This article is brought to you by CareAcademy. The article is based on a panel discussion that took place during a live session with Helen Adeosun, CEO and Founder of CareAcademy; Jennifer Sheets, president and CEO of Interim HealthCare; and Tim O’Rourke, President of Help at Home. The panel took place at the Home Care Conference in Chicago held on December 9, 2021. The interview has been edited for length and clarity.
HHCN: Before we get going, I just want to get started by you each giving a brief introduction to yourselves, and then also your company. Helen let’s start with you.
Helen Adeosun: My name is Helen Adeosun, from CareAcademy. We provide professional development and upskilling for direct care workers. We really believe that education is fast becoming a health intervention. It’s a way to bring in new workers. That’s when we talk about staffing, we’ll definitely go into that. It’s also a way to really upskill direct care workers. Obviously, everyone in this room knows that it’s highly needed coming out of COVID. We’ve been really proud to look at ways in which we can change the paradigm around staffing, and certainly bring in new and fresh blood and talent into direct care, so yes.
Jennifer Sheets: I’m Jennifer Sheets from Interim Healthcare. What you may or may not know about me is I’ve spent my entire career in healthcare. I actually started as a transplant ICU nurse a million years ago, more years than I’d like to admit. That makes this very near and dear to my heart how we make sure that we are developing our clinicians, and that we get every single clinician we can into our industry because that is the future of healthcare. Interim Healthcare is a part of a global company called Caring Brands International, roughly 600 offices in 8 countries.
Tim O’Rourke: Hi, I’m Tim O’Rourke, from Help at Home. I’ve spent the last 26 years in the health care industry on the Medicare and Medicaid side. I joined Help at Home last year. Help at Home is one of the largest home care agencies in the country, we actually are pretty specific around the Medicaid, MLTSS waiver business almost exclusively. We’re in 9 states today. On average, we have about 50,000 clients and about 32,000 caregivers across those states.
Our caregivers spend around 17 hours a week on average with clients, and have had a relationship of about four years. Just to give you some sense of that, our caregivers spent over 4 million hours with clients in their home in October alone. We’re excited to be here, excited to really help people and talk to you guys today about recruiting and what we’re doing in that space.
HHCN: Okay, great. We’re going to start with the elephant in the room: vaccine mandates. Things are changing rapidly. Litigation is moving forward at a really quick pace. How has that affected your staffing situation? How are you dealing with the fact that these mandates are so up in the air and everything’s a little bit unsure? How are you proceeding as a business, knowing that a mandate could be coming, but also things are a little bit in limbo?
O’Rourke: Yes, vaccine mandates. The way we think about this, I think no matter what happens, we all are in it for the same thing. We all want to stop the spread of COVID. Whether that’s private companies or the federal or state governments, that’s where we’re all at. We all want to keep our clients and caregivers healthy. From our perspective, there are mandates in some places we do business, or in other places, there aren’t mandates. We educate our caregivers on the effectiveness and the merits of the vaccine. We also educate our caregivers on testing and PPE and all the other pieces of effective prevention of the spread of COVID.
The other thing is we provide incentives for our caregivers to actually go get vaccinations. We’re going to keep encouraging that as we go forward. At the end of the day, we see that vaccine’s not the only issue that we have, it’s how do you stop the spread of COVID? How do we keep our clients healthy? What we found is our caregivers actually have been in a really tough spot during this pandemic. At Help at Home, we actually put out a million-dollar Help at Home Cares Fund for our caregivers for other things that they might need in terms of helping them through this pandemic. We think it’s not just vaccines, but there’s a lot of other things that we can do to help our caregivers as we go forward.
HHCN: You have vaccine mandates in certain areas that you guys serve. Has that hurt the staffing situation and how have you worked through those issues if it has?
O’Rourke: No, we’ve actually done a really nice job. We’re working with the caregivers, educating them, giving them incentives, and our vaccination rates are really high in those places where we have those mandates.
