Ep:14 How to Get 80% of Your New Hires from Current Employee Referrals, According to Executives at Family & Nursing Care

Miriam Allred (00:02):

Hey, this is Miriam. Allred and you’re listening to Vision | The Care Leaders’ Podcast by Home Care Pulse. Today, we’ll be joined by Neil Kursban and Jennifer Sussman from Family and Nursing Care in Maryland. Neil joined the family owned business back in 1995 and became president in 2008 and has now been the CEO since 2018. Jennifer is the VP of Caregiver Services and started with the agency back in 2002. Neil and Jen are here today to talk about what’s working at their agency in regard to the current landscape of caregiver recruitment. How are you both doing today? Really excited to talk about recruitment right now. It’s top of mind for so many providers, and I think a lot of people are asking these questions that we’re going to cover today. So I’m just really excited to dive in. So to kick this off, Neil, I know you’re passionate about company culture and how that pertains to both recruitment and the retention side. So I want to, you know, turn the time over to you to talk about company culture and how it impacts your recruitment efforts.

Neil Kursban (01:07):

Sure. Thank you. And just as a one who’s listening, I would might want to know our company is been around since 1968. We have two different models of home care. Each one of them around the same size in total $40 million in revenue, we’re in the Maryland DC area. And it’s hard to believe we’ve been in business 52 years and I, myself am approaching my 25 year anniversary. Crazy. Wow. Okay. So your question around culture and caregiver culture. And in my view, I don’t think there’s a more important question that’s that can be asked. I mean, if the caregiver can get the company culture, right, the rest just becomes so much easier. And I know we work really hard and I’m proud to make it an area of strength that family nursing care. And of course, there’s always more we can do to create a better caregiver culture for what I call there are unsung heroes, the caregivers that are out doing the work every day, but to get specifically, I mean, one, I’ll just list a number of things that we do to try to create a healthy caregiver culture.

Neil Kursban (02:25):

And one of them is caregiver surveys. We used to make the mistake that we thought we know what the caregivers were feeling and thinking about our company, but really the caregiver surveys captures their feedback. You see it in print, we’d highlight the volume and the frequent responses of certain questions. And it really helps guide us on areas where we can improve. Another one is the communication with the caregivers. You know, we, we send frequent caregiver newsletters. We also have client and professional newsletters, but we, our volume is much greater on the caregiver side and the others, because again, well, anyway, so we send a lot of caregiver newsletters. During this covert period, we have been providing PPE of course, three of created the caregivers and we actually have chosen not to charge the clients COVID pay you know, when they tested positive or have been exposed and they can’t work reimbursing them for COVID testing, if they’re uninsured or if the insurance isn’t covering it the every week in some places they have to get tested and the insurance doesn’t want to keep covering.

Neil Kursban (03:41):

So we’re reimbursing them for the testing. One of the basic things that all companies really should strive to do is keep the caregivers working. I think the biggest likelihood of losing a caregiver is their case comes to an end for whatever reason. And if they’re out there for a day, two days, three days, I mean, they have to put food on the table. So ideally you want to keep your caregivers working. You know, once a case comes to an end in a very short timeframe because in this market, you know, it’s a caregiver shortage around most of the country. And if you don’t get them to work, somebody else will, and then you could be losing a really good caregiver. So we as a company, next item is we, you know, we intentionally choose to pay well above the market rate for CNS, for certified nursing assistants, usually around two to $3 higher than what CNAs earned in our market.

Neil Kursban (04:40):

We choose to pay over time and don’t limit it at a company sort of restrict and have their caregivers stop at 40 hours a week because they don’t want to have to pay over time and we’ll pay more on weekends. We’ll pay more in shorter hours. I mean, just certain things that caregivers are less reluctant to, you know, work weekends or shorter hours and you incentivize them in one way to do it is through money. Another one is we, again, ways to celebrate the caregivers will give a year end bonus $40,000 last year, just to our highest performing caregivers. We have a, an appreciation bonus over a hundred thousand dollars in gifts and gift cards and praise. And when we hear a lot of positive feedback, which fortunately we do, we want to continue to recognize the caregivers for the amazing work that they’re doing.

