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In home care, turnover tends to beget more turnover. If providers don’t nip the issue in the bud, they will open themselves up to a larger problem.
Home care agencies report average turnover rates of 76%, which challenges their ability to deliver high-quality services. High employee turnover also means high financial costs. On average, caregiver turnover costs agencies $171,600 annually, a report from Activated Insights showed.
Turnover results in extra hours for the remaining staff caring for clients, often leading to burnout. This also negatively impacts clients, as they don’t always receive the necessary attention due to the limited number of staff.
“These agencies are competing in a broad economy, and there are numerous job opportunities available for workers across various sectors,” Joanne Spetz, director of the University of California San Francisco Health Workforce Research Center, told Home Health Care News. “Licensed nurses are in high demand in hospitals and ambulatory care settings, while direct care aides and assistants with valuable interpersonal and organizational skills can find opportunities in many different sectors of the economy. As a result, there is significant competition for workers.”
Spetz stated that while health care organizations have revenue limitations, particularly in Medicaid or private pay, the significance of work culture in tackling burnout and retention should not be underestimated.
“Often, direct care workers, aides, and assistants are treated as disposable and unskilled, despite having valuable skills that should be appreciated,” Spetz stated. “Home care organizations need to find ways to show respect and appreciation for these workers, and create avenues for them to take on leadership roles, even if they may not be able to offer competitive wages.”
Spetz used the example of Washington State’s Medicaid program, which set up basic training standards and options for caregivers to follow. In this program, pay raises are linked to specific stages in the training options, allowing caregivers to receive formal recognition for their increasing skills and expertise.
Similarly, Austin State Hospital in Texas employs peer providers who are not licensed therapists, but peers who have experienced the same illnesses as some patients. The hospital recognized their contributions and began a career ladder process to move them into other opportunities in the organization. Spetz suggested the same idea could be implemented in home care organizations.
“It’s not all about compensation,” National Association for Home Care & Hospice (NAHC) President William A. Dombi told HHCN. “It’s about worker respect. It’s about people understanding that meaningful work is being done. It almost seems we’ve got a culture change that is developing within home care employment practices, recognizing that once you have someone employed, you must take steps to ensure you can keep them as an employee. Turnover rates are high, mainly because it seems everyone was spending time on recruitment and not enough time to focus on the retention side of the equation.”
Caregivers frequently face high levels of stress due to demanding job responsibilities, unpredictable work conditions and feelings of isolation. These stressors can lead to low job satisfaction and emotional burnout, ultimately causing caregivers to resign from their positions.
“We are aware that factors such as burnout and low compensation contribute to turnover,” Molly Candon, assistant professor in the Center for Mental Health and the Department of Health Care Management at the University of Pennsylvania, Philadelphia, told HHCN. “We also know that characteristics of home health care organizations, such as the quality of supervisory feedback and long work hours, can drive turnover.”
Caregivers value work-life balance and seek assurance that their jobs are not a dead end. They want the chance to develop and grow within the organization. Thus, continuous and thorough education and training can improve staff retention. Training prospects and internal advancement opportunities are crucial for attracting new employees. Candidates are more inclined toward employers who provide them with opportunities for improvement and progression.
For some caregivers, the idea of shift or client assignments helps with burnout and gives them a sense that they are making a difference and offering the best care to their clients by providing continuity.
“Clients and staff generally seem to want continuity of relationships,” Spetz said. “Caregivers want to know, whenever possible, they are going to get a certain client on Monday, Wednesday and Friday and a different client on Tuesday and Thursday, for example. That creates predictability and a sense of routine that can help with burnout and work-life balance.”
For agencies experiencing high turnover, checking in with caregivers can be a great way to understand what they need to feel valued.
“Exit interviews are important, but I would suggest retention interviews,” Spetz said. “When someone has been with your team for a while, interview them to find out why they are staying and what they like about the job or your organization.”
Condon echoed the necessity of interviews, but also acknowledged they can sometimes be challenging to facilitate.
“Surveys and exit interviews are great resources for understanding why and how employees leave their position and could contribute to a root cause analysis,” Condon said. “However, employees need to feel comfortable disclosing their true intentions.”