HHCN: Jennifer, so obviously, you guys are in a unique position where you’re a franchise so rules apply a little bit differently in terms of OSHA. Then, also, you’re home health across the continuum of care, so you have multiple mandates affecting you guys. How have you dealt with that? How have you kept your workers getting vaccinated, but also, maintain the status quo as a company?
Sheets: Yes, I think there’s two sides to the story. Unfortunately, as we all know, the pandemic and vaccination or not have become so isolating on both sides. It’s become so political that we are trying to support both sides. What we do is, we absolutely encourage immunity. We want to support our nurses and our physicians who understand how immunity works. They understand that natural immunity is more effective than vaccinated immunity. What we do is we try to go out and we say, “Listen, we want every single person to be immune, and we want to stop the spread,” but we also know that there are educated clinicians out there that understand their immunity, they get their testing and all that stuff.
What we do is, we offer education, we offer incentives, we gamify it, we do drawings for people that get vaccinated, all of those pieces, but because we offer the full continuum, we don’t want any clinician to leave. We redeploy clinicians that are not vaccinated, but are immune to those cases that don’t fall under one of the two mandates. That’s one of the ways that we’re trying to support everybody out there.
The bigger thing that we’re doing, in addition to pushing increased vaccination and increased immunity, is we’re also finding ways to support clinicians with further education on how they protect themselves. The important thing to remember is these are the same clinicians that were running to the fire when we didn’t even know if there would be a vaccine. A lot of them got COVID, they now have immunity, and now we’re saying, “Hey, guess what, you’re going to lose your job.” We’re really trying to advocate both at the federal and the state levels to help people understand that it should be about immunity and not about vaccination.
That being said, right now, it’s about vaccination. We’re also out there making sure we’re educating, we’re protecting, we’re doing things for our clinicians that are on the front line. We’re doing things like free giveaways and stuff like that for vaccination. We’re really bifurcating our workforce to make sure that those that fall under the mandate, we’re redeploying the ones that are vaccinated, and the ones that aren’t, they’re providing service somewhere else that we can use them.
HHCN: Helen, you have obviously worked very hard on vaccine efficacy, helping homecare agencies, maybe who were struggling, get a higher vaccination. I think there’s been a lot of different strategies deployed and a lot of people that I’ve talked to have had different strategies that did work. What have you seen that’s been the most successful from your perspective?
Adeosun: Absolutely. I think if anything, I started in this work as a direct care worker myself. A lot of our work centers on how we help bridge relationships between direct care workers and their employers. What we found out pretty early on in terms of COVID itself and understanding the disease was that we had a lot of direct care workers who had misunderstandings about what COVID essentially was.
I think before we talk about vaccine mandates and before we talk about the vaccine itself, we had a lot of direct care workers who felt left behind in terms of understanding the moment and understanding what the disease was. As a company, we saw it as a mandate pretty early on starting in March to really walk hand in hand beyond our own asynchronous classes to create forums, where direct care workers could just even have the ability to ask questions, so that they could really get up to speed on understanding the moment what COVID was. We were surprised by– I remembered, we brought in a clinician who just really thrives on helping people sort of bridge the gap and understanding.
Moving into this moment, now that we’re at a state of understanding what the vaccine is, we saw that agencies and employers who are deploying and walking through what COVID was, and making sure that they’re working in partnership with their employees, really saw higher levels of vaccine compliance. For us, the understanding at Care Academy, and really beyond even this moment is, as these moments are arising, how do we work in partnership to make sure we have an understanding of what the moment meant, but are we doing that also with direct care workers? We saw it as a learning moment to really just even start with the basics and work our way up and we saw that caregivers were much more understanding and trusting. Frontline workers were more trusting and understanding when they understood what the disease was, so, yes.
HHCN: The vaccines have been a cause for concern for many providers who think it’s going to be a long-term drag on staffing situations. Do you guys consider this a near-term problem or something that’s going to drag out for maybe even years?
