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Episode 27

The Top 3 Causes of 90 day Caregiver Turnover

Jeff Howell (00:01):

Welcome to home health, 360 a podcast presented by AlayaCare. I’m your host, Jeff Howell. And this is the show about learning from the best in home healthcare from around the globe.

Jeff Howell (00:18):

Hi everyone. And welcome to another edition of home health, 360, where we speak with leaders in home care and home health from across the globe. Today’s guest wears many hats in 1996. He took his speaking and consulting business and broke it down into two divisions, executive mastery in executive coaching and team development, consulting practice, and leading homecare, which you can [email protected] a strategic advisory service strictly for home health, hospice, and private duty. Working with leaders that wanna be in the top 10% of the business. And in 2012 Home Care CEO Forum was formed, which is a place for owners, administrators, and C-suite executives from leading agencies to be able to connect to each other, share information, solve problems, and develop strategies for growth. He’s also the author of conquering the crisis, proven strategies for caregiver recruiting and retention. So listeners today we’ve scored the guest who literally wrote the book on caregiver recruiting Stephen Tweed. Welcome to the podcast.

Stephen Tweed (01:31):

Well, thanks so much, Jeff. It’s great to be with you.

Jeff Howell (01:33):

So Steven you’ve been serving home health, hospice and private duty home care since the eighties. What let you to get into the industry?

Stephen Tweed (01:41):

Well, of course it was a natural progression as you might expect, I started my career working in the underground coal mining machinery business. And my first assignment was 600 feet underground in the bottom of a coal mine in Southern West Virginia. And it’s been uphill over since and in the early eighties, of course the economy was pretty ugly looking. And I shifted my business from working with manufacturing organizations to the service sector and particularly healthcare and a local home health agency in the small town in Western Pennsylvania asked me to work with their board of directors and their leadership team on some strategic planning. And we did that and they like what I did. And they liked me as a person. I liked them and we formed a long term connection and that CEO is still a close personal friend in spite of having been retired for a few years. And she introduced me to other home health companies in Western Pennsylvania. She took me to their state association and then to national associations. And that led me into the industry. And I just really connected with the people in, in home health and hospice and home care, mostly because of the core values and the culture that guide their thinking and their decisions. And so it’s been a love affair for almost four decades now. And we love the people and we love what they do. And we think we’re making a difference.

Jeff Howell (03:14):

Well, it sounds like you’re on a, you, you have a great cause. What I’m really obsessed with is that I love the idea of masterminds and I find that they’re so very rare. I noticed on your website that you break down your mastermind groups by proof of service of hours of week. And I’m just curious, how, how did this come to evolve and what can someone expect if they’re interested in joining one of the masterminds?

Stephen Tweed (03:41):

Well in 2002, my son and I got together informed the part of our company that we now know is leading home care. And a lot of our emphasis was on the home health and hospice side, but we also recognized that this other sector that back then was known as private duty home care is now simply known as home care, but it’s the in-home personal care side of the business. And so we, we developed a focus there and over the next decade, we really worked with a lot of different companies. And so in 2012 the owner of a company in St. Louis was coming through Louisville. He stopped in our office. We had a conversation. He said, I would love to have a group of other companies the same size as our company who could get together and share ideas and solve problems and support one another.

Stephen Tweed (04:32):

And so I said, I think we can do that. And we put the very first mastermind group together in February of 2013 and it was five companies. And back then we called it the 5 million mastermind group. And at that time 5 million was a big company. As you know Jeff, the, the home care space the in-home personal care is a highly fragmented sector of the industry and the us, there are 26,000 companies doing this work and the median size is 1,000,006. So these are fairly small company. So a 5 million company at that time was a big deal. So we had five companies come together. We met, they liked each other. They liked what we did. And they said, yeah, let’s keep it going as a mastermind group. And so that group ran is still running today. We shifted the name about eight years ago, and now we call it the top 5% group.

Stephen Tweed (05:22):

And right now it is 13 companies and they range in size from 10 million to 25 million in annual revenue. So that puts them really at about the 98 percentile in terms of, of annual revenue. And then we had some smaller companies that express some interest. So in 2015, we started a group called the strategic growth mastermind group. And this was companies between one and a half and 3 million. And that group is still going and we actually split it into two groups. And I was just with them yesterday in Chicago visiting one of our top 5% members. And so we have 24 companies and we divided it then into two groups and they’re between one and a half and, and 3 million. And then a couple of years later, we started our top 10% group and that’s companies between three and 6 million. And then our top 7% group is companies between six and 12 million. And the reason we have all these different groups is we learned that that people want to be in a group with similar size companies. And also they want to be in group where there are no competitors. And so having five different groups enables us to lead these F people in conversations with companies that are their same size and with whom they do not compete.

