Showcasing: Donna McNamara, MPH, RN; Vice President, Chief Operating Officer, Unlimited Care, Inc.
“We grow with our challenges. It's not in the easy times that we grow."
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 Donna McNamara, Vice President and Chief Operating Officer of Unlimited Care. Established in 1975, Unlimited Care is a leading licensed home health care provider with 16 offices in New York. In this article, Donna tells us how she began her 35-year career in homecare, why she believes an open-door policy is key, and why she’s hopeful brighter days are ahead of us.
What is a typical day like at Unlimited Care?
In homecare, there are no typical days. I start every morning with a meeting with the Director of Human Resources and Payroll, because as we know, homecare is a very person-centered industry. It’s all about the people – the patients, the field staff, the office staff. I’ll read through my emails, answer phone calls, respond to requests, attend meetings. And then all of a sudden, without fail, something will happen. It will either be a new regulatory requirement, or Department of Health surveyors will walk in, or we’ll get a request for OMIG…
No matter what happens, our primary focus every day is to maintain compliance, quality, and integrity. I go where I am most needed – whatever path it takes me, that’s the path I follow.
Did you always know that you wanted to work in the homecare industry?
From the time I was a kid, I always knew I wanted to be a nurse. My mother went back to work when I was in kindergarten, so one of our neighbors would watch me after school. That neighbor was actually an LPN and worked private duty. I remember her coming home in the white nurse’s uniform and the white shoes, and she’d take me to the hospital after school on Fridays to pick up her paycheck. Everything about the hospital environment just fascinated me.
As a sophomore in high school, the guidance counselor asked me what I wanted to be, and I said a nurse. I later founded my high school’s Future Nurses Club.
When did you make the move to homecare?
I started out my career as a nurse at a large medical center on a medical/surgical unit. At that facility, we really learned about primary care nursing and how essential it is for nurses to work alongside the multidisciplinary team to develop a personalized plan of care for the patient.
Later, I decided to get my master’s degree in public administration with a focus in healthcare management. I learned about operations, finance, and budget, and how to shape a healthcare organization’s leadership and administration.
While I was working on my nursing home AIT (Administrator in Training) program, the administrator of the nursing home was seeking department of health approval to operate a long-term home health care program . The program was approved and they needed a per diem nurse, so they asked if I’d come on board. I never did homecare in my life, but I said, ok, I’ll try it.
The first day I worked in homecare was April 1, 1985, April Fool’s Day. The director of the program had called in sick. I said, well ok, what do I do now? They told me to answer the phone and read the charts, so that’s what I did. And that is how I started in homecare. It was kind of like a baptism by fire, but I liked it.
What makes you so passionate about your career in homecare?
When I was doing homecare visits, I’d care for people with medical conditions and disabilities, and whether their illness was acute or chronic, they really wanted to stay home. They fiercely wanted to be home with their families, and their families wanted them to be there. It was like being in primary care nursing again. People accepted the primary care nursing services in the hospital, but now they were able to receive the care and service where they wanted to be – in the home.
I love my work. I love my job. I like working with the staff, training, problem solving, supporting them no matter what. I’m very hands-on. I understand what they do because I did it. I’ve been there. I did homecare visits in New York City, walking up 19 flights of stairs in a housing project where the elevator is not working and it’s July and it’s 100 degrees.
I guess you might say I like a challenge, and homecare is certainly a challenge. I would never work in any other industry.
What are some of the changes made during COVID-19 that you think will stick in the post-COVID world?
In homecare, you have to recruit and hire care professionals all the time – you can never have enough. We had to devise virtual ways of doing almost everything – from interviewing, to submitting applications and paperwork, to the whole hiring and orientation process. We also moved our in-service education programs online. I’m sure that many of these practices will continue going forward.
Most importantly, we’ve learned to adapt. I’ll say to the staff, we all knew our jobs, but now our jobs are different every day. We all have to move forward with the challenges.
If you did not work in the homecare space, what would you be doing as a career?
