Irisi Dulo

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 Irisi Dulo, who serves as Chief Operating Officer at AZ Billing, LLC, a consultancy that helps consumer-directed personal assistance (CDPAP), home health, and nursing services get their finances on track. Prior to AZ Billing, Irisi worked for eight years as an administrator at Mrs. G’s Services, a New York-based homecare agency providing care to patients of all ages and abilities. In this article, Irisi shares her unexpected path to homecare, what she believes to be the mark of a successful agency, and why today’s industry members may need a mindset shift.

What brought you to the homecare industry?

I had just earned my Master’s Degree in Criminal Justice, and my husband’s family needed help running their homecare agency, Mrs. G’s Services. I thought I’d help them out while I was looking for a job, and then move on to something else. That was almost eight years ago, and I still haven’t left homecare.’

Did your education in Criminal Justice prepare you for your work in homecare?

I started out working in Human Resources, then I became the agency’s compliance officer, and then I transitioned to administrator. My knowledge of security and investigation definitely helped me in my work as compliance officer.But nothing can prepare you for homecare – you learn it as you’re in it. It can be very overwhelming, in the good and the bad. You love it and you hate it. There’s never enough money to do what you want to do, because you want to do it all. You have to know how to prioritize.

What do you love most about your work?

We are all in this business to help people. It’s satisfying to know that you have changed so many lives for the best, and to see so many happy patients and their families.But that’s just one part of it. I love to be busy, and I don’t think anything could keep me as busy as homecare! I wake up, and I know I have something to do. I go to sleep, and I know I have something to do. For my personality, I need to have something to do at all times, otherwise I get bored.

If there is one key to running a successful homecare agency, what might it be?

I tell my staff all the time: When you wake up, you have to think of your mom and dad. Think about those two people, and pass those feelings to your patients and aides. If you treat your patients and aides as you treat your parents, they will never leave you, because you’re treating them like your family – with respect, and with dignity.Everything else – the rules, the regulations, they come and go. They’re never going to stop. If those things keep you from running an agency, you probably shouldn’t be operating one in the first place. You have to be prepared for those changes.

What’s the mark of a successful homecare agency?

Mrs. G’s Services never had money for marketing. We always had families working for us – mothers and their sisters, sometimes five, six, or seven members of the same family. I always felt, we must be doing something right for our employees to want to bring their whole family to work for us.Same with our patients – we always cared for the neighbor of the neighbor, the friend, the sister, the husband of someone. When people have a positive experience with your company and tell others about you, that’s how you know you’re doing something right.

What’s your greatest challenge in the position you’re in today?

The biggest challenge is having the money to do what we want to do. The caregiver shortage is the next one. I don’t have answers to either of those challenges. If we had answers, I don’t think the whole industry would be in the same situation as we are.Ideally, the solution would be to pay caregivers more, and recognize their work more. Pay is tied to funds, so that is a bit difficult because you can’t pay them more if you’re not getting the proper reimbursement. The best you can do is treat your caregivers with dignity, as you’d treat your family.

What are your daily habits for success?

I’m constantly learning. I don’t think I could be where I am today if I didn’t spend hours researching every night. Just yesterday, I spent two hours reviewing the FMAP (Federal Medical Assistance Percentage) – the ins and outs of the law, how to make changes, how to apply, how to make the best use of it.It’s a lot of reviewing policies and regulations. This takes time, and it’s usually not something you can do during your 9-5, because your priority during those hours is running a company and handling emergencies.You need to be very organized, very focused, and very patient. You’re working with sick people who are frustrated and upset, and who might take their frustration out on you. You need to exercise patience and understand that nothing is personal.

How do you handle the difficult tasks that come your way?

There were times, especially during my first three years in homecare, when the work was mentally, emotionally, and physically draining. I had my moments when I wanted to walk away and not come back. But the part that keeps me going is the challenging part. I don’t give up. That’s not me. I can do it. I find a way to do it.You can put systems in place that make it easier for you. Stay focused and find a way to organize your day. The more you learn, the easier it becomes.

Have you made any mistakes along the path to where you are today? How’d you handle them?

I’ve made many mistakes. The only thing you can do, is do it again. Failures are the best way to learn.I tend to be a perfectionist in my professional life. If I make a mistake, I look at other people who did it right, and I learn from them. Or I think, if they can do it, then I can do it better – I just have to put in the effort and try harder.If others did it, I can do it, and my family can do it. My daughter can do it. Homecare is run by women and owned by men. We have to switch that. Women can get there – we have all the abilities, because we are running the companies. It’s time to take that mindset and move up.

What are three things homecare agencies can do to thrive in today’s environment?

1. Manage money well. The reimbursement rate is limited, and we have to do the best we can with what we have been given.
2. Invest in training. The more prepared your staff is, the better your patients will be treated, and the more growth your company can achieve.
3. Embrace the younger generation. I cannot stress this enough: You need to hire younger people and share your passion for and knowledge of homecare with them. The older generation is a wealth of knowledge, but the younger people are the ones who are going to walk with me in Albany for seven hours to advocate for what our staff and patients need. Take your younger staff to conferences and industry events so they can learn what our problems are and advocate for better.

If you could give your younger self any advice, what would it be?

Homecare is not a sprint – it’s a marathon. There is no finish line after five miles. There are miles, and miles, and miles. You just have to keep putting the work in, and the success will come.

What is one goal you’d like to achieve this year?

Right now, my goal is to support other agencies, as I supported Mrs. G’s Services. At AZ Billing, our primary focus is to help agencies overcome their management challenges and improve their reimbursement rates. The more agencies we can help, the better.To make homecare work, the industry needs to work together. There is enough business to go around – we don’t have to see other agencies as competition.What we can accomplish together is tremendous – we just have to put our minds to it.