what did you do in a past life? You know, what are your hobbies? What things? What do you do with your time, just getting to know their preferences, and that really does help establish a good relationship. And that's information we can communicate to providers like this is their preference. This is what they would like to see in acaregiver, and just pass that information along to providers to try to make a better connection and a better fit for them.
Cody Pittman 08:28
Seems to me like Flourish becomes a very appropriate name. What is something that you know, now that you wish you knew when you were getting started? Sounds to me, like you've both been on the job for several years had a lot of things, lots of learning opportunities. What kind of advice would you give back?
Natalie Ellis 08:43
Yes.
Natalie Ellis 08:49
I feel like for me, I just, I didn't even know that like in homecare or like CICOA, or anything even existed before I started here. I just thought that when you went to the hospital, then you could get on in home care that way. And so I feel like just learning all that like just even me taking care of my grandmother like I would have been able we would have maybe been able to have meals coming in or you know, give me a break to have someone you know, there and so it's just I just knowing about the like everything having to do with what, you know, the waiver services or anything else does, where we can get in home care and stuff. I feel like that's big for me.
Nancy Kemp 09:36
And overall, I wish I had known more about community resources out there. There's so much out there that we're still find out every day new things, new resources for our clients, even for our family members. We're finding that out and just how to use technology too I mean, that's become a much bigger thing is we can take our laptops into the home we can look things up right there on the internet and connect them to resources much quicker than we used to be able to. I think just knowing how to do that has really, I definitely did not know any of that when I started. Now I do.
Cody Pittman 10:12
Yeah, I haven't been in the industry that long. But the thing that I find the most interesting is even on just the A&D waiver, you have services like pest control, you have specialized medical equipment, personal emergency response, now the most utilized is attendant care and homemaker and nursing. But you have all these other services like home modification, like you said, and transportation, vehicle modification, you have all these things that help people stay independent. That yeah, I think the general public doesn't really know exists.
Natalie Ellis 10:47
Exactly. Even people that are on the service, they might not even know that it exists.
Cody Pittman 10:54
Yeah, that's very cool. Similarly, what kind of advice do you have for a new care manager? You're both trainers so you have a lot of people coming in the door. What advice do you give them?
Nancy Kemp 11:06
We always tell them to be patient with themselves. It's a lot of information to learn. And to ask questions, we always say, please ask us questions, we want to, to give the information that we wish we would have known when we started to share that. And I think a big part of it is I tell my new hires, listen, listen to your clients, you're gonna get so much more information than just a checklist of questions that you need to go to. Just ask them, you know, just listen to what they have to say, and you get to know them as a person.
Natalie Ellis 11:39
And just to, like, build that rapport with not only the client, but the providers as well, you know, especially if you're working in a specific area, you might recognize some of the providers, because maybe you have a couple of clients that have the same place. And so it's building that rapport with them. And you know, having that open communication, I feel like is a really a big thing, you know, having a phone number that you can call to them, and then to be able to call directly to you, so that you can work quicker and more efficient.
Cody Pittman 12:13
Seems to be like, trust, transparency, and understanding that we collectively, the AAA case manager, and the provider are the support community team that takes care of the client, right? These aren't silos that remain separate. It's like, No, we're integrated. We are a team, we might be different companies. But our goal is this one client.
Nancy Kemp 12:36
Yes, and to maintain professional boundaries, too, because we've seen caregivers get too close to clients, and then everything blows up. And it's a big mess, or care managers who get too involved in the lives of their clients, you know, we are professionals, we are not their friends, so we can be friendly, we can be nice and listen to them. But you know, that our main job is to be professional and, and do now that job which we were hired to do, which is to connect them to the resources they need and, and help them in our homes.
Cody Pittman 13:12
Yeah, and I think you kind of, one, I'm going to bump up a question I was gonna say for later, but it's a difficult job. And it's difficult for different reasons. But one of those is we're talking about people and people that have great needs. So how, how do you take care of yourself, in this work?
