Alliance, Royal Care Slash Caregiver Turnover by Investing in Creative Benefits

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Home care hasn’t always had a reputation for great employee perks or benefits packages, but a handful of providers are beginning to change that.

In other sectors, including the technology and startup worlds, perks like free daily meals, access to wellness programs and 401(k) matching, with stock options, are relatively common. Some home care operators have begun experimenting with similar benefits to help lessen recruitment and retention challenges, especially in light of the COVID-19 emergency.

Overall, the median caregiver turnover rate for home care providers was 64.3% in 2020, according to data from Home Care Pulse. Todd Austin, the Idaho-based research and education firm’s chief operating office, has seen the increase in operators offering creative employee benefits firsthand.


“A few that I thought that were really interesting … were things like paid school leave,” Austin told Home Health Care News. “With this, you get to attend school programs, for example. I’ve heard of a handful of agencies offering this perk to alleviate the pressure on working [parents], allowing them to attend events and be present for their children.”

Other creative perks being offered by some home care providers, he said, include back-to-school assistance programs for caregivers with children. Some agencies have even been carving ride-share allowances into their benefits packages.

Royal Care has been able to stand out in the crowded and highly competitive New York market due to its distinctive caregiver perks program.


Founded in 1995, Royal Care is an in-home care agency that provides professional nursing and geriatric care, plus rehabilitation and housekeeping services. The company’s New York locations include Brooklyn, Flushing, Jamaica, Nassau and the Bronx.

Originally established in 2016, Royal Care’s perks program gives its caregivers access to top manicurists, hair stylists, makeup artists, salon specialists and more, most of which are housed within the company’s Brooklyn-based “perks facility.”

Put bluntly, caregiving is an unglamorous but highly necessary job. Unique programs allow caregivers, many of whom often earn low wages, to have access to services that are often viewed as “indulgences,” according to Josh Klein, Royal Care’s founder and CEO.

“We are a people company. As a people company, you have to put yourself in their shoes and try to understand what they do, then try to facilitate their needs,” Klein told HHCN. “We promote caring for home health aides.”

Along with the beauty services, Royal Care’s perks facility also offers a certified in-house nutritionist, ESL classes, advanced home care training and various technology classes. It also comes stocked with food and beverages.

Partly thanks to its investments around caregiver perks, Royal Care has seen a 90% retention rate over the past few years, according to Klein.

As home care continues to prove its value when it comes to lowering rehospitalization rates and keeping seniors safe in their homes, caregivers will likely find themselves in a position to demand even more, Klein believes.

“You need to entice them, appreciate them and pamper them,” he said. “There is no reason that it should just be big tech companies.”

Of the hundreds of agencies that took part in Home Care Pulse’s most recent Home Care Benchmarking Study, more than half said they offered travel reimbursement as a caregiver benefit in 2020. Over 40% of agencies also said they offered benefits like PTO, health coverage and 401(k) matching.

Just 1.3% of participating agencies said they offered child care or day care services for caregivers. Nearly one-quarter said they offered educational reimbursement.

Other home care companies with standout benefits and perks programs that have translated to industry-low turnover rates include Care To Stay Home and Atrio Help at Home.

Santa Ana, California-based Care To Stay Home is a 500-employee agency with offices in Southern California, Utah, Washington, Idaho and Arizona. The company’s package includes week-long catered events and 401(k) matching.

In recent years, Care To Stay Home has gone from a turnover rate of 78% to 40%.

Atrio Help at Home is a Grand Rapids, Michigan-based home care provider that offers health, dental, vision, disability and life insurance. The company also offers a flexible spending account​ and the option to cash out vacation days.

Additionally, Atrio Help at Home offers a wellness program and access to a success coach. The company has achieved a 37.5% turnover rate.

“In terms of agency size, [Royal Care, Care To Stay Home and Atrio Help at Home] are all over,” Austin said. “The commonality we saw was turnover rate. The proof is in the pudding. They’re able to keep and retain caregivers by focusing on [caregivers’] mental health, wellness and family.”

Generally speaking, if there is a single benefit that has the ability to lower home care turnover, it’s access to child care services, according to Austin.

“When it’s offered, it has had a huge impact on turnover rates,” he said. “Although the data is pretty limited, agencies that offered child care services to caregivers had a 30% turnover rate.”

Like Royal Care, Alliance Homecare is another company that is no stranger to thriving in the competitive New York market.

Founded in 2006, the Manhattan-based Alliance is a private-pay agency that operates throughout New York City and its surrounding suburbs, as well as in Bergen County, New Jersey.

As part of its benefits and perks package, Alliance offers weekly pay, 401(k) matching, health care, covering 60% of premiums, as well as a starting pay of $17. For context, direct care workers across the country earned a median hourly wage of $12.80 in 2019.

“We took feedback from a lot of caregivers, via Home Care Pulse,” Greg Solometo, CEO and co-founder of Alliance, told HHCN. “It allowed us to understand the needs and wants of our caregiver community. A lot of people requested that they get paid more frequently, … so we operationally set ourselves up to do that.”

Alliance also runs “Alliance University,” a caregiver training program that allows caregivers to beef up their knowledge across various topics.

“It’s really important for caregivers to get the opportunity to improve, learn and gain wisdom for their career — and personal lives,” Solometo said.

Along with gaining caregiver feedback, keeping an eye on what his peers in the industry are doing in terms of perks and benefits has been a key to getting it right.

“I’m in touch with the industry, and I do have a sense for what other companies do,” Solometo said.

Not satisfied with resting on its laurels, Alliance has plans to further enhance its benefits package. One area the company is looking to develop is access to child care services, according to Solometo.

“A lot of our caregivers have children,” he said. “This was especially obvious during the pandemic when the schools were not open. People that typically didn’t have childcare needs during the daytime had to figure one out. That’s something we want to try to get in front of.”

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