Sheets: I think it’s here to stay for a while. I think it’s going to be a long-term challenge that we’re all faced with. That being said, I think that it also creates opportunity. We know the home health industry were big COVID winners as far as certainly knowledge and appreciation for what can be done for the home.
We just recently completed a study and we found that from the recruiting side 71% of clinicians or skilled clinicians, so we included physical therapists and physicians and practitioners and nurses and aides, actually have considered a career in home health. What kept them from making that leap was that there wasn’t any education out there. They didn’t receive training when they were in school on home health and what it was, so they were unsure of the ability to make that leap.
That’s something that we really capitalized on. We actually launched a campaign to create a new pool since we’re all trying to fish from the same pool. It focused on really three personas. The first was an industry exchanger, we found it in the midst of the pandemic, and we’re still seeing people that were displaced from their job. They were people that came with the skill set that we needed in home health care.
What we targeted was helping them understand that that skill set is exactly what you need in home health care, and they were actually made for home health care and didn’t know it.
The other thing that we were looking for was difference-makers, and so this has been really popular during what we’re seeing now with the vaccine mandates because what we wanted to say is home health care is the place that you really make a difference. You build long-term relationships. You keep people in their home happy and healthy where they want to be, so if you want to be a difference-maker, there’s a place for you.
Whether that is, in a different segment of our business, whether it’s an office position, whatever it may be depending on where they are and what state they’re in, and what the mandates are, we have a home for you and so that was the other persona that we targeted.
Then the final one was industry exchangers. What we found on the recruiting side of things was that 71% had considered a career in home health. What we did with the industry exchangers is we focused on resources and support for burnout. We highlighted the fact that you don’t work 3 or 4 12-hour shifts. We focused on the fact that while you’re trying to homeschool your children or your spouse is displaced, you have flexibility in when you provide care and where you provide care. So that’s one of the things that we did to capitalize. Some of our states that are under mandates, we did initially see an impact, absolutely, when the vaccine mandates came out. Colorado, for example, we saw a big impact.
What we saw is that we were filling about 20% of the referrals coming in because we didn’t have the staff so we had to figure out a way to increase our applicants in our pool. What we saw through that campaign is about a 13% increase in our applicants. We also saw our conversion rate increase by more than 5% through targeting and helping people understand that they were really made for home care, so I think that’s the biggest thing we did to counter them.
HHCN: Tim, are you considering this more of a long-term thing as well?
O’Rourke: Yes, we think it’s going to be around for a couple of years. We all thought it was going to end in September and here we are again with another variant in the books. Our caregivers were there before the pandemic, they were there for our clients during the pandemic, and they’ll be there for them after the pandemic.
I just want to tell you a little story. I talked to a caregiver in Pennsylvania when I first came on. As I was chatting with her, I said, “How’d you get through with COVID?” She said, “My client got COVID. She gave me COVID. It’s the sickest I’ve been for two weeks.”
As I continued to chat with her a little bit, I said, “What kept you going?” There are a lot of other people in the industry, at that point, they sat out. They said, “We’re going to wait this out.” They’re going to sit out and not do anything and move to the side but you went right back after those two weeks. I said, “Why’d you do that?”
She said, “I’ve been with that client for over eight years. If I’m not there for that client, they don’t get the support they need to stay in their home. I’m like family to her and she’s like family to me.” She said the last word that really stuck with me was, “I will not let her down.”
I think as we think through this whole pandemic, we think about our caregivers, we think about the nurses and clinicians, that’s their mentality. While I think this might stick around for a long time, I know the caregivers that help at home are so passionate about what they do that they’re going to continue to be there for their clients.
HHCN: Helen, I assume you started dealing with the mandates a long time ago because of states. I assume you’re preparing to help clients with this for a long time.
Adeosun: Absolutely. I’d be remiss in not echoing a lot of the sentiments that both Tim and Jennifer shared in that, yes, I do believe that this is going to be with us for a while, however, there’s a wonderful opportunity and both these organizations have done a pretty masterful job in seizing on it.
