A Pretty Damn Comprehensive Guide On How to Recruit and Retain Caregivers For Your Home Care Agency
One of the biggest challenges you’ll face is the question of how to recruit, hire, and retain caregivers for your home care agency.
Recruiting caregivers is the bane of most home care owners’ existence, and the biggest obstacle to growth for most home care agencies.
While there’s no silver bullet for the challenge of home care staffing, there’s a lot of information that that can help.
Here’s what we’ll cover in this guide:
- Where'd All the Caregivers Go?
- Putting Together The Pieces of A Good Recruitment and Retention Strategy
- A 15-Point Checklist to Audit Your Agency
- Piece 1: Choosing the Right Recruitment Sources
- Piece 2: A Fast, Efficient Hiring Process
- Piece 3: Scheduling and Hours
- Piece 4: Pay and Benefits
- Piece 5: Managers
- Piece 6: Career Paths and Training
- Piece 7: Employee Recognition
- Piece 8: Onboarding, Orientation, & Client Introductions
- Piece 9: Communication
- Piece 10: Focusing on the First 90 Days
- Conclusion: Be The Agency You'd Want to Work For
Where’d All The Caregivers Go?
Yes. Everyone else is feeling the same hiring crunch as you are.
My team and I talk to home care owners every day. Everyone, everyone, is struggling to some degree with recruiting and retaining caregivers right now. Every year, more agencies say that caregiver shortages are the biggest obstacle to their growth. Many agencies are telling their marketers to hit the brakes because they can’t staff their existing cases.
It begs the question: What’s going on?
Here are a few answers:
1. There weren’t enough caregivers to begin with. Caregiving is an important, necessary, and often brutally difficult job. It requires someone who is simultaneously nurturing, patient, responsible, organized, and constantly attentive. While caregiving is one of the most important roles in our society, it doesn’t get the level of respect it deserves and the challenges of the job will always cause many people to steer clear.
2. More people are aging into retirement than are joining the caregiving workforce. You’ve probably heard the stat: according to US census data, roughly 10,000 Baby Boomers are turning 65 every day, and within 10-15 years many of them are likely to require in-home care. According to Paul Osterman, a professor of labor economics at MIT, we’re “headed for an absolute train wreck” in terms of our society’s capacity to care for our elders.
3. The last five years have mostly been a job seeker’s market. Until about May 2022, we’d had 12 months of some of the strongest job growth in US history as society cautiously returned to normal after COVID-19 appeared to be somewhat in the rearview mirror. Jobs returned faster than business grew, making it a great time to be an applicant and a brutal time to be an employer. As we’re now likely headed into a recession, this may be poised to change—but any ease in recruiting due to a recession will probably be a lagging effect. (By the way, here's a quick overview of how a recession would likely impact your agency.)
4. Home care agencies aren’t just competing with other home care agencies for employees. They’re competing with companies like Amazon and Walmart that offer $15 minimum wage or more, career growth opportunities, and robust benefits packages. They’re also competing with companies like Uber and DoorDash that allow people to work as much or little as they want and make money when they need it.
Bottom line: it’s tougher than ever—and more important than ever—for home care agencies to become the best employers possible to attract the caregiving talent we need to look after our elders.
Let’s talk about how to do that.
If you're interested in reading more about caregiver shortages and why you're struggling to recruit enough caregivers, I can't recommend this book enough. We've learned so much from it that we send it to all new hires at Careswitch in their first week.
Putting All The Pieces Together
Here’s the thing about recruiting and retaining caregivers: It’s not about finding a secret recruitment channel that works the best, creating a marketing gimmick that gets community attention and draws applicants, or even about paying the most (although all those things can help).
It’s about understanding all the different pieces to an effective staffing strategy, making sure you have each piece, and making sure each piece is as effective as possible.
No strategy is complete without all the right pieces in play.
If your agency is a great place to work but you’re missing solid recruitment channels, you won’t get enough applicants.
If you pay more than your competition but have schedulers and supervisors who are tough to work with, you’ll lose caregivers as fast as you hire them.
If you have a sluggish hiring process that loses candidates to faster competitors, it won’t matter if you offer competitive benefits.
All of the boxes need to be checked—and continually optimized.
