In 2019, the overall national turnover rate for US based home health care employees was a staggering 21.89%. Better put, last year you lost 1 out of every 5 employees you had. Those are employees that you had spent money recruiting, onboarding, and training. Those are employees you then had to replace, spending more money recruiting, onboarding, and training the replacements. In fact, the Society for Human Management estimates it costs a company an average of 6 to 9 month’s pay to replace each lost employee.

The numbers are even more dismal in certain disciplines. Home care aides had a turnover rate of 25.36%, with LPNs running a close 22.50%. If you own or manage a home health care organization, you’re already aware of the high turnover rates and the unrecoverable costs involved.


Why is there such a huge turnover rate in healthcare? The answers can vary depending on the setting where care is being delivered.

Home-Based Care Providers

When queried, the top 10 reasons for caregivers to leave a home-based healthcare business were:

  1. Poor Communication
  2. Hours and Scheduling
  3. Low pay and benefits
  4. Receiving little or no training
  5. Lack of recognition
  6. Lack of expectations with first client
  7. Lack of client compatibility
  8. Rude office staff – lack of respect
  9. Lack of openness to new ideas by management
  10. Travel or commute times

Identifying the areas of dissatisfaction and then controlling the controllable in your employee relations is one of the fundamental keys to improving employee retention. Though not stated as such, please notice that each of the enumerated complaints focuses on either an issue of respect or an issue of personal quality of life.

In fact, it could well be argued that a perceived lack of respect directly impacts personal quality of life, therefore making all 10 top reasons quality of life dependent.

Community, Facility and Hospital Based Care Providers

The top 10 reasons for employees to leave location-based care providers leave is comparable, but different in a few key elements

  1. Lack of advancement opportunities
  2. Work overload
  3. Poor salary
  4. Insufficient staff
  5. Poor organizational culture
  6. Lack of mentoring
  7. Poor personal fit with boss
  8. Insufficient access to technology
  9. Lack of training
  10. Insufficient time with patients

Though perhaps worded differently, there are clearly key commonalities why employees leave healthcare that stand independent of “where” the job is conducted. Ironically, they also stand independent of what discipline is queried.

Again, there is a clear level of importance placed on quality of life, as well as being provided the tools and information necessary to perform their job at an acceptable level.

Commonalities irrespective of location or discipline include:

  1. Poor communication
  2. Perceived lack of support
  3. Heavy workloads resulting in overly long hours
  4. Lack of training
  5. Insufficient compensation/benefits
  6. Lack of growth potential

Improving Employee Retention & Quality of Life

Employee retention is dependent on addressing these common concerns. You must control the controllable. To do so, your healthcare company must implement programs that address the following fundamental areas that lead directly to employee dissatisfaction:

  1. Centralized Communication
  2. Support Resources
  3. Digital Workflows
  4. Preparing New Hires For Success
  5. Training and Education
  6. Career Planning

Centralized Communication

Lacking cntralized communication, workers in the healthcare industry can feel disconnected from their organization. Feeling they have no easy way to communicate with different departments, send feedback to upper management, or learn about upcoming events throughout the community, there is no sense of connectedness or ownership. The inability to engage and acquire information easily can lead to frustration for employees and cause to choose to move elsewhere.

A cutting-edge centralized communication system gives an organization a competitive advantage when it comes to both employee acquisition and retention in several key areas:

  • Information
  • Recognition
  • Improved performance management results
  • Engagement
  • Support


With a distributed workforce, such as generally found in home-based healthcare, obtaining current, changing or new information in a timely fashion is challenging. To be a provider, held to the highest best-practice standards yet not even know when those standards may change, produces a level of anxiety that is not only unnecessary, it is detrimental to their overall quality of life, and has a direct impact on their interest in remaining with your organization long-term. Other changes, like organizational policies or procedures also must be communicated quickly and directly to all staff members, whether in the office or in the field.

Finally, being in the field means a lack of access to traditional resources like bulletin boards, opportunity posting, event calendars and the like. Sharing of this information via your centralized communications system reaffirms their connectedness with the rest of the organization and underscores the concept of “team” that organizations must achieve to improve employee retention.