I think widely at CareAcademy, we are of the opinion that what we have been doing is essentially health care and there’s an opportunity here to frame because we are all looking at a lot of the same caregivers. There’s an opportunity to go beyond that and find talent. At CareAcademy we have a mandate that we talk about direct care workers as the talent and so how do we level up the talent to meet the need and how do we bring in new talent.
One of the things that led us to go about was creating a survey that we launched. We actually launched our findings last week. We found that 85% of direct care workers, currently in the field, had never had a conversation about what comes next for them and it’s that basic. I believe in the 20% for the 80%, but how do we find a way to position this moment and talk about direct care workers?
Like Tim shared about a story, it’s beautiful, of people who are in it because they care for their clients, they care for their patients, and also the opportunity to forward home care and home health as the future of health care and bring alongside people.
One of the statistics that kept me up at night among many was we talked about this internally at the CareAcademy, but because of the pandemic, you had 80,000 people who applied to nursing programs and were turned away because you had this moment where people said, “I want to be part of a solution. I want to do something. I have a heart for caring for people.”
Of those 80,000, I said, “There was a point where we can encapsulate and bring in those people who cared so much who saw the opportunity because of this challenging once in a five-generation pandemic that came about to frame this as a moment for home care.” I’m really about making sure that we leverage this as an opportunity and not get cowed by the drag of what we’re seeing, but really turn this as a paradigm shift within home care to bring in 80,000 people. I see it is a real opportunity to bring in new people into home care.
HHCN: Tim, can you explain or describe the type of worker that you’re having trouble recruiting or retaining right now?
O’Rourke: The toughest one we have is in the nursing field right now. It’s been a really challenging market when we’re looking at nurses. It’s not a big portion of our staff. It’s only about 2% to 3% of our total workforce, but if there’s one spot where we’re really having trouble right now, it’s the competition for nurses. It’s really important in our business too and especially in some states they’re in charge of the admissions or discharges into the state program so it has been a very challenging environment. I see that probably being the most challenging environment for some time to come.
HHCN: Jennifer, what about you?
Sheets: I would say nursing is certainly challenging, but I would say the home health aid. The CNAs are really where we see the biggest competition, and part of that is, what we know and why we all advocate for what we do because the rates are tough. When you think about the job and you think about how hard it is, you think about how mentally taxing it is as well. These folks are making roughly the same thing as somebody working at McDonald’s, and that’s a challenge, and so that’s one of the reasons we try to focus on why.
To your point, it’s like-minded, mission-driven folks that want to make a difference and highlight that piece.
On the vaccination side, it is the higher level clinicians which is odd. That’s not typically what you see. You typically see the challenge with the CNAs or the home health aides, but it’s actually the nurses and physicians we’re seeing that are most resistant on that side, but overall, I think that the hardest position to fill is that home health aide. certainly, the hardest position to keep long-term because you are talking about the ability to go do something a lot easier for more money. That is the challenge. We have to, collectively as an industry, keep banging that drum because the reality is, what COVID did for our industry is really attack that knowledge deficit that we’ve all been fighting for years about what could be done in the home, so people are aware of it.
We have more than four times the admissions that are referrals that we had prior to the pandemic. People need the care, they understand the care. The survey we just completed showed that 67% of people thought differently about the care for their loved one during the pandemic and that 65% would have chosen home health had they known it was an option. We still have more education to do but I think both of those statistics are pretty mind-boggling when you think about how long this industry’s been here. We’ve got to figure out better ways to collectively raise our voices and really drive reimbursement where it should be for the meaningful work that we do.
HHCN: Helen, are those sentiments consistent with other sentiments you’ve been hearing from providers? Also, when they come to you with issues like this, what are usually the first steps to get them going in the right direction?
Adeosun : Absolutely. We’ve definitely been hearing that across the board with folks. We are thinking about this from an opportunity-driven mindset. It’s a lot of the messaging that Jennifer pointed out. I think it’s also about thinking about the data-driven approaches that we can take. When you’re talking about homecare leading from the front as a health care intervention, what is going to matter most and I think folks have talked about this way before we’ve talked about it, before the pandemic.
