3 Ways Home Care Providers Can Maximize an Employee’s Last Day

With industry turnover rates consistently above 60% and estimated costs to replace veteran employees averaging thousands of dollars, strengthening retention remains a top priority for most home care providers. Getting off to a good start with new hires is a pillar to successful retention, but providers can’t afford to overlook employees’ last day on the job either, labor experts caution.

In many ways, home care employees’ last day can actually be as important and valuable as their first, Crystal Adams, director of HR for South Carolina-based Interim HealthCare of the Upstate, told Home Health Care News.

“We invest heavily to ensure that employees’ benefits are competitive, the workplace is fun and engaging, and that our teams feel a sense of purpose in their work,” Adams said. “Despite all our efforts, employees still do occasionally leave. We meet with the employee to ensure their concerns are heard, and we respond timely — communication and follow-up are key.”


Anna Ortigara — workforce innovations consultant for New York-based direct care workforce advocacy organization PHI — echoed those sentiments.

“The big thing is just creating a general culture of retention,” Ortigara said. “That doesn’t mean people won’t ever leave — because that’s going to happen. But if you’re talking to people all along the way, finding out how they’re doing, asking them what’s working and what isn’t, then you put yourself in a better position.”

The direct cost of turnover per frontline home care employee is at least $2,500, based on a conservative working estimate, past PHI research has found. The indirect cost — for example, losses attributable to quality of care or client satisfaction suffering — is likely much higher.


More than regulatory uncertainty or changing payment models, staffing is currently viewed as the in-home care industry’s No. 1 challenge, a recent HHCN survey revealed.

Here’s how home care providers can prepare their businesses to get the most out of their employees’ final days. In addition to Adams and Ortigara, advice was also provided by Mari Baxter, vice president of operations of Maryland-based Senior Helpers, and Aaron Marcum, founder of Idaho-based Home Care Pulse.

Take advantage of exit interviews

Throughout the business world, exit interviews are conducted about three-quarters of the time an employee leaves, a Harvard Business Review survey of more than 200 companies found.

However, those interviews don’t always achieve what they’re intended to.

In the home care industry, in particular, face-to-face exit interviews all too often fail to boost retention, largely because exiting employees aren’t honest in their responses or home care providers aren’t asking the right questions.

“A lot of times, employees just leave and aren’t that willing to talk about why,” Ortigara said. “It gets back to that idea of people not wanting to burn bridges or thinking, ‘I’m done. I’m done with you.’ It’s hard.”

In some cases, having employees who aren’t direct supervisors perform the interview can provide a solution. Because they’re further removed from the departing worker, they may be able to secure more transparent feedback. In other situations, conducting exit interviews via phone may also help elicit more honest responses.

Being able to read body language is one major advantage of an in-person exit interview, Marcum, who now serves as Home Care Pulse chairman after stepping down from the CEO position in November, told HHCN. Erik Madsen currently serves as Home Care Pulse’s CEO.

“Sitting down [with an employee] is always better, in my opinion,” Marcum said. “When you’re sitting down with them, you can maybe read body language and better assess feelings.”

In that interview, here are three questions that every provider should ask: How likely are you to recommend employment to another individual? What can we do to improve? What is it that you enjoyed most about working here?

Recommendations about the optimal length of an exit interview vary, but typically range from an hour to 90 minutes, according to the Harvard Business Review survey. Normally, the healthier communication was during employment, the better it will be during an exit interview.

“Half the battle of having employees leave on good terms is making sure the caregiver has had steady employment and consistent communication throughout their time with the employer,” Senior Helper’s Baxter told HHCN. “Working remotely can leave some caregivers to feel isolated, unappreciated and without constructive feedback. It’s important to stay in constant communication with caregivers, visit them onsite, offer training experiences and provide feedback.”

Use third-party follow-up services

Home care providers that attempt to gain last day feedback via multiple avenues often increase their chances of uncovering actionable insights, labor experts point out. Those avenues can include web-based surveys, telephone follow-up interviews or even hardcopy questionnaires sent through the mail.

Nearly 60% of former employees who receive and answer a questionnaire several months after leaving their job provide different reasons for leaving than those given during their in-person exit interview, a Personnel Psychology study previously observed.

“There’s power in getting that non-biased feedback,” Marcum said. “Sit down with a caregiver, but then maybe follow up with a survey.”

Another interesting note from the Personnel Psychology study: Every exiting employee who participated later ended up providing a reason for leaving their companies — even if they didn’t during an initial exit interview.

Besides sniffing out additional information on employees’ motives for departure, follow-up surveys or questionnaires complementing an in-person interview can also show that a provider is willing to go above-and-beyond when it comes to creating a positive work environment and improving retention.

“Whether the separation is voluntary or not, we want all departing employees to leave with a positive image of the company and their time here,” Interim HealthCare of the Upstate’s Adams said. “We ensure that all measures have been taken to rectify any previous issues as well as ensure our patients and other staff members are taken care of.”

Don’t stop trying

A final tip for home care providers looking to maximize their employees’ last days: Don’t stop trying to keep them.

“Is there an opportunity to save them?” Marcum said. “Perhaps there were some things that they misunderstood — or that you misunderstood. Maybe it’s somebody you really want to keep.”

More than 2 million home care workers across the country provide personal assistance and health care support to older adults and people with disabilities. While many states have moved to raise their minimum wages, a substantial portion of these workers live at or below the federal poverty line.

That means an offer to even slightly increase pay could have a huge impact. Of course, that’s not always a realistic strategy for providers.

“And offering them more isn’t always a reason an employee will stay,” Marcum said. “But trying to keep them might show them you’re recommitted, that you’re going to fix the possible problem.”

As a way to discourage workers from leaving to competitors, some home care providers have also begun to use noncompete clauses. As the caregiver shortage continues and home care demand continues to rise, some home care attorneys believe the use of restrive agreements will become more common.

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