Some factors causing people to leave their jobs may be outside of an employer’s control, but there is one aspect that can be influenced: how employers recognize, reward and engage with their employees in the workplace.

One study found that only 42% of healthcare employees feel they are valued by their employer. Considering how much is asked of employees and the difficult conditions they often face, putting in the effort to make them feel appreciated should is a core responsibility of all managerial and leadership staff.

By practicing recognition and reward in the workplace, your organization will unquestionably see reduced staff turnover rates and absenteeism levels as your employees form a deeper connection with you and see the positives of working on your behalf.

However, the impact of this activity will also bring about other positive effects. For example, it has been shown that when employees are engaged and motivated, both their productivity levels and quality of work improves. With the healthcare sector constantly looking to meet a multitude of ambitious targets, tackling the employee engagement issue first could start them off on the right foot for tackling all their other priorities.

Use your centralized communication system to publicly recognize outstanding work performed by your staff members. Celebrate their achievements, both large and small, globally within your team. This will foster the feeling of value and recognition that your employees need and deserve. Don’t be afraid offer accolades on personal achievements, as well. This reinforces the employees sense of value and builds a long term attachment to the organization.

Improved Performance Management Results

One of the commonalities in employee dissatisfaction noted was a perceived lack of opportunity. Using a performance management system has been shown to increase goal/objective achievement and improve perceived opportunity to grow within an organization.

You can improve performance management results, as well as improve employee retention, by using your centralized communications platform to:

  1. Announce new objectives or goals as they are developed
  2. Publicly recognize employees when they meet or surpass those corporate goals
  3. Announce new growth opportunities when they are offered
  4. Give and receive feedback from your team members on goals/objectives


To many workers, an organization that allows them to make their voices heard and acts on their concerns is highly valued. Health care is no exception. Ensuring that employees feel valued is important, but forward-thinking organizations that want to keep their people on board will take the next step and help workers see exactly how their efforts are helping those around them, while allowing them to offer suggestions for improvement.

Here, it’s essential to be transparent about your organization’s goals and mission. Many employees won’t remain with an organization that doesn’t prioritize the same values that they do. It’s also important to ask for employee feedback and ideas on everything from improving patient care to boosting community outreach. This makes them feel more engaged in their work and more invested in helping your organization accomplish key objectives. An invested or engaged employee is one that feels a valued part of the organization. It feels like “family”, and no one wants to leave their family.

Your communications system can be utilized to foster vertical, as well as peer-to-peer communications, sharing ideas and obtaining input. You can use it to recognize organizationally based ideas fostered by your employees and get group feedback on new concepts or ideas.


Home-based care workers are required to be independent and autonomous given they work without direct supervision most of the time. The catch-22 is: extended periods of working remotely also contribute to a sense of isolation and emotional distancing from their office and clinical teams. Their successes, failures and stressors are their own and rarely shared or supported. This feeling of isolation leads directly to feelings of dissatisfaction with the organization and contributes to feeling undervalued and unimportant.

Your centralized communication system is the best possible tool to change those feelings. Your support for your employees can be shown in many ways, but here are a few suggestions:

  1. Identify an individual whose first priority is to address in the field emergencies or issues
  2. Contact your staff members after they have seen a particularly difficult client
  3. Check in with a staff member if they are serving in a risky neighborhood
  4. If assistance is requested, send a broad, open message to all team members requesting response.
  5. Allow peer-to-peer communications. Sometimes, your staff needs an opportunity to vent and no one understands better than someone in the trenches.

Offering supportive options for your staff members increases their level of overall satisfaction, reaffirms their value to your organization and decrease dissatisfaction with their immediate situation. 


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Support Resources

Your staff’s isolation has other repercussions, as well. Invariably, they will need some form or piece of educational information that they do not have with them. Their options then are (a) drive to the office, get it and return; or (b) hope they remember to bring it next visit. Neither option is optimal, and both increase the stress level of your employee.

Ideally, your staff would have everything they could possibly need right at their fingertips. Consider this a digital briefcase. All your educational or informational handouts, copies of your forms, lab results information or whatever your staff needs at the moment, instantly available to them digitally.

