Thrive: West Coast Home Care Agency Finds Success Despite 110% Turnover Rate

Home Care owners and operators often identify the caregiver shortage as the No. 1 challenge facing the industry. Ana Preciado — who owns a Woodland, California-based Comfort Keepers — is no exception.

Last year, Preciado’s franchise location had a caregiver turnover rate of 110%.

“That means we turned over everyone we hired in the year,” Preciado’s son — Jorge Preciado, the agency’s director of business development — told Home Health Care News.


Despite the high turnover, the franchise has been identified as one of the top home care agencies serving California’s Yolo and Solano counties, suggesting providers can thrive even in the midst of high turnover rates. In 2017, readers of two area newspapers — The Daily Democrat in Yolo County and The Reporter in Solano County — voted Preciado’s agency as the region’s best provider of senior in-home care services.

Additionally, the agency was identified as a 2019 Provider of Choice and Employer of Choice by Home Care Pulse, a home care research and solutions company. Home Care Pulse bases its results on feedback and satisfaction ratings from clients and caregivers.

The Preciados say exemplary customer service helps distinguish them despite the high turnover — which they’re trying to improve with an action plan that puts caregivers at the center of agency decisions.


“In our 15 years, there’s never been a time that we called a client and said, ‘Sorry, no one can make it,’” Jorge said, noting that he and his mother have subbed for caregivers who missed a shift. “If, by nature, hearing that someone didn’t show up for Mrs. Smith’s shift doesn’t make you get out of your seat, get in your car and drive there, regardless of what your boss says, [you’re] not the right fit [for us].”

Building a brand

After growing up as a caregiver to her mother, who had rheumatoid arthritis, Ana Preciado entered the home care field professionally in 2001, when she was hired to do sales for a local Home Instead Senior Care franchise location.

“I just fell in love with it,” she told HHCN. “I felt like it was what I was supposed to do.”

After being laid off in November 2004, Preciado decided to open an agency of her own.

“The next night — if not that night — I was online looking for Comfort Keepers,” she said. “I had heard of Comfort Keepers, and looked into them and contacted them. By January 2005, I was in new-owner training.”

Comfort Keepers is an in-home care franchise with more than 700 locations worldwide. An initial franchise fee of $50,000 is needed to open a location, in addition to working capital to finance start-up costs, according to the national Comfort Keepers’ website.

Meanwhile, Jorge joined the family business in 2014.

Currently, the agency serves about 100 clients with about 120 caregivers in Yolo, Solano and Sacramento counties, according to the Preciados, who declined to share the location’s profit margin.

While the pair admits their revolving caregiver lineup can be a turn-off for some, they make up the difference by providing clients with a different kind of consistency.

“If there’s a concern, we are physically out there,” Jorge said. “We’re not the right company for everybody because some people want to hire someone and have very little management, very little oversight, fewer people in the home, less phone calls coming in — and we’re just not that company.”

Instead, they do what they can with their resources, making themselves available to clients after hours and responding to concerns quickly and compassionately.

“We used to do a lot of apologizing when caregivers did things that made us unhappy, now we’re honest. We say, ‘We’re really [angry], too, that she didn’t show up,’” Jorge said. “Getting honest with [clients] and making them feel like [their] mom’s care is as important to [them] as it is to [us] just goes a really long way.”

Turning around turnover

With two colleges nearby, some of the Preciados’ caregiver turnover can be attributed to students returning to school or graduating, there’s plenty of room for the agency to improve recruitment and retention. In fact, lowering turnover is a key priority for the agency in 2019.

“[Turnover] was really high last year,” Jorge said. “It’s definitely a big focus this year.”

That focus includes initiatives that put the caregiver at the center of every business decision.

“One small change we made was trying to ask clients to be a little bit more flexible in their scheduling for caregivers’ benefit,” Jorge said. “We know that if we keep these caregivers busy and give them the hours that work for them, that they’ll be here long-term, and it benefits us and it benefits the client.”

Last year, the agency also took steps to improve and professionalize caregiver training, with the goal being to better prepare workers for the demands of the job.

“From that came an 18-hour orientation, which before was 6 to 8 hours in person,” Jorge said. “From that came a lead caregiver department that we created. It’s basically just a team of mentors — caregivers that have been with us for a while that have a passion for Alzheimer’s or … hospice or … whatever it may — [teamed] up with newer caregivers.”

Similar upskilling has been lauded by industry leaders as a way to improve patient care and retention.

Now that the programs are in place, this year, the Woodland agency is working to perfect them.

“The ultimate goal is better care for the client always,” Jorge said. “The first step in that naturally is you better train the people that are providing the care, so that’s what we focused on last year. Now this year, it’s honing in on it and focusing on the client experience.”

Thrive is a HHCN series that explores the successes, struggles and strategies of home care owners and operators on the local level.

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