Paying your care staff more won’t keep them around longer. Kristen Duell, HCP’s New Chief Marketing Officer, and other industry experts explain what really retains care staff and why pay rates won’t cover up the real issues of turnover and lack of engagement.

Every day, 10,000 baby boomers turn 65, making the post-acute care industry one of the fastest growing industries in the United States.

Yet it also ranks among the top 5 industries with the highest workforce shortages.

98% of agencies were negatively impacted by care staff shortages last year, meaning only 2% of providers are confident that they have adequate staff to run their agency—the worst it’s been in 3 years.

To make matters worse, hospices have lost social worker employees at a faster rate than any other health care setting in the care continuum as turnover rises to 27%. In the last two years alone, more than 6/10 nurses have changed jobs.

It’s never been more important to keep care workers in the industry—but paying your employees more isn’t the long-term solution to workforce shortages.

Four industry experts share what is:

  • Protect your entire staff from burnout by starting with your office staff 

  • Keep your care staff engaged through a recession 

  • Prioritize what is most important to your employees

  • Invest in solutions that simplify the experience for care staff and clients


Short on time? Jump straight to the action steps.

Why Leaving the Care Industry is Like Moving Out of California

Kristen Duell, HCP’s Chief Marketing Officer said, “Very similar to people that have lived in California at a certain point in their life who then decide to leave—they realize that it’s very hard to return and go back to that cost of living. If you lose employees from a health care perspective, it’s very hard to get them to come back into the industry.”

According to the latest HCP Benchmarking Report, the difference in turnover between agencies who are paying above 75th percentile versus those who pay below the 25th percentile is lower than it’s been in 3 years.

Which means providers who are paying their employees more than average are still seeing a 63% turnover rate.

So while paying your employees more definitely impacts retention, the data shows that your caregivers are still looking for more than just pay.

They’re looking for you to listen to them and turn their data into action.

Here’s how.

1. Protect Your Entire Staff from Burnout by Starting with Your Office Staff

In the booming post-acute care industry, providers experienced a 7.3% growth rate on average last year, making client growth the highest it’s been in the last 4 years. While this is great news, the average care staff turnover rate has stayed at a steady 65% for 3 years in a row.

Meaning that although providers are seeing an influx of clients, their number of available staff remains the same.

The care at home industry is also the only environment where long-term care providers are expected to deliver care to all their patients between the hours of 9 a.m. and 1 p.m.

This has understandably caused burnout for everyone within your agency, but it’s your schedulers who have taken the greatest hit from workforce shortages as they struggle to find enough care staff to meet all your clients’ needs.

Rescue your schedulers from reaching unprecedented levels of burnout:

  • Reassess your remote operations by “role mapping” your office staff’s responsibilities: As your office staff are not necessarily within the 4 walls of an office anymore in a post-pandemic work environment, your schedulers may be struggling to work from home if they don’t have access to necessary resources such as reliable Wi-Fi, a fax machine, or support from coworkers. Dr. Amy Moss, SVP of Clinical Operations at Amedisys Hospice said, “We have an opportunity to really reassess those workflows and those things we’ve taken for granted for so long and do a lot of work role mapping to see what each office role should look like. In the process we’ve uncovered opportunities to create some advancement pathways for staff that we didn’t previously realize and create some efficiency as well.”

  • Prioritize relationship-building: Jobseekers who enter the industry are people-focused and relationship-driven, explains Jason Banks, Vice President of Post-Acute Business Development at nVoq. While it’s easy to see how your care staff values their relationships with clients and their families, schedulers also need to feel a support system as they adjust to working under pressure in isolation without much interpersonal connection.

  • Be consistent in what you ask your schedulers by proactively assessing your clients’ needs: As the face of your agency, schedulers bear the brunt of workforce shortages as they’re tasked with filling every open shift. Balance their workload by ensuring you only take on clients to whom you have the staff to meet their needs. Dr. Moss suggests, “We need to be proactive about what we think our needs are going to be as an organization down to the care center and patient level. Our workers and patients both like it when we are proactive about what we think a client’s needs are going to be over the next several days, 37 days, 12 days, or 5 days, and create tailored schedules around that.”

  • Learn from other industries and from your schedulers themselves: While schedulers in the post-acute care industry are struggling with the burnout, they aren’t the only schedulers navigating the workforce shortage. “We have to question everything if we are going to meet the needs of the future,” Matt Kroll, President of Assistive Care Services at BAYADA explains. “We need to change the paradigm a little bit and learn from how our partners on the Medicare side of the fence handle scheduling. Our schedulers also have some great solutions because they see things that are happening directly in the market. We have to crowdsource with them to figure out how to navigate those difficult conversations.”