Jeff Howell (06:42):

And by competing, you mean in the same geographic market?

Stephen Tweed (06:45):

Yeah. They’re, they’re all spread over ground geographically. Of course, our market is all the us and Canada. We don’t have any mastermind groups in the, in right now with members from Canada. But I’ve done some work with some of the home care companies in, in Canada. But our, our members are spread from from Honolulu Hawaii to Southwest Florida from Boston to Spokane, Washington and Seattle Tacoma and a lot of places in between. And so the fact that they’re spread out geographically means that they can be in the same group and not compete with one another.

Jeff Howell (07:21):

Got it. And what would be the frequency of how often you get together and has that been affected by COVID?

Stephen Tweed (07:28):

Our groups meet twice a year, face to face for a day and a half. And then once a month by zoom video, and then once a month, we have what we call our mastermind town hall, and that is a gathering of all 52 companies on zoom. And we have a program around a particular topic. So this past couple weeks ago, the first part of September we had mastermind town hall focusing on leadership development and what companies are doing to develop members of their leadership team. Other topics are related to other things that they may be interested in that affect everybody that, that don’t involve a competitive discussion. And then we follow up those mastermind town halls with our individual mastermind groups. So as I mentioned, I was just with our strategic growth group up in Chicago this past weekend.

Stephen Tweed (08:23):

We started on a Sunday night with a, a dinner social time. The next morning we, we went and visited another larger company for half a day. Then we went back to the hotel, had lunch debrief that visit that afternoon. And that was an amazing conversation as they talked about what they learned from visiting this larger home care company. And then the next morning we talked about what we call the big burning issues. What’s the one thing that you’re working on that that’s, that’s important to growing your business business. And then we adjourn people catch a flight home. And so that’s pretty typical of, of our group meetings. And we take them all around the country for, for different locations visiting other companies, visiting our member companies. Sometimes we go somewhere warm just to get away from the snow and the cold.

Jeff Howell (09:16):

what we’ll get to recruiting and retention of course, a little bit later, we, can’t not talk about that. What would you say though, O other than recruiting and retention, what are the hot buttons that people are talking about these days?

Stephen Tweed (09:30):

I think there are a couple of things that our members are working on diligently. One of them which is related to recruiting and retention is really crafting their company culture. One of the lessons we learned from our, our mega companies was that, you know, culture eats strategy for business culture is the way we do things around here. And the culture of a company is influenced by four specific factors. One is the leadership style of the CEO. One is the core values that guide decisions and actions. The third is the behaviors that we expect. And then the fourth is the behaviors that we permit. And so a lot of their groups are working on defining their core values, defining the behaviors that go with those core values, and then communicating that to the organization and working to get all of their people in alignment with those core values of the company and dealing with, how do you address behavior?

Stephen Tweed (10:35):

That’s not in alignment with the expected behaviors. My wife is a executive coach and works with CEOs of hospitals and works with physician leaders in academic medicine. And one of her mantras is the behavior you permit, you promote. And so as working on crafting the culture, it’s really about defining those values and defining the behaviors. And then we take that out. Obviously building your office support team culture becomes important, becomes really critically important when we get to that recruiting and retention issue, cuz it’s all about creating a great place to work and using that to leverage our message as we’re trying to attract new caregivers.

Jeff Howell (11:19):

Got it. I love the behavior you permit is what you promote. I’ve always said it in you, you get what you tolerate

Stephen Tweed (11:27):

that’s right.

Jeff Howell (11:28):

So our, our chat on LinkedIn, this is how we connected. We were all already sort of random LinkedIn friends. And then love it when, you know, you hook up with someone that just threw comments on social posts. The chat was around 57% of the turnover coming in the first 90 days in the industry. And in response to that, your mastermind groups have been able to identify the top three causes of this 90 day turnover, phenomenon, and strategies to overcome them. So let’s dive right in. What have you identified as the three and, and how are you going about solving these?

