9 Approaches to Improving Retention

Turning clients away, increasing wages, waiting for interview no-shows, training in COVID-19 safety: These are some of the realities of managing a caregiving business today. Without enough workers to meet demand, the industry is facing a major shift in how it must plan and provide services. To stem the bleeding, caregiving agencies have turned away from seeking clients to focus on recruiting and retaining caregivers—and are learning new lessons along the way.

It was no secret that caregivers were in short supply even before the pandemic. A rapidly aging population and the declining labor participation rate in the United States has made caregiving a staffing challenge. COVID-19 has turned the homecare market upside down by further decreasing the supply of labor while driving a higher demand for services. The availability of unemployment benefits plus a need to care for children in virtual school have taken a sizable number of caregivers out of the market. There was even a period when caregivers could earn more staying at home than working in the field.

For this article, the owners of three growing caregiving agencies shared their best practices for recruiting and retention, particularly the changes they have made in response to COVID-19 that have helped them run their businesses. They are:

• Tim Murray of Aware Senior Care in the greater Raleigh, North Carolina, area;
• Mark Turnbull of ComForCare West Linn in Portland, Oregon; and
• Benny and Alice Latino of Heavenly Care of Austin, Texas.
• Here are nine tips on how best to hold onto caregiving staff in difficult times.

1. Pay competitively.

An agency that pays competitively has a better chance at securing the higher-performing caregivers in the market. When candidates have numerous job opportunities available, the agencies that will be attractive to caregivers are those that have always been proactive about offering competitive pay and benefits.

Increasing wages, however, can be tough for owners. They must decide whether to raise client rates or to take a hit on margins. A good way to determine whether an agency has the flexibility to raise rates is to measure how many clients it must turn away during a month because of a shortage of caregivers. If the number represents more than 10% of the current clientele, then increasing client rates in order to keep caregivers may be the right decision.

Aware Senior Care targets pay to be at least in the upper 90th percentile of what agencies pay caregivers.

“Homecare is growing a lot, but we have a challenge,” Murray said. “We’ve raised the ante. We just sent out letters for the second price increase this year. We’ve got to do what we’ve got to do to in order to get the talent by raising our homecare rates to clients.” Murray said no clients have complained about the increase.

2. Train to retain.

Training is critical to employee retention. According to a Gallup poll, only 12% of employees believe that their company’s onboarding programs adequately trained them for their roles. A study by the Society for Human Resource Management recently revealed that 69% of employees are likely to stay in a role for three years with great onboarding.

For Turnbull, training is an investment in the agency’s most important asset—caregivers. His agency has added several components to its training program, including the assessment of each caregiver’s character strengths to target areas to coach new employees.

“Unlike other businesses, the employee is the most influential person and has the most impact on your business’s bottom line,” Turnbull said.

3. Keep a budget for retention & spend it.

Having a budget dedicated to retention offers a degree of protection during good times and bad. It can include surprise rewards, such as gift cards or dinners out, but also more regular recognitions, such as awards for monthly top performers. Retention bonuses can also be useful to help caregivers focus on long-term development goals. In essence, spending money on retention sends a message to caregivers that management cares enough to take something from the bottom line.

Aware Best Care uses its retention bonus for many typical expenses, such as gifts and recognitions. They also use it for benefits, including 401k matching and health care. Murray realized that caregivers were stressed about health coverage and sought out a way to offer a plan that was affordable and met employees’ basic needs. Aware Best Care splits the cost of a direct benefit plan with caregivers who opt in. As a result, it can address a lot of staff concerns about being able to receive care if they become ill.

4. Hire recruiters to keep the pipeline full.

Although not all agencies can afford to pay a full-time recruiter, Benny Latino said that should be one of the first administrative positions that a company takes on. Latino said that having the full focus of a recruiter is critical, as an agency needs to be recruiting continuously in order to keep up with demand.

“A recruiter has to show high sense of urgency,” Latino added. “They have a love of what they do—to connect with others. They are someone who is very organized who understands how to use social media and virtual meetings to schedule interviews.”

