The Role of Registered Nurses in Home Health Care

The government may change the rules concerning the services that are covered by nurses or limit what can be paid for nursing services.

LEGAL

REGULATORY

In provision of a complete line of health care services, one must not be a registered nurse. All that is required is an individual who can be Red Cross certified and bonded, can get along with people of all types, and is willing to perform that job and Maribeth believes that any mature person can be trained to meet all these requirements.

According to the state government’s regulatory agency, a registered nurse is required to visit the home of the patients only once every week to carry out administrative job which involve filling out health reports concerning the patient. Nonetheless, a registered nurse is not needed for ’care and comfort’ services.

ECONOMIC

DHH revenues come from private charitable donations and charges made to third-party payers.

DHH does not have adequate cash to fall back in case of some negative changes in the market such as decline in demand.

TECHNOLOGICAL

DHH uses a website to market the organization and also to its stakeholders.

COMPETITIVE

DHH is the only non-profit organization that has been operating in the local community for the last 25 years providing nursing services at the homes of the clients. 

Some for-profit organizations that provide home care services such as Manpower and Kelly are widening their services to offer full home services including nursing services which are also offered by DHH.

There are also several clubs and organizations who volunteers to offer care, meals, and comfort services to individuals who may not be apply to pay for the services.  

INFRASTRUCTURE/TOPOGRAPHY

EVENTS

DHH volunteer to help in community activities such as sporting and scouting events.

GEOGRAPHICS

DEMOGRAPHICS

DHH provide nursing services predominantly to the elderly and the disabled.

PSYCHOGRAPHICS

INTERNAL ENVIRONMENT:

STRENGTHS

WEAKNESSES

MISSION/IMAGE

DHH has a positive image as it has built a good relationship with the local community and all relevant stakeholders.

The former executive director had personal issues that affected the reputation of the organization with doctors, hospitals, and local agencies.

GOALS/STRATEGIES

Maribeth is considering not just providing nursing services but offering a complete line of home health care services, what she refers to as ’care and comfort’ services.

Registered nurses are not needed for ’care and comfort’ services. Moreover, other full-service home health care organizations are expanding their service provision to include home care and comfort services.

ORGANIZATION/CAPACITY

RESOURCES

Though DHH is a non-profit organization, it has enough financial resources to meet all its expenses including billing, payroll, rent, and telephone charges among other costs.

In the case of situations such as new competitors entering the market, the government changing its rules concerning what services is to be provided by nurses and what is to be paid for nursing services, and decline in demand for DHH nursing services, the financial resources will not be enough for the organization to fall back on.

PRICE

The full cost of DHH nursing services including overhead and benefits is approximately $85 in every hour.

DHH nurses charge expensively for normal activities involved in home health care.

Moreover, there are for-profit organizations that provide Home Care Services like Manpower and Kelly which are also widening their service provision to include nursing. These organizations are efficiently run and provide similar services as DHH at competitive and at time lower prices than not-for-profit organizations such as DHH.

PRODUCT

DHH provide nursing services.  

There is increasing demand for services full line of home health and not just nursing services.

PLACE

DHH has been the only non-profit organization providing nursing services to the local community.  

There are some for-profit organizations that also provide nursing services to the local community.

PROMOTION

Maribeth, the executive director of DHH use community events such as sporting and scouting to advertise the organization. Moreover, DHH is also advertised through its website.

Problem Identification

The problem is that DHH offers only nursing services and Maribeth, the executive director of the organization is worried that new establishments that provide full services concerning home health care may enter the market to provide comfort and less-skilled home care in addition to nursing services. Such facilities may be more attractive to the hospital and other referrers, and this may make DHH lose nurses and also business if the organization does not increase its service provision to include a complete line of home health care services. This situation will cause problems for DHH since its overhead costs are fixed. Therefore, loss in income may force DHH to layoff administrative staff and nurses and decrease office space.    

Alternatives

Due to increasing need for healthcare aids with the population of elderly, single heads-of-household, and dual-career families growing at an average rate of 10% annually, Maribeth recommends that the organization should consider providing care and comfort services to the patients who need it.

Maribeth has also been considering asking the board of directors to allow DHH to provide full line of health care services at the homes of the clients, what Maribeth refers to as ’care and comfort’ services. Besides, though the current primary concern of DHH is providing professional nursing services in the homes of the clients, DHH nurses have reported that they end up offering ’care and comfort’ services since the clients they care for usually are too older to care for themselves.

Maribeth also recommends that DHH should expand its services beyond nursing services and use less-skilled personnel and paraprofessionals to provide broader and better services to the clients and enhance the effectiveness of the staff, office, and technology.             

Recommendation

DHH needs to provide full services with regards to home health care in order to meet the increasing demand for the rising demand for healthcare services by the growing population of the elderly, single heads-of-household, and dual-career families. To make this change, the organization will need to her more staff and also use less-skilled personnel and paraprofessionals to provide broader and better services to the clients and enhance the effectiveness of the personnel, office, and technology.   

Swans Ice Arena

SWOT Analysis

EXTERNAL ENVIRONMENT:

OPPORTUNITIES

THREATS

SOCIOCULTURAL

Ice skating is done by various social groups including children the youth, family groups, and couples

Each social group has its own unique expectations and interests that have to be met to attract them.

POLITICAL

LEGAL

REGULATORY

ECONOMIC

Hockey skating can generate as high as $200 per hour while public skating can earn up to $3,500 in two hours when every person is charged $5

Only a few public skating session register high attendance

TECHNOLOGICAL

Swan’s Ice Arena use Facebook and Twitter in advertisements

These forms of advertisement only reach the youths.

