Home Care Agencies in 2021 Saw Client Turnover Spike, Caregiver Churn Stay Flat

Home care agencies saw client turnover spike in 2021, though not necessarily for negative reasons. Operators at the same time saw caregiver churn remain mostly flat, despite the ongoing labor pressures associated with the COVID-19 pandemic.

That’s according to preliminary data from Home Care Pulse’s annual benchmarking study. Executives from the Idaho-based firm previewed these and other insights Tuesday during its Home Care Growth Summit.

“When you get the study here in a couple months, these trends could slightly change,” Home Care Pulse President Todd Austin said. “But we do feel like there’s a large enough sample size to put an early trend to them.”


The Home Care Pulse benchmarking study collects roughly 300 data points from hundreds of different home care operators each year. The 2022 version, which digs into trends from 2021, already has responses from 504 agency locations.

“Data is really important to the industry,” Austin added.

One of the big takeaways so far is that the home care industry’s client turnover rate jumped in 2021, hitting a five-year high of 76%. Home Care Pulse measures client turnover by taking the total number of clients who stopped services and dividing that by the average number of clients.


In 2020 and 2019, client turnover was 57% and 59%, respectively.

Source: Information shared during the Home Care Pulse Home Care Growth Summit on Feb. 15, 2022.

“It’s a bit of a surprise to see numbers this high,” Tyler Guthrie, director of revenue operations for Home Care Pulse, said. “But it’s something that we’re going to keep an eye on.”

High client turnover may sound problematic, but it’s often a result of home care agencies behaving more strategically when it comes to the delivery of services. With a shortage of caregivers and skyrocketing demand, operators need to make sure they’re deploying those resources in the best way possible.

In some instances, that could mean diverting a caregiver away from low-needs clients who require an hour or two of care and reassigning that worker to a more complex, time-intensive case. In others, it could mean dropping clients because they turn out to be “bad fits” for the assigned caregivers.

“When it’s a struggle to staff, you really look at optimizing who you’re staffing for,” Austin said. “And so we likely saw that being a pressure on the industry – of going through your clients and making sure they’re right-fit clients.”

To some degree, the fact that caregiver churn stayed flat last year was likewise surprising.

Across employment sectors, roughly 33 million Americans have quit their jobs since the spring of 2021. The mass exodus of workers – driven by pandemic-related burnout, early retirements and other factors – is so pronounced that it has become known as “The Great Resignation.”

And senior care employers have been hit especially hard.

Even so, the median caregiver turnover rate in 2021 was 64%, according to the preliminary Home Care Pulse findings. That’s right in line with 2020 and 2019, when the turnover rates were 65% and 64%, respectively.

Across jobs, the overall turnover rate was 57.3 % in 2021, though that figure drops to 25% when considering only voluntary turnover, according to the U.S. Bureau of Labor Statistics.

“We’ve seen a lot of economic turmoil. You have The Great Resignation. COVID and other economic issues impact turnover,” Guthrie said. “But we’re sort of breathing a collective sigh of relief that the turnover hasn’t jumped and spiked any higher.”

Source: Information shared during the Home Care Pulse Home Care Growth Summit on Feb. 15, 2022.

To stave off caregiver turnover, many home care agencies have raised caregiver wages.

The starting pay rate for companion and homemaker positions increased by 9% from 2020 to 2021, preliminary Home Care Pulse benchmarking study data suggests. Starting pay for personal care attendants jumped 8.5% during that time, while pay for certified nursing assistants climbed 6.5%.

“We increased right around 9%,” one Home Care Growth Summit attendee commented. “[$15 an hour] is now our new-hire minimum wage.”

“It’s very difficult when people can go to Walmart and make $15,” another attendee noted.

The bulk of home care operators surveyed by Home Care Pulse thus far – about 45% of respondents to the 2022 benchmarking study – view recruitment and retention programs as their No. 1 growth opportunity. In contrast, 5% see “expansion into new markets” as a top growth opportunity, with just 4% feeling that way about acquisitions.

“Anytime there’s external pressures like we have in industry today, there’s going to be winners and losers,” Austin said. “And so, you know, I love seeing initiatives around company culture, and really working toward a long-term solution to your employment brand.”

Median home care revenues, tracking readmission data

In addition to previewing data on client and caregiver turnover, Home Care Pulse shared the latest home care revenue figures, along with some interesting findings around tracking hospital readmissions.

Over the past five years, the home care industry’s median revenue has grown by about 20%. That positive trend continued from 2020 to 2021, though the overall growth rate slowed slightly.

In 2021, the median revenue for the home care industry was $2.02 million, according to Home Care Pulse. That figure was $1.95 million in 2020 and $1.81 million in 2019.

“We’re seeing a slight bump in median revenue,” Guthrie said. “Despite a lot of the challenges that we’ve [had], both economic- and pandemic-related over the past few years, we are seeing revenues continue to climb.”

As for tracking hospital-readmission data, just 18% of home care agencies did that last year. That’s actually down from 2020, even with many industry leaders touting the importance of data tracking, with payers and referral partners asking for that information more often.

“If your scheduling [system] or your EMR doesn’t have this capability, you need to be a voice of change with them,” Austin said. “And we need to start really tracking this metric.”

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