As the heartbeat of your agency, your schedulers’ well-being determines the health of your business. Keep a pulse on their workload and offer them opportunities for interpersonal connection to see an increase in both client and employee satisfaction.

2. Keep Your Care Staff Engaged Through a Recession

Regardless of which sector of the industry you work in, industry-wide workforce shortages are putting a financial strain on providers and care staff alike; costing $2,600 per caregiver in turnover costs, $19,500 per scheduler, and $88,000 per hospice nurse.

As Kroll explained, providers need to meet their staff where they are during an economic downturn to keep them in the industry:

  • Connect your employees to their work’s greater purpose and remove barriers to fulfillment. Millennials and Gen Z, who make up over 1/3 of the American labor force, are searching for jobs that provide them with both meaning and purpose, not just a paycheck. Connect your employees to your agency’s mission, vision, and values to show that their work enables the most vulnerable population to age in place from the comfort of their own homes.

  • Create work-life balance with flexible but consistent work schedules. “Our workers want flexibility, but they also want consistency,” said Dr. Moss. “They want to know when I need them so they can plan the rest of their life which feeds into the notion of work-life balance. They want to have some control over creating that and the way we do that is by being consistent in our ask of them.” Be careful making changes to your staff’s work schedules without enough notice to alleviate their anxiety. Find out what work-life balance looks like for your employees to create manageable schedules tailored to their needs.

  • Periodically re-evaluate your employee wages and mileage reimbursement. While increased pay isn’t the only answer to increase employee retention, reevaluating your wages is crucial in times of economic downturn. For example, Kroll explains that his agency had to increase his mileage reimbursement twice in the last 6 months and increase pay rates by 50 cents every quarter to match the changes in inflation. Take the financial strain off your care staff by budgeting for mileage reimbursement wherever you can.

  • Be transparent about the struggles the industry is facing and invite your employees to be a part of the solution. Overall, it’s never been more important for your care staff to know that their employer prioritizes their needs and well-being. Duell explains, “Sometimes your people just want to know that you care and that you’re willing to do something about it.”


3. Prioritize What is Most Important to Your Employees

Unless you prioritize your care staff’s needs, it is projected that 65% of your employees will turn over by the end of the year—and 57% will quit within their first 90 days. As recruiting in the post-acute care industry is increasingly challenging, it’s never been more important to retain the employees you do have.

Learn what your care staff really need to stick around:

  • Visit local offices to align your agency’s mission, vision, and values with the needs of each location and its community: Kroll explained that providers can only navigate industry workforce shortages when they are aware of the state of their own workforce: “I did a tour last year where I visited about 25 offices and asked, ‘What was your COVID-19 experience like?’ The answers were anything from those in New York City who didn’t want to talk about it because it was still too raw for them, to those in Arizona who weren’t even sure it was going to come to them. As leaders, we need to be out in the offices connecting with our caregivers, our teams, and finding the right balance so we are all aligned on mission and values; while still meeting the needs of our community and local office teams based on their geography and what’s taking place in their healthcare communities.”

  • Conduct a listening tour at every business location to solve geographic-specific challenges in real time: Dr. Moss suggests travelling to individual regions to hear each location’s experience and solve their problems right then and there. Listening tours are an opportunity to gather insight into the challenges those in your agency are facing and learn what you need to start or stop doing as a company to improve your agency’s overall experience. 

  • Collaborate with institutions to provide career advancement opportunities: 3/4 of caregivers enter the industry with the intent to pursue a career in nursing or healthcare. Do your agency’s professional development opportunities reflect that? Dr. Moss and Kroll suggest creating a nurse residency/graduate program and offering scholarships to signify that your agency is the step employees need to advance their career.

  • Communicate to your staff that you’re actively solving their problems by dedicating an employee council to advocate for, address, and solve employee concerns monthly: While you must prioritize the needs of your care staff, it’s just as important to communicate your commitment to doing so. Banks does this by addressing his employees’ concerns monthly, “We developed an employee council comprised of individuals from the clinical team, caregivers, and office team that were responsible for monitoring suggestion boxes in between the quarterly or annual surveys. Those employee council members were to come to leadership meetings on a once-a-month basis, and review those comments in the suggestion box where we then would come up with an action plan to address those.”