I think I would be in a field that is customer-based. I will say that I could not see myself in any career as rewarding as homecare. I could assume it would be in some aspect of health care. I am always looking or a new challenge and welcome change.
What has your staff’s experience with the COVID-19 vaccine been like so far? What challenges are you facing as a home care professional with the vaccine roll-out?
The main challenges are securing appointments and decreasing staff hesitancy around the vaccine. We’re encouraging staff at all levels – office, field, clinical staff, management staff, everyone—to get vaccinated. We provide staff with educational resources, whether from the CDC or New York State Department of Health, so they can feel informed and confident in their decision.
As new community-based vaccination sites open up, I’m encouraged that more people will get vaccinated. It’s a challenge to be working in homecare, not knowing your work schedule well enough in advance, taking care of children doing remote schooling… so for the vaccine to be more accessible is a very good thing.
Staff hesitancy is something we always deal with, even with the flu vaccine. We try to educate and motivate employees every year. We’ve also promoted vaccination with incentive programs, gift cards and raffles for everyone who gets vaccinated.
What traits do you think make a good leader?
As a leader, you have to be knowledgeable, and you always have to demonstrate respect. People need to be respected and need to know they are respected.
Communication is also key. It doesn’t always have to be in a grand fashion; it can just be a matter of saying thank you.
For example, one of my sayings is, “Tell the story and close the circle.” That’s how you do your documentation. You leave no room for “what-ifs”; everything is right there on the report. If I read an incident report that a nurse or other staff member did an excellent job filling out, I’m going to reach out and acknowledge their good work.
Also, you should never be too busy to listen. I have an open-door policy; people can call me and talk to me about anything. I might not have all the answers, but we’ll work through it. As a leader, you have to recognize that you’re only as good as your team is.
What are some of the things Unlimited Care does to help their caregivers feel confident and empowered on the job?
Unlimited Care is very focused on training and education. We also work very closely as a team. Homecare can be isolating at times, so we make sure aides know that we are all part of one team and that they are never alone. We encourage our aides to speak up if they are ever struggling with anything and to let their needs be known.
Unlimited Care was started in 1975 and it is still under the same ownership. Most of our employees stay with us for a very long time. I think one of the main reasons for that is because we focus on each individual and we offer and encourage career progression; we want to see them move up on the career ladder.
What advice would you give to a caregiver or another person who is struggling in their work right now?
As I say, we all used to know our job and now every day our job changes. I remind them that we will get through this, we have become stronger and more resilient. We keep persevering because we’ve made a commitment to the people we care for.
We grow with our challenges. It’s not in the easy times that we grow.
After the pandemic in 1917, came the roaring twenties. I’m hopeful that we’ll get to the roaring twenty-twenties. You have to have hope.
How do you keep up with the industry’s changing rules and regulations?
I do a lot of reading – newsletters from the homecare associations and the state, bulletins from attorneys and other regulators. I attend meetings and webinars. I love to learn so I am always looking for new opportunities to learn and grow.
Years ago, before the growth of technology, when the NYS Department of Health had a change they’d send a letter to your organization. You’d never know if the letter would end up on the right desk. Now we get emails delivered directly to our inboxes. I think now, more so than 30 years ago, there’s a great sense of being connected to the industry and being a part of it all.
What’s the best piece of advice you’ve ever received?
My mother used to say, “There’s a right way and a wrong way, and you have one choice.”
But figuring out what is the right thing to do is not always easy. That’s why I’ve been driven my whole career by compliance, quality, and integrity. Because those are the right things. And you have to do the right thing by people.
What keeps you going on the tough days?
I’ve been a nurse for over 45 years and in homecare 35 years. I’m just very thankful – for all the patients we care for, whom we mean so much to.
The staff, the people I’ve worked with today and over the years have just been an inspiration to me to keep going. I just love what I do.
I wish COVID would end. We just have to be hopeful. That is what I try to give the staff. We will get through this. We’ll do it together.