Natalie Ellis 13:36
It's a good question.
Nancy Kemp 13:38
Maintain those professional boundaries. And we tell people, you're off the clock, when your hours are over. You're not supposed to work past your hours. And I didn't listen to that advice. So that's another thing that I should have. I would have liked to know that when I started, is that is for your own, your own health, your own mental health, is to maintain your work hours and don't work past that. Because then you, you actually when you take your breaks, you take your lunch break, do you have time to refresh yourself and you are a much better care manager or professional when you have that time away to just relax, not think about everything and just take care of yourself.
Natalie Ellis 14:20
Yeah, and especially since in this, you know, virtual world that we're really living in right now with COVID. Even though you know, the numbers are going down, we're still primarily at home. And so sometimes it does get hard to work, have that work life balance, you know, especially if you have children or anything like that, but we always stress to our new hires that we want them to have that work life balance, and if they feel overwhelmed, they need to talk to their supervisors. If they feel like they're getting burned out, maybe take some time off, you know, take a day a couple days or just take one personal day even just to just you know sit back and relax and watch a show or, you know, just have that time to yourself. It's needed.
Cody Pittman 15:07
I can imagine a lot of that advice could be given to a caregiver as well, definitely. However, what kind of specific advice would you give to a family caregiver or a provider?
Nancy Kemp 15:20
Yeah, we tell them to take care of themselves, thinking specifically of one individual who's taking care of his wife with Alzheimer's, and I keep telling him, You have to take care of yourself, if you're going to be around to take care of her, go to your appointments, go to your own medical appointments, do your surgery that you need to do, we'll get your services in place to cover that time, you know, just take advantage of the services that are available. And, and our job is to communicate what is available so that they know what's available and can take advantage of that.
Natalie Ellis 15:55
Right, that's a big thing, you know, especially when someone is overwhelmed, because they're taking care of their family member, you know, maybe a husband taking care of their wife. And it's just what you do, you just that's your every day. And so, you know, getting services and things like that they're huge for those people, because they just, they need that time to have just like we're talking about self care, they need to be able to watch a show or take a bath, or go to their doctor's appointment or go to the grocery store, you know, and that's when we come in, and we help and we try to figure out what kind of hours and everything that we can get for this person, so that their caregiver can have that rest that they need.
Cody Pittman 16:42
There's probably a sports analogy in there somewhere. It's like we ask our all stars to play at their best, but if they're going to play at their best, they need to be at their best. And so if the caregivers and people involved in these individuals lives, if their job is to take care of the client or patient, they themselves need to be operating at their best.
Nancy Kemp 17:06
Exactly.
Natalie Ellis 17:07
We want to give them as much rest as we can.
Cody Pittman 17:11
When working with a client to find a provider, what are some key factors that impact the client, and the choice they make?
Natalie Ellis 17:18
For me, I feel like it's communication, I feel like that's a really big thing. You know, if a client has trouble getting a hold of someone, then they will call me and say I can't get ahold of them, you know, and I try to call, maybe I can't get a hold or, or maybe I get a hold of them. And they say they're, you know, like we're having this kind of barrier here. I feel like, that's always a big thing for why someone might be like, well, maybe I need to look for someone else, or something like that. Also, I feel like good matches, you know, which is hard to find, sometimes when you're just trying to hire as many people as you can to, to be able to staff for hours and everything like that. But I feel like, you know, having those common interests and things like that with the client, I feel like that always keeps the client happy. And ultimately, the staff member happy as well.
Nancy Kemp 18:16
And I see some of the things that impact in a negative light there's just too many choices they have too many providers to choose from, and they look at a list and they're like, I don't know who any of these are, yes, they're not familiar with any of them. Or they on the other end is that maybe they have a connection already. They know somebody who works there, they have a family or friend or we've had a family member be hired there, or they have a family member that wants to be hired as their caregiver, which agencies are willing to do that and hire a family member to take care of that loved one. So and we've also seen, you know, connections by if somebody's got a website, or they, you know, have easy access, like Natalie had said about now just communication, you're able to reach them. If you're, you know, that phone number that's available in the system, does it work, you know, does that email address work? So that's a huge impact of who that person is going to choose.