It’s really leading from a place of, what does that mean? What does that materialize inside the home? For CareAcademy, when we have these conversations with our agencies, when we have them with our stakeholders, it’s on the recruiting side, in terms of addressing the immediate shortage, how do we create opportunities for you to leverage the wider world of service workers, people who have a heart for this, and bring them in, and what does that look like? About six months ago, we launched one of the first efforts to get a one-for-one credit from CareAcademy’s classes directly with our college, one of the largest credentials of nurses in the world.
The first HHA just landed on their shores, actually about a month ago, and is taking nursing classes right now. That one for us is many, how do we create and recreate opportunities to bring in and leverage people into this industry? How do we position opportunities that make us just, if not more I believe, a great opportunity for folks who are looking for work? It may be easier to work at Walmart or work in an Amazon warehouse but we believe that this is an industry that posits a future so really talking and leading from the front in that way.
I think from a data-driven approach, we look at ways in which direct care workers essentially are interventionists. We’ve been doing health care in the home, there’s much more to be done. The consumer also wants it. How do we drive that data-driven approach? We started actually alongside this mandate, thinking about COVID mandates and helping agencies leverage education as a way to educate the direct care workers. We started about creating certifications that were condition-based.
Ultimately, the goal there is saying, if they’re helping clients manage these conditions within the home, how do we help and work in partnership with agencies to leverage education in that way and ultimately measure the impacts of that? Those are the initial first big steps, and as an industry, we can be taking to leverage this idea that direct care workers or new direct care workers should be coming into our industry and then further taking data-driven approaches of measuring the outcome and the output of care in the home in order to tie up that reimbursement story.
HHCN: I know you are all working on really great initiatives to help recruiting and retention. But I do want to get a little bit more on the negative side. Has there been anything that you guys have tried to do that has not worked, that you’ve abandoned, whether that was a couple of years ago, or it was during the pandemic? Is there anything that you tried your hand at and you’ve realized is not generally effective at either recruiting or retaining employees?
O’Rourke: I want to start this without going to the negative first. We’ve actually seen a lot of success in recruiting and retaining caregivers. Over the last third quarter, we hired 5,331 caregivers in that quarter alone. I say 5,331 because they used to say 5,300 and the head of recruiting said, “No, you’re missing 31 of those folks.” She made sure I got it. We’ve been really successful in that spot and a lot of it is things we’ve done in terms of streamlining, what we’ve done in terms of the hiring and recruiting process, ripping out all the unnecessary pieces, and optimizing our recruitment strategy.
On the other side, retention for us and, Helen, I loved what you said about career path and having that conversation. We retain over 60% of our caregivers and the industry average is about 36%. We’re really proud of that and a lot of that is the culture that we’ve brought. I loved your conversation around career pathing. 50% of the folks in our admin side are former caregivers. We really want to professionalize the caregiver space and what they do.
Now I’ll get to the negative, Andrew, but I had to get that out because I would be remiss if I didn’t. We tried a lot of different experiments early on in the pandemic, and one of the ones we tried was, we’ve typically had sign-on bonuses for home care aides and what we tried to do is really increase that sign-on bonus. We doubled it in some areas and it got to a really high level, at some point $750 for a sign-on bonus, close to $1,000 for a caregiver. What we found, those caregivers stayed on, some of them took the bonus, took the first couple of shifts, and within 90 days they left.
We realized pretty quickly, it wasn’t about a money issue or a bonus issue. What really helped that retention and recruiting other than streamlining and the optimization is the flexibility we have in our local density in hours. The hours for their schedule, the location of a client, and the convenience for that caregiver goes so much farther than a bonus or a cash bonus upfront. We really have the flexibility to fit in their lifestyle, and that’s why we’ve been really successful. We see that throwing money in sign-on bonuses was a very short-term effect and they actually walked out the door within 90 days afterwards.