Once you’ve collected information about what your employees really need from you, Duell explains, “Turn insight into action. Don’t have analysis paralysis. Get out there, take the data, and make a difference. You’ve got to be able to recognize your people and if you’re taking the data and you’re creating action from it, those are the things that are going to make the most difference for your staff and for your agency that allow growth.”

4. Invest in Solutions that Simplify the Experience for Care Staff and Clients

Simply put, agency owners need to slow down to speed up. When you’re struggling to engage and retain staff, it’s time to go back to the basics:

  • Role map to ensure your staff are operating at the top of their skill level: Dr. Moss explains: “In some ways, we may have done this to ourselves because we are just so eager to get our patients taken care of that we don’t really appreciate the anxiety we have created by putting those folks out in the field without the confidence and resources such as knowing who your point of contact is. You know when things are tight and you have really skilled and talented people that can do a lot of things but maybe they didn’t do them all exceptionally well—the temptation is to make them utility players. I think this is a good temporary solution in many cases, but we must be cautious about making that the status quo. Instead, we should take the time to role map so we can get back to encouraging and expecting folks to function at the highest level of their skill set.”

  • Eliminate or moderate anything that isn’t adding value to the employee experience: Banks explained that providers who know the difference between what their staff does and doesn’t enjoy will help them cater the employee experience to keep their staff around longer, “If you been out there with clinicians or caregivers, you’ll see that their world lights up when they’re doing what’s in their heart, which is operating at the top of their licensure if they’re clinician or if they’re a caregiver figuring out how to serve their patient or family right. We try to be smarter about how we deploy our clinicians so that they can do what they love which is building relationships and operating at the top of their license.” Wherever possible, ensure your employees have enough tasks that fill them with purpose to counteract the necessary mundane tasks.

  • Use technology to streamline communication processes to provide care staff with the information they really want: Your employees want the little details that make their job easier, and with the help of technology, it’s easy to give it to them. Kroll suggests using technology to your agency’s advantage by recording the details that make your staff’s day easier, such as: where to park, what door to enter, the basic layout of the home, what not to do/watch out for, and any other helpful details that will provide a polished client experience while putting your staff’s minds at ease.

  • Meet your staff where they are by adding color to the numbers: Kroll explained that while a satisfaction score offers quantitative data, the real richness of their feedback is the story and reasoning behind your Employee Net Promoter Score (eNPS). Add color to the number by reading your staff’s comments and taking their qualitative feedback into consideration.

  • Equip your staff with the tools they need to emotionally and physically excel at their job: Duell explains that agencies can’t afford to cut corners when it comes to equipping staff with the tools they need: “There’s nothing more uncomfortable than getting sent out to a patient’s home and feeling unequipped to serve the patient in the way they need to be served. To be able to serve that patient the way they need to be served. I can tell you from firsthand experience how emotionally distressing it is to leave a patient’s home and feel like you’ve done a disservice to them. I promise you that the majority of caregivers are harder on themselves than you ever could be, so understanding that and arming them with the right tools is really important.”


While we may be in a workforce shortage, your staff should never feel like they’re in a learning shortage.

Free Scheduler Success Training Series

The industry’s first training series created just for home care schedulers. Available for a limited time only. 

Replace Temporary Fixes with Long-Term Solutions

The bottom line: only your staff knows what will keep them around longer. Solve the workforce shortage by listening to your employees and delivering on their feedback.

While 70% of providers currently use a professional training provider, lack of training jumped to the number one industry complaint from care staff all around North America.

There’s hope: providers who use the HCP Care Intelligence Platform (including RN-developed HCP Training) generate 48% more in annual revenue and hire 60% more staff on average.

The solution to workforce shortages isn’t what everyone’s been telling you, but what your employees have been telling you all along.

What to Do Next:

TL; DR: Paying your care staff more to keep them around longer is causing a record industry-wide workforce shortage; address their number one complaint to see long-term solutions instead—training. 

Here’s how to successfully address the workforce shortage: 

HCP’s Care Intelligence Platform offers RN-developed training, satisfaction surveys, and reputation management tools to help you become the best employer and provider in your area—and make sure everyone knows about it.

Like it the old fashioned way?


  1. Emwedat Tesfa August 24, 2022 at 12:18 pm - Reply

    Thank you

  2. Eric Berkman April 25, 2023 at 8:37 am - Reply

    HI. Have you surveyed Caregivers about this, and do you have that data available? Thanks.

Leave A Comment