The Caregiving Organization's Dilemma

I spend A LOT of time thinking about caregivers.... Like.... A LOT (you may have noticed). It's no secret that without caregivers, there would be NO caregiving organizations. Yet, changes to the labor market both with respect to caregivers and other "non-skilled" workforces has dramatically increased the difficulty of recruiting and retaining caregivers. You don't need a lot of insight to see this fact. Just talk with a few leaders of care organizations. I talk with these leaders all the time. New owners, folks who've been in business a couple of years, organizations that have been around for 15+, and the theme I hear is pretty common. "We hire one and lose two." "I can't seem to keep [my caregivers] around for more than a month." "I'm turning away clients because I can't staff the shifts." There are, of course, lots of theories behind why this is and when it will improve. "Once COVID is over, they will come back....

Respect. Aretha knew all about it…. And the fact that getting some can mean the world. I recently had an amazing LIVE training session with one of the organizations I work with. There were some important topics that caregivers had sent me to go over. Topics like difficult shower transfers, handling tough family dynamics, understanding scope of services, inter-caregiver communication… This session was PACKED with really intense and important information and conversations. But the overall theme? RESPECT. And the fact that it goes both ways. We all get that clients need to be respected. They need our empathy. They need us to look deeper to meet their needs. They need us to be proactive, and kind, and compassionate. And, of course, your caregivers actually have the SAME needs. But, they also need something else from you. They need to know you have their back. See, caregivers walk into work every day by themselves. And while the caregiving organization leadership is worried about limi...

I was listening to a book recommended to me by the wonderful Judy Cornish, called Getting to Maybe (and, yes, audio books are the only way I can get reading done these days!). Early in the book, there is a discussion about rigidity, and the way it undermines the ability of complex systems to adapt and innovate. This particular point struck home so perfectly, I felt compelled to share it with you. Briefly paraphrased from Getting to Maybe, rigidity (or resistance to change) is one of the greatest barriers to progress faced by any organization, institution, or system. Although rigidity often begins as the stabilized result of years of successful processes and experience, over time, it morphs into inflexible ways of thinking and doing that -at best- hamstring organizations, and -at worst- cause them to fail. Of course, rigidity in an organization can also become established simply through force of habit, lack of better process options, the assumption that things are as good as they...

  In the business of private duty home care, the organization leader’s dream is to achieve stable growth and work flow (preferably at 1000 hours/wk or above). In the dream, they sleep peacefully through the night – unafraid of phone calls from caregivers or clients with problems. They waltz casually into the office - knowing that things will be humming along with the efficiency of a well-oiled machine. They meet confidently with prospective clients - describing with pride the level of care they know they can provide and exactly how they will do it. They review their financials with certainty – knowing what they should expect… and when. Their spouses greet them at the door each evening with kisses and cocktails! Their children are well behaved geniuses who mine Bitcoin! They…. Okay, I may have gotten carried away there at the end… but in the dream, they do get to GO ON VACATION. If you’re reading this with stars in your eyes, there are a couple things you should know. 1. ...

Get ready for a blog that is going to be distinctly un-sexy (disappointing, I know. Especially for a Friday post!). In a blog committed to the deep examination of how caregiving businesses can run more efficiently, safely, AND profitably (by increasing QUALITY!), we have come to a subject most might prefer to avoid thinking about. Lost. Time. Accidents. If these are words you’ve never heard before, let me explain. A lost time accident is when an injury occurs on the job that causes a loss of productivity. Lost time accidents are recorded in many industries, like manufacturing, as a matter of course. Why? Because it helps organizations to track how safety is impacting their bottom line. Usually, a lost time accident is recorded when an employee is injured such that they can’t return immediately to work. In caregiver organizations, however, it needs to be defined a little differently. Why? Because in any caregiver interaction, there are AT LEAST TWO people who could be injured and ...

The home care industry has been through A LOT since the start of the pandemic 1 year ago. To say it has been a wild ride doesn’t even come CLOSE to describing   the rollercoaster businesses, caregivers, and clients have been on. Now, there are some new shake-ups on the horizon, as President Biden proposes a 400 BILLION dollar investment in home based and community care, and the people who provide it. So, what could that mean for home care organization owners? First, there’s a good to great chance that an increase in funding will mean an increase in demand (which has already been growing rapidly for many home care organizations as a result of COVID). If you’re a home care owner trying to grow… This. Is. Awesome. But… as any business owner knows growth comes with its challenges. Primarily, HOW are you going to RECRUIT and RETAIN caregivers in an increasingly competitive employment market? There is already fierce competition amongst home care organizations to tap into the small su...

