The First 90 Days: What Amedisys, Bayada Have Changed To Retain New Hires

The first 90 days of a caregiver’s journey at a home-based care company are more than an initiation period.

They are a make-or-break window where both long-term employees and quick turnovers are made.

Providers always had an inkling that was the case. Now, more complex data tracking is proving that, forcing providers to dig their feet deeper.


“What I say within our organization is that we actually don’t have a retention issue,” Amedisys Inc. (Nasdaq: AMED) Chief People Officer Adam Holton told Home Health Care News. “We have a nurse retention issue. And to get even deeper, we don’t have a nurse retention issue — we have a nurse first-year retention issue. So, as we solve nurse first-year retention, quite honestly, we solve everything within our organization.”

The Baton Rouge, Louisiana-based Amedisys is home-based care company that operates in 37 states and the District of Columbia. The company offers home health and hospice, as well as high-acuity services in the home through its subsidiary, Contessa Health.

Recruiting with speed, efficiency

A recent study conducted by MissionCare Collective and the National Association for Home Care & Hospice (NAHC) found that 57% of all caregivers in the space quit in the first 90 days.


“In the last five months, we have had the best gains in net clinical hires in the history of Amedisys and we’re really proud of that,” Holton said. “That being said, our retention numbers are not where we need them to be. Having better retention is where you start to see the quality net increase.”

When clinicians leave Amedisys, over 50% of the time it is in the first year.

With nurses moving around so frequently, getting them interviewed, hired and up to speed as quickly as possible has become of major importance.

“From an HR leadership perspective, 90 days has always been a bit of a magic window,” Bayada Chief People Officer Jeff Knapp said. “Knowing that you either capture someone’s heart and mind in that period of time or you don’t. I think that time has actually shrunk. It’s been 90 days for as long as I’ve been in HR, but now our realization is we have to really connect and engage those caregivers much more quickly than that because we’ll lose them a lot sooner.”

The Moorestown, New Jersey-based Bayada is also one of the largest home health providers in the country. It has over 360 locations across 23 states and six other countries.

Nurses, caregivers and clinicians generally know their services are in demand and that they have options.

That’s why providers have focused on being quick and efficient during that hiring process.

“So many of our caregivers are essentially gig workers where they are working for multiple companies,” Knapp said. “It’s whoever can be the fastest to the offer — along with the engagement around the organization. But speed is really, really important.”

For Bayada, the hiring process includes less fat than it used to. It’s a more streamlined process that shows a job candidate that their time is valuable, that they are desired and that they can expect to get to work quickly, Knapp said.

“Our values are compassion, excellence and reliability,” he said. “Philosophically, we’re trying to infuse the cultural part from the very beginning. From the very first time you interact with us, whether it’s from an ad or job posting, even though we’re not telling you our core values word-for-word — we want you to experience that. Because it’s a little tough to say we value reliability, for example, if it took you four days to get an interview and you couldn’t get someone to call you back.”

For Amedisys, the process has also become more personalized and less tedious on the new worker’s end.

“In the first week, what we found in the past was that we — like a lot of organizations — tried to jam too many things into that first week and it created a less than satisfying first-week experience for the new caregiver, for their manager and for the care center staff,” Holton said. “So, at the beginning of this year, we really looked at where we could make this process more efficient – where we could consolidate some of these tasks, centralize some responsibilities and move some things that would have been in that first week later down the road.”

Amedisys reduced the responsibility on new caregivers by 75%, Holton said, which has added to what caregivers should be doing: spending time with their managers and peer mentors.

“We can’t have a one-size-fits-all onboarding program,” Holton said. “You’re going have people who join from a home health background who — and I’m going to make up a number — but five hours of training, they get the basics and then they’re ready to go. Then you bring in a new grad and they might need 70 hours of training and a lot more reinforcement on things that they hear for the first time.”

To manage that variety, Amedisys has hired a number of preceptors to help new caregivers feel confident in their new roles at a quicker pace.

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