Based on MissionCare Collective’s comprehensive data, the report illuminates important issues related to caregivers’ emotional, physical and financial positions. It goes beyond statistics, providing an analysis of the factors that contribute to the struggles of the workforce, including financial instability, training and development, and poor physical and mental health. 

Furthermore, the report offers specific data for each state regarding workforce gaps, wages, and the composition of the workforce, equipping industry leaders with the insights necessary to address these challenges directly.

“One of the most concerning findings in the report is the poor health and wellbeing of direct care workers,” MissionCare Collective CEO Brandi Kurtyka told Home Health Care News. “These caregivers, who dedicate themselves to supporting those in need, struggle financially, mentally and physically. This creates a paradox where we have a workforce tasked with ensuring the wellbeing of others while they face significant personal health challenges.”

A lack of health insurance and reliance on public assistance affects caregivers’ personal and professional wellbeing. According to the report, 15% of caregivers lack health insurance, and 42% come from low-income households.

Additionally, the report emphasizes a widening wage gap, with direct care workers in most states earning $2 to $3 less per hour than workers in industries requiring similar skills.

“While many caregivers are motivated by more than just a paycheck, the widening gap in competitive wages is exacerbating workforce shortages and creating challenges in recruitment and retention across the health care industry,” Kurtyka said.

When caregivers lack access to proper health care, they are at a higher risk of developing chronic health problems, facing delays in treatment and experiencing increased stress, all of which can negatively impact their physical and mental wellbeing. This difficulty can make it challenging for them to fulfill their caregiving responsibilities effectively. Additionally, the financial instability that comes from relying on public assistance adds another layer of stress.

“Worrying about necessities like food or transportation can distract caregivers, no matter how dedicated they are,” Kurtyka said. “A healthier, better-supported workforce is essential for delivering higher-quality and more consistent care.”

The emotional health of direct care workers is a significant concern, with 21% reporting poor mental health, according to the report. Direct care workers are three times more likely to struggle with anxiety and depression, with role misunderstandings and expectations to perform tasks beyond their training adding to their stress. Working in unfamiliar and potentially unsafe environments exposes them to risks such as drug activity, violence and assault. Social isolation, coupled with the high physical and emotional demands of the job, leads to elevated stress levels as well.

How leaders can provide support

Supporting the workforce begins with understanding their needs and going beyond traditional employer approaches. The report indicates that caregivers don’t often feel respected and sometimes feel as though they are seen as housekeepers, which is beyond the scope of their job duties. One survey participant called for a professionalization of the role, which begins with educating the client on what the caregiver is there to do.
“It’s difficult to scale and manage a workforce that is struggling at home, but to build a high-performing team that shows up and is capable of delivering great care, we need to ensure they are supported,” Kurtyka said. “The data in the report needs to be better understood and discussed, and the workforce’s wellbeing needs to be prioritized.”

The post Home-Based Care Workers Face A Wellbeing Crisis, According To New Report appeared first on Home Health Care News.

Having a well-thought-out strategy can alleviate some of that pressure, however.

“The real elephant in the room for all of us is that I think most of us in this space are really trying to recruit our way out of a retention problem,” Kevin Kirkland, a senior business strategist with MissionCare Collective, said during a National Association for Home Care & Hospice (NAHC) webinar Thursday. “I met with a home care agency owner just last week and he told me that he’s operating two businesses: one business is a recruiting business, and the second business is his home care agency business.”

MissionCare Collective — the parent company of myCNAjobs and CoachUp Care — is a staffing and recruiting company focused on caregivers.

To change the way the home care industry tackles recruitment and retention, it has to change the way it thinks about it — both from a business perspective and an operational perspective.

It’s usually pretty easy to point to human resources as the arm of any business that handles recruitment. Retention, on the other hand, is tougher to pin down.

“What I’ll usually hear from agencies is that retention is something that’s owned by the entire leadership team, or every employee of an organization,” Kirkland said. “I think all of us can understand that if everybody owns it, no one really does truly own it at all. So my advice and my direction would be to ensure that someone in your organization owns retention. Make it assignable. Make it accountable that someone on your team is owning retention.”

Home care agencies should also be changing the way they track new hires, Kirkland said.

The days of getting as many candidates in the door as possible are gone. That shouldn’t be the barometer for recruiting success anymore.

“Net new employees is the new metric for success,” Kirkland said. “I challenge all agencies to start thinking about measuring your net employee growth, as opposed to measuring new hires.”

Another important factor is making sure new hires are placed in the right situations in the first 30 to 60 days.