A 15-Point Checklist to Audit Your Caregiver Recruitment/Retention Processes
While the needs and circumstances of every agency are different, we’ve put together a checklist to audit your agency against industry best practices.
This may seem like a lot—but it takes a lot to hire and keep good caregivers these days.
The more of these questions you can answer Yes to, the stronger your recruitment and retention will be.
1. Are you updating your online job ads (such as on Indeed) at least every two weeks?
2. Are you using a mix of free and paid ads on Indeed?
3. Are you including a mix of shift-specific and general hiring posts in your job ads?
4. Are you incorporating texting into your hiring process to enhance communication?
5. Are you sending a reminder text to candidates on the morning of an interview?
6. Are you reaching out to all candidates that you’re interested in within 24 hours on a weekday or 72 hours on a weekend?
7. Do you have someone on staff who has the time and energy to focus on recruiting and hiring caregivers?
8. Are you paying caregivers for their orientation and training?
9. Are you paying in the 75th percentile of your local market based on your best knowledge?
10. Are you providing a clear way for caregivers to get paid more as they complete more training? Are all your caregivers aware of it?
11. Do you provide mentors or other types of added support during a caregiver’s first 90 days?
12. Do you have some type of caregiver recognition program in place?
13. Are you keeping caregivers’ schedules full 95% of the time?
14. Do you regularly check in with your caregivers individually with no agenda other than to see how they’re doing?
15. As the owner, do you know all of your caregivers personally?
In my experience running industry education for Home Care Pulse and working with agencies around the country, I’ve found those to be among the most important elements of successful caregiver recruitment and retention.
If you’re only doing a few of these and this list feels unrealistic or insurmountable, recognize that it takes time and start prioritizing one of these initiatives each month.
If you’re doing all of them and are still frustrated, don’t give up—we’ll go into more detail on each topic and see if we can give more context that helps you find the right solutions.
Before we talk about how to put the pieces together, here's a quick shameless plug: I work for Careswitch—a new home care software built for small but growing home care agencies. It’s built by a team of crazy talented designers and engineers with initials like MIT, IBM, and PhD on their resumes, and customers are loving the simplicity and ease of use. We even have dedicated engineers who take your feedback and use it to add the features that are most important to you. If you want to try it out for free without talking to a salesperson, you can get started here.
Piece 1: Choosing the Right Caregiver Recruitment Sources
Here’s a broad list of recruitment sources I’ve seen agencies use to hire caregivers. How many have you tried?
- Employee referral programs
- Facebook Ads
- Recruiting open houses
- CNA schools
- Networking through religious communities
- Keeping in touch with past caregivers
- Local Facebook groups
- ATS systems like Hireology or CareerPlug that post to a range of job sites at once
- Putting up flyers around town, especially in places like restrooms and elevators where people’s attention might be captive for a few moments
- University job boards
- Community clubs, especially service clubs
Remember: you can’t boil the ocean. Try as many different recruitment strategies as you can initially but zero in on the ones that are driving results.
Many home care owners believe that because recruitment is so difficult, you need to use every channel possible to recruit caregivers. In truth, the opposite is true; recruiting is too difficult to waste time on tactics that aren’t pulling their weight.
Find the few things that work and become the best at them.
Volcanoes can boil the ocean. You can't. Quit trying.
Piece 2: Sharpening Your Caregiver Hiring Process
Although they ultimately stay with the agency that treats them the best and helps ensure the best lifestyle, caregivers typically start working for whichever agency hires them first. How fast is your hiring process?
Looking to make sure your hiring process is up to par? Here’s where you can start.
1. Contact every applicant (that you’re interested in) within 24 hours on a weekday or 72 hours on a weekend.
2. Use a mix of communication channels including phone calls and texting. Where possible, allow applicants to choose how they prefer to be communicated with.
3. Send texts the morning of interview to remind applicants.
4. Use an Applicant Tracking system such as Hireology or CareerPlug to coordinate the process and do as much of the hiring as possible from one place.
5. Build your onboarding process around the goal of being able to move them from 1) final interview to 2) paid orientation to 3) their first shift as rapidly as possible.
Piece 3: Scheduling and Hours
I’ll be honest: scheduling is one of the hardest pieces to get right.