HHCN: Okay, Jennifer, anything you want to add?
Sheets: Yes, I would say, initially, when COVID first hit, we were really focused on education around what it was, what we were seeing. We put out our first education in February before the world blew up on March 16th and just said, “Hey, we think this thing might be big.” We started educating, just prior to it hitting. What we found, though, was what the clinicians were hungry for, and we have about 80,000 nurses right now within our organization and many more sides than that, but what we found is they weren’t so much worried about infection prevention, they know how to do it.
They were there with H1N1, they were there in the ’80s when HIV and AIDS was unknown and all of that stuff. They know how to protect themselves but what they were really concerned about was their families. Not only bringing something back to their family but also how were they going to manage this new world where again, they had kids that they were supposed to be homeschooling, and people that needed care. What we found is we had to rethink our strategy. We started thinking about more support. Obviously, the education was there, but we focused on support.
We launched a program that focused on how to keep your family safe and reminded them of things that they probably hadn’t thought about since nursing school or aide training about hotspots and designating a hotspot in your garage, this is where you dress and undress, and how you bag things, reminding them how to keep themselves safe and their family safe and mainly focused on again that flexibility. What we had them do is see all of their COVID patients– One of the things that came out early was that the nurses were saying, “It’s taking so much more time because I’m completely changing gear, and often clothes and everything else if I’d been in a COVID-positive house, going to the next patient.”
We re-thought our staffing and we put all of the COVID clients at the end of the shift. That way they weren’t technically ever going from a dirty home to a clean home. It was just really re-thinking strategy and support. Like I said, we really focused on how we meet that need. We launched programs where we let them do night visits. We worked with family members that didn’t mind if it was a night visit so that they could be home educating their kids or waiting till their spouse could relieve them. I agree with you. The money is not going to keep them. It might get them to jump, but then they’re just going to jump somewhere else. What we really focused on was, how do we meet their need, and overwhelmingly the need was not money and it wasn’t benefits, the need was, how can I do this? I’m called to do this. I love my work. But how can I do this and also, still be there for my family? That’s what we focused on. That was a surprising lesson for us because we thought it was going to be more about education and about a resistance to care for COVID patients initially and it really wasn’t. We didn’t have a resistance to care for the patients, we had concern for the family.
HHCN: Helen, what is the least consistent strategy that you see being deployed the most often by providers? What is something that you have advised against over the years because of the fact that it isn’t always working even though providers are confident that it will?
Adeosun: I’m going to see if I understood that question. What is the thing that people aren’t doing?
HHCN: That or what’s a strategy that agencies deploy that doesn’t end up working in the end?
Adeosun : I think it’s a lot of the things that Tim and Jennifer already pointed out. It’s things that are very short-term oriented so bonus pay. If people were not already bought into the idea of doing this for the fact that they are making an impact on the lives of people and they’re doing it for just the money, then there’s definitely going to be misalignment. The things that we see work are actually a lot of what Jennifer mentioned and we have started building out tools to help agencies think in that way. There are a lot of agencies who are already thinking about ways of providing soft support. Something as simple as, there’s one of the organizations that we have worked with for the last three 30 years always made sure.
I know that for myself personally, as a Direct Care Worker, it’s all made all the differences in the agencies that I work with. Do you care about me other than what I do for you and how are we making sure that you systematize that, you build it into your way of operating with direct care workers? We see that it has an impact when we sometimes get to sit out as a third party when we are surveying direct care workers and very often they’re saying, it is those moments that matter as to who I will work with and continue to work with. Those are the things that I think we sometimes do, but systematizing those things in order to really drive retention is a big thing.
HHCN: Jennifer you said earlier, how you were trying to build a new pool because everyone’s fishing from the same one. I want to get into one of the initiatives that you guys have, which is essentially, you touched on it earlier, but it’s taking people in health care that might not be happy right now with their job and trying to bring them into the home. How did that campaign or that initiative come about? Whether that’s data that you guys found internally? Also, how did you end up deploying that strategy?