Stephen Tweed (12:10):

The 57% in the first 90 days comes from data from home care pulse. And of course they produce the annual home care benchmarking study and we’ve been watching the turnover number in home care for a decade. And back in 29, 2009, it was like 36% and it’s increased steadily. Okay. And it peaked in 2018 at about 82%, but then it leveled off in what we realized in looking at that data that overall caregiver turnover, the last six years has been in the mid sixties. But coming out of that same study, we learned that as you said, 57% of turnover happens in the first 90 days. And so we dug into that and we actually created what we called a program called caregiver quality assurance. And we put together two caregiver quality mastermind groups that spent two years really digging into five different phases of recruiting and retention and selection and onboarding.

Stephen Tweed (13:11):

And so digging into this 90 day turnover issue, we identified the three big causes. Number one is bad hires. And what we learned is that most home care companies are not doing a good job of selection. They’re hiring anybody who can breathe on a mirror because they’re so desperate for caregivers and those caregivers come on board. And in the first two weeks, they figure out they’re not cut out for this work. And so they leave. And as you know, oftentimes the way that caregivers leave a home care company is they just disappear. They ghost the company, they don’t, they, they don’t show up for a shift. They don’t call they don’t answer. And so they just, they just disappear. And so we then began to look at what can we do to attract better quality applicants and what can we do to do a better job of selection to reduce those bad hires?

Stephen Tweed (14:04):

And the bad hires usually disappear in the first 30 days sometimes 14 days. And so we’ve made some significant progress in that area. The second big cause of 90 day term is what I have labeled paycheck balance. And that is a caregiver. And, and as you know Jeff a lot of these caregivers are low income, relatively low education level. And they’re often what we call economically fragile workers. They live paycheck to paycheck and if something happens that disrupts their work and their pay they’re in a short term crisis. And so what we realized is that if we can work with a caregiver to understand how much money they need in their paycheck at the end of the pay period, and then we can give them enough hours to meet their financial needs. They’re not gonna have to go look somewhere else for more hours or more work or a higher rate of pay.

Stephen Tweed (15:06):

And so we’ve developed some techniques to have the scheduling coordinators in home care. Companies have an awareness of the paycheck, take home paycheck, expectations of each caregiver and monitor their hours throughout the course of the week. And so they can have a conversation with that caregiver around Sally. You said you needed to have $500 in your paycheck, but this week you’ve only worked enough hours to have 400. If you want to get that amount in your paycheck, you’re gonna need a few more hours. I have a shift available for you. Would you like to work and get your paycheck up to your expectations? And that’s a very different conversation than Hey Sally, I’m really in a jam. I need somebody to cover this shift. Can you help me out here? And so it, it shifts the focus on the caregiver and how can we help you meet your needs, which is to have a paycheck that, that meets your financial obligations.

Jeff Howell (16:05):

Do you find that most agencies don’t create the right scheduling culture where it’s just schedulers that are saying, oh, who, how can I just best fill this visit? And they may use their tribal knowledge of who’s who, or who they like. And there may be some caregivers that get all the hours they want, and it’s based on the personal bias or preferences of the schedulers and that the right culture isn’t being set for schedulers to be benchmarked against trying to reduce turnover by providing this minimum threshold for the new caregivers.

Stephen Tweed (16:43):

Yes, you’re exactly right. And, and it’s, it’s a, as you said, a natural phenomenon, you know, people wanna do business with people that they like. And so the schedulers have caregivers that they like and will help them out and bail ’em out of a jam and they tend to call the same people over and over and over again. And that’s this paycheck balance because the newer caregivers get hired. They go through orientation, they get their first shift and maybe they have a full schedule for the first two weeks, but they lose a client who goes in the hospital or cuts back their hours or whatever. And now that, that caregiver who said, I want 40 hours is only working 30, but that scheduling coordinator who doesn’t know that new caregiver, cuz she’s only been on board for four weeks, doesn’t think to call her up and offer her a shift.

Stephen Tweed (17:28):

And so her paycheck is now below where she needs it to be. And she goes and looks for hours with another home care company or some other place of employment. So you’re exactly right. And the scheduling coordinator is really a key to this process. And one of the things that we’re working with our mastermind members on is helping them put in place systems and helping their scheduling coordinators understand the benefits of, of balancing the workout among all the active caregivers metric. We were having a conversation yesterday because many of our home care companies are turning away new clients. And one of our members was saying, well, wait a minute, I have some caregivers that aren’t working. And yet I’m hearing the person taking the inquiry call saying, no, I’m sorry. We can’t help you. We don’t have any caregivers. Did she saying what’s wrong with this picture?