Neil Kursban (05:35):

Definitely. if it’s, I mean, we provide real health insurance, not him, it’s comparable with what our office staff has and a 401k match. And some other things that came up from the more recent caregiver survey, we’re going to look into other insurances. We can, we can offer to the caregivers. We have a caregiver parties while most years they’re face to face this year, me, but, but real parties. I mean, DJ and native foods to their country and photo booths, the size chairs, gift giveaways, iPads, $50 bills. I mean just giving, make it a celebratory event. And we get hundreds of caregivers that show up to our parties, which is wonderful. And really just another one is just finding genuine ways to connect and continue to find out how just to express our value and appreciation and some of the basic just treating them with dignity and respect.

Neil Kursban (06:41):

And I view it, we view as a company, it’s an honor that they’ve chosen to work at our company. I mean, they could work in other locations. Again, there’s a caregiver shortage. They choose to stay with us and we have a very low, like a 10% turnover rate. So suggests we’re doing something really well when you know, the, the benchmarking, the home care Paul’s benchmarking report shows there’s like a 60 or 70, or I don’t even know 80%. I mean, there’s a high caregiver turnover ratio, and that’s something we certainly don’t want to have. And then we have a Goodwill committee for caregivers, if there’s hardships or challenges in their lives and will help. We have a budget for that. We have a caregiver advocate who’s reaching out and just literally asking, how are you and what can we do to help improve your experience with our company?

Neil Kursban (07:33):

We have a regular meet and greets where now it’s over zoom, where many caregivers talk about that. They share their concerns to answer questions that may have. And we vary the times of the day, the days of the week and pre COVID. We used to have food and drinks, but now we’re doing it over zoom, send birthday cards and anniversary cards and milestone anniversary gifts. We also, in our agency’s side, you know, I mentioned we have two different models. We do extensive training with an organization in the know which has been wonderful. And you know, just, and then also we have in services with our RNs. And again, that’s the online platform of our training and a lot of OJT on the job training at the client home and continuing to message the training that we offer in our newsletters and things of that nature. So that is many, many more that we do. And I want to take up the whole time the podcast, but that’s some of the ways we try to create a positive work culture for the caregivers.

Miriam Allred (08:40):

Yeah. Thank you for sharing all of that. You know, we can’t emphasize enough creating a culture or being an agency or a place where the caregivers want to work, and that really helps on the recruitment front. You know, if you can recruit caregivers that want to work someone like yourself, you know, that’s really the end goal. So let’s kind of dive a little bit deeper here, Jen, I’m really excited to hear you know, you’re the VP of caregiver services. So you’re on the ground level, really talking to these caregivers and, you know, on the front of the recruitment side. So before we talk about, you know, your top three most effective recruiting methods right now, I want to talk a little bit about tracking. How does your team track all of your recruitment efforts?

New Speaker (09:22):

Yeah, that’s a great question. We actually use several tools to track the various steps within the recruitment process.

New Speaker (09:30):

I’m the one that we use most is actually our management software that we use for everything else, which is a matrix care. So we track all of our applicants in there, and then we can track all their activity and then once they become a caregiver and become active, then we can quickly activate them for scheduling. And we found that that has been helpful. Although there are other recruitment strategies platforms out there that this has been the easiest for us to navigate and keep all that information in one place. So aside from that other tools we use actually is a tracking spreadsheet. So we look at from a high level what our recruitment funnel looks like. So we look at how many are applying, how many we phone screen go through testing, interviewing, and ultimately our hired which has been great.