Natalie Ellis 19:16
And I feel like also with what Nancy was saying about the large list, sometimes the client will like look at the location and see oh, okay, so I live in Noblesville. So I'm gonna pick this one because it's in Noblesville. But they might be, not... they...they're kind of hindering themselves in that because they might have a perfect match with someone in a different company that that they don't know goes to Noblesville.
Cody Pittman 19:46
Yeah, it's interesting, because actually, these providers are licensed by the state to operate in the entire state so many actually... I know you both work for CICOA but many of your providers also work with NWICA/Northwest Indiana Community Action. And so their offices are here in Indianapolis, but they sent or they have providers and caregivers that are that operate in Gary or live in Gary themselves. That's very interesting. If you were sitting across from a provider, what would you want them to know about your work as a case manager or as a AAA employee?
Nancy Kemp 20:24
I think first is I think sometimes there's the perception like, okay, you need to answer your phone every time I call you and I need to have immediate action. But know that we're juggling a lot of clients at one time, we have a lot of people that we're helping, and we really try to be that mediator and get to our phone calls quickly and answer and respond. But there are a lot of situations that come up or where you're like, I've got to take care of this, first, I'm going to get to you just hang on. So I think good communication is definitely the huge thing that we want to make sure that they know. And really, we feel like we're in a mediator position as care managers. We are hearing the client side of the story, we're hearing the provider side of the story. And when they don't match, we're kind of in the middle of like, okay, we got to make peace here, we got to figure out how to do this. And, and sometimes it just doesn't work out. And we have to try to find another provider that the things will work out so that hopefully, you know, each side knows that they can come to us and we can try to mediate that situation and try to get good communication going between.
Natalie Ellis 21:36
And ultimately it is up to the client, what provider they want. And if they don't have a connection, then it might not just be the provider, maybe it's just that staff. And we do try to suggest why don't we try to ask for another staff member to come out. Sometimes that's a try that and that doesn't work out. And ultimately, it's the client's choice for if they want to leave to find a new provider.
Cody Pittman 21:59
How many clients are in a caseload for a care manager?
Nancy Kemp 22:05
Anywhere from 65 to 80, depending on the care manager, some of them people like to be a lot busier and are quicker at their work. So usually that the least amount is about 65.
Cody Pittman 22:19
Yeah. So, which is a lot! Yes. There's still only 30 days and the average. That's quite a bit. What is something that clients need to understand about a case managers work?
Natalie Ellis 22:36
Kind of the same thing as what Nancy was saying, we do have a lot of people on our caseload and, you know, we do try our best to make it seem like they're our only client, and we want to do everything that we can for them. But that is, you know, it's it gets hard sometimes, but we have a lot of fires that we're trying to take out. And, and, you know, I feel like going back to what to say to new care manager. I feel like one thing is building that trust with your client to know if they call you and they leave you a voicemail that you're going to call them back. And you're going to call them back in a timely manner. And get back to what they need. Because like I just said, we want to have our clients feel like they are only client.
Cody Pittman 23:29
Much like that last question what do client's need to understand about their providers and caregivers.
Nancy Kemp 23:35
I think the first thing they need to understand is that there is a shortage, there is a shortage of caregivers, that companies are doing their best to recruit caregivers. They're not perfect, and not every caregiver is going to be a match. And again, communication is the big key. If you are having issues, you need to talk to your company. And I even sometimes some don't come running to me because I can't fix a lot of the stuff that you're coming running to me about. So I always refer them back to their provider, please talk to your provider and let them know what's going on. If your caregiver doesn't show up, don't call me because I can't do anything about it. Unless you call your your provider and don't get any response. So but just really encouraging them to have that direct communication with those providers. And to let them know if it's not working, they're not gonna they can't read your mind. And so you have to let them know if some if this caregiver is not working out, you want to request somebody else. Yeah, most of the time, they're going to be respectful of that and better than I know blowing up and and yeah, just leaving with no warning so and leaving you without a caregiver.