Stephen Tweed (18:25):

And they dug into it. And they did in fact have caregivers who had hours available that wasn’t being scheduled. And yet the schedulers were saying, I can’t find anybody to take these shifts. And so it, it, part of it is, is people that is the, the scheduling coordinators and then working with the people that they like. But the other is processes to help the scheduling coordinators see who’s available, who could use more hours. And that goes back to this paycheck balance piece. And it goes back to the technology. You know, when you look at AlayaCare and that scheduling system there’s capabilities in there to help those scheduling coordinators systematize the process. But if they don’t use it to the full capability, then as you said, they call the people that they like and they don’t call the people that they don’t know.

Jeff Howell (19:18):

Right. I can rely on Megan to fill this visit. That’s what my objective is. I’m gonna get it done. And poor Ryan who just started needs the hours and he needs to ramp up to the, the utilization rate that allows him to stay and not have to seek employment elsewhere. Cause he has bills to pay.

Stephen Tweed (19:37):

Exactly. Yep. Good, good illustration.

Jeff Howell (19:40):

Okay. So what’s number three.

Stephen Tweed (19:42):

So the third one is lack of employee engagement. We did a best caregiver study a couple of years ago where we surveyed several hundred caregivers who were identified by their employer as best caregivers, based on two criteria. Number one was client satisfaction and number two was reliability. So we had 184 individuals complete our online survey and we learned a huge amount about this issues of the best caregivers. And, and, and what we learned from that is the reason best caregivers stay with a company is number one, they’re doing meaningful work. The best full-time professional caregivers love their work. They love their clients. They, they believe what they’re doing makes a difference, and this is their career. So then it’s a question of they’re gonna work with your company or my company. So that that’s a given the next one. The reason they stay is they feel valued and appreciated by their clients.

Stephen Tweed (20:49):

The third one is they feel valued and appreciated by their immediate supervisor. And number six is they feel valued and appreciated by the owner of the company. So this feeling valued and appreciated and connected, but we take a new caregiver, we put them through orientation, we treat them nicely. We give them a schedule and they’re out there working on their own. And many times they don’t hear from anybody for the first 30 days. And so it’s that lack of connection, nobody to talk to who can help me out here, I’m all on my own. Maybe I didn’t get enough training that I feel competent and confident in caring for this elderly person. And so when another opportunity comes up or if I lose a client or whatever, I just sort of slide away and nobody notices. And so as part of our 90 day retention plan, we have built out a template that companies can use to have a series of touchpoints with caregivers beginning on day one. And we have touchpoints multiple times during the first week, multiple times during the second week, we do a paycheck balance check at the, at the end of the first pay period. So there’s a whole series of things that we have built into this 90 day retention plan to increase that employee engagement and help these caregivers feel like they’re part of a company that cares about them and that they feel valued and appreciated.

Jeff Howell (22:21):

So that’s interesting because I can see the life of coordinators and schedulers being hectic as well. And you have this invisible workforce that I can totally see how the schedulers are. Hey, I need to fill these visits and I’m gonna be sending out offers and I’m just gonna be, I’m the one who’s filling the visits, right. And yet there’s a human on the other end of this. That’s looking for some kind of sense of community and belonging and appreciation that they’re, they’re not getting the love if it’s just, they’re getting these offers to fill visits and there’s no human connection here.

Stephen Tweed (22:58):

Exactly. Yep.

Jeff Howell (23:00):

So you mentioned you you’ve been at this for quite a while. I’m curious, you know, the numbers were much more in check in the past and I’m curious, you’ve seen, you know, thankfully the numbers sort of peaked in 2018 and they’ve come back to a bit more of a reasonable amount, but to be down at just 36% from 2009, what’s your view of how has the world changed and why are we still in the 60, you know, 60% turnover instead of 36%? What, what’s your view of how life is different from 2009?

Stephen Tweed (23:37):

Well, I, I think there are several issues that contribute to that increasing turnover. Number one is in 2009, we were coming out of the major recession that happened in 2008. Unemployment was very high and people were looking for work. And so people weren’t leaving their jobs for, for minor reasons. They, you know, there had to be some significant reason why they would quit one company and go to another, or quit one occupation in home care and go to food service or hospitality or whatever. But, but from 2009, up to 2017, we saw this steady increase in turnover as the economy improved and as the need for home care increased dramatically. You know, if you look at the number of home care companies and the number of older adults who are using home care services, it’s increased dramatically from 2009 to 2018.

