Why Daily Pay Is Home Care’s ‘Flavor of the Day’

Preparing for the Patient-Driven Groupings Model (PDGM) and other regulatory hurdles has largely taken center stage in the home health care world. But when it comes to at-home care operations outside of the Medicare environment, workforce challenges remain top of mind for many executives.

That group includes the leaders of Right at Home, Interim HealthCare and FirstLight Home Care, three of the biggest home care franchise companies in the nation.

Overall, the caregiver turnover rate has gotten progressively worse over the last few years, jumping to a staggering 82% in 2018. Last year’s all-time high is a 15% increase compared to 2017, according to Home Care Pulse.


While the CEOs of Right at Home, Interim and FirstLight mostly agree on the significance of the workforce challenges home care faces, they’re each approaching solutions differently.

For Sunrise, Florida-based Interim, winning the workforce battle has partly meant creating a comprehensive “customer service” program for its employees. Broadly, the program revolves around getting feedback on the total caregiver experience and also includes a mentorship initiative.

To make sure new workers don’t feel isolated on the job, Interim additionally uses 30-, 60- and 90-day touchpoints, a strategy often carried out by employers in other sectors, including in the technology industry.


“This is where someone on the Interim leadership team is assigned to every new employee, and they get a touchpoint at 30, 60 and 90 days into their tenure,” Jennifer Sheets, president and CEO at Caring Brands International and Interim HealthCare, said Wednesday during a panel discussion at the 2019 HHCN Summit in Chicago. “Just so they know we’re there — and this [approach] has been really successful.”

Caring Brands International is the parent company of Interim, founded in 1966. Currently, Interim’s team of caregivers provides almost 25 million hours of home health, hospice and palliative care services to 190,000 people annually.

Another workforce solution Interim has implemented: an eight-tier internal certification program for its caregivers, according to Sheets, a former nurse who took over as CEO in January.

“Caregivers and clinicians have a career development path,” she said. “What we get in return for that is a higher quality caregiver, but also some strengths that help keep them attached to our organization.”

In general, career development and training go hand-in-hand with employee engagement. Companies that have higher employee engagement — involvement, enthusiasm and commitment — tend to have better retention rates, according to Gallup.

Another approach Interim is taking to combat workforce challenges is its implementation of “stay interviews” to complement the exit interviews the company already utilizes.

“We routinely pull a random selection of employees and we do a stay interview, [which asks], ‘Why are you here what makes you stay and what would make you leave,’” Sheets said. “That’s been very interesting because are you catching them at a time when they are not trying to leave.”

The franchise company has also found success with its points-based employee recognition program, rewarding active engagement more so than tenure, though the company’s average tenure is over 19 years.

Meanwhile, FirstLight has taken its own measures to retain caregivers and close workforce gaps, most of which are centered around professional development. Today, the company’s turnover rate sits at about 26%, far below the industry norm.

“From Day 1, we’ve really prided ourselves on having core training, orientations and just really forcing the value of the caregiver’s role,” Jeff Bevis, co-founder and CEO of FirstLight, said during the Wednesday panel. “I don’t really subscribe to the caregiver crisis. I think there is a crisis of quality caregivers — but not overall. If we do a good job of taking care of the caregivers, there are plenty.”

Cincinnati-based franchise company FirstLight Home Care provides about 100,000 hours per week of companion, personal and dementia care services to nearly 4,800 clients across more than 254 locations in 34 states.

Bevis’s views on the caregiver crisis are not entirely new within the industry. In August, a long-time home care veteran got candid with HHCN, calling the worker shortage a “myth and an excuse.”

For Omaha, Nebraska-based Right at Home, addressing worker challenges means not only dealing with the current landscape but looking ahead. Already in 2019, the franchise giant is planning for the fact it will soon have four generations of caregivers — millennials, baby boomers, Generation X and Gen Y — within the workforce.

“We are putting a lot of time and effort into research to understand the dynamics of the different generations and their expectations for work,” said Brian Petranick, CEO and president of Right at Home, at the HHCN Summit. “The one thing that we know is — universally, across all of the generations — [caregivers] want to find meaning in their work.”

Right at Home has nearly 500 U.S. locations.

Another way Right at Home is taking workforce action is by pursuing a “partnership approach” with caregivers, according to Petranick.

“They want to be partners in care. They want to feel like they’re partners with the agency and with the family,” he said. “Those guiding principals that [caregivers] are more connected to the family and client than they are to the agency has informed us of the things that we can be doing.”

Digging into daily pay

Daily pay is often singled out as an effective strategy to combating staffing shortages.

In fact, 30% of industry professionals call it the best way to combat staffing shortages, according to Axxess, and companies like BrightSpring Health Services have seen success with the method.

Nonetheless, Bevis warns that daily pay isn’t a silver bullet for the industry at large.

“We have done focus groups with caregivers and most of the time, pay was [the No. 4 issue],” he said. “We don’t really think that daily pay is going to be some kind of silver bullet because our caregiver is primarily not there because he or she is making $12 an hour.”

FirstLight has implemented daily pay for its caregivers on a trial basis, but Bevis doesn’t believe that it will be a permanent solution or benefit.

“I think that it’s almost the flavor of the day, but we are going to wait and see,” he said.

Interim utilizes daily pay intermittently as needed, but at this time the company similarly does not view it as a long-term strategy, according to Sheets.

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