The Big-Picture Strategy to Combatting Caregiver Turnover

Recruiting top talent—and retaining them—continues to be a balancing act that management teams struggle with, regardless of the industry. This issue has certainly become an epidemic in the home health care sector, and more hard evidence available supporting this notion.

Stephen Tweed, CSP, is CEO of Leading Home Care, a Louisville, Kentucky-based boutique consulting and publishing firm servicing home health care, hospice and private-pay in-home care agencies across the U.S. and Canada.

In 2006, he began his research on the topic of talent recruitment and retention and discovered a persistent trend: The inadequate supply of nurses and other frontline caregivers simply cannot meet the growing demands of an aging population.


Tweed compiled his years of research into his latest work, Conquering the Crisis: Proven Solutions for Caregiver Recruiting and Retention, and spoke to HHCN to share his insight, as well as best practices, on how to combat employee turnover in the home health sector.

A shrinking talent pool

Contributing to the talent shortage is the dwindling number of faculty, clinical sites and overall budgets for nursing schools to accommodate nursing students. In fact, in his research, Tweed found that U.S. nursing schools turned away close to 80,000 students in 2012 due to the shortage in educational resources.


“It’s hard for many nursing schools to attract faculty because a graduate degree nurse can earn more dollars working in a home health care company than they can being faculty at a nursing school,” Tweed told Home Health Care News.

The lack in nursing faculty is only exacerbated by budgetary hurdles that many educational institutions face throughout the country, he adds.

“Colleges and universities are challenged with budgetary issues across the board, and oftentimes, that carries over into how they fund the nursing school, even though there’s a huge demand for nurses,” he said.

Another contributing factor is the age of registered nurses in the workforce.

In Tweed’s research, roughly 55% of the registered nursing population in the country is 50 years of age or older. However, many nurses leave bedside nursing jobs between the ages of 52 and 55 in favor of other nursing jobs that are less strenuous, such as working in a doctor’s office or clinic.

This lack of new talent to supplement those moving away from bedside nursing creates a growing disparity, explains Tweed.

“We’ve got this aging nurse workforce that’s … moving into retirement or working part-time, [yet] we don’t have the number of new nursing graduates that we need on the front end of the pipeline to keep the pipeline filled,” Tweed said.

Current hiring practices

The shortage in talent has pushed home health agencies to retool their hiring and selection process—but in a way that creates even more issues down the road, according to Tweed.

Many agencies are now hiring candidates that they would not have otherwise interviewed five years ago, as some have been forced to “soften” their criterion for candidates.

“As a result of easing up on their selection criteria, [agencies are] finding that they’re having more turnover, either voluntarily … or involuntarily, where they let people go who aren’t performing their jobs,” said Tweed.

In fact, the talent turnover rate for the in-home care industry was 65.7% in 2016, according to Tweed’s research.

Create and instill culture

While various factors—such as the quality of candidates in the current talent pool—may be out of an agency’s control, establishing and instilling a sense of culture early on in the hiring process may be the key to combatting the industry’s recruiting and retention issues, according to Tweed.

An agency’s culture is comprised of four factors: The leadership style of the CEO; the core values that guide the agency’s actions; the behaviors expected from staff; and the behaviors an agency permits, according to Tweed.

Analyzing, refining and revisiting these four components should lead to creating, what Tweed calls, a “culture of attraction and accomplishment.”

“It’s all about creating a kind of organization where employees want to work, and then telling your story and attracting them and helping them to feel valued and appreciated that they will stay,” said Tweed.

Refining the talent selection process

Systematizing recruiting and talent management processes creates consistency and allows agencies to be more proactive and productive, according to Tweed.

This can involve utilizing technologies like applicant tracking systems that automate the interviewing process, as well as pre-employment selection tools.

Refining and utilizing a system paves the way for consistency in the talent search process, explains Tweed.

“[The] first step in the process is defining your best caregivers … How did you find them [and] how can we use that information to go out and attract more people who are like them?” said Tweed.

Management buy-in

Creating a culture and refining recruiting practices starts at the top, and buy-in from management is integral to success, according to Tweed.

“I think the big thing is for CEOs and C-suite leaders in home health agencies to craft a big vision of what they want to grow as an agency, and recognize that part of fulfilling that vision is the culture of that agency,” said Tweed. “This is a big-picture, long-term strategy.”

Written by Carlo Calma

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