Stephen Tweed (24:41):

And, and so this, some of it is just pure demographics. There simply aren’t enough people working in this industry to meet the needs of the aging population and they know they can go and work with any company anytime. And so there has not been a lot of loyalty to the company. The other issues that then have to do with changes in the industry, as we said, it’s a highly fragmented industry with 26,000 companies. The median size is 1,000,009, so a lot of little companies, but in the last five years, there’s been significant consolidation in the industry as companies are growing through acquisition. As some private equity groups have come into home care bought a home care company as a platform and then, then have gone out to acquire other home care companies. So that has changed the dynamic of the industry.

Stephen Tweed (25:40):

We see, I think it’s 10 of the top 12 franchise companies in, in the us and Canada are owned by private equity groups. And so the, the, the business model and the dynamic of the home care space has shifted pretty dramatically in the past decade. And so all of that coming together has contributed to the increasing turnover. Then we hit C and the, the COVID relief programs and all the government money that’s out there. And we saw a significant drop off of new applicants to caregiver recruiting in the spring of 2021. And we looked at it and identified what we called the perfect storm of recruiting in, in April these caregivers that were working had just received their federal income tax refund checks. And the average caregiver making $20,000 a year was, was getting $2,600 back from the IRS.

Stephen Tweed (26:44):

We saw the COVID relief money and people were getting hundreds of dollars of benefits from the government. And then unemployment was rampant. And the federal government and the state governments had extended the unemployment compensation. And they were not enforcing the regulations that said, you need to be looking for work in order to stay on unemployment. And so you put those three things together. And there were just a lot of people that had money from the government that meant they didn’t have to work. And in some cases they were penalized for working. And so that continued through 2021 early into 2022. When some of those benefits began to go away and people had spent the money in their checking and savings accounts, then we started seeing more people applying to come back to work. So that’s part of the dynamic that we’ve UN identified. And some of that is still with us today.

Jeff Howell (27:43):

And then the more people starting to come back to work is that sort of anecdotal through your masterminds, or is anyone tracking that data on an influx of caregivers coming back in, or

Stephen Tweed (27:56):

We don’t have any industry data, but we have a number of examples of our mastermind members who, who tr you know, they, we, we help them set up scorecards. So they’re tracking every week, how many applications they’re getting. And then, then if you can imagine this recruiting and retention process as a big funnel, and we put applicants into the top of the funnel, and then we have our filtering and screening and our selection process. And, and so we filter people out and coming out of the bottom of the funnel, if we do it well, is a steady straight of high quality applicants. What’s happened is that as we have, we, we set up a series of metrics from the top of the funnel to the bottom of the funnel. And as we track those metrics and our members report reported out, we saw in, in the spring of, of 2022 a lot of our members were saying, you know, we’re getting almost no applicants.

Stephen Tweed (28:55):

We’re doing all the things that we’ve done. We’ve, you know, all these ideas we get from our colleagues and yet nobody’s applying for work. And then in the spring, it began to open up and through may like may and June, we began to see more applicant supplying, and our members were telling us we’re seeing more quality applicants. We’re seeing people coming back to work who were home care caregivers who maybe had been off for a year because they had money in their, in their checking accounts. I remember anecdotally one of our members told us about this, it was this summer and they were doing orientation for a group of new caregivers. And at the end of orientation, they sent their people out of the room with a schedule to start work sometimes as soon as the next day. And they had an applicant in the room, went through, hiring, went through orientation at the end of the day, they said, well, here’s your schedule?

Stephen Tweed (29:50):

And she said, oh, no, no, I can’t, I can’t start work now. In July I still have money in my checking account. So I won’t be able to start working again until September. And it was just one of those, you just shake your head and say, what’s wrong with this picture, but that was the mindset of this individual that as long as she had money in her check account, she wasn’t going back to work. And so I think that’s part of the phenomenon that we have seen. And, and, and so all of the companies in the industry are struggling with what to do, what to do differently, what to do that works. And that’s a big part of what we’ve been doing in our mastermind groups is having very specific conversations around very specific techniques and what different members are doing and what’s worked and how you tweak it here and how you shift it there, you can’t use the broad brush approach, you know, the, the home care pulse data show that, that the number one recruiting source in home care is and their online job board.