“The reason that my CNA jobs tend to be stickier and have a higher success rate of candidates that stay with the organization is because we do a more effective job of matching the criteria and the quality of those candidates on the front end with the opportunities that we’re looking to hire for on the back end,” Kirkland said. “When there’s a greater alignment of the candidate’s interests with the opportunities you place them in, they’re happier. Happier candidates and happier employees translates to a better and more positive memorable service experience with the families and the patients that they’re caring for.”

Business development hires

Aside from caregivers, hiring a dedicated and focused sales and business development team is also hugely important for an agency’s bottom line.

However, offering business development and marketing positions to a broad audience is not the best use of resources, especially in home care.

“A lot of folks are hiring people who want to do email marketing campaigns or social media management,” Home Care Evolution CEO Steve Weiss said during the webinar. “Those things are great and those things do help, but to get the high-need home care clients that can eventually boost revenue, you need direct referral marketing.”

Home Care Evolution is a business development and training company specializing in home-based care.

Marketing to new sales team members should explicitly say the job requires building and establishing relationships with referral partners.

“I can’t stress this enough,” Weiss said. “I have seen a very high number of folks turnover because they don’t want to do the business development — but that is what’s required to bring in the right type of caregivers. Building relationships, business development, community relations — that’s the first step to make sure you have skyrocketing revenue in 2024.”

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That was one of the many takeaways from a study conducted by MissionCare Collective and the National Association for Home Care & Hospice (NAHC), which focused on current caregiver challenges and opportunities.

The study evaluated more than 65,000 personal care workers across more than 90 data sources.

“It’s important for providers to ask themselves questions like, ‘Who are you attracting to your organization? What does your messaging look like? What are you doing today to retain those folks?’” Maggie Keen, VP of corporate development at MissionCare Collective, said during a Polsinelli webinar Wednesday. “There’s an opportunity for providers across home-based care to not engage, recruit and retain everyone like everyone is the same.”

One of the high-level insights that Keen pointed out from reviewing the study’s findings is that caregivers are seven times more likely to live in the poorest income category compared to the average U.S. population.

“The reality is that 63% of CNAs, and nearly as many home health aides, have a net worth of less than $25,000,” Keen said. “We already know that retention is a struggle in this industry: 57% of caregivers quit in the first 90 days and 85% of all home care providers are turning away cases due to lack of staff.”

Keen added that 61% of caregivers and 59% of home health aides reported $0 in discretionary income.

The study also found that over half of home care workers and a third of CNAs rely on some form of public assistance, while 90% of caregivers do not have a credit card.

“This report provides some insight that hopefully can be the basis at the beginning of conversations that we’re having with caregivers,” Keen said. “It can be used as a tool to understand, hopefully, some of the challenges that may be facing our direct care workforce. That can be both at a local level – and as an industry as a whole – as we look into expanding our workforce.”

Providers should be able to advertise and market job openings to different types of caregivers, MissionCare suggests. For instance, it uses labels to describe the different types of caregivers, whether those be career ones or those looking for work on the side.

“As we think about our own workforce and as we think about opportunities to expand our workforce, challenge yourself to think about, ‘Does your existing workforce represent all of these groups or just some of them?’” Keen said. “Do you have different job ads for each group? Do you have different sales strategies to recruit each persona? The goal here is to keep them engaged, especially in the first 90 days, so they’re not joining that 57% that are churning.”

Apart from understanding how to better recruit and retain caregivers, it’s also important for providers to stay up to date on immigration policies that will undoubtedly affect the home-based care space.

Replacing the retiree workforce with U.S. workers appears to be a losing battle, Carlos Ortiz, a shareholder with the law firm Polsinelli, said.

From now until 2031, it’s estimated that 332,000 home health and personal care aides will drop out of the workforce each year.

“The difficulty of replacing the retirement workforce with an ever-shrinking population of native-born workers will create substantial shortages in low- and middle- skilled occupations, including the home health care sector,” Ortiz said. “Home health is considered a low-skilled job, but the position demands a high range of physical, psychological and emotional skills, including being able to safely transport people and dealing with diseases such as Alzheimer’s or dementia.”

Today, there are about 2.1 million immigrant workers in the home health space, Ortiz said.

“Even though the sector is already highly dependent on the foreign-born workforce, the U.S. immigration system lacks temporary, non-immigrant and immigrant visa categories designated for low-skilled home care workers,” Ortiz said.

One key piece of workforce law that Ortiz said to keep an eye on is the expiring rule that allows for I-9 workforce employment and identification papers to be filed remotely. That law was changed during the pandemic for flexibility reasons, but is set to expire later this year.

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That’s one key takeaway from a recent webinar hosted by the National Association for Home Care & Hospice (NAHC).

“There is such a huge and interesting opportunity to go deeper, to get more personalized [and] to reach more people,” Brandi Kurtyka, CEO of MissionCare Collective, said during the webinar presentation. “The more you understand [caregivers] and the more you can unpack, the greater you can come alongside [them]. You can recruit and retain, and you can set strategies to really scale your business.”

