Caregivers Leave Managers, NOT Companies

April 12, 2022

By Stephen Tweed

I became of fan of Marcus Buckingham with when he worked with the Gallup Organization and wrote his first book,  First Break All the Rules . He shared lots of facts and data from Gallup surveys of employees, and came to some conclusions that can help companies grow. One of those conclusions was the quote above.

We got a sneak peak at the  2022 Home Care Benchmarking Study from Home Care Pulse,  and the turnover number for last year was 64%. That’s a little better than the 65.2% in 2020, but not much. Turnover has basically been flat for the past six years.

We also learned that 57% of turnover happens in the first 90 days of employment. That’s a refinement on the number we have been using for a while that said that 80% of turnover happens in the first 90 days.

WHAT CAUSES CAREGIVER TURNOVER?

Every month, Home Care Pulse surveys thousands of caregivers. From that data, they have identified the  five big reasons caregivers leave :

  1. Lack of Communication
  2. Pay is too low
  3. Lack of Consistent Schedule with enough hours
  4. Lack of Support from Office Staff
  5. Management is Disorganized and Operates Last Minute

We see that four of the top five causes are related to the action, or inaction, of managers and office team members.

“Caregivers leave managers, not companies.”

WHAT ROLE DOES YOUR OFFICE TEAM PLAY IN CAREGIVER RETENTION?

This month of February 2022, the  Mastermind Groups  in our  Home Care CEO Forum  has been discussing the role that their office team plays in retaining caregivers. Members have had open discussion about what they are doing to help their office staff be more responsive to their caregivers. We have seen that companies with the highest growth rates in 2021, companies with the lowest turnover, and companies with the highest 90-day retention have some things in common.

It is pretty clear from the data and from anecdotal examples that the home care office team plays a huge role in finding and keeping high quality caregivers. Here are some things high performance home care teams are doing to reduce turnover and improve caregiver satisfaction:

  1. Set up a consistent process for communicating with caregivers, particularly in the first 90-days
  2. Set up a system to match caregivers’ desired paycheck with their actual hours worked and actual take-home pay
  3. Clarify who is actually responsible for supervising caregivers, and communicate that to everyone
  4. Provide education and training for team members who supervise caregivers on what caregivers need and want from their supervisor
  5. Set up systems so that office team members are more organized and can devote more attention to individual caregiver needs and expectations

It is pretty clear from our research that the best caregivers stay with a home care company when they are doing meaningful work, when they feel valued and appreciated, and when their take-home pay matches their financial needs.

PUT CAREGIVERS FIRST

We’ve been working with home care companies across the US, Canada, the UK and Australia for over three decades. In all of that time, most companies we know have had a “customer-first” mind set where they do everything they can to create a high level of client satisfaction. And that has worked amazingly well for many companies.

In 2022, the tide has turned and larger, faster-growing companies have proclaimed a  “Caregiver-First Mindset.”  That doesn’t mean that client satisfaction and customer service are no longer important. But it means that in this world where you can’t bring on new clients if you don’t have the caregivers, the company priorities and mindset are shifting. It means getting our office team members involved in working together to understand the needs and wants of caregivers first, and putting in place people and processes to meet those needs. It means using caregiver satisfaction data, recruiting data, and retention data to help office team members work together more effectively to keep our best caregivers.

This shift from  Clients First  to  Caregivers First  is quite difficult for company leaders and team members who have been in business for many years and have constantly focused on client needs. It is taking some major shifts in thinking and in actions to make that shift.

CREATING INCENTIVES FOR OFFICE TEAM MEMBERS.

Just before the outbreak of COVID, we were doing a site visit to one of our Top 5% Mastermind members. As they discussed their growth % in 2019 over 2018, they shared some data on what they had done to improve 90-day retention. The results were very impressive. As we discussed their process, we heard the CEO repeat back the mantra that we have been promoting for years:

“What gets measured gets managed, what gets rewarded gets repeated”

This company had set up a new incentive plan for each of their office team members. The incentive plans varied from department to department, but everyone was incentivized based on three performance Metrics:

  1. Increase in Weekly Hours of Service
  2. Home Care Pulse Satisfaction Survey Results
  3. Caregiver Retention

The were able to show each of their team members how they contributed to those three numbers, and how they would be rewarded when the numbers moved in the desired direction. It became pretty clear from talking with them about how tracked the metrics, and how they calculated their incentives, that nearly every member of the team had bought into working together to grow the business, improve client and caregiver satisfaction, and keep good caregivers.