5. Monitor & measure retention to manage it.

Turnbull says that measuring retention with attrition metrics is key to managing caregivers. ComForCare tracks 30-day, 90-day, 180-day and annual retention so that aberrations from the average are highlighted and addressed. For example, if 30-day retention plummets, then recruiting and onboarding are likely culprits. If 180-day retention falls off, then the problem is more likely related to ongoing communications between administrators and the caregivers or conflicts with clients.

“We are about at 70% retention annually,” Turnbull said. “We keep track of everyone who comes in and exits. We have exit interviews for those who leave.”

Because his agency focuses so much on the right fit on the front end, he said, a large number of those caregivers who leave are seeking expanded opportunities in care.

“They are inspired as caregivers and want to go on and serve as a nurse and further their careers,” he said. “They find they had innate talent.”

6. Promote your brand & culture.

Building a culture within an agency and communicating a brand are keys to standing out in a crowd. According to Benny Latino, differentiation is important when it comes to expanding the supply of caregiver labor.

“We’re having to sell (caregivers) on the culture of our company in order to reach those individuals who weren’t necessarily thinking of being caregivers or being in the health industry,” Latino said. “You have to sell your employees more than your clients. We’re having to look at people who don’t have the background but can do the job with training.”

7. Fire clients to retain caregivers.

Caregiving agencies want to be known for managing client-caregiver relationships effectively. Retention can depend on maintaining good relationships between caregivers and the clients. Given that a caregiver can quickly join another agency to escape a bad client, the key for Murray is protecting the caregiver if the relationship shows signs of stress.

“We have discharged some major clients that were rude or unprofessional to our staff,” he said. “If your focus is taking care of your people, you need to back it up. When you do, the staff gets the message and becomes even more vested in the company.”

“You have to have the mindset of finding the right clients,” added Alice Latino. “That’s a different mindset [than in many other businesses] because it’s easy to say we have to do everything we can to satisfy the client. Often that’s impossible and it’s not a good business decision.”

8. Become a matchmaker.

In addition to selecting clients carefully, Turnbull wants his agency to become known as “master matchmakers.” His enthusiasm for matchmaking stems from observing caregivers who quit based on conflicts or negative interactions with clients. He worked to identify compatibility in caregiver assignments. As a result, it has attracted both prospective caregivers—who will stick around longer for a better client—and clients, who know that they will be placed with caregivers with the right character strengths rather than just the first available.

His agency uses MiliMatch, an analytical application for assessing both client relationship needs and caregivers’ strengths to identify viable pairings.

“We were looking for something to help us identify the soft skills,” said Turnbull. “With MiliMatch, we can measure them and predict how they best fit a client’s needs. Before, we knew whether they could change a brief or feed a client or bathe them, but we couldn’t see the interpersonal relationship skills that caregivers possessed.”

With established processes for matchig caregivers to clients, ComForCare promotes their expertise to both potential clients and caregivers. The clients have been receptive toward finding the right caregiver, and the caregivers, in turn, are surprised to find out that the company has an interest in seeking good matches.

9. Connect caregivers with resources & communicate.

Limited income presents a stark reality for some caregivers. Add to that the unpredictability of client hours and government subsidies over the past few months, and many have had trouble paying bills. Heavenly Care makes a point of ensuring that caregivers know what support is available, including food, clothing and shelter. To keep the list up to date, leadership reaches out to various nonprofit and municipal organizations.

“We were able to connect [caregivers] with resources in the local counties to provide caregivers with ways to support utility bills and with assistance with making financial decisions,” Benny Latino said. “We leveraged our relationships to get caregivers as much information as they could.”

In addition, keeping caregivers engaged and feeling appreciated can be just a phone call away. Latino said administrative staff was assigned several caregivers to communicate with regularly, particularly as COVID-19 heated up.

“Everyone took four or five caregivers and called to check on them every week,” he said. “During the height of the pandemic, we would call with a list of several questions and find out what we could do to help.”

The road ahead

Agency owners face a difficult challenge today—but the pandemic may also provide an opportunity. Those who can master recruiting and retention by learning from others and following disciplined practices will be positioned to realize sizable growth.