COMPETITIVE

Swan’s Ice Arena is the only enclosed ice space in northern US

There are other public ice skating rinks in the area run by the recreation department.

INFRASTRUCTURE/TOPOGRAPHY

EVENTS

Swan’s Ice Arena provides public and hockey skating. Hockey skating is limited to 12 or 24 individuals and it also provides 14 sessions of public skating.   

The 14 public skating sessions are not attracting many people as David hoped, therefore, the strategy is not effective as his reason for adding 14 sessions of public skating was to generate more revenue, however, poor attendance makes this difficult. Moreover, public staking requires addition of more staff including ticket sellers, skate rental, guards plus more concession assistance. So, the net income from either use is approximately the same.

GEOGRAPHICS

Swan’s Ice Arena is located in the northern United States with approximately 450,000 in population. In this area, Swan’s Ice Arena is the only indoor ice space. 

Changes in weather patterns within the northern US affect skating business. For instance, during spring the attendance reduce by half based on how pleasant the weather is. In summer, David is forced to cancel all public skating session and focus on figure skating and hockey clinics instead.

DEMOGRAPHICS

More than half of David’s clients are young children and family groups. Davis has also managed to attract couples and the youths to Swan’s Ice Arena.     

Every demographic group has their own interests and demands and meeting all these requirements at the same time has been a major problem. For instance, when David installed soft lights and introduced music in order to change the evening atmosphere, couples liked the change and were encouraged to skate to the beats of the music. Nonetheless, other demographic groups complained about the kind of music that was played terming them as old, especially the young boys.

PSYCHOGRAPHICS

People love skating on Saturday and Sunday afternoons. During this time Swan’s Ice Arena experience high attendance especially in the public skating sessions with a population of about 200 individuals during winter.  

There is always very low attendance on Saturday and Sunday evenings and daily afternoon sessions and this lead to low profit generation.

INTERNAL ENVIRONMENT:

STRENGTHS

WEAKNESSES

MISSION/IMAGE

Ice-skating can be used as a form of exercise, for recreation, and also sport.

Satisfying these perceptions in all the clients is difficult.

GOALS/STRATEGIES

David added public skating sessions to the normal hockey skating in order to increase profit generation. After realizing that some sessions were not working, he decided to cancel unattractive public skating sessions such as the everyday sessions at noon whose attendance was very low. Moreover, David adapted the format used by roller skating rinks in order to attract young adults. He also decided to improve the evening skating atmosphere by installing soft light and including music.

Among the 14 public sessions that David added, only one session worked as he expected, that is, Saturday and Sunday afternoon sessions.  Additionally different public sessions attract different types of people and this is something David never planned fro from the beginning. Furthermore, public sessions require increased staff to manage.

According to industry newsletter, very few ice-rinks have adopted the roller-skating approach and become successful.   

ORGANIZATION/CAPACITY

Swan’s Ice Arena is a rink for ice skating with a surface of 85 feet x 200 feet for hockey skating.

The rink can only accommodate a few people per session to other public skating rinks run by recreation department in northern US.

RESOURCES

In addition to the rink, Swan’s Ice Arena provides skates hockey equipment for hire.

Swan’s Ice Arena has a small rink that limits the number of people per session, for instance it accommodate 12 to 24 per hour of hockey session.

PRICE

For the public sessions, David charge $5 per person and this can lead to generation of up $3,500 for a two hour period hence yielding good profit. On the other and, he can obtain as high as $200 per hour from hockey sessions.

Scheduling public sessions doesn’t necessarily mean that a large number will attend. Actually, only a few prime sessions likely Friday and Saturday evenings and Saturday and Sunday afternoons will experience high attendance.

PRODUCT/SERVICE

Hockey skating and public skating programs

Hockey skating is limited to 12 to 24 players per hour. Moreover not all public skating session are attractive.

PLACE

Swan’s Ice Arena is located in northern US in a city with about 450,000 people in which it is the only indoor ice rink.

Though not indoor, there are other ice rinks operated reaction department that have bibber capacities than Swan’s Ice Arena

PROMOTION

David installed soft lights to improve the atmosphere in the evening skating sessions. He also included music selection to encourage people to skate to the beats.

Use of local rock radio station disc jockey to broadcast from Swan’s Ice Arena, playing and music and advertising the Friday and Saturday evening public sessions.

Use of Facebook and Twitter accounts to advertise the business

Only a few people joined the Facebook and Twitter groups. Moreover, not every promotion approach is effective:  even though David had spent about $3,000 in changing the lights and more than $9,000 in promotion of the session with no significant improvement.   

Problem Identification

The problem is that David wants to increase his profit by maximizing the use of Swan’s Ice Arena through improvement of public skating sessions to add to hickey programs which though have been very successful, limit the use of Swan’s Ice Arena to 12 to 24 players in an hour.

Alternatives

To improve the current public skating programs, David has included 14 public skating sessions though many people have not attended the meetings as he hoped. Moreover, public skating demands additional employees such as the ticket sellers, guards, skate rental and other and, therefore, the net revenues from either use is approximately the same.

David has created a market for the young adults and the teenagers for a “social activity” taking the form used by roller skating rinks. David, therefore, installed some soft light to change the evening atmosphere and also included music which was selected to encourage individuals to skate to the beats and even couples to glide together.

David also considered limiting the Friday and Saturday evening sessions to individuals age 14 years and above to change the environment. However, when he assessed the customer who visited Swan’s Ice Arena during these sessions, he realized that they mainly 13 years and below.      

Recommendation

David needs to do away with all the public skating sessions that register low attendance and focus on Friday and Saturday evenings and Saturday and Sunday afternoons when the turnout is normally high in addition to the hockey programs.