Caregiver Safety & Compliance: Real-World Strategies from the Front Lines

Caregiver Safety & Compliance: Real-World Strategies from the Front Lines

Erin Cahill

00:00:08

Hello, dear listeners,  welcome to CareSmartz360 On Air, a Home Care Podcast. I’m Erin Cahill, Account Executive at Caresmartz.

Today, we’re thrilled to welcome Emily Scarbrough McFadden, Vice President of Compliance & Education at Showd.me. With over a decade of experience at the crossroads of healthcare, compliance, and education, Emily leads the creation of scalable, state-aware training—CEUs, multilingual modules, and competency-based content—that turns audit readiness into real-world impact.

She champions compliance as a competitive advantage, empowering caregivers with practical, people-centered learning. In this episode, we explore Caregiver Safety & Compliance: Real-World Strategies from the Front Lines.

Welcome to the podcast, Emily.

Emily Scarborough McFadden

00:01:04

Thank you. Thanks for having me.

Erin Cahill

00:01:06

What proactive strategies should agencies use to assess and mitigate the unique risks inherent in home care environments?

Emily Scarborough McFadden

00:01:13

Great question.

Emily Scarborough McFadden

00:01:14

So in home care, we all know there’s no controlled environment like you might see in a hospital floor. Caregivers truly are walking into someone else’s home, into all of the variables and nuances that come with that. so rather than thinking of risk management as sort of a one time checklist and treating it as such, what I like to think of it as is a continuous loop. So starting before a visit even happens. pre visit risk screens play a really important role. These help us identify things like are there safety concerns. Are there weapons in the home or their pets that might interfere with care? challenging family dynamics? those are all really important to help identify as early as possible so that plans can be put in place. But what I want to call out here is that screening just once or just upon intake isn’t oftentimes enough, because risk changes constantly. We want to update it every time new information comes in. That can be from the caregiver, from the supervisor, from an incident report. One, you know, very simple strategy that we see.

Emily Scarborough McFadden

00:02:23

It’s simple but really effective is using a red yellow green indication system where green means the visit is clear. Good to go. Yellow signals, maybe some concern, a check in before the visit, or perhaps a buddy type approach. And red means that there really should be a mitigation plan in place before an assignment is made that might involve the supervisor or making adjustments to the care environment. It doesn’t need to be complex, but it should be consistent. and, you know, talking about that red, yellow, green system, one thing I want to call out is the role of the schedulers in this. They play an absolutely critical role here because they’re oftentimes at the front line of decision making when a caregiver is sent into a potentially risky situation. So alongside caregiver training schedule or training is hugely important, not just in terms of how to read, apply and respond to some of those risk flags, but how to do it in a way that’s fair and equitable. So, you know, for example, we don’t want to see bias creep in really, at any point throughout this process where perhaps certain caregivers are disproportionately assigned to those green assignments, where others might more frequently get yellow or red visits.

Emily Scarborough McFadden

00:03:38

And on the flip side of that, you know, we don’t want risk flags to be misused as a way to deny or limit services to certain clients or certain communities. And so that’s one of the really big reasons why scheduler training is a part of this as well. the other piece that I’d say is absolutely essential is ensuring that this is all backed by a culture where caregivers know that they have the permission to step back if they feel unsafe. So I mentioned earlier that sense of like implicit or explicit understanding that a caregiver should just deal with it. That’s honestly, that’s one of the fastest ways to lose people, or even even worse than that, I end up with preventable harm. and ensuring that caregivers feel safe, confident and that they’re backed by policy and process that supports those decisions is really a big part of this. so, you know, risk management and home care, looking at it kind of at the 500 foot view. it’s more of a loop than it is a checklist as I see it, screening, planning, support, debriefing and then iterating on that based on new information as it evolves, including multiple touchpoints throughout the organization.

Emily Scarborough McFadden

00:04:52

The caregivers, of course, schedulers and supervisors too.

Erin Cahill

00:04:57

And how should agencies operationalize boundary setting and harassment response in the client’s home?

Emily Scarborough McFadden

00:05:03

Yeah, that’s a really, really good point. And honestly, something that a lot of agencies challenge are challenged with because we sometimes assume that caregivers will know how to set boundaries. Will have some language that they can draw upon. But oftentimes in those moments, there is a sense of discomfort that, you know, we will want to practice navigating through in very low stakes environment before something comes up that’s potentially higher stakes. So one thing that we typically recommend is leveraging short, concrete dialogic practice that model respectful but assertive communication in these situations. So for example, if a client makes an inappropriate comment, the caregiver can respond with something simple like that comment makes me uncomfortable. Please don’t say that again. It’s clear, it’s kind, it’s confident and assertive, and it sets a boundary and it potentially prevents a situation from escalating. if the situation escalates, you might coach caregivers to say something like, I don’t feel safe right now.

Emily Scarborough McFadden

00:06:06

I’m stepping outside and I will call my supervisor again. kind clear. leaves room to implement a plan going forward that protects both the caregiver and also allows us to set boundaries and continue care with that individual as well. so again, all of this has to be backed up by policy. A huge part of that operationalization process comes down to how organizations kind of codify this within their, their own systems. if a supervisor, for example, tells a caregiver, oh, well, you really should have stayed in that situation. And any training, any, you know, policy, on paper it kind of falls apart. And that’s where that disconnect between policy and practice can kind of contribute to a little bit of a schism between anything that’s done on the training standpoint, as well as what happens in the real, in-home environments that caregivers are often working in. so, you know, to me, operationalizing this isn’t just about the education piece or about providing scripts. It’s about practicing over time, embedding those things into a framework where caregivers, supervisors, and the organization as a whole has the sort of knowledge and awareness of what appropriate response and follow up looks like in terms of policy.

