Six Numbers that Can Unlock Better Home Care Staffing

It’s no secret that staffing presents a huge challenge for home care providers, with agencies across the country routinely seeing sky-high turnover rates. As of 2015, the median caregiver turnover rate was upward of 60%, according to survey data from Home Care Pulse.

“This is crazy high,” Georjean Sweis, director of operations for Visiting Angels/Living Assistance Services, said Tuesday at the annual Home Care Association of America (HCAOA) Leadership Conference in Anaheim.

There’s no silver bullet for bringing turnover down and improving recruitment, but home care providers can achieve notable improvements by being sure that they are following best practices throughout the hiring and onboarding process, Sweis said. Home care providers looking for a place to start may want to consider the following numbers, to see if their workforce strategies are adding up to success.


2 Interviews

Hiring home caregivers is a “speed game,” Sweis emphasized. That’s because qualified candidates are in extremely high demand—caregiver shortages ranked as the top threat facing the industry, in Home Care Pulse’s 2016 Benchmarking study.

Therefore, agencies need to streamline their hiring process as much as possible to prevent losing prospective workers to competitors. So, if an agency intends to offer an applicant a second interview, don’t let that person walk out the door. Instead, ask the person to stay and conduct the second interview immediately, Sweis advised.


Checking references, doing background checks, and other due diligence is necessary, but if possible, she would even make a job offer on the spot, she said.

20% Hired

To have a maximally efficient recruitment process, it’s crucial to be measuring how many applicants make it through various stages of the hiring journey, such as a first interview, second interview and job offer. If too few applicants are viable, that means an agency needs to reevaluate its practices, said Sweis.

“I would say that if your numbers aren’t around 15% or 20%, you may want to look at where your folks are coming from to begin with,” she said. “If you’ve got a hundred applicants from Craigslist, but only one is a viable candidate, what does that tell you?”

Some agencies are hiring dedicated recruitment/retention coordinators to be responsible for maintaining an active, high-quality pipeline of candidates, and spearheading retention efforts. The savings achieved through lower turnover and the value-add of a more experienced workforce could well make the salary paid to this person well worth it, Sweis noted.

30 Minutes

If it’s taking applicants longer than 20-30 minutes to fill out an application, that is a barrier that needs to be addressed, according to Sweis.

It should not only be easy for caregivers to apply for a position, but they should have various options for doing so, such as online versus in person, she added. And it’s always a good idea for agencies to have an attorney review the application if any changes are being made, to ensure it’s still compliant.

5 Hours

The onboarding process for new caregivers is a crucial part of setting them up for success. A four- or five-hour orientation is reasonable, Sweis said.

This time should be spent in a variety of ways to keep the new hires engaged, she advised. Having different people speak, mixing in a PowerPoint, and showing video are some options for different ways to convey information. But more outside-the-box approaches also can be effective. One agency, for instance, brings in a recipe for cookies and has the group prepare them.

Other suggestions for orientation include having the new workers affirm verbally that they are committed to being a part o the team and meeting the quality expectations that have been conveyed. Emphasizing customer service and the customer experience also can be powerful. For example, ask the new hires to imagine what a first-time home care client feels like half-an-hour before the first scheduled visit—the nerves and uncertainty—and then the positive feelings the client experiences when the caregiver arrives on time.

Coming out of orientation, agency managers should have a sense of the new caregivers’ strengths and some “stretches,” or areas for them to work on improving, Sweis said.

90 Days

The first 90 days are crucial from a retention standpoint, Sweis stressed. So, agencies should devote extra time and attention to new caregivers in this period. That means having robust communication, accompanying them on ridealongs and providing a steady stream of feedback.

At the end of the first 90 days, or after a certain number of hours worked, do a performance review, Sweis recommended. What is said should come as no surprise, and should be related to the “stretches” identified at orientation and the feedback that has been given; rather, the review is a chance to reinforce a plan to keep the caregiver engaged and improving.

10% of Caregivers

Mentoring programs are catching on in home care, Sweis said, and they can provide a big retention boost. One approach is to identify the top 5% to 10% of caregivers on the payroll, provide them with some mentorship training and extra pay, and then pair them up with new hires. The mentor might accompany the new caregiver on his or her first case, and then provide ongoing guidance and support.

On the other hand, it’s also important for agencies to be tracking the lowest-performing 5% to 10% of caregivers. At weekly meetings, the management team can evaluate these workers and discuss strategies for improvement or, if need be, an exit. But to really reduce turnover, the focus also should be on the most troublesome 5% to 10% of clients—and separating from these clients also is a move that agencies need to be willing to make, Sweis said.

That’s because maintaining a positive working environment is crucial for high retention, and clients that are extremely difficult to work with can compromise this; and, in many cases, the manpower and other resources being devoted to these clients means that they’re not even profitable cases, Sweis said. It may be that the individuals simply are not good candidates for home care, and the agency needs to prioritize its workforce over these problem clients.

Written by Tim Mullaney

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