Industry struggles to recruit and retain caregivers
by Dennis Petroskey
September 9, 2018

In recent years, the home-based care industry has seen significant growth. As baby boomers age and their care needs increase, the home is expected to be the venue for more services in the coming decades.

This good news has been tempered somewhat by the fact that agencies are already facing challenges in attracting and retaining enough employees at all skill levels to provide needed patient care, and this trend is expected to continue.

The U.S. Census Bureau estimates that by 2030 some 76 million Americans will be older than 65, which will account for 1 in 5 people in the United States. Research from the Health Resources and Services Administration (HRSA) indicates that the demand for nurses will grow 46 percent by 2030.

Adding to the challenge of meeting care needs is the trend showing that nurses are getting older, and more of them are leaving the workforce every day. A study from the National Council of State Boards of Nursing puts the average age of a nurse in the United States at 50. This age group makes up more than half of the current total number of nurses.

Beyond the need for skilled nurses, the home-based care industry also continues to struggle to recruit and retain home health aides and personal caregivers to serve clients.

In a recent survey by myCNAjobs.com, 97 percent of personal caregivers admitted they were open to taking another job, while 65 percent indicated that they are always looking for another job. In the same survey, respondents said they considered leaving home-based care entirely for higher-paying jobs in retail or fast food.

On the positive side, recent data shows a new generation entering the workforce every day, and they have shown a strong desire to work in health care. A Health Affairs study found that millennials are 186 percent more likely to become a registered nurse than baby boomers were at the same point in their lives. But attracting younger workers to home-based care will take a concerted effort to spark the interest of a generation that is used to keeping their options open.

During the 2018 Texas Association for Home Care and Hospice winter conference, staffing expert Eric Scharber with Exact Recruiting highlighted a few things to consider when seeking to attract workers:

  • Pay a fair and competitive wage.
  • Make sure millennials understand your agency’s culture.
  • Give millennials opportunities to grow beyond an entry-level position.
  • Provide continuing education or professional development opportunities.

Money is the biggest obstacle in attracting millennials. Registered nurses will make about the same whether they work in home-based care or hospitals. But home health aides earn an average of $23,210 a year, and that is often not enough to hold the interest of younger workers. Supplementing pay with additional compensation, such as providing benefits, is not a guaranteed solution either. In the myCNAjobs.com survey, 64 percent of caregivers said the benefit they want most is a higher wage.

In a recently published white paper examining staffing issues facing the home-based care industry, Axxess compiled a variety of innovative steps being taken to proactively address these challenges. Among the more unique approaches to retain staff is an effort at Abe’s Garden, a Tennessee-based Alzheimer’s and memory care center.

Instituting pre-scheduled overtime for its workers, Abe’s Garden budgets for its employees to earn five hours of overtime each week. To qualify for the overtime pay, staff must first work all of the regularly scheduled hours. Using this model, Abe’s Garden can get the same number of hours from 89 full-time employees as they would from 100 full-time employees. The center pays almost the same amount of money but does not have to provide benefits for an extra 11 people. Employees also like the model because they can plan to earn the extra money if they work the pre-arranged hours. Using this approach, it is less likely that staff will be interested in leaving for a slightly higher wage, but there is no guarantee of overtime.

The shortage of home-based nurses and aides also results from a lack of exposure to home health in the nursing training and certification process.

A review in the journal Home Health Care Management & Practice highlighted nursing residency programs as a means of growing the home-based care workforce. The problem is that these types of programs are only available with 2.2 percent of home health or hospice providers, compared to 42.9 percent for hospitals. More needs to be done to ensure home-based care gets visibility as a valuable career option.

Among more positive developments is that emerging technologies are being created to help agencies identify qualified help to serve patients. For instance, Axxess has developed a solution that connects agencies with qualified nurses who can handle visits as needed. AxxessCARE is in pilot in Texas and Illinois as a free scheduling and staffing solution for Axxess clients, and will eventually be expanded to help address all forms of home-based care.

Solving a problem as difficult as staffing in the home-based care industry requires awareness combined with a willingness to explore innovative solutions. Companies that create an environment that invests in their employees and their culture are likely to see the highest rates of recruitment and retention. Embracing new technologies can also bridge the staffing gap and make it possible that the future for our industry may not be as challenging as it seems.