New Speaker (10:17):

Cause then you can look at it from a big perspective and see, okay, what steps of the process do we need to push more applicants through and what do we need to do to improve our recruitment effort? And I’m assuming you have a team that’s meeting on that, you know, weekly or monthly, what does that patient look like? Yeah, so they meet on a monthly basis. They look at what the recruitment was for the prior month and we’ll get, where do we need to advertise more of, how do we need to add more people to the funnel or, Hey, maybe we’re not finding the right people and what do we need to do to attract better applicants? Definitely. Yeah. That’s a great segue into, you know, your actual recruitment methods. There are so many and a lot has shifted since COVID, so I’d love to hear what are, you know, you’re probably your top three, you know, fruit bearing recruitment methods right now. Yeah. So interestingly enough even prior to COVID and during our number one referral source continues to be referrals from other caregivers that work with family and nursing care like around between 70 to 80%. So that continues to work very well for us. That word of mouth, for sure. And then, Oh, sorry, go ahead. Go ahead. Go ahead. Oh, I was just going to say aside from that the ones that probably yield the highest results for us is a combination of posting on indeed and zip recruiter.

Neil Kursban (11:43):

Okay. Okay. Yeah. And I just, sorry, I just want to interject one thing snail again, it, I mean, we’re proud of the fact that 80% of our caregivers are referring other caregivers to come work for our company. And, you know, in my view, like we have done work really hard to create that reputation about an amazing culture that they’re going to be proud to refer another friend or somebody else that they work with or know that’s a CNA to come work at our company. So it’s, and it also reduces our advertising costs by having a word of mouth. I mean, the caregivers referring other caregivers, you don’t have to do as much on indeed. And what was the other one? Jen? Ziprecruiter. ZipRecruiter. Yeah, we do it, but not, it’s not needed as much because of caregivers wanting to refer people they know to come work for us.

Miriam Allred (12:39):

Yeah. Can I ask what yeah. That looks like specifically every agency, does it a little bit differently? You guys are doing the surveys or how are you capturing those referrals from your caregivers?

New Speaker (12:51):

Yeah, so right now, the way that it works is when an applicant applies on their application, we ask, how did you hear about family nursing care? And they’ll write the name of the person that referred them. Sometimes it’s actually more than one person. But so typically the way it works is that whoever is interviewing them. And then again at orientation, we will clarify. Cause as I mentioned, sometimes there’s multiple people and they have to pick one person and we pay out our bonuses once the person has gone through orientation or through on our registry side, our introductory business meeting. Okay. Well in 70 to 80% of your new caregivers are referrals.

Miriam Allred (13:32):

That is incredible. Has it always been like that or have you seen that number go up over the last few years or, you know, can you kind of break down maybe that growth, how you’ve gotten to that point?

New Speaker (13:46):

Yeah, I would say it’s always been our number one referral source. That’s a good question. About the 70 to 80% and beyond not sure if you happen to know from prior year.

Neil Kursban (13:57):

No, it’s, it’s pretty consistently hovers around. This goes back almost literally decades. I mean, this is always been by far our vast majority of caregiver referring and my personal goal is to not even have to advertise. I mean, I would love for us. I’d love for it to be a hundred percent. And I mean, it’s, you know, again, we’re in a market of caregiver shortage and it didn’t used to be as pervasive and yet it’s still, we spend very little Mark our advertising dollars on, on caregiving, I mean recruiting caregivers, but yeah, I think it’s pretty much hovered around that amount for as long as I can remember.

Miriam Allred (14:37):

And like you said, Neil, then when you can cut back on ad spend and you know, recruitment spending, then you can put it back into the caregivers, through these parties and these incentives and benefits. That’s really, you know why these are referrals keep coming. So that’s incredible. Let’s talk a little bit about indeed and ZipRecruiter. Jen, if you don’t mind you didn’t mention using an ATS platform. So how does your team just post to those platforms manually? Or what does that workflow look like?

New Speaker (15:09):

Yeah, so they’ll post to those platforms manually and then the emails will come in and then they’ll reach out to the applicants either through the platform or directly to go through the screening process.

Miriam Allred (15:22):

Okay, let’s kind of keep moving here. If an agency is struggling with low show up rates for interviews, what, what are you guys doing to limit that number of no shows for interviews?

