Home Care U - A Former Insider's Breakdown of the 2023 HCP Benchmark Report

Episode Date: July 17, 2023

The HCP Benchmark Report, formerly the Home Care Benchmarking Study, is a 200-page report on operational benchmarks and trends for home care agencies. Did we mention members of our team used to run the study? We're here to give you the most important insights from this year's edition in 60 minutes.Enjoying the show? Send me a text and let me know!Learn more about Careswitch at: careswitch.comConnect with the host on LinkedIn: Miriam Allred This episode was produced by parkerkane.co

Hey, welcome to Home Care U, a podcast made by the team at Care Switch. Nobody went to school to learn how to run a home care agency, so we're bringing the education to you. Join our live audience by going to careswitch.com slash homecareu or listen on your own time wherever you get your podcasts. Home Care U is hosted by myself, Miriam Allred, and Connor Koons of CareSwitch. Enjoy the session. Welcome, everyone, to Home Care U.

Before we get started, I just want to say welcome and thanks for joining us. I'm Miriam Allred, head of partnerships at CareSwitch. You are tuning into Home Care U, U for University. If you haven't joined us before, this is a weekly live event series where we bring on a variety of guests to cover in-depth home care topics that are not being talked about or aren't being talked about enough or aren't being talked about to the level that we would like to cover them. So thanks for joining us live today. We hope you will get something interesting and informative to take back to your business today. So today I'm joined by my co-host, Connor Koons. He's no

stranger to many of you. He also helps host Home Care U. We tag team, we switch off, we pick topics that we're passionate about. But today you've got both of us as a double whammy to cover today's topic. So today we're going to do something slightly different than what we normally do. So you're in for a treat. We're actually going to give you an insider's breakdown of the 2023 Home Care Pulse benchmarking report. Connor and I both were actually at Home Care Pulse previously to CareSwitch. And so he and I have an insider's look from that perspective. Connor actually owned the survey and the production of this report. And so he is very familiar with the data collection and the data production. And we've spent a lot of years with this data and familiar

with the trends and interviewing other people and talking to owners about this data. So we're going to actually give you kind of our take on what this data is telling us. So let me give a quick background on the report itself and the demographics. I'd imagine most of you here are familiar with the report or have seen this data referenced in conferences and presentations and webinars and podcasts. But for those of you that it's slightly newer to, I'll just reference that this report is produced by Home Care Pulse, a vendor in the home care space that provides client and caregiver satisfaction surveys and training and also online reputation management. And this report is an additional service that they provide to the industry. Aaron Markham,

who was the founder of Home Care Pulse, saw a gap in data for the industry and felt passionate about filling that gap by providing this rich, comprehensive data for the industry and felt passionate about filling that gap by providing this rich, comprehensive data to the industry. And just for reference, today we'll be focusing on the private duty sections of the report. There is some hospice and home health data that they've incorporated this year, but today we'll be heavily focused on the home care specific data. And for reference on the size of the report, this year, 855 home care providers represented over 2,400 locations. So it's pulling from a large sample size of owners and operators nationwide. 52% of those providers that participated are independently owned and operated locations,

and 40% are a franchise. Beyond that, there's kind of a mix of some that are operating under different models. So hopefully that kind of gives you a background of the report itself. Connor, you want to jump in anything that I missed or that you'd add about home care polls or the report itself? Yeah, just one or two things. So like you said, I'm excited for this episode. It's a little bit different than we usually do. It's kind of fun and different being on like almost kind of like the guest side of this, you know. And as far as the report goes, just a couple things. I mean, like you said, we're both very familiar with this. We've helped at all stages of producing it in multiple past years. And so there's a few things where I think this episode will give not only unique insight into maybe what can be learned

from the data, how to interpret it, things like that. But I think there are also things where we may have unique insight on how to look at the methodology on certain parts of it, which then relates to how to interpret it. And there are a handful, I mean, a small number of places that I have thoughts or opinions on maybe what the sample size, you know, how the sample size may have influenced it, things like that, that I'll mention too, which also just points to kind of the accuracy of the overall study of the rest of it., which also just points to kind of the accuracy of the overall study of the rest of it. I was also just going to mention kind of an appreciation for Home Care Pulse and what they've done by producing the study. If you have followed Care Switch very much