Stephen Tweed (30:54):

Yet the same report shows that the highest turnover of caregivers comes from And so recruiters are using these online job boards, and they’ve got a revolving door. They’re hiring people and they’re leaving in the first two weeks or the first six weeks or the first 90 days. And there are other techniques that are way more effective, but takes more work, don’t get as many applicants. And so they’re not applying those other techniques. So that’s what we’ve been digging into with our members is how do you really make work? Or how do you make your employee referral program work, or how do you go out and, and recruit caregivers from four year schools of nursing? So you, you gotta really dig into the specifics.

Jeff Howell (31:40):

Yeah. And I mean, that’s the I, I absolutely love this structured series of touchpoints and creating a culture around everyone in the back office is part of the retention team. And if you show me the incentive, I’ll show you the behavior mm-hmm right. So if, if you reward that team for, and we see the same things in our data, is that exiting caregivers say, I didn’t feel like I was communicated with, from the, from the office. And also I didn’t get the hours I needed to, I, I needed to pay my next my next rent check. So the other and I love this concept of the, the paycheck balance. So rather than turning, you know, I’ve got shifts to fill. It’s more that you’re helping the caregiver be able to pay their bills by having top of mind, what they’re, you know, what the paycheck is that they require to stay at the company. Right.

Jeff Howell (32:41):

So I’m curious the have you seen much in the way of innovation and I’ve talked to some agencies that they, their recruiting process through COVID they just rethought everything and they were able to change the length of time of hiring a caregiver from days down to hours. I’m curious if you’re seeing automations and virtual onboarding, what it is that, you know, rather than just people applying and showing up physically and doing an interview, I’m curious what success stories you’ve heard of, of agencies being able to condense just the amount of time and friction involved in the actual hiring process.

Stephen Tweed (33:26):

Absolutely. we have labeled it speed to hire, and as we’ve had this conversation, many of our members have really focused on what they can do to improve their speed, to hire. And w you know, we can remember D times when bigger organizations that had more bureaucracy were taken, you know, 21 days to hire a caregiver. And we have members that have it down to two days or three days or four days. And some of that depends on the weekly cycle, but they have a system whereby you know, they’re recruiting all the time. They’re interviewing all the time, they’re orienting on a regular basis. And so that speed to hire could be anywhere from two days to five days with, and, and, and we define the timeframe or speed for speed to hire from the moment the applicant pushes the submit button on their phone or their tablet or their computer. And that application is submitted until they’re what we call shift, ready, they’re ready to take their first shift. And most of our members have their models, so that as soon as they complete orientation, they have a schedule and that, and that first shift could be the next day. And so again, we know it goes back to this paycheck balance thing is that if people are not working, they need to get back to work. And the sooner they get a shift and, and get into the system, the sooner they’ll get a paycheck.

Jeff Howell (34:53):

Got it. So I think people all roads leading back to Stephen I presume start with That’s where you can actually find the home care CEO mastermind groups as well conquering the crisis, proven strategies for caregiver recruiting and retention that can be found on Amazon. Is that right?

Stephen Tweed (35:15):

Yes. And you can get it’ll direct link to it on, on another page, on our website and that you URL alpha operators just conquering the and you can also get to the mastermind groups directly. We have a URL We’re actually in the process of building a whole new website for the CEO forum, and that’ll roll out by the end end of the year. And so the URL for that will continue to be home care

Jeff Howell (35:44):

And I saw plenty of great references on your website from basically a collection of who’s who and home care. So you’ve been an amazing ambassador for the industry, and I’ll get you outta here on this last question. Give us a reason to be optimistic about care delivered in the place that clients call home.

Stephen Tweed (36:06):

Well, I’ll give you a couple reasons, cuz it, it comes together nicely. The number one reason is that the data are very clear that older adults want to receive care at home. And this has really been exaggerated through COVID with all of the challenges with nursing homes and senior living communities and the dangers that people saw there. And so number one, older adults are more comfortable in their own home. And number two, they’re afraid to go into a facility now and so people want to be cared for at home. So given that, then it becomes a matter of how do we create the, the industry, the business model, the infrastructure to have companies that can meet those needs. And as we said earlier, that’s a highly fragmented industry. So we see is the industry coming together with companies growing larger and the consolidation and then the industry.