Neil Kursban (15:38):

I guess I’ll start Jen, and then you add some color to what I’m about to say. Oh yeah. I mean, this is, I know I’ve never understood why someone would apply to a job, get an interview set up and then not show up. But it’s a pervasive in this industry, which is so frustrating. And you know, last year we had around a 30% no show rate, which I just don’t understand. And it’s fortunately gone down like since coven looking around at 20%, no show rate again, I would say what’s have a 0%, no show like they should, all people should show up to an interview or are, you know, we want to at least strive to get it under 10%, but we’ve always, since the pandemic hit, we had to, we’ve had to rethink recruitment as an organization to find new ways of using technology to still recruit great caregivers.

Neil Kursban (16:28):

So since transitioning to video conferencing with Zoom, we found there’s been an increase in the number of caregivers who show up for an interview. And I mean, we don’t have hard data on this, but the thought being is just removing the barrier of on your way to the office. And people may not know where to park or they get lost or whatever it may be, and that barrier goes away. And then maybe the appointment times didn’t fit with their schedule, but doing it over zoom, there’s more flexibility because they don’t have to hop in their car and drive. And in our area there’s usually traffic pretty pretty COVID.

Neil Kursban (17:08):

And so there’s that aspect. And then again, not having to take time off from another job, but it’s a, it’s an event to go to drive, to show up lead versus doing it over. Zoom can be much more efficient. So to me, what was once I’m thinkable to, you know, we are really strongly considering continuing the zoom interview option, it was COVID to grow. And the benefit of that is to reduce the you know, to reduce the, the no show rates. And the other piece is around texting. I mean, texting reminders to caregiver applicants about the interview on the day of the interview that morning email reminders being sent after an originally, when the appointment’s made. And we want to get, we’re kind of looking into like auto text. Like if you get from like Apple or your dentist or the bank or someone where they automatically text you after you’re done setting the appointment, I mean, that’s, that’s ultimately where we want to go. Definitely. So those are some of the ways that we’re reducing the no show rate for interviews. What am I missing Jen?

Jen Sussman (18:18):

The only other thing I was going to add that we’ve been really trying to do is from the time that we first talked to them too, we interview, we try and decrease that time, keeping the interview appointment like the next day or the day after. So they’re not losing sight of us are going to another agency, you know, like trying to jump on those leads and get them moving as quickly as possible. Something else we’ve really been honinig in on.

Miriam Allred (18:41):

Can I ask what your goal is there, you know, how many days from contact to hire?

Jen Sussman (18:47):

Yeah, I mean, ideally within a week or so it depends on sometimes the background checks how quickly we can get references back. But the quickly, the better it, caregivers have a variety of places where they can be applying and working. And there is definitely a sense of urgency and wanting to get them moving. Definitely, definitely any, I appreciate it.

Miriam Allred (19:08):

You know, to what you were saying about the texting. I think it’s such a simple, you know, addition to that onboarding process, but you know, people are on their smartphone, caregivers are on their smartphones, so what better way to reach them then you know, where they are most comfortable in, you know, where’s most convenient.

Neil Kursban (19:27):

Right? And hopefully the software packages, whether it’s the Matrix Care or the others that are out there, we’ll have the technology caught up to be doing this audit texting thing that we’re looking to push. The other thing, I just, sorry, just another comment I didn’t think of is, you know, we are in a fortunate position having so many characters that want to come work for our company and we only bring on 10 what’s the most, I don’t even know what the percent is now. Like the people that apply that actually are brought on, like what’s, I know it’s somewhere in five and 10% of a do you know, it’s a low percent of people will bring on, do you know offhand?

Jen Sussman (20:11):

I don’t know what this current is at the moment, but yeah, I think the highest is 97% that we’ve brought on.