Let’s face it: caregivers with a consistent, full schedule are a lot less likely to quit. The nature of caregiving makes it tough to provide this, however.
One simple way to help ensure full, consistent schedules for your caregivers, especially when you’re starting your business, is to impose high minimum lengths for shifts and avoid clients who want lots of short shifts.
Think about it in terms of supply and demand. In general, it’s easier to find clients for a home care agency than it is to staff the cases. Focusing on only the clients in need of longer shifts, at least at the beginning, helps to even the supply and demand by limiting the demand to the most desirable clients while also increasing the supply of caregivers because you’re providing desirable schedules.
Does it take careful planning and balance to do this right? Yes.
Will you need to adapt as you go? Yes.
Is it going to be better for your recruiting and retention than taking every short shift that comes your way and trying to staff it?
Piece 4: Pay and Benefits
Let’s talk about the painful one.
The common belief is that pay is basically the determinant of success in recruitment and retention.
It’s true that money is generally the motivation behind getting a job, but my experience is that pay is only about 30-40% of the decision when it comes to caregivers deciding where to work. The other pieces to the puzzle that we’re discussing here fill a lot of other critical gaps.
That being said, how do you decide how much to pay?
While some of the answer depends on your approach to positioning your agency in the market, you should generally aim to pay in about the 75th percentile of your local home care market: in other words, you’ll be paying more than 75% of the home care agencies in your area.
This number is a little arbitrary but it’s a good rule of thumb to help you pay more than most agencies while also not completely breaking the bank.
Doing so is likely to cut into your margins for a while, but nothing is more important to the long-term success of your business than recruiting and retaining good caregivers.
Piece 5: Managers
People don’t quit bad jobs. They quit bad managers.
A lesson I learned early on when I ran a $10M service business is that there’s almost never a valid reason to keep a manager who’s abrasive, uncaring, or uninterested in the wellbeing of their team.
Find and keep staff members who care as much about the caregivers as you want the caregivers to care about the clients.
You might be familiar with business guru Jim Collins’ analogy that getting the right team is like getting the right people in the right seats on the bus. Sometimes, someone’s the right person but they’re in the wrong seat.
The impact of office staff on caregiver experience is massive. During my time at Home Care Pulse, I led research that found that for every one office staff member who leaves, you’ll lose an additional five caregivers.
Caregivers gravitate toward good managers. Over time, a manager that caregivers love will become a talent magnet for your agency.
Piece 6: Training and Career Paths
The most successful agencies don't view training as a checkbox to stay compliant; they understand the best caregivers are committed to learning and improving at what they do. Therefore, an agency that wants to attract and keep top talent needs to prioritize and publicize a top-tier training program.
This can take various forms, but a simple way is to invest in an online training program and gamify the training by giving caregivers incremental pay raises for training completed on top of what's required for compliance. Over time, they can become specialists in fields like Alzheimer's care and develop their own professional value while also enabling your agency to stand out with speciality programs.
Piece 7: Employee Recognition
Everyone wants to feel recognized for a job well done, but not everybody needs it in the same way.
You might be familiar with the Love Languages test, which is often used by people in romantic relationships to better understand how their partner likes to feel appreciated.
Less-known is the same company’s work in identifying professional love languages—how do employees like to be recognized at work? They have some interesting resources for this here.
A key takeaway is that employers who take the time to understand their individual employees and learn how they like to be shown gratitude will have a significant edge in recruitment and retention.
Some tips to make employee recognition a cornerstone of your caregiver recruitment/retention strategy:
1. Use a mixture of public/private recognition as well as planned/spontaneous recognition.
2. Take the time to get to know what makes each employee tick. You’ll understand who loves when they’re recognized in front of their peers, who prefers a quiet thank you, and who needs validation more than others.
3. Use various channels to provide recognition. This might include public shoutouts at training meetings, spotlights in a company newsletter, showcases on social media, and occasional texts of appreciation.
4. Seek feedback from employees as you’re building your recognition program! Give them options. See what they want and how they’d improve it.
One of the best recognition programs I’ve seen was used by SYNERGY of Mid-Penn, whose owner Michelle Lisk instituted a program called SYNERGY Bucks. When they wanted to recognize an employee, they give them a certain number of SYNERGY Bucks that can be redeemed for anything from raffle tickets at training meetings to gift cards to extra PTO. The SYNERGY bucks provided a currency to allow caregivers to turn the recognition into tangible value.
