With ongoing caregiver staffing and retention challenges, at-home care organizations are looking to leverage the employees already on the payroll, maximizing their potential in order to benefit from the full range of their skills.

The Pennant Group (Nasdaq: PNTG), for instance, expanded its 100 CEO initiative.

“At the end of the pandemic, we were experiencing high levels of burnout,” John Gochnour, president and COO of Pennant, said during a panel at Lincoln Healthcare Leadership’s HomeCare 100 conference in January. “We asked employees what we needed to focus on as an organization, and our focus became how we develop C-suite level leaders. We started the tagline 100 CEOs. We’ve expanded that now to include chief clinical officers (CCO) and chief business development officers.”

Headquartered in Eagle, Idaho, Pennant supports independent operating subsidiaries that provide health care services through 103 home health and hospice agencies and 51 senior living communities.

Going further, Pennant took its CEO training program and adapted it to developing those within the company who would make solid leaders.

“We looked at our clinical workforce,” he said. “It’s filled with people who go out every day and change the lives of their patients. And the question we asked was, how do you ensure those people are led by leaders who inspire them, motivate them and help them live up to their potential?”

The idea focused on rewarding high-performing employees for their expertise, hoping to retain them while advancing their careers. This would be a win for both the company and the employee.

“We wanted to make sure that we didn’t just identify those people and say, ‘Manage this large clinical workforce and help people get better outcomes,’” he said. “Instead, it was, ‘How can we develop these talented nurses who are ambitious, want opportunity, want to be leaders? How do we give them the tools and training to achieve that?’”

Pennant’s clinical team developed the training program and the first cohort graduated a year ago. The company now has four cohorts.

“They’re working through a leadership library, doing case studies and in the end, they do a capstone project where they look at a critical issue and develop a solution for it. Then they implement that solution and report back,” Gochnour said. “It’s been inspiring to see these clinical leaders develop skills to step into a CCO opportunity or move on to operations and lead from that side. We need the best talent to want to be part of our organizations. It’s essential if we’re going to retain people in our industries.”

Creating the right culture for retention

The leaders also agreed that culture is a key to unlocking retention.

“If your team is not your number one priority, you’re going out of business,” said Vitas Healthcare CEO Nick Westfall. “You need a unified team, and that’s our secret to success. To that end, as leaders, we discussed empowering our frontline managers and helping them to allocate time to create relationships.”

Vitas Healthcare is a Miami-based provider of end-of-life care operating 53 hospice programs in 15 states and the District of Columbia.

Westfall said Vitas has had 10 quarters of growing net bedside medical capacity, rooted in day-to-day interaction. The company’s number of patients cared for increased from a low of 17,100 in August 2022 to north of 22,000 at the end of the third quarter of 2024.

Empowering localized leaders, including clinical supervisors, and ensuring that they understand the company expects them to take the time to establish relationships with all their team members is imperative, according to Westfall.

“We went through a time study to find out how to eliminate 10 to 15 hours of non-value-added work a week so leaders could allocate it to spending time with their teams,” he explained.

This study aimed to empower leaders and help them understand that they were expected to take the time to grow relationships.

“That became intentional underneath everything,” Westfall said. “That included the manager calling to check in with a new employee, asking how everything was going, and continuing to get feedback at seven, 30, 60, 90 days and beyond.”

Westfall said that solidifying relationships led employees to buy into the culture and become invested in ensuring its replication.

However, some solutions don’t work as intended. And sometimes, that leads to even better outcomes.

CommonSpirit Health at Home President and CEO Trisha Crissman said her team was nearing 50% turnover after the pandemic, and employees were burned out. To create additional capacity, she developed a virtual nursing position that the company believed would relieve some of the field case managers. However, the experiment didn’t work as the organization hoped.

“The reality is, over the course of about 18 months, the initiative failed tremendously because we couldn’t gain buy-in from our registered nurse (RN) case managers,” Crissman said. “I could never get that virtual RN to operate at full capacity. The silver lining was that failing there led us to a different place where we’re now piloting new ideas.”

CommonSpirit Health at Home, headquartered in Loveland, Ohio, owns and operates 83 locations across 13 states.

“We created a plan for moving toward remote case management, and we went into a pilot phase at four locations,” Crissman said. “While we’re still in proof of concept, we have seen an increase in our ability to recruit, and retention has increased. We have increased patient satisfaction and employee engagement. Our outcomes are up. Our goals are accomplished.”

This pivot illustrates the significance of adaptability in leadership and the readiness to consider new strategies when facing challenges.

As leaders continue to refine their approaches, the ultimate goal remains clear: to create an environment where care professionals feel valued, supported and empowered to excel in their roles, ensuring better outcomes for both employees and patients. The journey toward improving retention and satisfaction in health care is ongoing, but with creativity and collaboration, positive transformations are certainly within reach