Why Home Care Leaders Are Now Banking On ‘Caregiver-First’ Cultures

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Over the last several years, a notable trend is emerging in home care: Top-tier companies are shifting their focus from prioritizing customers to prioritizing caregivers.

This strategic move reflects a growing recognition of the critical role caregivers play, and aims to address persistent caregiver shortages.

“The trend has always been there, but I think now we’re acknowledging it for what it actually is,” Best of Care CEO Kevin Smith told Home Health Care News. “And the reason for that is rooted — in my opinion — almost squarely in client demand. We know the clients are going to be there. Now the question becomes: What are we going to do to find the people to come and work for our companies and keep them here for a long time?”


The answer is solidifying a more caregiver-first culture, acknowledging that customers will be better taken care of down the road as a result.

Caregiver preferences

Caregiver shortages are a significant barrier to home care company growth. In response to those barriers, executives are tinkering with their approaches by placing greater emphasis on caregiver well-being and satisfaction.

One way to make sure a caregiver feels welcomed and part of something bigger than themselves is giving them reliable and consistent work.


“The best companies, in my opinion, are going to do everything possible to ensure that a new hire gets out to work immediately,” Smith said. “To me, the employee experience basically begins the moment that the signatures on all of the hiring and employment docs are dry. Because you’re only as good as what you tell people when you’re recruiting them.”

Best of Care is a Quincy, Massachusetts-based personal home care agency. The company has over 400 home care aides, administrative staff, care managers, nurses and move managers.

Making a strong first impression to new team hires is a critical step in setting a foundation of reliability, Smith said.

Communication also plays an important role in the process. Whether it be understanding what workload a caregiver wants to handle, or making sure on-the-job problems are solved in a timely manner, caregivers need to know they’re supported early and often.

“If you want to work 40 hours a week, we’ll get you 40 hours a week right from jump,” Smith said. “If you can’t do that as an employer, they’ve got 10 other options in their inbox. At our company, we are determined to make sure that the people who come in that get hired walk out with a schedule on Day One. And, from there, what can we do to support that person when they have that first question or the first hiccup with a client to make sure that they feel supported in those moments?”

Sometimes it’s difficult knowing if the culture that a CEO is trying to set is resonating with new hires, Smith said.

Recently, as caregivers are onboarded with a variety of backgrounds, needs and wishes, he feels like the message is getting across.

“Looking through our new hires I’ll see a home health aide in Boston who is available on weekdays from 11 p.m. to 7 a.m.,” Smith said. “The next one is available from 8 a.m. to 2 p.m. three days a week. The next one four days a week. What that tells me is that the message is clear: when you apply with us, we’re going to accommodate you.”

‘Our job to take care of you’

At Family Tree Private Care, the caregiver has been at the forefront for company leaders since it was started in 2011.

“It’s been our mindset since Day One,” Family Tree Private Care CEO Daniel Gottschalk told HHCN. “When our new care providers come to orientation at Family Tree, we make sure that they understand that it is our job to take care of them, so that they can take care of our clients. I think the industry has done a pretty good job of trying to embrace that.”

Family Tree offers concierge-level caregiving, private nursing and care management services in Texas and Colorado.

Because the company doesn’t cover a large geographical area, its focus — and most of its success — comes from concentrating on the markets that it’s in. That includes hiring and retention strategies.

“Our entire strategy has been built around depth in markets,” Gottschalk said. “We aren’t in 300 locations like many providers, we’re only in a handful, but we are a big player in a handful of locations. Our stated goal is to become the employer of choice in every single market we serve and that’s what gives us growth. The clients are there, but the care providers are not. So if we can be the leading employer in every market we serve, it gives us a great reputation and a leg up on all the competition.”

This strategy also allows flexibility when making sure its caregivers are top of mind. For instance, Family Tree pays near the top of the market, offers pay advances to its caregivers and has a competitive benefits package.

One of the four core values of Family Tree is to provide outstanding service. A point of emphasis within that core value is that it includes providing outstanding service to its own employees.

“It’s not provide outstanding client service,” Gottschalk said. “As a core value, you don’t look at the client first and the care provider second. You look at them together and they both have to be served. And you have to start with the care provider because serving the care provider well serves the client well.”

Looking ahead

The current shift in focus is not something that happened overnight.

“The first time I really started to notice this was in the early 2000s when the caregiver shortage really started to become an issue,” Stephen Tweed, founder of consulting company Home Care CEO Forum, told HHCN. “Then, when the market crashed in 2008, it wasn’t as difficult to find caregivers. Now, over the last few years is when the home care leaders that I talk to have really started to take stock in this idea of focusing on what their caregivers need and want.”

Tweed pointed to a number of companies he’s worked with in the past — like Bayada Home Health Care — as pioneers of this shift.

Whether they’re national brands that have existed for 40 years or up-and-coming providers, one thing that remains consistent in successful companies is a clear and concise set of values.

“Those core values are usually determined by the leader, by the CEO,” Tweed said. “There’s a responsibility to live out those values in order for your caregivers and other employees to act and work with those values in mind.”

In order to succeed in today’s landscape, caregiver satisfaction needs to be at the top of any priority list.

“A caregiver-centric approach to operating and growing a company is — in my estimation — the only way to do it,” Smith said.

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