Sheryl Duclos
Sheryl Duclos-Zagame, RN, is executive director of Salmon Home Care.

Sheryl Duclos-Zagame, RN, the new executive director of Salmon Home Care, has spent nearly all of her professional life at the same company — but she has hardly stayed in one place.

She started as a certified nurse assistant at Salmon Health and Retirement, a senior living and care operator in Massachusetts, in 1992. She quickly moved up the food chain, becoming an LPN. Before long, the company paid for her to pursue her RN license. 

“I worked on the rehab floor of Beaumont Northbridge to obtain that skill set,” she said. 

From there, Duclos-Zagame became intrigued with hospice, which the company had recently started, and became a hospice nurse, traveling to all six of the firm’s campuses. After obtaining her BSN degree, she moved into management, managing the hospice team — a combination of facility hospice, and community hospice through the Visiting Nurses Association, which Salmon bought in 2012. 

“I eagerly took the post and immediately fell in love with home health and the community hospice team,” she said. 

Following a brief foray into the insurance industry, she returned “home” to Salmon as business operations manager for the home health division, quickly moving into the role of clinical director. Last month, the company named her executive director of the home care division, formerly Salmon VNA and Hospice. Salmon Home Care offers home health, hospice and private duty care to several Massachusetts communities. 

Duclos-Zagame took a break — and a breath — to discuss her new position with McKnight’s Home Care Daily Pulse.

McKnight’s Home Care Daily Pulse: What do you like about home care?

Sheryl Duclos-Zagame: I love the field staff, their dedication, how we’re able to take care of the patients in their homes … and get them as well as they can be so they can be independent again. I love being able to support our community. We’re a small community and people know who we are. We are making a difference every day in that population.

McKnight’s Home Care Daily Pulse: What are your goals in your new role? 

Sheryl Duclos-Zagame: My home health staff, they are incredibly burnt out. They didn’t leave [during the pandemic]. I was very fortunate that in the last two years my home health staff was pretty solid. It’s just recently that it’s caught up with staff, the burnout. I’ve lost staff who have changed careers. Being a nurse, there are so many opportunities. My biggest goal  right now is staff morale and staff retention and how can I make them feel like a part of the team.

McKnight’s Home Care Daily Pulse: What is your turnover like? 

Sheryl Duclos-Zagame: For home health, I’m down four 40-hour slots. I’ve lost just recently two long timers. One was ready to move on and the other was offered a lot more money. We’ve been very, very lucky. I have 45 nurses, RNs and LPNs and CNAs in home health.

McKnight’s Home Care Daily Pulse: Is the nursing shortage real?

Sheryl Duclos-Zagame: I think it’s worse now because they’ve just worked through COVID the past few years. Everyone has altered work lifestyles. It feels like it’s worse because now they’re just willing to call it quits, whereas before they might not have done that. 

McKnight’s Home Care Daily Pulse: You’re a small agency. What are your challenges?

Sheryl Duclos-Zagame: I think some of the challenges we have are the bigger agencies are able to jump on referrals faster. They obviously have more staff. We want to take what we can handle. Coming out of COVID, for home health, PDGM still keeps us on our toes and getting information we need from referral sources so we have adequate referrals so we can get paid. Before PDGM, you’d grab everything and make it work. You can’t do that anymore. [We are] trying to change the referral sources’ mindset. There’s a lot of work behind the scenes. People don’t want to understand it. They can’t send us any referral and not send us supporting documentation. [They think] get the referral and make it happen. 

Patients are coming home sooner and sicker from the hospital. It’s hard on our staff. Sometimes some patients are sent back. The medical system is a challenge that way. We’re trying to figure out how we can support patients in the home who can’t afford to pay for extra help.

McKnight’s Home Care Daily Pulse: How do you do that? 

Sheryl Duclos-Zagame: We have these great social workers who are so talented. They can connect patients to the eldercare services to whatever town they live in and whatever sources they are entitled to. They have the hard conversations. Some patients shouldn’t be home. Patients have the right to make poor decisions so [social workers] honor what they can safely. Social workers do a lot of that work behind the scenes.

McKnight’s Home Care Daily Pulse: Any other thoughts?

Sheryl Duclos-Zagame: One of the ways we’re trying to decrease staff burnout is finding better ways to decrease our acute care hospitalizations, addressing our LUPA rates. I actually hired a data person for quality to help drive numbers, so that we can encourage our staff to have patients be on longer visits — the same number but stretch it out longer — because we see the patients too many times at times. It will decrease burnout, decrease the amount of resumptions of care they have to do and increase overall satisfaction of care. If we can educate the field staff that way, they’ll see the positive in that. She [the data person] started a month ago but we are already seeing wonderful things. 

Editor’s note: Peer-to-Peer is a feature from McKnight’s Home Care Daily Pulse in which we talk to the leaders in home care, your peers, about their operational initiatives, efforts and ideas. If you think someone in home care would make a good subject for Peer-to-Peer, please email Diane Eastabrook at [email protected]