Turning the Tide on Turnover: Recruitment and Retention Threaten the Future of Care Quality and the Time to Act is Now

 In Reducing Employee Turnover

With less than five months until PDGM takes effect and pilots underway testing lower clinical qualifications for hospice, home care organizations are focused on preparing for major change. But the biggest issue impacting the industry – the one with the greatest potential to impact long-term performance – isn’t regulation. It’s turnover.

Median turnover rates skyrocketed in 2018 to 82 percent, according to Home Care Pulse’s Home Care Benchmarketing Study, well above levels experienced in any other industry. (For comparison, the tech sector, which has the highest turnover among the Fortune 500, tops out at around 13 percent attrition.) Given the level of skill required in hospice and the level of coding savvy needed for home health under PDGM, home care companies cannot successfully weather such high turnover rates.

Employee recruitment and retention should be toward the top of every hospice and home health leader’s agenda for the foreseeable future, commanding at least the same level of dedicated focus and support as marketing and referrer relationship management.

Because compensation is most frequently listed in exit interviews as the reason why an employee leaves, most leaders think they must raise pay to keep great workers. Your compensation strategy may be one element you need to address, but  often it’s the softer elements of people management and development that have the greatest impact.

Here are five questions to consider as you formulate your recruitment and retention strategy:


1. How is your agency different from all the other providers in your market? How is it different from all the other employers in your market? Differentiation is a critical element of branding, but it’s also essential in building an attractive culture and employee value proposition.

2. Are those differentiators reflected in how you recruit, assess, onboard and develop employees? Your differentiators must be evident in job listings, in how you evaluate talent and how you onboard new team members. Review your recruitment ads. Are they focused on compensation and benefits or on an employee experience that will only increase in value over the years? When it comes to training, what kind of development opportunities are there for employees outside of regulatory compliance? Do individual development plans help employees feel valued, engaged and consistently contributing to your mission and vision.

3. How do you regularly solicit and address feedback from employees? Having a method to request, communicate and address feedback from employees shows that leaders care about the employee experience. This is make or break stuff in employee engagement. It’s hard work, but it’s worth the time.

4. Do people know how to handle or escalate problems as they arise? This question covers a lot of ground, but at the core is how the organization supports employees in problem solving. QAPI provides a fantastic framework for solving problems while building culture and deepening employee engagement. Quality and culture go together like peanut butter and jelly.

5. Do team leaders regularly have conversations with employees about development and engagement topics or do conversations pretty much focus on the daily scope of work? Employees consistently list “limited development opportunities” as the real number one reason why they leave their jobs. Weaving development into regular conversations between team leaders and employees makes development an ongoing priority.


Your brand as an employer is as important as your brand for patients and referrers. Articulating and cultivating your culture and employee value proposition and making sure those values permeate the employee experience goes a long way toward reducing turnover.

With PDGM on the home health horizon and reimbursements beginning to reflect patient and family quality assessments, it’s time to put the same level of care and dedication into employee relationships as referrer relationships.

To learn more about this topic and snag practical tips and Fortune 500 best practices for reducing turnover, catch me at the International Council on Active Aging Conference in Orlando on October 12 or at the Association for Hospice & Home Care of North Carolina Leadership Conference on October 28.

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