Caregiver retention in post-acute care has historically been a challenge, but in recent years, the problem has become a crisis. 

According to the 2023 HCP Benchmarking Report, the turnover rate for home care was a shocking 77% in 2022. Nursing homes didn’t do much better, with the Long-Term Care Community Coalition reporting nursing home staff turnover at greater than 50%. 

While these percentages are clearly high, the severity of the issue is highlighted when compared to the average US turnover rate across all industries sitting at 17%. This of course, begs the question: why are home care, long-term care, and senior living struggling so much with caregiver retention? 

One big reason is competition from other industries. Big box retailers, food service, etc., are all competing in the same hiring pool. When comparing the responsibilities of caregivers to cashiers or food servers, there’s a considerably higher amount of pressure and responsibilities in caregiving roles. For similar hours and pay, a caregiver could have a less strenuous position in another industry. Sure, offering higher pay is an obvious solution, but the already-thin margins of post-acute care limit feasibility. 

So, what else can be done to make your organization competitive and attractive to caregivers that isn’t going to put you out of business?

Enter onboarding – an area of the employee experience that is often overlooked, but which research shows to have a high impact on employee retention. Work Institute reported employees who have a good experience in their first 90 days of employment are 10 times more likely to stay within their organization. In other words, the quality of an organization’s onboarding process can be a major factor in its turnover rate.

Rethinking caregiver onboarding

In addition to validating the importance of a good onboarding experience, research shows that the bar for what is considered a positive onboarding experience in post-acute care is shockingly low. According to our newly released 2024 Caregiver Onboarding Experience Report, 63% of surveyed caregivers described their onboarding experience as “good” or “excellent,” but a deeper dive indicates that only 41% of surveyed caregivers said they received a warm welcome during the onboarding process, only 40% believed they received clear and transparent communication, 38% reported their questions were answered promptly and helpfully, and 29% said they felt as though the onboarding process was structured and well organized. 

Summed up, the first data point indicates that caregivers view onboarding as somewhat acceptable, but when diving into the details, it becomes apparent that onboarding in this industry has very low standards with room for improvement. 

While it may initially seem as though that’s fine (after all, caregivers aren’t demanding better onboarding processes), when you consider the effect onboarding has on retention and the overall retention statistics of post-acute care, it is clear a rethink is long overdue.

The path to creating a great onboarding experience

A great place to start improving your onboarding is by creating enriching and meaningful experiences for new hires. At a minimum, each new hire should feel comfortable and receive a warm welcome (a piece currently only found in 41% of onboarding processes). 

Considering that 40% of respondents in the report said they regularly speak a language other than English at home, onboarding documents should have multiple language options. Additionally, it’s important to make sure you are available for personal, live support to provide clarity and answer questions that may arise (tax documentation, benefit elections, etc.). 

Finally (but not really finally), make sure your caregivers understand their pay and how they get paid. Only 40% of respondents strongly agree that they understand how their employer calculates their pay, and only 41% strongly agree that their employer calculates their pay accurately.

These are just a few recommendations to help you start to break the script and raise the bar for onboarding at your agency or facility. Remember – it is about key moments. Onboarding needs to be personal, personable and never one-size-fits-all.

Onboarding experiences set the tone for retention

The quality of onboarding has a major impact on how caregivers perceive their employer throughout the duration of their employment. According to our report, organizations whose caregivers believed they had a good or excellent onboarding experience (“Onboarding Leaders”) had a significantly higher rate of feeling “secure” or “very secure” in their employment. Eighty-three percent of caregivers at Onboarding Leaders felt “secure” in their employment compared to only 44% of caregivers who described their onboarding experience as poor (“Onboarding Laggards”). 

To hammer this home even further, a shocking 90% of caregivers at Onboarding Leaders believed that they had a good work-life balance compared to only 34% at Onboarding Laggards.

These stats showcase how a strong onboarding process can have a major effect on the way that caregivers view their organization. With this information, it was no surprise that of the surveyed caregivers at Onboarding Leaders, only 29% were actively or passively searching to change employers, considerably less than the 46% at Onboarding Laggards. 

These findings all point to the same conclusion: Onboarding makes a difference on caregiver employee satisfaction, which makes a difference on caregiver retention. With a good onboarding process, you show your caregivers from day one that your agency or facility is committed to investing in its workforce.

Terra Vicario is the Chief Marketing Officer at Viventium. With 20 years of experience in the HCM industry, she’s held various leadership positions in go-to-market functions. Terra has spoken and written on a variety of topics surrounding caregiver workforce trends, including pay, onboarding, training, culture, and more. 

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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