ENGAGE IN CONVERSATION WITH PEER COMPANIES ABOUT KEEPING YOUR CAREGIVERS

A significant number of our in-depth conversations in our Home Care CEO Mastermind Groups are about keeping high quality caregivers. Developing managers and team members so they have the knowledge and skills to nurture those relationships is part of the process.

If you would like to have regular conversations about issues like this with leaders of other companies your same size who do not compete with you, you may want to consider becoming a member of a  Home Care CEO Mastermind Group  in the  Home Care CEO Forum .

This article re-published with permission of the writer, Steven Tweed:

Stephen Tweed, CSP,  is an internationally known health care and business strategist, award winning professional speaker, and published author. He is the CEO of  Leading Home Care… a Tweed Jeffries company  and the Founder of  The Home Care CEO Forum®  and  Caregiver Quality Assurance®.


Should you need assistance with your home care, home health, or hospice agency, then call  Kenyon Homecare Consulting  at 206-721-5091 or  contact us online . We help agencies develop practical solutions for success in the home care industry.

Results Based Consulting

Did you find value in this blog post? Imagine what we can do for your home care or hospice agency. Fill out the form below to see how we're leading the industry with innovation, affordability, and experience.

Contact Us

Stroke training
By Ginny Kenyon August 12, 2026
When a patient returns home after a stroke, the clinical landscape changes instantly. Survival is just the first hurdle; the real challenge lies in navigating the complex, often unpredictable journey of rehabilitation and long-term care. For home health and home care agencies and senior care facilities, caring for a stroke survivor requires more than help with Activities of Daily Living (ADLs). Stroke can affect a patient’s neurological, physical, and emotional functioning simultaneously. That’s why specialized, stroke-specific clinical training for caregivers is essential to improving patient outcomes, supporting staff retention, and strengthening the agency’s overall performance. The Multidimensional Complexity of Post-Stroke Care A stroke is not a singular event with a linear recovery path. Depending on the location and severity of the brain injury, caregivers may confront a baffling array of concurrent deficits: Physical and Motor Deficits: Hemiparesis (one-sided weakness) or hemiplegia (one-sided paralysis) completely alters transfer techniques. Improperly moving a patient can cause severe shoulder subluxation or skin tears. Cognitive and Communication Barriers: Aphasia (difficulty speaking or understanding speech) and dysphagia (swallowing difficulties) require immense patience and highly specific intervention techniques to prevent profound frustration or life-threatening aspiration pneumonia. Neurobehavioral Changes: Sudden emotional lability, post-stroke depression, or structural personality changes can easily overwhelm an untrained caregiver, leading to burnout or adversarial dynamics in the home. Without structured education, caregivers are left to rely on intuition. In complex neurological care, intuition is rarely enough to prevent adverse events. 4 Strategic Benefits of Specialized Stroke Education Investing in robust stroke-specific training programs transforms an agency's frontline staff from general monitors into clinical assets. 1. Drastic Reduction in Hospital Readmissions The first 30 to 90 days post-discharge are high-risk windows for stroke survivors. Educated caregivers act as the eyes and ears of the clinical team. They are trained to look past basic symptoms and identify subtle warning signs early: Recognizing micro-signs of silent aspiration during meals. Monitoring for deep vein thrombosis (DVT) in affected limbs. Identifying skin breakdown early on the hemiplegic side. Spotting the warning signs of a secondary stroke using the B.E. F.A.S.T. protocol (Balance, Eyes, Face, Arms, Speech, Time). Early identification allows for timely home health or physician interventions, keeping the patient safe at home and protecting the agency's rehospitalization metrics. 2. Safeguarding Staff and Patients (Risk Mitigation) The process of transferring a patient with dense hemiparesis requires precise biomechanical knowledge. Specialized education teaches caregivers how to support the affected side without pulling on weakened joints, how to properly utilize assistive devices (gait belts, sit-to-stand lifts), and how to manage one-sided neglect (where a patient completely forgets one side of their body exists). Proper training mitigates the risk of catastrophic falls and shields caregivers from debilitating musculoskeletal injuries, directly lowering workers' compensation claims and liability exposure. 