Neil Kursban (20:18):

So yeah. And I know that the national average is like 40% of something. So, you know, we, we, but it goes back to that whole culture that you create the reputation and then the caregivers want to come work for you and then you’re able to be more selective and then you have better caregivers. And so that that’s, that’s kind of how the cycle works. If you can see that. And then, and then again, just not having this turnover, I just don’t understand how seven out of 10 caregivers, 70% of caregivers, turnover ratio in this, according to the Home Care Pulse Benchmarking Study, it’s somewhere around 70, maybe it’s I think I saw as high as 80 at one point.

Miriam Allred (21:01):

Yeah. Yeah. Last year in 2018, it was 82%. But then in 2019, we actually, as an industry, we’re down to 64%. So it has gone down because we’ve increased awareness and just continue to, to make that number known in the industry. And so agencies are working on it, but I think you guys are probably the exception to that. You know, what are the agencies driving that number down literally and setting the example for the industry, which I think is phenomenal, but really just focusing on that retention piece and focusing on creating that culture where caregivers want to work. So that caregivers are literally coming to you to work for you. I think that’s most agencies dreams right now, but to hear you guys preaching these principles, you know, really making it a reality is just instilling hope for agencies.

Neil Kursban (21:55):

Great.

Miriam Allred (21:56):

So kind of my next question is what are some of your goals that are directly tied to recruitment, Jen? You know, what metrics is your team constantly tracking to make sure you’re always driving those results?

Jen Sussman (22:11):

Yeah, so, like I mentioned earlier, we look at how many inquiries is, what we call them. People who are interested in working with family and nursing care who have applied through indeed ZipRecruiter. How many go from there? How many interviews are we doing? How many people actually, we do use competency testing. So checking at each, each point within the recruitment process we track the number of people that go through each one of those to eventually become new hires or new newly on our roster. And then the other thing that we pay close attention to is how many caregivers we’re losing and then in any one month, cause you could put in all this effort recruiting, but then ended up losing more than you gained.

Jen Sussman (22:56):

So it’s a matter of staying on top of who’s coming in and who’s leaving and why they’re leaving and what we can do to fix that. Definitely, definitely tracking that monthly, I think is so important that turnover rate, you know, a lot of agencies are, but some aren’t and being aware of those caregivers that you’re losing. And I know you guys do a lot of surveying. Do you survey or how do you follow up with those caregivers that are leaving? What does that look like? How do you get that feedback? Yeah, that’s a great question and a good opportunity. I haven’t necessarily thought of a lot of times we have caregivers who are working with many agencies at the same time, which I think is more the norm and we just don’t necessarily hear from them. And if we don’t then you end up taking them off rest or cause we want to keep it as active as possible, but there’s definitely opportunity there to find out what’s going on. We do have a lot of people that do end up coming back. And we do try and keep in touch with them, with the postcards and that kind of stuff. Now that I think about it. So we do try and keep in touch and try and get them to come back when we can definitely,

Neil Kursban (24:06):

I mean the ones that go on to become LPMs or RNs, I mean, to me, that’s a success like this is the trajectory in their career and they want to further themselves and you know, and then there’s the lifelong caregivers, the lifelong CNAs. And you know, that goes back to if, you know, I would love to say we’re perfect every single time. And right, when a case comes to an end, that same exact character was working tomorrow, but it doesn’t, you know, you can’t control when Hey client call today or potential clients. Right. I mean, it is frustrating. And we don’t have work for the caregiver, especially cause we know they’re like really good caregivers and we don’t want to lose them, but you know, it does happen I guess, up to 10% of our, well maybe less than 10 because some go on to become nurses and they leave for other reasons or they move out of the area. But you know, again, we can get that caregiver turnover rate lower if we could just get them back to work the next day. Now again, that’s the challenge of having to manage that flow of clients coming in and the caregiver, you know, the cases available at the hours that they want with the right skills and the right location and all the other things that take to match the right character with the right client.

Miriam Allred (25:19):

Right. Definitely. We’ve talked, you know, briefly about, you know, the technology that you’re using and the resources that you’re using to recruit. I just wanted to open it back up, Jen, to see if there’s any other recruitment specific software products that you’re using, you know, to communicate throughout the whole recruitment process. You know, what have you seen that’s been effective there? What tools are you using that are, you know, really driving results, right.