Business owners are rightfully concerned about the bottom line. If you aren’t profitable, you can’t grow. Maybe more pressing, if you don’t make money, you can’t serve the people you are trying to serve, you can’t pay your employees…. you certainly can’t pay yourself! So, it makes sense that when business people encounter new potential costs, they want to avoid them (no matter how small). But what happens when the avoidance of perceived costs leads to avoidance of innovation and new solutions? When long term financial gain is sacrificed over fear of up-front investment? How does that effect long term goals, growth, finances, and values of an organization? Examples of the consequences of short sighted or fear-based decision making in business are not hard to come by, and trust me, I’ve been there myself. It’s hard to look towards big goals and the future when you’re drowning in day-to-day tasks and bills are on the way. Home or senior care organizations are frequently so buried ...

  As many senior care organizations work to win market share in an increasingly crowded marketplace, many are trying to distinguish themselves by focusing on a certain type of client, or opening themselves to clients with significantly more complicated needs. That might be folks with dementia, Parkinson’s disease, serious injuries, stroke survivors, etc.  That is a great strategy to get clients "in the door," but it causes problems when caregivers don't actually have the skills necessary to care safely for these increasingly complex clients.  It can also place well intentioned senior care organizations in an awkward position. Advertising and marketing trumpet specialty services to care for clients with greater needs. At assessment, there is discussion and promise of a custom care plan. Meanwhile, the care coordinator or manager has sweaty palms hoping they can actually match needs to a caregiver with the right skill set…. For multiple shifts. This all leads to one o...

  Question: Who is the most important person in your organization? You? Your scheduler? Your marketer? Your front desk, HR, or care coordinator? If you’re reading this blog post, I’m guessing you already know the real answer. The most important member(s) of your organization are your CAREGIVERS. Your caregivers are the ones who are DIRECTLY RESPONSIBLE for the quality of care your organization provides. They are there, day in and day out, deep in the weeds, making the thing your organization gets paid for HAPPEN. They also tend to have the lowest level of education, the lowest pay, and the least amount of resources to help them meet the varied and complex needs of their job. Here’s the thing though. I don’t believe for one second that organizations don’t care or don’t want to offer something better to their caregivers. Call me naïve, but I just don’t. There are honestly way easier ways to make a buck than to own a caregiving organization, so it stands to reason that the vast...

  The average cost of turnover for a home care organization with 50 caregivers is $86,710/year. Holy smokes Batman. For a small business, that is a LOT of money. The above number is based on a couple of different numbers. The American Center for Progress estimates that for employees making less than $30,000/year, the cost of replacement is 16% of their annual income (see it in the formula below). The average percentage of turnover, according to the 2018 Homecare Benchmark Report, is 66.7%. So, depending on the rate of turnover for a company, that big number could get much smaller…. Or also much worse. Here's how to calculate your yearly loss due to turnover: Average yearly caregiver earnings x .16 x Your total number of caregivers x Your percentage of annual turnover = Annual cost of caregiver turnover (*notice this formula does NOT include potential lost clients or hours related to lost caregivers) The great news is that home care organizations don’t have to just accept...

  Let me preface this blog by stating the obvious: Losing clients is not good for organizations in the caregiving business. Duh, I know. Don’t tune out yet, I promise to say something of value soon. While there is one obvious circumstance where losing clients is a natural part of the caregiving world, losing clients outside of that natural process is more than just bad for the bottom line. It’s a sign that there might be bigger problems within the organization. In order to identify those problems, their causes, and their solutions (they won’t all be what you think), let’s take a closer look at four main reasons caregiving organizations lose clients. In no particular order, they are: death, admission to a hospital or higher level facility, leaving due to issues with quality, and inability to manage the complexity or acuity of the client. (What about money? Clients might say they are leaving for financial reasons, and, of course, sometimes that is true. It’s more likely though that...