Private Duty

New study: Turnover rate for caregivers continues skyrocketing, rises to 66.7%

Seek out ways to encourage and promote your agency’s top caregivers. Doing so will help with your agency’s retention rate — an ongoing struggle that’s worse now than ever before for the private duty industry.
Several years ago the turnover rate at A Caring Hand Inc. in Vernon, Conn., roughly matched the national average. To combat the recruitment-and-retention challenges plaguing her agency, Executive Director Mary Ann Dunbar worked to set up a community college course that trains A Caring Hand’s high-performing homemakers to become personal care attendants (PCAs).

A year and a half later, only three of 18 employees who completed the course had left the agency.

A Caring Hand’s turnover rate in the past 18 months has been 38%, and the added opportunity for promotion has been a contributing factor to the low rate, Dunbar says.

By comparison the national turnover rate for caregivers in 2017 inched up to 66.7%, according to a newly released benchmarking study by Home Care Pulse of Rexburg, Idaho.

That’s the highest turnover rate in the nine years Home Care Pulse has released its annual benchmarking study. The turnover rate was 65.7% in 2016, data show.

It makes sense that an agency that invests in caregivers’ futures by offering education and training would have a good turnover rate, says Stephen Tweed, CEO of Leading Home Care in Louisville, Ky.

Top caregivers are interested in professional growth, and one major reason why caregivers decide not to leave their agency is because they feel valued and appreciated, he says.

How does the PCA course work?

The role of PCA pays more than homemaker, but it requires more skill. At A Caring Hand, PCAs can perform techniques such as Hoyer lifts, catheter cleaning and feeding tube cleaning to a certain point.

In 2014, Dunbar was asked to serve on an advisory board for Manchester Community College in Manchester, Conn. The college was designing a course for unskilled aides.

Dunbar decided what would really help her agency with recruitment and retention was to have a course that would lead to a promotion for existing homemakers. A Caring Hand signed a contract in November 2014 to have the college teach its homemakers to become PCAs.

Although the agency pays to send homemakers to receive the 32 hours of training, A Caring Hand determined the course actually pays for itself in three months.

Demand for the course is high and the opportunity is also a recruiting tool, Dunbar says.

There are now two opportunities per year for the agency to send up to 20 employees to a course taught by an advanced practice registered nurse. The course itself is offered on four consecutive Saturdays, with eight hours of training per day. The agency’s employees still work regular hours that week.

When identifying which homemakers are the best fits for the course, A Caring Hand looks for the ability to think independently, the ability to assess client needs and the ability to deliver one-on-one care. Employees also must have successfully completed a 90-day probationary period at the agency. In agreeing to take the course, candidates commit to a minimum of 20 hours per week of serving as a PCA for the agency for the first six months after successful course completion. That minimum amount is listed because many of these employees “would like to hold on to some of their clients that they’ve had for so long as homemakers, and we certainly don’t want to disrupt that relationship,” Dunbar says.

Keys to setting up a PCA course

    • Identify the right person within a local college to call about setting up a course.
      If the college offers a certified nursing assistant (CNA) course, contact the head of that department and explain your agency’s challenges, Dunbar recommends.Explain how quickly growing the home health care segment is, she adds.

      A new report about the health care workforce states good news — there will be 423,200 new job openings for home health aides by 2025, according to the National Association for Home Care & Hospice. But the report also brings bad news — there will be a need for 446,300 aides.

    • Offer input into the course’s structure. 
      In the PCA certification course at Manchester Community College, students learn about: patient care plan; communication skills; infection control; safety in the home; proper body mechanics for the caretaker and patient; personal care; vital signs; CPR training; nutrition; medication; and diseases and difficult behaviors. — Josh Poltilove (