3. Boosting Staff Retention and Professional Empowerment High turnover in caregiving is often caused by burnout and feeling unprepared for challenging cases. When an agency provides specialized clinical training, helping staff understand stroke-related behaviors and advanced transfer methods, it strengthens the caregiver’s role. Staff members feel empowered, confident, and valued as professionals rather than viewed as standard domestic labor. This professional dignity translates directly into higher job satisfaction and improved staff retention. 4. A Powerful Market Differentiator In a crowded marketplace, families and hospital discharge planners look for specialized expertise. An agency that can explicitly state, "Our caregiving staff undergoes advanced, competency-verified training in post-stroke neurological care, dysphagia management, and transfer safety," holds a massive competitive advantage. It builds immediate trust with families and establishes preferred provider relationships with local health systems and stroke centers. Building a Competency-Based Training Framework Effective stroke education cannot be a passive, check-the-box exercise. To truly impact care quality, an agency's training framework should combine foundational knowledge with hands-on validation: Neurological Fundamentals Core Focus Areas: Types of strokes, one-sided neglect, emotional lability, and aphasia communication strategies. Competency Verification: Written scenario analysis and communication roleplay. Mobility & Safety Core Focus Areas: Safe transfers (bed to chair), handling the flaccid or spastic limb, fall prevention, and skin integrity. Competency Verification: Hands-on return demonstration with a mechanical lift/gait belt. Nutritional Security Core Focus Areas: Dysphagia precautions, recognizing pocketed food, fluid thickening consistency, and aspiration prevention. Competency Verification: Direct observation of meal prep and feeding techniques. Conclusion: An Investment in Excellence The care of a stroke survivor is inherently complex, demanding, and volatile. Expecting caregivers to navigate these intricacies without targeted clinical education places an unfair burden on the employee and exposes the patient and the agency to significant risk. By prioritizing advanced stroke education, agencies and facilities do more than just improve compliance; they foster a culture of clinical excellence. The results are undeniable: safer patients, more confident and loyal caregivers, and a highly respected agency brand that stands out as a leader in complex home-based care. For in-depth education on caring for a person with a stroke, contact Kenyon HomeCare Consulting, which offers an 8-hour DSHS-certified continuing education course . Each chronic disease course includes a certification with a red-and-yellow flag guide that can be laminated for caregiving staff. To learn more, call 206-721-5091 or email gkenyon@kenyonhcc.com .
MS care
By Ginny Kenyon August 8, 2026
MS is notorious for its volatility. Understanding nuances like the MS Hug or Uthoff's phenomenon are crucial to providing the quality of care these patient's need.
arthritis care
By Ginny Kenyon August 5, 2026
Arthritis can cause daily pain taking a massive toll on patients, often leading to depression and anxiety. Education bridges the gap between frustration and empathy.
Depression patient
By Ginny Kenyon July 30, 2026
Educating staff on depression isn't just a treating mental health issue—it is actively preventing a cascade of physical declines and re-hospitalizations.
Dementia care
By Ginny Kenyon July 27, 2026
Without proper training, caregivers are thrust into a complex role with no map. Providing structured education is not a luxury, it's a critical intervention.
COPD education
By Ginny Kenyon July 25, 2026
COPD represent a highly vulnerable population. Every field staff member plays a critical role in keeping these patients safe, comfortable, and out of the hospital.
blood sugar
By Ginny Kenyon July 21, 2026
In the caregiving profession, the difference between proactive care and reactive crisis management is education because diabetes impacts almost every body system.
CHF
By Ginny Kenyon July 17, 2026
Chronic disease management can be intimidating for staff, particularly for aides or newer clinicians who may feel unequipped to handle complex cardiac patients.
fixit
By Ginny Kenyon July 14, 2026
Without specific training on how these illnesses behave, caregivers are flying blind, unable to spot subtle warning signs that separate stability from an emergency.
policy
By Ginny Kenyon July 10, 2026
Policy and procedure manuals are the blueprint for your agency’s success. It protects your business, ensures clients receive safe care, and gives staff structure.