or like looked at what we do and the free resources we publish, the way we market Care Switch is by trying to be as helpful and useful and educational as possible. And really, that was something we learned from Home Care Pulse from working there. And the first thing that they really did to set that standard is by producing what was then called the benchmarking study, now the benchmark report. They do charge for it if you don't participate in the survey to help get the data. But overall, it's largely a labor of love they do for the industry and essentially a marketing tool in what I would consider the best way to do it, which is just be helpful, be useful, be educational,

and let that speak for the company itself. So shout out to them for doing that. And again, just kind of some personal appreciation on my part for this being a tool that showed me how I believe marketing should be done for companies now. Just one or two other things not related to the study as much. Those who listen to us always know I mentioned this. I have a stutter. You heard it a couple couple minutes ago, probably. Some days it shows up, some days it doesn't. You'll probably hear some random pauses and things while I'm talking today. If you do, know that that's not your internet buffering, probably. That's not Zoom buffering. That is me buffering. And it's totally okay. I'm good. So we'll get through it.

That's probably everything I've got for now. Let's jump into things, Miriam. Awesome. Yeah. Thanks for adding some of that background and context about the study. I failed to mention at the beginning, Connor was the former head of marketing and education at Home Care Pulse and is now our head of growth here at CareSwitch. So he's very well-versed and competent with all of this content today. The other thing that I was going to call out and you references, we may share some hot takes where we have a different viewpoint of the report at this point. We may share some things that are a little controversial or a little different than how you're hearing this data interpreted

elsewhere, but we hope that it's still interesting and of use today to you today of how we share some of this information. So all that being said, let's go ahead and jump use today to you today of how we share some of this information. So all that being said, let's go ahead and jump straight in. We're going to tackle for reference five to seven data points today. There are hundreds in the report. We're not going to attempt to tackle too much today. Our goal today is to go pretty deep on five to seven areas of focus that we found most interesting and that we also can speak most prevalently to. So we're going to start kind of high level talking about the growth opportunities in the report that are outlined. And then we're going to drill down into marketing sources, recruitment sources, turnover, et cetera. So know that we're going to kind of start high level, then we're going to drill down, but we're only going to

cover about five to seven areas specifically. so some of you may have the report open in front of you this is you know more of an audio format experience and so we're not actually going to pull the report up in front of you but we're going to speak to everything that's shown on the graph inside of the actual report so connor with that i'll turn you loose on the first topic which are those growth opportunities why don't you start out by previewing what the data is telling us and then give us your insights and takeaways on this specific point? Yeah, for sure. Just as one more little piece of introduction, like Miriam mentioned, as we go through these like five to seven data points here, some of them kind of tie in with what I would call an overall

hypothesis of what this year's benchmark report has to tell us. And so we'll kind of start with some more high level ones, then zoom in on some more kind of granular, here are some very specific tactical things you should do data points. And then we'll zoom back out at the end to look at some that kind of recap or finish off what I think are the biggest takeaways about the industry from the study. So with this one here, so there is in the first section of the study, there's what are listed as the top five growth opportunities for 2023. And essentially in the survey, they just asked, what do you see as your number one growth opportunity in 2023? And so the top five answers from agencies were kind of aggregated and listed here. And so the first one is caregiver recruitment and retention

programs. 33% of agencies said that was their top growth opportunity this year. Then the second one is strengthening relationships with referral sources. 27% of agencies said that that was their top growth opportunity this year. The next three are all much smaller percentages. They're all around five to 7%, but they're still the next three largest. So that is expansion into new markets, increasing client referrals by improving client satisfaction, and strategic partnerships with continuum of care related companies, meaning just more strategic partnerships along the entire continuum of care. That last one is closely related to strengthening relationships with referral partners, but a little bit different. So there are a couple things that I get from this