Stephen Tweed (37:05):

And so by having larger companies, it gives us the ability to have a more sophisticated leadership structure, more sophisticated technology putting systems in place. And you had asked a question earlier about lessons we learned, and, and I was going back through some material I had created for the home care association of America. A couple of years ago, I did a presentation called lessons from the mega companies. And one of those lessons is that, that the leaders of these bigger companies are systems thinkers. And they think in the context of, of a system, which is a combination of process, that is step by step by step. Here’s how you do this task that is repeated every day or a couple times a week. And then people, and it’s having people who are willing to do this step by step process consistently and have the discipline to, and as, you know, being software people if it, if it wasn’t documented it wasn’t done.

Stephen Tweed (38:08):

And if you don’t put it into AlayaCare, then when you go back to get the data out, you, you don’t have it. And so part of that discipline and our our message to our people is document every single touchpoint between the home care company and anybody outside the, the home care company. So if you touch it an applicant or a caregiver with a phone call, a, an email, a text message, document it. If you touch a client document, if you touch a referral source document it. And it’s only when you document each of those touchpoints that you have the raw data. But as you know, Jeff data by itself is useless. It’s just bits and bites stored in that computer. It’s only when we analyze and tabulate that data that we get information. And so your reporting system creates reports that tabulate the, the data into information that we can use.

Stephen Tweed (39:10):

But again, that information is not really very helpful because in most industries we’re were information rich, but knowledge poor. And so analyzing and synthesizing the information, gives us the knowledge. And then I always say knowledge plus gray hair equals wisdom. , you know, so knowledge plus experience. And so what we’re seeing with these larger, more sophisticated home care companies is leaders who have the data, the information and the knowledge, and they have the experience and wisdom to make good strategic decisions. And so a lot of the things that we’re talking about today have come out of our work with these companies in the top 10% of the industry or the top 5% of the industry who bring that level of sophistication, curiosity, knowledge, wisdom, to be able to, to make good decisions, to put in place systems that make their business run more smoothly that make their caregivers feel more valued and appreciated that make their clients have a more positive customer experience.

Jeff Howell (40:18):

Well, you really struck a nerve with me in, in talking about systems thinkers, cuz I’m rereading atomic habits right now. Ah,

Stephen Tweed (40:25):


Jeff Howell (40:26):

He draws the analogy of everyone wants to win the super bowl. Everyone has that same goal and only one team does cuz they’ve got the best system in place. My takeaways, I take notes during all of these episodes and I’ve reached three full pages here. But love the idea around once you get a caregiver to sign up that you have this culture of making sure everyone knows what the paycheck balance is and that you’ve got this structured series of touch points where it’s the back office’s job to make sure that the caregivers get the love and attention that they need and you care for the caregiver. And that even before all of that happens, even though it’s a situation where there are far more clients than there are caregivers that we as an industry should not be settling for the bad hires that are just gonna be a pain for everybody. So I wanna thank you for coming on Steven. This has been so informative and I think we will bump into each other at a conference at some stage. So I look forward to meeting in real life and thanks for coming on today.

Stephen Tweed (41:40):

Well thank you Jeff, and appreciate all that you and your company are doing for the industry and it’s appreciate all your listeners. And if we can help anyone any further, if you have questions, you can reach out to us at or you can email me directly [email protected], always happy to answer questions and offer resources to help feed folks grow their business care for more clients and hire more caregivers.

Jeff Howell (42:07):

Awesome. Thanks Stephen. Take care.

Stephen Tweed (42:09):

Thank you very much.

Jeff Howell (42:12):

Home health 360 is presented by AlayaCare. First off I wanna thank our amazing guests and listeners to get more episodes. You can go to health360 that’s spelled home health 360 or search home health 360 on any of your favorite podcasting platforms. The easiest way to stay up to date on our new shows is to subscribe on apple podcasts, Spotify, or wherever you get your podcasts. We also have a newsletter you can sign up for on health 360 to get alerts for new shows and more valuable content from AlayaCare right into your inbox. Thanks for listening. And we’ll see you next time.

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Episode Description

Through a survey on LinkedIn, we found that 57% of caregiver turnover comes in the first 90 days on the job.

Home health and executive leadership consulting expert Stephen Tweed, founder of Home Care CEO Forum, shares his insights and expertise on home health strategies for growth and caregiver recruitment/retention. Stephen, dives into the causes of the 90 day turnover and strategies to overcome this. Listen now to learn more about how owners, administrators and C-Suite executives from leading agencies can solve problems and develop strategies for growth.

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