‘Wow’ Benefits, Gamification, Other Strategies Boost Home Health Care Worker Retention

Home-based care stakeholders are laser-focused on workforce challenges assailing the industry. In particular, they’re turning to creative approaches – from “wow” benefits to gamified training – to improve worker retention.

Just in the past month, National Skills Coalition (NSC) launched an advisory council focusing specifically on the workforce crisis and, in a separate initiative, the National Alliance for Care at Home, CVS Health (NYSE: CVS) and MissionCare Collective announced a partnership to improve home health worker retention. 

“People spend so much time recruiting staff and then training staff, only for those staff within the first couple of months [to] move on because what they anticipated may not have been there,” Bill Dombi, senior counsel for Arnall Golden Gregory law firm, told Home Health Care News. “Devoting time to retention is the most efficient, economical and successful way to deal with the workforce shortages today.”

There’s no question that the stakes are high and the need is pressing, with regard to improving retention among at-home care providers. The average home health and hospice professional caregiver turnover rate in 2023 was 32%, according to data from Activated Insights, a provider of digital tools used to help senior care providers collect information from workers and clients. For home care, the median professional caregiver turnover rate was 79.2%.

Creating an environment where employees desire to stay on board can save providers money and improve clinical outcomes, according to Ken Albert, president and CEO of Andwell Health Partners.

“The employee experience supersedes the patient experience in many regards,” Albert said. “I don’t mean to be disrespectful to the patients and families. The research, the evidence, is replete where if you have highly engaged employees, you’re going to have better clinical outcomes all day long. … If we can’t execute on that, then you spend a lot of money on recruitment and you’re going to lose it on the retention side.”

Androscoggin Home Healthcare + Hospice rebranded as Andwell in May 2024. Lewiston, Maine-based Andwell offers home health, home care, palliative and hospice, pediatric and behavioral health services, among other offerings. The independent nonprofit employs over 500 workers across Maine. 

Andwell’s year-to-date turnover rate is 9.2%, which Albert says he is satisfied with, given state, regional and national turnover trends.

New recruits

Some of the strategies designed to improve retention rates are most helpful when deployed early in a worker’s tenure.

For TheKey, a provider of home care, memory care, skilled nursing and other services, helping new caregivers adjust to the emotional labor that comes with caregiving requires significant support in the first year.

Caregiver managers, who make the initial connection with new caregivers, are crucial to keeping caregivers engaged with the company, according to Emily Kraeter, senior vice president of human resources at TheKey. Maintaining a strong connection with caregivers after onboarding is among the largest predictors of retention or turnover.

“If there’s turnover in that [caregiver manager] role on our side, or if we have a caregiver manager who’s struggling, you’ll see that directly correlate to turnover within our caregiver population,” Kraeter told HHCN.

Lengthy delays between orientation and beginning caregiving make it less likely that the new employee will stay with the company long enough to engage with patients and clients, and can increase the likelihood that the caregiver will struggle, Kraeter said, because information gleaned during orientation may have faded to the backs of caregivers’ minds.

Consistent and flexible schedules are also critical, Kraeter said.

The highest risk for home-based care employee turnover is in the first 90 days, according to Brandi Kurtyka, CEO of MissionCare Collective, the parent company of myCNAjobs and CoachUp Care.

“In many home care agencies, the recruiter owns the process up to the offer letter, and the scheduler owns getting them on the schedule,” Kurtyka told HHCN in an email. “But who owns making sure that employee feels connected, supported, and set up for success? Often, no one. Or it’s everyone — which usually means no one. Without a clear handoff and intentional connection points early on, employees can feel isolated, especially when the only people they interact with are their recruiter and scheduler.”

Introducing employees to the company’s culture, values and community from “day one” is key to improving retention within this critical 90-day period, Kurtyka said.

To improve connection with new employees, TheKey is exploring gamifying specific work-related tasks.

“[The gamification platform] allows messages directly with the caregiver, and it allows us to incentivize the types of behaviors that we want,” Kraeter said. “It might be incentivizing them to take their first shift as soon as possible. It may be additional training that we want to provide. So if you take this training right, you get points. We make it fun, but also that’s going to help better prepare you for the client that you may be staffed with.”

Advanced employees

While a company’s reputation is key to recruiting new employees, execution drives retention, Albert said.

Health care workers want to work for organizations that are highly respected, Albert said, but after an employee is onboarded, the organization“can’t rest on their laurels.”

“When you recruit somebody, [they are] coming to work for you based on your reputation. You better be able to deliver on that on the back end from a retention standpoint,” Albert said. “Is the culture as employee-friendly and as respectful as the reputation would suggest? Are we able to deliver on leadership? People leave their jobs because of their supervisors and managers, not because of the work, usually.”

As the tenure of home-based care employees increases, other benefits and strategies may prove most helpful.

In other industries, employees are interested in career progression after a year with the company, Kraeter said. However, caregivers are more likely to be interested in flexible hours and ensuring they are placed with a client who will be a good match for them. Still, TheKey is seeking to create career paths for caregivers, but this progression typically involves acquiring additional knowledge and skills, tied to changes in compensation.

Keeping wages competitive also encourages retention among caregivers, according to Kraeter.

“Pay is a factor,” she said. “We are constantly looking at our competitors to make sure that we are competitive in wages. We’ve got tools that allow us to monitor that in real time.”

While pay matters, it’s only one “piece of the puzzle,” Kurtyka said.

“For Medicaid providers, the ability to continually raise wages simply isn’t sustainable,” Kurtyka said. “That’s why we talk about the six pillars of retention: appreciation and recognition, training, pay and workforce supports, employee fit at hire, engagement, and active listening. Pay is a factor, but it’s not the reason most people choose this work — or stay in it. People are drawn to care work because of a deeper purpose.”

Benefits helpful across the board

Some retention strategies and efforts to improve employee experience help retention across all stages of an employee’s tenure.

For instance, Andwell pays for end-of-life care for employees’ family members, and sometimes even close friends.

“It’s those kinds of benefits that are unique to our industry that I like to call the ‘wow’ benefits,” Albert said. “You have your traditional life insurance, dental, and health insurance benefits. But then there’s this other column of benefits that are meaningful.”

Among its nontraditional offerings, Andwell has created a program called “Life Happens,” for which the organization solicits donations. Before the program, employees would sometimes dig into their own pockets to help a patient buy a necessary item, like an air conditioning unit for a congestive heart failure patient. Through this fund, employees can request funds to care for patients, whether for a wheelchair or a bouquet of flowers.

Employees appreciate this innovative benefit, Albert said.

Ultimately, home-based care workers are mission-driven, so driving home a company’s culture is among the top retention drivers, sources told HHCN.

“They are going to be watching for things like an overemphasis on profit and a de-emphasis on care,” Kraeter said. “If they feel that the organization is prioritizing profit over care, that’s their tipping point. They will leave. If they feel like those two things are aligned and connected, then they’re going to stay a lot longer, regardless of what that hourly wage might look like.”