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2021 Annual Report

A note from John Dahm
Accra President and CEO

Photo of John Dahm

In 2021, Accra continued to provide quality homecare to clients throughout Minnesota and expanded our service offerings and client base, even though our operating margins continued to be under pressure due to external factors such as PCA pay increases, rising minimum wages, and costs incurred due to the COVID-19 pandemic. 

Despite those external factors, our revenues increased 11.7% to $318.2 million, and I’m pleased to share that in 2021, Accra had a Return on Mission (ROM) of 0.92%, and COVID-19 relief funds assisted in covering our other increased costs.  

Our 0.92% ROM follows two difficult years due to planned investments in our operating infrastructure in 2019 and unexpected COVID-related expenses in 2020.

We achieved the 0.92% ROM in 2021 by: 

Continuing to scale, so we can meet our mission by providing more services to even more of the people who are underserved by the current health care model with homecare services  

Reducing our indirect costs (both administration and overhead) 

Reducing our direct costs, primarily due to our focus on curbing overtime and other compliance measures 

Now that Accra is slowly emerging from the complications of COVID, we are well-positioned to continue to serve our mission into the future. We also continue to pursue potential partnerships to advance our vision of building the ecosystem that delivers personalized care in the home to better meet the needs of those served by the current health care system.  

We are grateful for our employees’ dedication to our mission and are honored to serve each of our clients.  

Administrative and support employees
PCA Clients Served
Minnesotans served
Direct Care staff employed

Client Stories

Highlights from 2021 to present
Reimagining the Hybrid Workplace

Hub and Home

Amid the COVID-19 pandemic, Accra transitioned to a new hybrid workplace model called “Hub and Home.” This new model provides Accra employees with more flexibility, allowing them to work either from home or the office.

With less office space needed, Accra discontinued leases in New Ulm, Lake City, and Red Wing, and we subleased portions of the Accra offices in Minnetonka and Duluth.

Expanding Mental Health Services

Accra acquires Eustice Counseling

In 2021, Accra began the expansion of its mental health services by acquiring Eustice Counseling LLC, a provider of office-based and in-home behavioral health services in St. Louis County. Gary Eustice, the prior owner of Eustice Counseling and a therapist with 45 years of experience, and Eustice Counseling’s full-time therapists joined Accra in the acquisition.

Accra now provides individualized mental health counseling throughout the Twin Cities metro area and Goodhue and St. Louis counties.

Accra also provides adult rehabilitative mental health services (ARMHS) to residents of Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, St. Louis and Washington counties. ARMHS help clients manage the symptoms of mental illness, develop independent living skills and lead a more fulfilling life at home.

Increasing PCA Wages

Accra commits to pay PCAs $14.60 per hour

Photo of a special needs caregiver with her client

To meet rising demand and preserve our caregiving system, we need to provide PCAs with enhanced benefits, standardized training, advancement opportunities, and most importantly, an increased wage. This is the bare minimum these heroes deserve.

Watch now

A Look at Accra’s DEI Initiatives

Accra has continued to build on the work initiated by the DEI committee, which was formed in 2020. An employee survey indicated that our staff wanted more learning opportunities, so Accra launched a monthly DEI newsletter, providing information on important monthly acknowledgments and ways to continue supporting DEI initiatives at Accra.

We have continued our monthly staff support groups and expanded that effort by holding additional sessions to address current events and provide space and support to process as a collective group. Accra continues to host quarterly speakers that deliver inclusive learning opportunities for employees. 

CFSS Transition in Minnesota

Accra was approved as a Community First Services & Supports (CFSS) consultation services provider by the State of Minnesota. CFSS is a new self-directed option being developed by the State of Minnesota to replace the current PCA Choice program and the state-funded Consumer Support Grant (CSG) benefit. CFSS will offer those who need home services more choice, control, and flexibility with their services and supports required to live and work in their community. The implementation date for CFSS is expected to be in 2023. We have developed a business plan around the transition to CFSS and will communicate with our current and prospective clients about the change.

Susan Morgan and Mary Ngunu

Susan Morgan and Mary Ngunu assume new roles

Susan Morgan, Accra Chief Operating Officer

In March 2021, Susan Morgan was promoted to Chief Operating Officer and assumed increased responsibility for operational performance and the overall client and caregiver experience.

In February 2022, Mary Ngunu was named Accra’s first Diversity, Equity and Inclusion Lead.

New board chair and members

Accra Board of Directors

Accra’s board of directors elected a new chairperson and three new members in 2021.

Mark Heston, CEO of Heston and Associates, was elected board chairperson, succeeding Bob Gordon, who retired from the board.

The board also elected three new members:

  • Robin Brown, CIO for Cargill Protein North America
  • Mike Neill, Chief Technology Officer of C.H. Robinson
  • Bonnie Hays, Delegated Vendor Oversight, Enrollment, Electronic Data Interchange and Coordination of Benefits Manager at Hennepin Health Plan.
Supporting Self-Directed Lives Through the Accra Way Fund

Accra Way Fund

The Accra Way Fund is a program that offers funding support for our clients, their families and caregivers.

The fund is used to purchase an item or service that supports a therapeutic goal or enables a more self-directed life. Funds are available for items or services that cannot be paid through Medical Assistance or other funding sources.

  • In 2021, the fund distributed 23 awards, totaling more than $9,200
Analyzing Employee Engagement

Employee Engagement

Early in 2021, Accra organized its first-ever employee engagement survey.

We had an 82% response rate from headquarters staff, higher than the average response rate of 72% for similar healthcare non-profits. Accra has an engagement score of 58%, based on three engagement factors: is Accra a motivating place to work? Are Accra employees happy and committed to staying? And are Accra employees willing to recommend Accra as an employer to others?

