Even with rapid-fire regulatory changes, potential technology disruption and sweeping consolidation on the horizon, most home care leaders agree: The recruitment and retention of workers is still the industry’s No.1 challenge.

With industry turnover hovering above 60% and a national unemployment rate dipping to below pre-2008 levels, it’s crucial home care agencies hit the ground running, showcasing a commitment to communication and an engaging workplace culture to new hires on their very first day. That may seem like a daunting task, but there are several quick-and-easy tips to help agencies start out on the right foot, labor experts told Home Health Care News.

“The first day and first 30 days of employment are so critical,” Anna Ortigara, a workforce innovations consultant for New York-based research and consulting organization PHI, told HHCN “We lose so many people within the first 30 days.”

From 2016 to 2026, there will be 7.8 million direct care openings, according to a recent report from PHI based on Bureau of Labor Statistics estimates. Of those open positions, 1.4 million will likely be created due to industry growth, but 2.8 million will likely be linked to workers leaving for non-caregiving jobs and another 3.6 million the result of employees leaving the labor force altogether.

“Setting the proper expectations on day one is important,” Aaron Marcum, founder and chairman of Idaho-based Home Care Pulse, told HHCN. “Those working in this field, they want expectations. They want to understand what you expect of them.”

Here are five steps home care providers can take to create the ideal first day for new employees.

In addition to Ortigara and Marcum, advice was also provided by Mari Baxter, vice president of operations of Maryland-based Senior Helpers, and Crystal Adams, director of human resources for Interim HealthCare of the Upstate in South Carolina.

1. Make new hires feel welcome

When a new hire comes into the office for the first time to kick off the onboarding process, a home care agency needs to make sure they’re welcoming that employee at the door, knows the person’s name and is making them feel appreciated, Ortigara said.

A helpful way to think about it: Try to build a relationship with a new hire from the first day modeled after what the agency hopes the worker builds with his or her clients.

“Literally, in those first moments walking through the door, new hires need to feel they’re being known, appreciated and valued,” Ortigara said. “The organization should be waiting for them — know they’re coming and have somebody ready to immediately welcome them.”

These may seem like basic things to do, but they’re too often forgotten, according to Ortigara. Agencies and supervisors sometimes view a new hire’s role more as transactional, as just necessary to keep the home care machine running, she said.

Interim HealthCare of the Upstate works to avoid that by getting all departments involved in orientation, Adams told HHCN. Interim HealthCare of the Upstate — part of the broader Interim HealthCare franchise network — serves Cherokee, Spartanburg, Greenville, Pickens, Anderson and Oconee counties in South Carolina.

“When we have a new employee coming on board, we have learned that communication with all departments involved in the process is critical,” Adams said. “From getting a computer ordered, configured and ready to use on day one, to alerting the management and support team of their orientation schedule. All pieces of the puzzle are equally important.”

Interim HealthCare of the Upstate makes an intercom announcement that encourages current workers to meet new hires when they arrive.

2. Prioritize high-engagement learning and set the training stage

Once a new hire is properly greeted, attention is typically shifted toward onboarding and education. In general, home care agencies should take a high-engagement approach to learning, one that is also catered to adults.

Broadly, that means presenting material in a way that gives new hires a chance to absorb and experience it on their own terms.

“We make an error if we teach in just sort of a didactic way where people watch a bunch of videos or somebody lectures, reads through materials assigned them,” Ortigara said. “Adult-learner-centered education means you’re working with each learner as, truly, an adult. The structure of the educational material is such where people get to experience it themselves, have their own ‘ah ha’ moment.”

Marcum, who stepped down from his role as Home Care Pulse CEO in November, echoed similar sentiments. Maintaining a high-engagement education mantra should be a priority for all new hires, even ones that have previous caregiving experience, perhaps outside of home-based care, he added.

“Even if they have 15 years of experience working in a nursing facility, that is going to translate differently into a home,” Marcum said.

New hires also want to know how invested an agency is when it comes to developing skills through innovative training programs.

“Right on that first day, set the stage for what their training is going to look like,” Marcum said. “Let them know what they can expect from you as an organization for the next 12 months and how you’re going to invest in them through training.”

A straightforward tip: Give new hires a training schedule if possible.

3. Don’t just focus on skill-building

Senior Helpers’ Baxter also highlighted the need for a home care provider to demonstrate value during the onboarding or orientation process.

“Once hired, it’s important the new caregiver sees value in the orientation process,” she said. “Although orientation can be time-consuming, it’s very thorough to better [a new hire’s] skills as a caregiver for clients with dementia or Parkinson’s.”

While skill-building is valuable, agencies should make sure to complement that aspect of education by describing their culture, mission and values.

The hourly rate for a home care aide normally falls around minimum wage, with many people entering the home care workforce because they’re passionate about care and have a service mentality. To that point, agencies should spend as much time discussing their dedication to care as they do on skills training, Marcum said.

“That’s really important to this group,” he said. “They want to know what they’re doing is making a big impact.”

4. Use mentors, relationship-strengthening tools in the home

Starting off on the right foot when new hires first come into the office is critical, but the first day a worker actually goes into a client’s home can’t be overlooked. Two steps agencies can take to ensure a smooth first day in the home for their new workers: use mentors and provide tangible relationship-strengthening tools.

“What happens often is that the supervisor goes in with the new person for generally like an hour and just shows them around,” Ortigara said. “That’s ok. But, wow, if they had a chance to shadow a regular worker, that would be ideal.”

If new hires had an opportunity to shadow a regular caregiver who is familiar with a client, they’re likely to help agencies achieve higher levels of patient satisfaction by knowing early on what clients like and dislike in advancing their plan of care.

“The other thing that could be really critical is for an agency to have some sort of policy in place where they have a tool to help the new employee with questions to ask the client to get to know that person,” Ortigara said. “Sometimes people have things like ‘getting to know you’ or ‘all about me’ [materials].”

“Getting to know you” tools could be as basic as a list of five or six conversation-starting questions, according to Ortigara, who used the method as part of a recently launched PHI initiative focused on retention for home care agencies in Minnesota and Wisconsin.

Agencies should also work hard to appropriately pair clients and caregivers, Baxter said.

“The biggest mistake we’ve seen is placing a caregiver with a client that is simply not a good match,” she said. “Some agencies will place the first available caregiver with the next client in line.”

Senior Helpers first determines if a particular caregiver has the skill set to care for a given client. If the skills match the needs, the franchiser then explores whether both parties will mesh with each other’s personalities.

“We’ve found it just doesn’t work out if we base the match simply on availability,” Baxter said.

5. Check in early and often

While all of these points are important, forging healthy and reliable communication channels may be the biggest step home care agencies can take in preventing future turnover.

Supervisors, in particular, need to have one-on-one time with the new hire they’ll be tasked with overseeing.

“If the supervisor happens to not be there and is maybe out in the field instead, there should be a phone call,” Ortigara said. “At the end of day one, the supervisor should give a call to the new employee if they’re not in the office, say, ‘I just want to ask: How did the day go? What questions do you have? What are you thinking?’”

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