one. The first one is that one really handy thing they show on the side of this chart is the change in percentage of respondents who listed this as a top growth opportunity from last year. So you can see the trends of what is important to agencies this year versus what was important to agencies last year. And for the most part, it's fairly similar. But the one that made a huge jump is strengthening relationships with referral sources. It jumped by like 11%, which, as I've said,

having been involved in this study for a lot of years, a lot of these points, especially like this one, stay very consistent year to year and only vary by a couple percentage points. And so seeing that one jump is a major, very trustworthy sign that a lot of agencies are increasing their focus on referral sources, making that their focus for this year, and seeing that as both a bigger opportunity and a bigger priority than they have in the past. Likewise, and I thought this was interesting, that top-ranked priority, so a caregiver recruitment and retention program, that went down like 7%, which again feels like a small number, but it's pretty big when most of these changes are like a

1% change over a couple years. And what I get from that is kind of a hopeful sign of there are agencies who are maybe seeing a little bit of a respite in caregiver shortages and caregiver turnover, things like that. Although there are nuances to that that we'll come back to later in this episode. So I'll pause there, see what your thoughts are on this, Miriam. Yeah, similar thinking here. A lot of the large providers that I've spoken to over the last few months have vocalized that their focus was so heavy on recruitment and retention during the pandemic that some of them have vocalized that quite literally they've let their foot off the gas on new client acquisition.

And so I think the trend that we're seeing here is that people have been focused on recruitment and retention for so long that they didn't lose sight of new client acquisition, but they just kind of put on the back burner slightly. And they're seeing and working on this enhanced focus on new client acquisition at this point. And naturally, those two things go hand in hand. You can't serve new clients if you don't have caregivers and vice versa. But we've saw the challenge of finding new employees for so long. And now it's kind of flipped the script a little bit, which is maybe healthy. There's major demand for home care and there's plenty of clients to service. And so I don't think it'll be a long lasting problem that

owners will have, but it's kind of a breath of fresh air from the challenges that they faced on the employee side. The one thing that I want to maybe pose as more of a question is this company expansion into new markets. I know I've talked with a variety of owners that are organically moving into new markets or are also making acquisitions to grow into new markets. What do you read into that expansion into new markets? I think that one's interesting. I mean, that one has also increased a little bit over the past several years. That one can depend a lot, I think, about whether they're looking at franchisees or independents too with this. I know it's pretty much half and half in the study. I think that's another hopeful sign, but kind of not nearly as strong or obvious as the huge increase in focusing on referral partnerships.

Yeah, I think that's a fair assessment. I'm just reading in the comments what Larissa said. She said, I felt like I said we have no staff too many times, and now I need to reassure people that we do have staff, which I think is the trend with referral partners. For a long time, you may have had to turn down new cases from referrals because of the lack of employees, but now it's going back to those referrals and saying, we do have enough employees, continue to send us new clients. I think it's this paradigm shift, which is actually a really healthy one. It's nice to see that sort of help confirm what we're noticing from the data here. Although also I get like there's always challenges and it's nice to get potentially a little bit of a rest from the degree of caregiver shortages we've had. But then at the same time, that just brings back the other, you know, the flip side of the coin of having to struggle to get new clients. Interesting. Well, let's jump into revenue. Something that owners

are often anxious to get their hands on the report for is this trend of historical revenue. So, Connor, why don't you start by prefacing what the historical median revenue was this past year and what that looks like in regards to the historical data? Okay, for sure. So this most recent historical median when it was $1,609,000. So up just over $100,000 a year in annual revenue in about four years. That is pretty interesting and pretty encouraging. There are a couple things that I think we need to consider with this one. So this is one of the most looked at and often cited data points in the study. And it's one of those ones I kind of have some opinions on from our experience with this. This one is one of the data points that

are most affected if there is just even a small change in the composition of the demographics of agencies taking the survey. So for those who are familiar with stats, I mean, these are fairly basic concepts. So there are random samples and there are convenient samples, right? And so a random sample is the ideal way to do a survey like this. However, it's much more difficult. You can't always do that. And with something that needs this level of participation where we have businesses giving really in-depth answers and data about their business, it can be virtually impossible to get. And so in some cases, the next best thing is going to be a convenient sample, which means you kind of get whoever is nearest to you that you can reach who will agree to do the survey.