Nancy Kemp 24:50
Communication is kind of becoming a little bit of a theme here. But I would take it maybe two layers deeper, maybe one layer deeper, which is it's communication, open lines of open channels, it's also treating each other with a little bit of grace and patience as you'd like, we've had some comments. It's we're imperfect, we're all human, we're all doing the best we can. And despite that, where it might fall short, but if we treat each other with some grace and understanding, we will get through it, we will get the result you want. So, what what makes for a good relationship between a provider and a client? What kind of targeting, we want to create sustaining matches long term relationships between a provider and a client? You've each had probably clients that you've had from the beginning of your career that you still have? So that's a long term relationship, how can a provider and a client build that long term relationship too?
Nancy Kemp 25:51
I have one that has had the same company and the exact same caregiver for for going on four years. And I've asked what makes that work. And what makes that work is she the client maintains the professional boundaries with that caregiver, she's not her friend, she is, you know, she is somebody she can talk to, but she maintains those professional boundaries, she communicates. So like, during COVID, she was not comfortable with the caregiver not wearing her mask, for taking the proper precautions. So she communicated that clearly to her, they had a conversation, they respect each other. And that has worked and that provider has been great, they update me every month on how the situation's going, how the hours are being staffed. So it's been a very good working relationship between all three of us, the care manager, the client, and the and the caregiver. So that is really kind of the ideal situation is, but that, that the client really has a big hand in that too, because she's not overly friendly with her caregiver, and is able to have that good communication and communicate her needs, and her wants, of what she would like that that caregiver to do within the boundaries of her job.
Natalie Ellis 27:07
And that relationship, you know, having some kind of probably shared interest that they can talk about, and having them have that good communication and things like that probably is good on the provider side, because then that keeps that aide there. And they are happy as well, not just the client, and it needs to be the aide as happy as well. Or that if they're not happy, they will leave and then they'll have to try to find someone new.
Natalie Ellis 27:12
Kind of move away from advice for clients, providers and caregivers. But kind of back to your own outlook. When you're looking at the year ahead, what gets you excited about your work?
Natalie Ellis 27:52
I just feel like I just always get so excited about like I kind of said from the beginning, just building that quality of life for people and being able to help them in their needs. And you know, if it is a bathroom modification, or maybe they it's a husband who's just overworked because he's taking care of his wife, I just feel like being able to get those kinds of services in the home, rather than having to result in going into a nursing home. But being able to have that loved one at home as long as possible. I feel like that just always gets me happy.
Nancy Kemp 28:32
And our in our role as trainers, we get to pass that excitement along to new care managers that are starting and we kind of get to give them that advice of like building that relationship with our clients and the importance of communication and documenting what you're doing so that there's nothing that's missed. And just we have new positions starting at CICOA, that's all meant to enhance that client experience, give them the resources they need. So that's exciting, too. We have a new position, community health worker that starting just really trying to build in more tools for our clients that will give them access to the things that they need to stay in their home.
Cody Pittman 29:17
When you look at the year ahead, what are some concerns you have?
Natalie Ellis 29:22
I just feel like there's always a concern of shortages. And so I feel like that's always a big thing that especially nursing, you know, in home nurses, or there's been a shortage for years, and that's doesn't seem like it's going anywhere. So that's always a concern when you have someone who needs nursing, maybe a kiddo or something like that, who can only really have nursing. So I feel like that's always a concern. And then also, I mean, the big scare of what's coming with managed care, and everything like that. Just what's that gonna look like?
Nancy Kemp 30:01
Changes always difficult. Yeah. Just there seems to be a lot of changes. But it can also be exciting. Exactly. But just the unknown is kind of a scary part.