For convenience, these documents can be arranged in groups or packets, such as admission documents or comprehensive protocols, such as hip replacement guidelines, recommendations and exercises. A simple download of the correct packet is all that is required of your clinical staff. Putting this same toolbox in the hands of your health aides gives them the ability to share tips on moving the bedbound patient, in a written format, at the press of a button.

If the client is receptive to email or text message delivery,. If printing is required, the provision of a portable printer is an easy answer. A quick note to the patient digital file regarding the file transfer and your staff has just documented the education provided, a key part of all Medicare reimbursed care.

Providing your staff with the tools they need to be effective in the field is absolutely fundamental to how they feel about your organization and their place in it.

Your staff went into the healthcare field because they want to help people. Now, you’re giving them the tools to do so and underscoring their professionalism and value at the same time. Further, their productivity levels will increase, due to time savings.

Employees remain with organizations that provide them what they need to do their job and show the public how highly valued there are within their organization.

Digital Workflows

Paperwork is every clinician’s nightmare. The challenge of employee retention demands that your organization examine and design, or redesign, its workflows to be more efficient and more effective. The need to think about workflow design is more critical than every due to several factors, including:

  • The introduction of new technologies and treatment methodologies into clinical care
  • The challenge of coordinating care for the chronically ill
  • The participation of a growing array of professionals in a patient’s care team, and new definitions in their roles
  • Cost and efficiency pressures to increase patient flow
  • Logistical challenges associated with a disbursed workforce

Your organization must incorporate technology into your daily workflow, without hindering or disrupting your care processes. The problem is not the lack of data, the problem for healthcare staff is getting easy access to the data they need to act upon.

Technology can now capture and store data and integrate with other systems to provide the right information at the right time to make decisions that impact operational, clinical and financial outcomes.

When technology is implemented properly, it can decrease the amount of time spent on manual tasks, freeing up clinician time and allowing for more time for direct patient care, which that will improve the overall performance of the healthcare organization and improve your employees satisfaction levels.

Your digital workflow program must offer several key features:

  • Ability for different disciplines to make entries, enter orders and identify new protocols in the treatment plan of care.
  • Ability to quickly obtain new, signed orders for medications, treatment protocols, DME, oxygen support and other patient-focused needs.
  • Automatically update MAR when medication orders change.
  • Easily locate advanced care directives and power of attorney documentation.
  • Reliability and uptime guarantees
  • User friendly
  • Integrates seamlessly with digital briefcase, online library and resource documents

Using technology to improve your employee’s workflow, reduce stress, improve patient care and reduce error risk are all integral to the development of an organizational culture that encourages and promotes employee retention.


Onboarding is the action taken by an organization to support a new employee’s introduction to the organizational culture, and to provide them with the necessary knowledge, skills, abilities, and behaviors to be productive and satisfied employees.

A well-executed onboarding program gets employees engaged early, raises retention rates and improves productivity. Studies show that a significant amount of staff turnover – as high as 20 percent – typically occurs in the first 45 days of employment. Studies also show that employees who go through professional onboarding programs are much more likely to stay with the organization after three years.

When bringing on a new hire, a company has one chance to make a favorable impression. A company with a structured, well-executed onboarding program creates the impression it is well run and values its employees, whereas a company without a program, or with a poorly executed one, comes across as disorganized and indifferent to employee success.

The time between the offer letter and the start date is crucial because new hires may still be interviewing with other companies and can change their minds if they have any doubts.

Here are some easy suggestions to help.

  • Send a welcome gift and note to new employees, such as a promotional item emblazoned with your company’s logo or a personalized letter from your CEO. This small effort can make a new hire feel valued and excited about your company. It also reiterates their value and anticipated contribution to the team.
  • Send the first week’s orientation schedule and new hire paperwork prior to the start date.  Human Resources should send the employee a welcome packet that contains new hire paperwork, including benefits materials, tax forms, and Form I-9. These forms should be delivered electronically and offer an electronic signature option.
  • Share the responsibility among multiple departments. Onboarding is most effective when hiring managers and senior executives are involved in a cohesive, structured way. Prepare a plan for each division or department to delegate roles and ensure that orientation goes smoothly.
  • Go paperless. Forward-thinking companies automate new hire administration. A web-based employee onboarding system streamlines the process by eliminating data entry and improving accuracy. Also, instead of overwhelming employees with information during the first few days, an employee portal serves as a useful tool which employees can consult long after the initial orientation.