And in this case, what this means is if there's a difference in who Home Care Pulse is focused on marketing to one year or something like that, that can sometimes bleed into the data a little bit. I don't think it affects most of the data really much at all. But since this one is not only closely tied to size, it's actually one of our measurements of agency size. This one changes really fast if who is part of the survey changes. And so I do know that there was at least one year where there was a slight but noticeable change in the composition and just average size of agency who participated. Not necessarily it being all the same agencies from the past year and they all just got bigger, but it was kind of some different agencies. And that made it look like the average revenue had increased when it hadn't necessarily because they were serving like a larger average group of agencies. And so that is very possible that that's happened with these numbers here. And so I don't necessarily trust too much the idea that

the average agency has grown this amount in revenue. That being said, I do think this is a sign that we can trust of average agency growth in general, that there are mergers and acquisitions happening. That's also something that might be hard to notice that factors in here. And so what we probably can take from this is that even though it's hard to tell if the average agency has grown exactly 7% like would be kind of the most obvious takeaway from this graph, I think it is safe to trust it in saying the average agency is getting larger. There are mergers and acquisitions happening. There is growth and consolidation in the industry.

Thanks for sharing that. I think that's an interesting way of looking at this that people that take this at face value may not have considered. So I appreciate your insights there. From my different perspective, taking this graph at face value, I am really interested to see what this trend looks like in five or 10 years from my, you know, four or five years in home care. I've often heard and seen and spoken with agencies that hit this plateau right around the 2 million mark and stagnate, you know, they're kind of at the 2 million mark, be it all sorts of reasons. Some people get into this business and just have the intention of getting it to this kind of steady growth that they can maintain year after year. Other people have different intentions and have this very

entrepreneurial mindset and want to grow this business to 10 to 15 to $20 million. There's no one right way here, but I think in my experience, I see a lot of businesses kind of stall in that two to three million range. And so I'm curious to see if this trend continues upward for the long haul, or if we actually see this chart stagnate or even decline in the next few years because of the trend that I've seen, you know, where businesses just kind of plateau. And again, I reiterate that there's no right or wrong. You know, everyone gets into this industry and into the home care specifically for various different reasons. But I think there are, you know, lots of agencies nationwide. And I think, you know,

a good majority of them kind of hit that stall period. I think that's a pretty interesting dimension to bring into it because I agree here that this can also be kind of a measurement of just where the average like stall period, like you mentioned, is for agencies and the hopeful takeaway that that appears to be getting higher and higher, which is a good thing for anyone listening to this. So yeah, agreed. I think one other thing that I want to make sure I'm mentioning, you know, since I've talked about kind of my nuanced take on like this particular data point is, you know, to reiterate the fact that again, like, though I did call out the fact that there's maybe a challenge due to this being a convenient sample,

like this is for most of the data that is in here, like bar none, the best source of operational data for home care agencies. And so it's not to shed any doubt on the study at large or something like that. It's to point out one specific nuance with one data point that is maybe more at risk of a result from that. This is overall still the gold standard in the industry for this kind of data. Yeah, good, good thoughts there. I'm just reading in the chat. I love, you know, the engagement here, confirming kind of what we see this, this person is commenting and saying they've been in that two to 3 million range for eight years now. But one thing that they're attributing to is the heightened competition. And that's something that I failed to mention. We are seeing so many new businesses in this industry. And I don't think that's going away anytime soon. It's public knowledge, the demand for senior care and this baby boomer generation, you know, coming of age. It's no secret, you know, and so a lot of attention is being drawn in this industry.