The survey results were used to compile departmental reports, determine focus areas that need to be addressed and create action items that will improve employee engagement.

  • 82% response rate from headquarters staff
  • This response rate is higher than the average response rate of 72% for similar healthcare non-profits.
  • Accra has an engagement score of 58%

Accra was selected as a Star Tribune National Standard Top Workplace in 2021 and 2022.

Broadening Legislative and Public Affairs Efforts

Dahm testifies in support of HF 663

In March 2021, Accra President and CEO testified before the House Committee of Human Services Finance and Policy Committee in support of HF 663 and providing livable wages for PCAs.

Watch his testimony below:

Throughout 2021, Accra maintained a robust public affairs effort, providing testimony and timely communications to legislative leaders regarding supports and services beneficial to Accra clients and employees, such as hero pay; change in eligibility for spend down; adjustment in hours to qualify for enhanced rate; increase in the reimbursement rate for PCA services, home care, care coordination and evaluation services; and extension for parents and spouses to provide PCA services.

Accra also prepared editorial pieces for placement in print media, provided testimony in both the House and Senate HHS Committees, and maintained close and productive working relationships with several community partners who share a dedication to our mission.

Our Programs
  • Personal Care Assistance (PCA) Choice

    Self-directed Personal Care Assistance (PCA) Choice services are available to children and adults with disabilities, chronic diseases, behavioral diagnoses and mental illnesses who need assistance with personal care in their homes or in the community. PCA caregivers help with “activities of daily living,” such as dressing, grooming, eating, bathing, transfers, mobility, positioning and toileting, as well as light housekeeping, laundry and meal preparation. The PCA Choice option gives clients a greater level of responsibility in managing their care, while Accra helps handle the employment and management-related functions of your PCA. 

  • Financial Management Services (FMS)

    Accra’s Financial Management Services supports individuals with long-term care needs or disabilities to easily hire and employ caregivers under the consumer-directed community supports (CDCS) program or the Consumer Support Grant (CSG). In each of these programs, Accra helps participants directly employ caregivers and purchase other supports that they need for living in the community. Accra helps participants determine how their program budget is used, receive approval from their county case manager, hire their own employees and choose their own service vendors. Accra then handles all required employer and employee paperwork, payroll, vendor payments, reimbursements, claims processing, tax filings and workers’ compensation on behalf of the individual.

  • 245D Waivered Services

    Accra is a Basic 245D licensed provider of Individualized Home Supports (IHS) without training, respite, homemaker, night supervision and Individual Community Living Support (ICLS) Services. In each service, the person or family selects a trusted, qualified worker suited for their homecare needs. Accra then assigns a 245D Accra Service Coordinator to work with the client and their county case manager to set up and administer Basic 245D Waivered Services while ensuring that all workers are properly trained.

    In 2022, Accra began offering Individualized Home Supports (IHS) with training, which is an Intensive 245D Service. IHS with Training provides support and training to adults who require assistance in at least one community living services category. These service categories include community participation, health and wellness, household management and adaptive skills. Accra matches each client with a fully trained and qualified IHS Designated Coordinator who helps them achieve their stated outcomes and goals. 

  • Home Health Care

    Home Health Care consists of medical and health-related services and assistance with day-to-day activities, including professional nursing services, home health aide services and rehabilitation services, which maintain the security and safety of people living at home. Accra primarily provides Home Health Care services to people requiring continuing care for chronic needs. (Home Health Care is only available in select locations.)

  • Mental Health Counseling

    Accra provides Individualized Mental Health Counseling throughout the Twin Cities metro area and in the Goodhue and St. Louis county areas. Our licensed counselors provide individual counseling for a variety of mental health issues. Counseling services are available in either an office setting or by mobile health, depending on our client’s preference.

    Accra also provides Adult Rehabilitative Mental Health Services (ARMHS) to residents of Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, St. Louis and Washington counties. ARMHS help in areas such as medication education and monitoring; developing symptoms management skills; household management; and employment-related or community living transitions. Supervised by mental health professionals, ARMHS can be provided in an office setting or a client’s home, based on client preference. Current office settings are available for adults in Minnetonka, Hibbing and Virginia.

  • Senior Assisted Living

    Accra High Street House in Lake City offers a quaint assisted living community with comfortable apartments. At High Street House, Accra partners with each resident to create a personalized plan tailored for their specific healthcare needs. 

  • Private Pay

    The Private Pay program allows people to buy home care services with their private dollars when they are not covered by other payers. Individuals are responsible for finding their own employees, and once they do, Accra will assist them with employee paperwork, record-keeping and payroll duties. 

  • Community First Services and Supports (CFSS)

    Community First Services and Supports (CFSS) is a new self-directed option being developed by the State of Minnesota to offer those who require home services more choice, control and flexibility with the services and supports needed to live and work in the community. CFSS, when implemented, is intended to replace the current Personal Care Assistance (PCA) program and the state-funded Consumer Support Grant (CSG) benefit. 

    Accra will offer Consultation Services, a part of CFSS that will help all participants (or the participant’s representative or family member) make informed choices about CFSS. The consultation services provider will support participants by providing instruction on CFSS, the service delivery models and self-directing skills. The provider will also offer guidance in becoming a participant-employer, assist with developing the required service-delivery plan, and obtain approval of the plan when applicable.

    As one of the most experienced providers of PCA Choice and FMS in Minnesota, Accra will provide homecare services under both the CFSS agency and budget models. We will serve clients using whichever model they prefer when CFSS is implemented.

Leadership Team
Board of Directors
Accra Financial Statements

Accra Income Statement for the years ended December 31, 2021 and 2020

Accra Balance Sheet — December 31, 2021 and 2020