Cody Pittman 30:14
What is not changing now is, we've got a lot of people that need help. That's not changing, that's for sure. Can you tell me a story about an experience with a client that changed your perspective, or maybe even changed your life?
Nancy Kemp 30:31
I'll tell my story is that my I mentioned her earlier about the this lady that has advanced Alzheimer's disease, and her husband is her caregiver, they really don't have any other family support, and just the relationship over the last five years that I had been there, her care manager, which I kind of consider myself his care manager, too, because he knows and he's told me this before that he's like, I don't know what I would do without CICOA. I just don't know what I would do. And he just knows that he can call me he can talk to me, you know, sometimes when you're around an Alzheimer's, dementia client, patient, you know, her a family member all day long, repeating yourself, repeating yourself trying not to argue with them, he just needs to have a conversation with somebody who he can communicate with normally. Yeah, so just giving him that support has a and just seeing how building a relationship over the years, he was very hesitant at the start to accept any services, he's said this is my wife, I need to take care of her. But just kind of building that trust and that relationship, keep offering every time every visit every month, offering services that are available. And finally, he's taken me up on that. So it's just neat to see that when it's like, okay, they finally get to the end of themselves. And they're like, Okay, I gotta get some help. And I was just so excited that he called me this week and asked for more hours, as like, yes, we will get you more hours so that you can take care of yourself.
Cody Pittman 32:14
I think you've highlighted something. One, that's a wonderful story. But I think you've highlighted something that's really interesting. We tend to refer to a client as one person, but oftentimes because of their lives. Your client is that one person, but they have family that are involved in the process in some kind of way, which can create challenges that must be overcome, but create opportunities as well.
Natalie Ellis 32:37
Yes, yes.
Natalie Ellis 32:39
So mine's kind of similar. I have a client who I've had from the beginning, since I started here, and they were brand new, when I was brand new. And the client is nonverbal, she gets agitated. And the husband, oh my gosh, he's just a wonderful advocate, for her. He, at the start, he was very, like Nancy was saying, this is my wife, this is what I'm supposed to be doing. I don't need to have anybody else in the home. We're just going to have like, one hour or two hours here and there. And over the years, it's, you know, I've talked to him and said, you know, you need your breaks, you need your time, you know, because he would say I uh feel overworked I, you know, we I helped him get help them get a bathroom modification and a stair lift. And some things like that to kind of just help out with him. Because she gets agitated, she does not allow people to give her a bath except her husband. And so it was like, Okay, well, what can we do to try to figure out how, you know, your husband can help you get up the stairs to get to the shower, and things like that. And over the years, you know, just like Nancy was saying, you you're not pressing them to say you need this, you need this, but you really do. And you know, and I feel like the last couple years, she has had an aide that's come in that she's had the same person from the beginning. And they, she this aide knows exactly how she works and how she gets agitated with certain things. And that aide knows if she gets agitated like this, then she knows what to do if she gets agitated like that. And, you know, it's it's like those success stories, but then you know, not everyone is like that. And not everyone has such a wonderful advocate to be able to take care of them either. And that's kind of where I feel like us as care managers. That's our turn to come in and be like, Okay, what can we do? We want to advocate for you to be able to help you like we're a family member and trying to figure out things that we can do to help and so...yeah.
Cody Pittman 35:00
You both said something that has kind of created a paradigm shift for me, which is a reminder also that we're talking about long term here. You said you had a client that your story, Nancy was a client, you've had her five years. And same for you. And that's we're not talking about 30 days. We're not talking about three weeks, we're talking about years and years and years of being involved in these people's lives, these clients lives these patient lives. And that that has implications to how we engage with people how we treat people as like, now we're talking about building something together for years. That's it. I'm out of questions for you. Natalie and Nancy, thank you so much for joining me today and sharing your experience. We're looking forward to sharing this with our audience.
Natalie Ellis 35:45
Thank you so much.