‘Once They’re Gone, They’re Gone’: Family & Nursing Care Rebuilds Workforce After COVID-19 Losses

While in-home care providers have always struggled with caregiver retention, the ongoing COVID-19 pandemic made growing a workforce nearly impossible. In fact, many operators are just now recovering from the labor disruptions of last spring.

Take Family & Nursing Care, for example.

The Silver Spring, Maryland-based private-pay home care provider had its total caregiver count drop by nearly 20% from February to April, according to Mitch Markowitz, the company’s vice president of business development.


Family & Nursing Care has gradually built those numbers back up since then, but retention remains a daily struggle for a variety of reasons.

For starters, the in-home caregiver job itself has never been more challenging, especially with new personal protective equipment (PPE) requirements and internal protocols. On top of that, employers must also now compete with stronger unemployment benefits and other health care segments, as many caregivers are leaving home care for hospital jobs.

“What I would say is our workforce, just in general — especially at that certified nursing assistant (CNA) level — is a very nomadic workforce to begin with,” Markowitz told Home Health Care News.


In-home care providers, too, must also learn how to recruit and onboard workers remotely — another difficult task. All of these recruitment-related challenges are barriers to growth for the Family & Nursing Care, particularly because the vast majority of its hiring comes at that CNA level.

Currently, Family & Nursing Care has about 700 clients in Maryland and the Washington, D.C., area. It has an average annual revenue of about $35 million.

The company has run into these issues despite having a retention rate above industry average, according to Markowitz.

For context, the home care industry’s turnover rate hit an all-time high of 82% in 2018, but rebounded to about 64% in 2019, according to the Idaho-based market research and education firm Home Care Pulse.

“We’ve been trying to rebound ever since May,” Markowitz said. “And it’s been very, very slow incremental growth. That’s mostly because those caregivers, once they’re gone, they’re gone.”

Some of Family & Nursing Care’s workers have come back, but not many. Others are new to the company, interviewed and hired through a virtual process.

Although some organizations see virtual recruitment as the new normal, it has been a struggle for Family & Nursing Care. Additionally, based on their experience, it has been far less efficient.

Even before COVID-19, the company was strict and fastidious with its choosing of caregivers. It went above and beyond to find the right ones for the job, which meant that it normally only hired about 9% of the caregivers that applied.

“Prior to COVID, we would bring our caregivers through our office for the interview process,” Markowitz said. “And it was a very in-depth, face-to-face process, because we want to make sure we get the best of the best caregivers. Then we went all virtual, so everything is being done via Zoom and our competency exams are all online. And that limits how efficient we are. It’s been our biggest barrier to rebounding.”

Having an open conference room where prospective caregivers could come and go throughout the day was a much more seamless process. The alternative route, forced by COVID-19, has led to a harder interview process and more logistical issues caused by technology problems and lack of comfort tech-wise on the caregiver’s end.

“Caregivers are more tech savvy than they were 10 years ago, but they’re not super tech savvy,” Markowitz said. “Many haven’t used Zoom before. Many haven’t used some of the tools like DocuSign. So we’re having to do a lot more hand holding than we ever have before, and it just takes a lot more time and energy to bring on the same number of caregivers.”

There were also heightened unemployment benefits in the spring, which are likely returning with the year-end spending bill just signed by President Donald Trump.

It appears there would be a $300 add-on for unemployed individuals.

But on top of that, there was a great amount of confusion for caregivers — whether they were working at the time or not — over whether they qualified for those benefits.

“We had a lot of caregivers — and some were eligible for unemployment, but there were many who were not — who were trying to file for unemployment. [They] hoped that they could earn money without working at all and exposing themselves to the virus,” Markowitz said. “And a lot of our caregivers are also staying at home because of personal issues and child care, just like anybody else. So we’ve been trying to crawl back up.”

The competition with hospitals

An additional issue for Family & Nursing Care has been luring caregivers back after they left for jobs in hospitals during COVID-19 spikes in their areas.

Hospitals, in some cases, are able to pay more than private-pay home care companies. Many are still looking for CNAs and other support staff, as hospitalizations have surged across the country. Currently, 75% of all inpatient beds in the U.S. are filled, with a significant portion of those being tied to the COVID-19 virus.

Even as care rushes more toward the home and companies like Family & Nursing Care offer hazard pay for workers dealing with COVID-19-positive patients, hospitals remain a formidable foe from a staffing-competition perspective.

Markowitz said he isn’t exactly sure how much more hospitals are paying caregivers — or if they’re paying them more at all. It’s also possible that caregivers enjoy the hospital schedule more.

As opposed to a home care position, where there could be 24 hours of cases available on one day and just four hours on the next, hospital shifts tend to be more regimented.

It could also be a perception issue, where health care workers feel as though the hospital is the best place for them to be. But that perception is likely being overhauled, especially during the COVID-19 crisis.

That’s a tailwind Family & Nursing Care is banking on moving forward.

“The tide is turning, and many caregivers already feel that way,” Markowitz said. “You have more control in a home environment, and you have more control over what hours you work.”

“In private duty, for instance, you can say ‘no’ to cases,” he added. “You can’t necessarily do that if you work in a hospital. So there’s definitely a sea change. … It’s definitely something that we’re seeing with our brand in our area.”

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