Sheets: It’s a great question. So initially, during the pandemic, we started listening like everybody else. The information was just coming out constantly by the minute. We were meeting my leadership team at least three times a day to just talk about what’s new today? What’s new, what’s the new thing out there? It really became relevant that a lot of people were being displaced from their jobs. At the same time, we needed every single healthcare worker we could get, so we started thinking about how to capitalize on the fact that so many good people are out there looking for work. That’s where Made For This came from.
We started interviewing our clinicians all over the country saying, why did you come to home health care? Why did you want to be a home health aid? Why did you want to be a CNA? Why did you want to be a nurse in home health? That’s actually where Made For This came from. We had a nurse in San Diego who said, “I was always made for this. When I was little, my grandfather was on hospice and I saw the impact that clinician or that care group made in our family’s life so I always wanted to do this,” which was odd, because this was a very young nurse in hospice, which you don’t typically see. That’s not usually where people say, “Hey, I wanna go work in end of life, right off the bat.” What we found is that there were definitely common traits. They were people that were resilient. Again, nothing highlighted that more than the pandemic. People that were creative people understood that they had to think differently, if they were going to be successful when literally the rug was being yanked out from under them. If they were in hospitality or food and beverage and all that, that just shut down. That’s how it started. What we started doing was highlighting stories of our actual clinicians across the country saying, “Why did you make the leap?” “I used to work for, I’m just making this up, but Marriot and here’s what I figured out. Here’s why I came to home care.” We started highlighting that because we wanted people to see themselves in our examples.
Again, when we launched Made For This, we focused on those three personas. We wanted to not only tap into that group, the people that were displaced and looking for meaningful employment, and highlight why you wanted purpose-driven mission alignment in your work.
We also highlighted the fact, of course, that we’re maybe not economy proof but we’re pretty darn economy resistant in health care. The other thing we really focused on again was what we called those industry exchangers, and really focused on the stats that we were seeing about burnout. We were seeing so many clinicians choosing to walk away from a career in healthcare because how grueling it was to provide care. We started talking to that group about flexibility and like I said, that home care’s the place that you can manage homeschooling and your spouse’s job hours and all of that at the same time and still connect to your common core, which is you’re here to care for people.
The whole campaign was about saying, “Listen, you may not know it, but you’re actually made for home health care and we’re going to show you how.” That included a lot of what we just talked about, what Helen talked about with career progression. If we bring somebody in who has no experience, then we invest in them, in that education to be a home health aid, then to be a CNA, then to be a nurse, or whatever they want to do and build that new pool. I think that was impactful. What we’ve seen as a result is, like I said, we’ve got about 13% more that make it to what we call, out in the field, delivering service, we’re able to build those folks. So we have about a 13% increase in our workforce which we hadn’t seen ever before because of the turnover.
You bring in a ton, but you also have the churn, so we actually saw that. The other thing that we saw that was interesting is we have about 6% of our applicants who are much, much more qualified. In the past, when you look at how many applied that really aren’t qualified, with Made For This, we were getting folks that, were definitely qualified, some maybe even overqualified because there is that increased awareness, both from the pandemic of what home health can be, but also the push to help them understand the flexibility and the difference in the work environment. I never knew what happened to my patients after the three days they were with me. It’s how do you help them understand that you are connected to these people for years maybe and you’re a part of the family.
We’ve had a lot of success with Made For This. I think we launched it at the right time because we launched it very early on. It launched in April after the pandemic hit to really focus on all the people that were being displaced, that’s where it started. Then as it got on in the year, and we started seeing the next challenge was burnout and people walking away from the field, that’s when we launched the industry exchanger side of it. Because the reality is we do not have a demand issue, we have a supply issue and we can’t keep trying to attack that supply issue with just switching people out. “I’ll give you the bonus this week. You give them the bonus next week.” We’ve got to think creatively so that’s really why we started thinking about how do we build a new pool?