NAHC and MissionCare Collective teamed up to conduct a data study on 67,000 caregivers. While the full study hasn’t been released yet, the organizations shared their insights on recruitment based on these findings.

The study breaks down the types of people, or cohorts, that make up the broader caregiver population. The list includes the colorful labels of: career caregivers, caring-on-the-siders, young-and-on-the-move, oodles of offspring, single moving mamas, empty nesters and still-going-strong retirees.

One mistake that home care providers make is putting out job ads that only speak to one of these cohorts, the career caregivers. These are individuals that have, typically, worked as a caregiver for three or more years.

In other words, if an employer took a peak at a career caregiver’s resume, they will find that most of their past jobs are caregiver roles.

“That’s who everyone wants. That’s who everyone’s talking to,” Kurtyka said. “Here’s the reality — there are not enough career caregivers.”

Providers should look at their current workforce and take note of where they are versus where they’d like to be, according to Kurtyka.

“You have control over thinking about how you advertise, how you approach it, how you inspire some of these different groups,” she said. “How you inspire a career caregiver and an empty nester to take your job are different, and how you inspire young-and-on-the-move and oodles of offspring to move beyond that 90-day mark — 57% of caregivers are quitting after 90 days — are fundamentally different.”

When thinking about recruiting different cohorts it’s important to develop a strategy that attracts the various cohorts.

Caring-on-the-siders, for example, can be found all over the internet, across a number of job boards. This group is typically made up of middle-aged people who are working a number of different hourly jobs in various fields, such as retail and food service.

It’s also crucial to examine how to create an offering that’s attractive to specific groups and to identify what benefits they care about.

For example, career caregivers value stability, training and continued growth, and earning enough money to avoid working jobs outside of care. The biggest turnover risk with this group is a bad client match.

Wages and flexibility are two of the biggest drivers for caring-on-the-siders when it comes to accepting and keeping a job. The biggest risk with this group is a scheduling conflict with a higher-paying job.

“As an employer, you probably just have the same benefits for your entire team, but how you talk about them can be different, how you address them in your job ads, how you address them in an interview,” Kurtyka said.

Another factor is figuring out ways to onboard individuals, and how you plan to engage employees over time in order to sustain a workplace that has longevity.

When engaging a career caregiver, for example, it’s best to be transparent in scheduling.

Ultimately, becoming more targeted in their efforts could be the key to helping providers stand out in a competitive labor market.

“It’s really wonky what’s happening in the labor market right now,” Kurtyka said. “We have unemployment going up. Yet we have this fight for hourly labor that’s never been more fierce.”

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Demand for home-based care continues to rise. Thus, more workers are needed.

What sounds like a simple equation to solve theoretically is far more complex in practice – getting “more workers” is easier said than done. Still, in order to satisfy that demand, home care agencies are getting creative.

Whether by leveraging certain training or using unique recruitment practices, home care agencies are figuring out different ways to recruit and retain employees.

“There’s not a one-size fits all strategy to recruit and retain caregivers across personas,” Brandi Kurtyka, CEO of MissionCare Collective, told Home Health Care News in an email. “For instance, a career caregiver is different from someone working a care job on the side and different from a retiree. We’re starting to see agencies adjust their approaches from a one-size-fits-all to meet people where they’re at.”

Understanding what prospective employees want

In order for home care agencies to recruit new talent, leaders have to know what future employees want.

As the leader of MissionCare Collective — the parent company of myCNAjobs and CoachUp Care — it is Kurtyka and her team’s mission to discover solutions that are grounded in what motivates the workforce.

“The more you know about who you’re trying to recruit, the more you can refine your recruitment and retention strategies to scale,” Kurtyka said. “The better you become at leaning into what employees and potential employees care about, the less emphasis they will have solely on wages.”

MissionCare Collective is St. Petersburg, Florida-based group of health care companies that serves as an educational and supportive bridge between providers and employees.

Consistent training, supportive work environments and a good work-life balance are just a few pillars that tend to resonate with all prospective employees, but especially millennial and Generation Z ones.

Knowing who to recruit may be half the battle. The other half is thinking outside of the box on how to recruit them.

As an example, 24 Hour Home Care has found ways to create flexibility in its schedule in order to attract workers and expand its overall workforce.

“To expand our caregiver workforce, we’re focusing on offering schedule flexibility and respecting personal obligations,” Stella Harsono-Peralta, 24 Hour Home Care’s senior director of people operations, said in an email. “Due to the nature of care being an around-the-clock job, we hire caregivers who are available to staff various schedules because that’s what works for them and their families. We’ve become very strategic and creative with our staffing planning to support our caregivers’ preferred work schedules and better serve clients.”