And naturally, there are going to be more businesses equaling more competition. And so I think that's a good thing to call out is the heightened demand brings heightened competition, which is also attributing to these growth numbers. So I think we'll kind of round out this specific data point here. I think we've covered it and shared some interesting insights here. Let's move on to probably the more two meatier topics that you and I are passionate about and know and want to speak to, which are marketing sources and also recruitment sources. So why don't we go ahead and start with the top 10 marketing sources and your takes on this data? Yeah, this is some of the stuff that I really like in the study. It's very reliable data. It's some of the only data we have for this kind of thing. And it's like really, really

actionable and tactical. So the beginning of the marketing section has both the top marketing sources in general for home care agencies and the top marketing sources for what's called like the master's division in the study, which is essentially like all the agencies who responded, who are earning more than 5 million in annual revenue to kind of demonstrate what they may be doing differently. So I'll look at the top five for each year because those are where the percentages kind of stand out. And then after that, there's a lot that are very close. So for the general home care agency top five marketing sources,

the one that is by far ahead of all the rest is word of mouth slash referrals from past and current clients and their loved ones. That's at like 27%. And what that number means is that 27% of agencies said that this was one of their top marketing sources. And then after that, there's a pretty big gap, but there's like the next four all kind of in like the five to eight percent range. So in order here, we have online specifically search engine optimization, which means like people finding you online through Google or something, but not through ads. And then the next one after that is ads through Google specifically. So you're actually paying for them to find you on Google. And then after that in fourth is government sources, specifically state Medicaid waiver programs.

And then after that is internet lead sites, specifically a place for mom.com. So those are the general ones. And then I'll kind of go through the masters like really quick here. So some of these are the same, some are different. I think there are things to be learned from this. So again, the top for the masters by far was word of mouth and referrals from past and current customers or clients and their loved ones. And then there's this like big gap again. And then we have kind of a few that are all in the same percentage, like the first list.

But these ones already look different. So the second source is a state Medicaid waiver programs, which I think isn't a surprise because the scale required to be profitable for Medicaid clients means that a lot of larger agencies are those who have lots of Medicaid clients. And then the next three are assisted living facility referrals, continuing care, retirement community referrals, and hospital discharge planners. So there's a few things that I think are interesting here. Again, kind of diving into like stats terms for a second here. So probably good for us to talk about

correlation versus causation because it's hard to understand sometimes like did one of these things like make the other thing happen or are they both just kind of like tied together and correlated hard to say whether these agencies are bigger because these are the sources they're relying on or if they're relying on these sources because they're bigger agencies but rig and it's honestly probably a mix of the two right um but in this case there is a lot we can still learn from it regardless i don't take a lot from the fact that Medicaid is higher on the master's list. Like I said, I think that's pretty predictable. It's interesting to me though, that they are so much higher on these referral partners versus

some of the more online and consumer facing sources. Part of that I'm sure is because it is easier to get those solid referral partnerships the bigger and more established you are to a degree. But my opinion here is that part of this is that these are agencies who have recognized and capitalized successfully on the value of some really high priority, high value referral partners. And this does kind of tie back to that first data point we looked at where agencies are prioritizing referral partnerships again more than ever before. And we're seeing that the agencies who are the largest and most successful in terms of revenue are the ones who have picked and capitalized on the best referral partnerships the most successfully. So I find that one pretty interesting. And again, I think that this is like a very actionable and reliable data set for this to look at.

I'm really glad you've taken a look at the master's data for this specific chart. I just want to kind of like regurgitate what you just shared and how I see it more simply put is the masters, which are these 5 million plus agencies are prioritizing and benefiting from really strong referral partners. You reference, you know, Medicaid waiver programs, ALFs, retirement communities, discharge planners. Those are their top marketing sources. They have developed really strong relationships and are seeing new client acquisition through those channels. The flip side, the rest of the industry is focused and seeing results from online sources, which isn't inherently bad, but there's a lot of room for improvement in creating those strong referral partners. And so it's really interesting that you've compared the two. I think there's a lot to strive for. The agencies that aren't at that