Integrating your onboarding process with your performance management system and your online training and management system creates a supportive network for your employees, both immediately upon hire and as their tenure grows.

It underscores your commitment to your employees as valuable team members and your organizational commitment to training, knowledge and providing staff with the tools necessary to excel in their positions.


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Training and Education

Did you know that lack of training and education, were high on the list of dissatisfaction factors for all healthcare providers?

Dissatisfaction directly correlates to loss of employee and increased employee turnover. Your organization is compelled by regulation to provide on-going training anyway. Provide training that not only meets compliance requirements, but also that your staff will find engaging, informative and promote professional development. Furthermore, you need to provide that training in a fashion that works within your staff’s already busy routine and works with your remote workforce.

Online training modules are the answer.

Online training modules empower your organization with the ability to develop customizable training, tailored directly to your organizational needs and your corporate business philosophy and goals.  They also negate the need for set scheduling, allowing your staff the freedom to determine where, in their schedule, they will accomplish the training/education they both want and need.

Ideally, your online training and education program will include real-time reporting capabilities, that provide you with completion status on each employee at the touch of a button.  Also integrated into your online training system, your company needs testing capability, to ensure staff understanding the materials provided as well as the ability of staff to return to the training, should question arise or memory fail.

To improve employee satisfaction, and the resulting reduction in employee turnover your healthcare company seeks, a well-designed, online training and education program is mandatory.

Career Planning

A natural by-product of an outstanding training and education program, particularly if coupled with a great performance-based management system, is the desire on the part of employees to reach for growth opportunities.

Caregivers want to get their CNA license. CNAs want to become nurses. Nurses eye the DON/DCS position. It is the natural order of business. Do you want these upwardly mobile, highly skilled, and well-trained individuals to go to other healthcare organizations? Keep them instead.

Offer career planning options, establish mentorship programs with senior staff members, encourage certifications, reimburse for tuition. An informed, well-trained staff is the product of an intentionally designed, fully integrated system. These individuals repay your organization with improved patient outcomes, higher levels of professionalism and skill, higher retention levels and better marketing opportunities, to increase your patient census and, overall, bottom line.

There is no better payoff than investing in the very people that are the heartbeat of your company.


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Key Takeaways

Healthcare has one of the highest employee turnover rates of any industry in the United States and, in fact, in the developed world. Commute times, long work hours, frequent schedule changes, and emotional turmoil are all outside the control of your healthcare organization. However, to reduce employee turnover, there key areas that your organization can master.

  • Centralized Communication to improve lines of communication between staff and management, improve information flow and reduce feelings of isolation. Increasing feelings of connectivity is a valuable step in improving employee retention.
  • Support Resources made available digitally to your distributed workforce, providing them with the tools necessary to perform their work in a professional and efficient fashion.
  • Digital Workflows reducing the stress level of your in-field staff by providing current, clear updates to plans of care, access to providers for obtaining new orders, assistance with medication reconciliation and obtaining needed patient supportive items, particularly in after-hours situations.
  • Onboarding, conducted in an online virtual format, introduces your newest team members to the culture and values your organization represents. Done correctly, that fosters a “team” mentality and has been shown to increase retention rates by 30%.
  • Training and Education underscores the value you place on your staff’s knowledge and skills. It encourages their professional growth and fosters a sense of confidence.
  • Career Planning takes that sense of confidence and extends into preparing your staff for leadership roles within your organization.

To reduce your employee turnover rates and stop losing the most valuable commodity your healthcare organization has, it is imperative that you address employee areas of dissatisfaction that are correctable. You simply must control the controllable.

ClinicalHQ provides free, no-obligation, strategy sessions to assess the needs of any healthcare business to address employee retention solutions. Contact us to schedule a session today.