Evaluating Employee Turnover in Home and Hospice Care

The number of home and community based services for older adults have grown tremendously over the past 20 years. This has occurred because of a continued shift in government expenditure related to these programs and an increasing desire of older adults to age in place in their homes and/or communities. Because of this growth, it is no surprise that questions about staffing quality and professionalization are now occurring related to home-based care. In response, a new study has compared the turnover rates of home care and hospice agencies among their direct care staff.

This study found that both organizational characteristics and factors related to the local economy often drive turnover in home and hospice care. The findings suggest that focusing on these organizational characteristics will improve retention and care quality. This study also provides direct care turnover rates for care providers in North Carolina

The turnover rate in home care agencies was 60% on average; while hospice agencies experience 30% average turnover. The researchers found that this large difference was often explained away by factors governing the way these organizations were run. For example, ownership status (for-profit vs. non-profit) was a significant predictor of the separation rate of an agency. For-profit agencies were found to have higher turnover rates, because they offered lower wages and benefits; which were associated with higher rates of involuntary separation.  Paying lower wages and offering less generous benefits often shrinks the pool of available applicants, leading to lower quality candidates, and higher rates of dismissal. On a different note, voluntary turnover was linked to the local unemployment rate. If the unemployment rate is high, then voluntary turnover understandably decreases and vice versa. Paying attention to the unemployment rate will help you forecast your own employee churn.

If home and hospice care providers want to be in a position to take advantage of growing home-based care opportunities, they must balance their budgetary needs with demands for better service and higher quality staff.

Source: Dill, J. and Cagle, J. 2010. Caregiving in a patients’ place of residence: Turnover of direct care workers in home care and hospice agencies. Journal of Health and Aging  22:713-733.

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