5 million mark, it's a great roadmap to look at them as kind of this blueprint for success and how can I get there and how can I become that and how can I compete stronger in my market with those referral sources. The only other thing that I want to call out that you didn't spend too much time on is this word of mouth as the top source. I want to just call that out as something that I love to see year after year, because it is a, you were saying correlation versus causation, but I think this is a direct correlation, if I will, to having a strong reputation as an employer. If your clients and their families are your number one marketing source, like pat yourself on the back because clearly you're doing something right. So on a really positive note, I love to see this trend year after year. And it's reassuring

that there is really great care being provided because you're seeing those referrals come in organically from your clients and their families. And one other thing that I would add to that is that most likely you're going to have a lower cost per acquisition, a lower CAC for these people because they're coming in naturally from your clients and caregivers and also a lower turnover rate. Like we all know, people that come from word of mouth oftentimes have more likelihood to stay longer. And so those clients actually aren't turning over as much as say someone that comes in from an online lead or a pay-per-click through Google, et cetera. So there's just a lot of inherent benefits from focusing on word of mouth. Any thoughts there, Connor?

Yeah. Just kind of one more thing. you mentioned looking at things like customer acquisition cost, which is, there's also some really great data in this section on that. If you happen to have the study, like on one of the next pages after this list, there's this big, huge list of marketing sources broken down by a few other data points. And it has both like the inquiry to admission ratio for clients with each of this source, or at least for agencies overall who reported these as one of their top sources. So it has their sales conversion rates for these sources. And then it also has the average customer acquisition cost for agencies who said that these are one of their top sources. And so I kind of looked through and found like the sources that had the best balance

of both a low customer acquisition cost and a high conversion rate, because a lot of them are kind of all over the board, or maybe they're really high converting, but also high acquisition cost or something like that. And just kind of for a little like actionable nugget here, the two sources that were the best in terms of both of those things were referrals from employees. So this is employees referring you new clients that had some of the lowest acquisition cost, which you would expect, and the highest conversion rates. And then also referrals specifically from home health agencies over other kinds of referral partners. Again, a very low comparative acquisition cost and a really high rate of people who went from leads to becoming clients. So those are just two sources that I think are already kind of thought about a lot

and bread and butter, but two ones to reemphasize here. I'm glad you called that out. That was actually one of my other takeaways of this chart is that employees is listed as the sixth source at only 4.1%. To me, that is extremely low. I've talked to a lot of large established providers that employees are up in their top three marketing sources. And for obvious reasons that you just mentioned, lower acquisition cost and higher conversion and lower turnover. And so your employees, in my opinion, I'd love to see employees work its way up this list over the next few years, because there's a huge opportunity there. Your employees know your market. They're talking to the clients. They know the family.

They know the next door neighbors. They are just like this hub in the communities that you're trying to target. And so put some sort of process in place to be regularly asking your employees for new referrals because it's an untapped opportunity that a lot of agencies aren't taking advantage of. The last thing that I'll call out, you referenced a place for mom is number five here. Some of you may or may not have heard of them. They have done a lot to help a significant amount of home care agencies in the space. We will actually be interviewing a couple of their team members about how to generate more online leads and how to convert more of those online leads here on Home Care U in just

a couple of weeks. So we've got something to look forward to, to talk about online lead generation in a few more weeks. So good information here, Connor. Let's go ahead and move on to recruitment sources. We're going to get into the territory that everyone loves to talk about, which is caregiver recruitment and retention and best practices there. So let's go ahead and start by talking about the top recruitment sources for caregivers. Awesome. So I'll kind of do the same thing as before where I'll give the top five kind of general among all agencies recruitment sources and then look at the master's sources and see what we can learn from that. So the top five are first by a wide margin is indeed.com both free and paid plans are inclusive in that. And so that's at about 40%. Second is current employees. So an employee referral program for other employees, and that's at about 13%.