The Los Angeles-based 24 Hour Home Care is a non-medical home care provider with 23 locations across California, Arizona and Texas.

The company has also leveraged technology to make 24 Hour Home Care a more attractive place to work. Onboarding and interviewing is completely virtual. Employees are able to communicate via text with their bosses, and they also use an application to submit their shift hours.

“It has modernized the process and enables them to submit their hours in real-time and get paid faster,” Harsono-Peralta said.

Time and again, home-based care employees have shown they want to learn, and place a lot of weight in their training in their onboarding processes.

Allowing the opportunity for continued education can be one way to show an employer also values that aspect of the hiring process, Helen Adeosun, CareAcademy’s founder and CEO, told HHCN.

“A lot of the examples that we have are customers who are using and leveraging education as a means of not only attracting the workforce, but really upskilling folks,” Adeosun said. “Often, we’re finding that when you see caregiver attrition, it’s because they either weren’t prepared for the position or didn’t feel like they had the support or skills needed to do the work.”

CareAcademy is a Boston-based training platform for caregivers that works with over 1,600 home care locations across the U.S.

Across the industry, Adeosun said she constantly hears reports of direct care workers yearning for communication, guidance and appreciation for the hard work they’re doing.

She has also seen providers use certain CareAcademy tools to boost recruiting and retention efforts.

One example is the Area Agency of Aging of Northwest Arkansas, which doubled its applicants for caregivers by highlighting that it offered training, through CareAcademy, that employees can take anytime, anywhere.

“When it comes to training in this space, I think people make the assumption it’s going to have to be done in person and that already creates a level of friction,” Adeosun said. “Just by stating out front, within an employee’s first few weeks, that they’re going to get access to a resource that’s not going to cause a point of friction, is a great introduction into the home care and home health fields.”

Searching for non-traditional caregivers

Another creative way agencies are recruiting is by looking outside of the normal or typical caregiver, a tactic that has gained significant popularity over the past couple of years.

Before getting into the home care space, Pete Morrissey worked in a number of fields that influenced the way he runs the Right at Home location in Gainesville, Georgia.

He graduated from West Point and was an aviation officer. He’s worked in pharmaceuticals, private equity and is the former vice dean at Columbia Business School. With such a varied background, Morrissey was able to tackle certain issues, like expanding the workforce, with a fresh perspective.

“Coming into this space, I wasn’t beholden to any historical norms or how things are supposed to be done,” Morrissey said. “In terms of talent acquisition, I’m more interested in the requisite skill set that someone brings, and they don’t necessarily have to have demonstrated that in home care.”

Morrissey took the approach of going after workers with retail or similar customer service backgrounds.

Two things that he always looks for – above everything else – is reliability and timeliness.

One specific non-caregiver example was when Morrissey needed a new scheduler at Right at Home. He kept the job description vague and encouraged people to apply even if they didn’t match each requirement.

Morrissey received over 50 resumes, interviewed 14 people and ended up hiring someone with management experience in the fast food industry.

“She was used to working in a high-speed environment with a lot of variability,” Morrissey said. “She had experience with employees who call out, having to manage day-to-day and operating in a pretty demanding environment.”

The results of Morrissey’s out-of-the-box approach have paid off.

“We grew in excess of 60% top-line growth in 2021 and this year we’re in excess of 40% year to date,” Morrissey said. “I only share that from the perspective that we can’t grow at that rate if we’re not hiring at the same rate.”

Incentives can also lead to better recruitment and retention results. Offering retention bonuses — especially to older caregivers who may already be at retirement age or “empty nesters” — can be particularly effective, Kurtyka noted.

Bonuses based on time spent at one company, and offering clear promotion paths, are two other incentive-based retention tools Adeosun has seen work effectively.

On its end, 24 Hour Home Care does a little bit of everything.

“To aid our caregiver retention, we offer sign-on bonuses, employee referral bonuses, flexible working schedules and timely payouts,” Harsono-Peralta said. “We consider our caregivers part of our 24 Hour Home Care family and offer them benefits, paid training and continued education.”

What agencies can do now

Recruiting a future caregiver right out of nursing school should be a different journey than recruiting a lifelong caregiver coming back to the workforce after years away.

As Kurtyka mentioned, a one-size-fits-all strategy is not good enough in today’s hiring climate.

“It’s also important to invest in a multi-prong approach to hiring, while measuring the cost per hire and the cost to retain,” Kurtyka said.

Adeosun echoed that sentiment, saying agencies should consider the ROI on incentive plans versus the high costs of turnover and hiring.

“We believe that employees and direct care workers are the greatest asset of any home care agency, in more ways than one,” Adeosun said. “Building a program with the employee is a really great way in making sure there’s buy-in and that you can entrust folks to be ambassadors alongside you.”

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