Erin Cahill

00:07:30

How do mobile training, certificate tracking and reminders keep remote caregivers audit ready?

Emily Scarborough McFadden

00:07:35

Yeah, so in in home care training really has to meet caregivers wherever they are. And honestly, most of the time that’s on their phones. It’s between visits. Maybe a quick check in over lunch. so if we make training complicated, it really derails the whole process. And by complicated, this could mean something as simple as even downloading an app, remembering multiple logins, having to find a computer to sit down at it, you know it simply won’t get done most of the time in those situations. so making sure that training is accessible as possible in terms of where caregivers are, is is a really important piece of that. the second piece I want to call out here is about accessibility. So the use of short, plain language lessons is really, really important here. most caregivers don’t have the time or the capacity to sit down and watch a 45 minute lecture straight through in one sitting. And many are also working in their second or third language.

Emily Scarborough McFadden

00:08:35

That’s why courses should be available across multiple languages designed at reading levels that make sense for the workforce. Again, working towards training that’s really equitable, not just technically available. We want to make sure we’re not just checking the box, but actually meeting our workforce where they are in terms of their their their role.

Erin Cahill

00:08:56

Absolutely.

Emily Scarborough McFadden

00:08:57

And then just a quick note on the compliance side, you know, when things like certifications, dashboards, reports are all automated and one click away that gives organizations that ability as well. So that’s another, you know, really key piece of this.

Erin Cahill

00:09:12

And how do you competency based compliance frameworks enhance caregiver safety and post-acute and home care.

Emily Scarborough McFadden

00:09:18

So as I see it, compliance and competency really go hand in hand. Compliance ensures that caregivers have the right training, the right foundation that’s delivered at the right time, and that the organization is, of course, meeting its regulatory obligations. It’s absolutely critical, but it is the foundation, and it doesn’t alone guarantee that a caregiver really knows what to do or how to apply what they know in the moment.

Emily Scarborough McFadden

00:09:43

And that’s where that competency framework comes in. So a competency framework spells out here’s the knowledge, here’s the skill, here’s the judgment we expect for this role. And doesn’t just test it in a, you know, in a vacuum. It’s not just with a quiz. It’s through observation potentially case scenarios. And if someone struggles, it’s met with remedial training and the opportunity to recheck that skill. So again, it kind of creates that, opportunity to to validate skill and evaluate skill, as well as that feedback loop to practice it in a low stakes environment over time. And the outcome of that is safer care, higher quality care. so I, you know, I’d put it this way. In summary, compliance lays that foundation, competency builds on that and provides assurance. And together they really knit together to create a safety net that both caregivers and clients are supported by.

Erin Cahill

00:10:41

Sorry. What outcome metrics prove training change behavior and not just completion?

Emily Scarborough McFadden

00:10:46

Yeah, that’s an important one. And that’s that’s honestly a really important shift for a long time.

Emily Scarborough McFadden

00:10:51

Success in training was measured by seat time, by just participation metrics. Did the caregiver log in and complete the module. And that sort of tracking is important because it proves the training was delivered, that the training was timely, but it doesn’t necessarily tell us anything about whether or not that caregiver can apply what they’ve learned. And you know, when it really matters. Can they apply it in the moment in the home. So that’s where some of these outcome metrics come in. We can ask ourselves things like, did incident rates go down after training our caregivers, reporting issues faster or more consistently? Are supervisors observing safer care by way of those competency evaluations? and another big one here is retention. Of course, that’s top of mind for many of us. when caregivers feel prepared, supported, invested in, they’re much more likely to stay. It’s not just a workforce win in that case, you know? because it translates to that, direct bottom line for, for agencies. So, you know, compliance level data, completion data tells you that training was delivered.

Emily Scarborough McFadden

00:12:02

That is continues to be extremely important. But building on that outcome, metrics tell you whether or not that training actually made an impact in terms of the day to day care that’s being provided. And that’s where we can kind of start connecting the dots between compliance and actual safety and quality and caregiving.

Erin Cahill

00:12:22

And last question for you, Emily. Which emerging training or compliance innovations in home care are most exciting, especially ones that make safety a strategic advantage?

Emily Scarborough McFadden

00:12:31

So I’m excited about a couple of things right now that I’ll call out. These are both things that I see as opportunities for organizations to position compliance, not just as a requirement or a check the box, but something that points towards a strategic advantage. The first is training that is adaptive and data driven. So right now many agencies deliver the same type of training to caregivers year over year on the same schedule. But you know, imagine if your system could learn and respond from actual incidents or actual competency assessments and, dynamically assign training that’s going to address the areas of, of of risk that you see specific to your own organization.

Emily Scarborough McFadden

00:13:18

So if there is workplace Place violence specific to particular assignments, you might be able to draw trends from that and assign really targeted training and alignment with that to help, of course, correct in those situations. And the other area that I’m really excited about these days is training that is more self-directed and just in time. So, you know, we’ve all seen caregivers walk into unpredictable situations instead of relying on what they learned months ago in orientation or in an annual in-service. Imagine pulling up a script, an exit checklist, a dialogue structure that allows them to have really real time support. It shifts training from something that you took and have to recall and remember to something that’s always available on demand and used as a, you know, truly as a support system, not as a, you know, something that you can check off and revisit, you know, a year down the line. and that layer to me is really the most exciting part, because when you layer in recognition, competency assessment career ladders that links, you know, the safety considerations to the quality of care, to professional growth and development.

Emily Scarborough McFadden

00:14:34

And that circles right back into that issue of retention. and I know that for many of us, that’s absolutely top of mind.

Erin Cahill

00:14:43

Thank you so much for your time, Emily. We really appreciate it. And to our listeners, thank you so much for listening to CareSmartz360 On Air.