Jen Sussman (25:50):

So it’s interesting. We found that actually trying to limit the amount of different technologies and tools we’re using is more helpful than having so many different ones. So that’s why we ended up with using matrix care. One of the other things we’ve talked a little bit already about is texting, we’re using a platform called zip what to do texting. And what’s great about that is not only being able to quickly get to the caregivers and there tend to be more responsible for texts, but they can also send us documents over test text message.

Jen Sussman (26:26):

So it’s helpful if you’re looking to get those documents, you’re waiting on to get them moving, they can quickly take a snapshot and get it over to you. So that’s been helpful.

Miriam Allred (26:37):

And I think that’s smart to, I mean, there’s so many technology products that can be used, but finding the ones that really make the most sense and cutting back, you know, when you can I’ve also had a lot of conversations recently with other providers about just communication in general, with COVID, you know, industry-wide and even outside of our industry, there’s just been an enhanced amount of communication coming at us from so many different directions personally and professionally. And I think we’re getting to the point where we’ve got to figure out how to cut through that noise. You know, there’s so much communication coming at us from all different fronts, but you know, how do we cut through that and be the most important communication or just communicate I’m thinking like the bare minimum, but not in a bad way.

Neil Kursban (27:26):

You know, I think it’s good to over communicate, but there’s so much communication going on. So finding, you know, what communication is the most important and you guys mentioned, you know, like newsletters, I think that’s a good opportunity to communicate a lot of information in a clear and concise way that’s relevant, you know, to your employees. Any other thoughts on kind of just that topic in general? Yeah, it’s interesting. And this has been a recent topic of conversation with our communications department is having more purposeful conversations and communications with the caregivers. There is a lot with COVID going on and something is always changing. It’s hard to, you know, kind of hang your hat on what’s going on. So we’re looking at how can we have more purposeful communication with them and limiting what we do so that they actually do read or hear what it is we’re trying to share with them.

Neil Kursban (28:18):

So that is something that we’re continually trying to work on right now, because there is so much noise definitely with what’s going on and trying to hone in on what is absolutely important and imperative and such a difficult time. And I think we’re figuring that out, you know, as an industry, what communication pieces are most important and how do we communicate them effectively so that the caregiver hears and ultimately listen. So I appreciate that. UI appreciate the conversation. UI feel like we’ve had some really good conversation here. Is there anything else that either of you want to speak to or feel passionately about that relates to recruitment right now? I don’t think so.

Neil Kursban (28:58):

Yeah. Nothing. These are excellent questions and I’m hoping your listeners will eat some of this advice because it’s, I will say this it’s really a passion of mine to make the lives of caregivers that much better and happier and stronger. And the whole dignity and respect it’s, it’s not just lip service. And I think sometimes some companies may not treat the caregivers in a way that they deserve. And I’m hopeful that if we’re able to shift some of those that are, you know, the paradigm of which they look at the caregivers in a, in a way that more along these lines, it would make me personally very happy and I think they deserve all that they do. And so much more

Miriam Allred (29:52):

Agreed and appreciate that. And I think, like I mentioned before, you guys are a shining example of doing this right? And I think agencies are aspiring to get to this point, but it takes time and it takes effort and it takes resources, but ultimately just takes, you know, a refocus on the caregiver as an individual employee and as an individual life. So appreciate all that’s been said. And thank you both for taking the time for joining us today. Really appreciate it and appreciate everything that you’ve shared. So thank you so much.

Neil Kursban (30:22):

Thank you. Thank you. Thank you.

Miriam Allred (30:26):

Thanks for listening to this episode of Vision with Neil and Jen. If you’re interested in learning more about Home Care Pulse, visit our website, homecarepulse.com to see how we can help agencies with client and caregiver, experience surveys, caregiver training, and online review management. Thanks for tuning in and we’ll see you next time!