Piece 8: Onboarding and Client Introductions
I’ll cut to the chase on this one. These are easy to get right if you focus on it but easy to get wrong if you don’t.
1) Get employees to orientation as rapidly as possible after they’re hired.
2) Pay them for their training time—especially in-person training. Whether or not it’s mandated in your state!!!
3) Provide a clear, updated care plan before they meet the client. (It sounds obvious—but so many agencies often fail to do this.)
4) Have a supervisor introduce them to their first client, where possible. (Or do it yourself if you’re just starting.)
5) Make sure they know who to call/text if they need anything and remind them there’s no such thing as a dumb question.
6) Make sure they know that you’ve always got their back.
1) Expect people to show up to unpaid trainings.
2) Be impatient with questions.
3) Expect them to figure everything out themselves.
4) Throw them to the wolves by sending them to new clients without adequate context or preparation.
Piece 9: Communication
I spent several years working with Aaron Marcum, who has owned several agencies (including the largest agency in the state of Utah at one time), founded Home Care Pulse, and consulted with dozens of agencies on organizational efficiency.
One thing he taught me has always stuck with me: Communicate for relationships, not just logistics.
Communicate for relationships, not just logistics. - Aaron Marcum
Print it out. Frame it. Make it your phone background. Write in the sky. I can't overstate the importance of that concept.
When the only time you’re communicating with caregivers is to let them know their schedule or alert them to a problem, you develop a customer service relationship where you only really talk when something bad is happening.
Take time to regular communicate with caregivers with no other objective than to see how they’re doing and ask what you can do to support them.
Additionally, audit the communication process when they need to get a hold of the office.
• If your caregivers have a problem during a shift, can they get answers promptly?
• Do they know who to go to with questions?
• Do you and your staff always treat your caregivers as the professionals they are, in any context and in any communication?
Piece 10: Focusing on the First 90 Days
You’ve probably heard the statistic: 57% of caregiver turnover happens in the first 90 days.
If your caregivers stay through the first 90 days, they’re disproportionately more likely to stay on with your agency long-term.
If you’ve read the above sections on Recognition, Training, Orientation, and Communication and taken them to heart, you’ll be pretty well set up to succeed here.
However, there are a couple more things you can do:
1. Assign an experienced caregiver to mentor new caregivers. They might call the new caregiver each week to check in, answer questions, and offer guidance/support. Sometimes it’s good just to have someone to laugh with.
2. Set up a way for your caregivers to build camaraderie with each other in an informal setting. You might facilitate monthly coffee hangouts or even just start a Facebook group. Building community among your caregivers is key to giving them reasons to stay. Tip: where possible, rely on trusted caregivers to push these initiatives forward for you. No social gathering is quite as natural when it’s facilitated by your boss.
3. Provide multiple channels for caregivers to provide feedback. An open-door policy is a good start, but you should also proactively seek anonymous feedback to find out the things they’re too nervous to say to your face.
Conclusion: Be The Agency You’d Want To Work For
It sounds cliché, but this is the most important lesson in caregiver recruitment. Whatever tactics you may find to help you reach more applicants, at the end of the day caregivers will be drawn to and stay with the agency that treats them the best.
We often talk about the idea of providing the care that you’d want your parents to receive. We need to take it a step further and consciously work to be the type of agency you’d want to work for as a caregiver.
Culture is to recruitment as marketing is to product. You’re selling caregivers on the experience of working for your agency as much as you’re selling clients on the quality care you provide.
This concept needs to be your mindset as you consider how to implement the rest of the points we’ve discussed here.
Company culture is like a garden:
Something is going to grow there whether or not you want it to.
It’s up to you to decide whether it’ll be flowers or weeds.
I hope this was helpful. By the way, I work for Careswitch—a new home care software built for small but growing home care agencies. It’s built by a team of crazy talented designers and engineers with initials like MIT, IBM, and PhD on their resumes, and customers are loving the simplicity and ease of use. We even have dedicated engineers who take your feedback and use it to add the features that are most important to you. If you want to try it out for free without talking to a sales person, you can get started here.