HHCN: So, Tim, you thought I was just going to make you hone in on the negative, but here’s your chance. The positive. Obviously, you guys have had a lot of success recently. You gave the number earlier, so what’s worked recently?
O’Rourke: The first thing we did is really streamline the recruiting process. If you take a look at what we did, we really took a look at the candidate experience and we realized as we went through it, the hoops we were making people jump through to get a job were ridiculous. People hate when I say it, we were ruthless in terms of our pulling out what we didn’t need people to do, the duplicate paperwork, the duplicate interviews and streamlined that process.
The other thing we found out is that once we had a candidate, we didn’t call that candidate back right away. It might be a day, it might be two days, it may be more than that. We looked at the time from the minute the candidate reached out to us, to the minute we contacted them and they actually got a job and got a paycheck. We shrunk that completely. Now we’ve gone from days to hours in terms of the time in that funnel. With what we’ve changed in our whole payroll system, we now have payroll weekly.
We have a weekly payroll so you can get interviewed, have a job on that same day, and then have a paycheck a week later. We really streamlined that. I think that’s been an unbelievable part of our success in terms of recruiting. The other thing that we’ve done really well is we have focused on retention.
If you take a look at our company we’ve got what we call a culture of caring for the caregiver and every decision we make is filtered through this thought of, “Is this best for the client? Is it best for the caregiver?” If we don’t have that filter or that culture in our company, we don’t do it. It’s been incredibly successful. Our engagement rate for our caregivers is well over 80%.
Like I said before, half of our caregivers have been with us for over three years, the top quartile for over nine years. We are pretty sticky in terms of our retention and we’re going to keep focusing on that. The way our team has defined success, if we haven’t left this industry with professionalization and acknowledgment for what caregivers do in the home, and what else they can do in the home because right now we think we’re just at the very beginning of the value that the caregiver can bring in the healthcare ecosystem. If we haven’t left with really professionalizing this business, we will have failed.
HHCN: Tim, in terms of the simplification of your recruiting process, is it more just what you just said in terms of streamlining it, or have there been elements that you’ve gotten rid of in order to make it a more simple process?
O’Rourke: Yes and yes. Literally if you would’ve seen the paperwork that people had to apply, the work that they had to do, the multiple interviews that they had to go through to actually get hired, it would’ve blown your mind. We’re actually taking that and reinvesting in technology now where if they respond to an Instagram ad, we’ll never lose contact with that person all the way through the funnel. Others are doing it too but what we thought through is this, we’re getting out of a health care recruiting mindset and to value recruiting and retention for us to do what we want to do in the healthcare space. It’s got to be foundational. It’s got to be the base of what we do as a company.
HHCN: What are you doing about boosters if anything? Are you approaching it the same way as the first couple of vaccinations, through education and allowing the workers to make the choice for themselves?
Sheets: We are educating, we’ve set up partnerships with some of our physician partners. We actually have our own little version of asking a doctor, so we have clinicians that can come in and ask anything that they want to ask, call in and ask about the vaccination. What’s the latest data show about the side effects because a lot of people don’t want to talk about that. It’s just an open forum. That’s been very successful.
We’ve seen a lot of clinicians that can call and speak to a physician that have then chosen to be vaccinated. The first thing that we did is start with an assessment in all of our offices. Who is vaccinated and who’s not. Of the people who aren’t, which of those employees then are willing to go get a blood test to show immunity? Then we have that bucket that we consider an active deployable workforce.
Then we’re working with that last group in every way we can. Like I said, incentive, education, ask an Interim doctor. Everything we can do to educate but it’s the same as with the original vaccine in our world.
O’Rourke: We’re just continuing the education incentive. I do want to go back to that last question whoever asked about streamlining. We are probably secretly dropping your agency, so you better have it down because we’ll know exactly how long it takes you to call us back at the same time. Just the same thing, we’re doing education, continued education incentive and that’s the way we’ve approached the boosters.CareAcademy provides high-quality, state-approved online caregiver training for home care agencies that increases caregiver knowledge. To learn more visit https://careacademy.com/.
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