How to Reduce Turnover Without Raising Home Care Wages

With home care workers in the midst of a nationwide push for higher wages, employers in the industry might naturally think that dissatisfaction with compensation is the main factor behind turnover. But pay very likely is not the primary reason care workers leave the job, and home health companies could improve retention — and their bottom lines — by enhancing communication with staff, experts said this week.

“You can’t buy [caregivers],” said Susan D. Gilster, Ph.D., RN, executive director of health and dementia care consultancy The Gilster Group. She spoke at the American Society on Aging annual conference in Chicago on Wednesday.

Workers in senior care settings routinely rank pay and benefits third or fourth among job satisfaction variables, she noted. Good communication is among the factors that workers rank as more important, but it often gets “the least emphasis and attention” from organization leaders, according to Gilster.


“Communication is critical,” she said. 

She and other senior care experts offered the following tips for improving communication.

Be honest and address rumors


Workers are attuned to challenges facing an organization, and keeping information from them only closes down communication, gives rise to rumors, eliminates a potential source of good ideas for how to improve the business, and makes employees feel that they don’t have a voice, Gilster said. While it may take time to build up mutual trust between staff and owners and managers, company leaders should ask themselves how transparent they are — and could be. 

“Is there anything you know that they can’t know?” Gilster said. “Do you think [staff] don’t know when money’s tight? Why not talk about it? Say, hey, we’ve got to be careful. We’ve got to save our pennies.”

One effective way to quash rumors and build open lines of communication is to play “Fact or Fiction” during staff meetings, said Maria L. Wellisch, vice president of corporate and community education at the Elizabeth McGown Training Institute at Morningside Ministries in San Antonio, Texas. 

Fact or Fiction is an open forum in which workers can pose any question and get an honest response, Wellisch explains. It enables leaders of a company to dispel rumors that might be undermining morale or causing unrest, such as that a building is being shut down or the company is going to be sold, she said. It also provides an opportunity to have conversations about important questions.

“I will tell you the truth,” Wellisch said. “I’ll say that’s fact, fiction, or we don’t know right now. We’ve been talking about it, we haven’t made a decision, do you have any ideas?”

Communicate inclusively

Communication should not take place in silos, strictly among members of a particular part of the organization or a particular shift, Gilster advised. Fostering inclusive communication can be difficult; for example, organizations like home health agencies might involve large numbers of workers who do not routinely gather in a single building together to do their work. Home care workers may be spread out over a wide geographic area and could feel cut off from the administrative side of the organization. 

Technology can help overcome some of these obstacles.

“I think you get over that decentralized problem with a Go-To-Meeting, where everyone can come in on the phone,” Wellisch said. “Then they’re hearing it from you, directly from you, and they’re all hearing the same thing.”

In other words, communication can become tangled if a manager holds numerous smaller meetings and expresses himself or herself slightly differently each time. This can cause staff members to think that some workers are being told different messages than others.

The conference calls also can be recorded, Wellisch noted, so that anyone absent also can get up to speed. And having an online or telephone meeting saves people travel costs involved in all gathering in the same place. However, overusing these technologies also can be a pitfall. Workers will stop participating unless they are assured it is worth their time.

“You’re not doing this every week,” Wellisch said. “You do it when you’re rolling out something new, or telling them something they want to know, or playing Fact or Fiction.”

Start small, be consistent

While having too many meetings might be a pitfall, perhaps an even greater danger is committing to have them routinely but then not following through, Gilster said.

“Whatever you’re going to do, whether it’s meetings or something else, it has to be a sustainable program,” she said. “Please don’t start and stop. Workers hate it more than anything else. They won’t trust you, they won’t participate.”

Wellisch agreed, citing this as a common problem in senior care, and not only in the realm of communication. For instance, starting an employee recognition program but then abandoning it also creates a negative response in workers.

If this lack of follow-through happens frequently, staff members come to see promises and plans made by management as “meaningless,” Gilster said. This erodes the sense of trust that is the foundation of strong communication throughout a home health agency or other provider.

As with many other efforts to improve an organization, a push to improve communication can lead to big success but start with a few modest changes.

“Anything in any amount, sustained over time, is better than some huge endeavor that you’re not going to sustain,” Gilster said.  

Written by Tim Mullaney

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