Then at 10%, we have referral sources, word of mouth. So I'm actually not entirely sure whether that is referring to kind of word of mouth among your referral sources. I think what that's saying is just word of mouth that is not from your current employees. And then fourth is mycnajobs.com. And then fifth is your own website. So what's interesting is that the masters are almost the same here. I mean, the percentages are slightly different and there's one where the order is swapped, but besides that, it's the same list. You have Indeed, you have Current Employees,

you have Word of Mouth, then you have two that are swapped. So like your website is next in fourth place for masters and then mycnajobs.com is the fifth. Fundamentally the same there. A couple things that I get from this. I mean, first, if you are one of the majority of agencies who is heavily reliant on Indeed, know that you're not the only ones. Most agencies are using Indeed. That's kind of the bread and butter right now. There's been a drop among both of those segments we're looking at in how much they're relying on current employees for referrals. I find that

interesting. I don't know how much of that is like they're focusing on it less and how much is like it's just getting harder to do that. But I hope that we see that number go up because like you mentioned, that's one of the most important, if not the most important sources for both employees and new clients. I don't read too much into kind of the small changes between the last two on these lists, minus that the larger you get, I think the more you can probably rely on your own brand and your own website to drive some of your leads. I think it's good to recognize here that it feels like with marketing, there's a pretty big difference that happens as you grow in terms of the types of sources you can rely on to get new clients. And I think most agencies

would agree that with recruitment, it's not so much that way where yes, your brand does get stronger. You kind of have more hiring that comes just through people who hear about you. But overall, the sources don't really change that much as you get larger, nor does it look like there's a secret sauce that the biggest agencies are using that other agencies aren't. There's not a secret sauce to recruitment. It's learning to put the pieces together and do a bunch of things really well. Can we talk about Indeed for just a hot minute? This is slightly tangential, but it is far and away above the other sources here, which is pretty interesting. I think this is, you know better than I, maybe the second or third year

that Indeed has dominated. I think this year though, over the past like six to 12 months, we've heard more grumblings and issues with Indeed. It has been so dominant for so long that Indeed itself is actually getting more costly. I think a lot of you have seen the increased costs that are coming with leveraging that platform. But also I want to call out it's getting more crowded and more saturated. And so I wouldn't be surprised if over the next year or two, we see a decline in the success on Indeed for those two reasons. It may actually price people out and that you won't be able to afford it anymore. And I know that seems wild, but the, the marketplace, the job marketplace and landscape is so starkly different than it was just a few years ago. And so I think Indeed is

something to not stop using, but just be very cautious of the cost and the results, you know, attach some KPIs for your recruiter or whoever owns recruiting in your market, in your agency to continue to measure the success on Indeed and the costs and make sure you're comparing and making sure it's a good use of your time and dollars spent. So just wanted to call that out. Any other insights on Indeed, Conor, you want to call out? Just one or two kind of tied to that. The first thing is there's one point on here that we haven't highlighted that I think is evidence of what you just said, which is that since it shows the percent change for each source over the previous year. So on both the general list and the master's list, they both are using Indeed more this year than they were last year. But that went up a lot more for masters, which you can take a couple ways. But to me, that says that the people who have more to spend

are the ones who are utilizing Indeed more, which kind of goes along with what you said, that even though it is the top source, it's being used heavily, it's kind of everyone's bread and butter, it's getting more and more expensive. And we're going to see that start to change. The other thing, too, is that in the charts that follow these, they give a breakdown of like turnover by recruitment source, which is a really good number to be tracking. And then also acquisition cost by recruitment source. And the one that I kind of zeroed in on here, kind of noticing a trend from past years over like five years was my CNA jobs. So this was an interesting one because they're one of the leading care specific job sites, obviously much more narrow in focus than Indeed. And they kind of went through a few challenging years there, where if you followed the stats on them as a hiring source in the benchmarking report, you could see that they sometimes had higher or the highest

turnover and sometimes also acquisition cost. And you saw the acquisition costs drop quite a bit this year for them, like especially comparative to Indeed and things like that, which I don't know exactly what that means changed in their website itself and applicants and things like that. But I found this data to be pretty reliable. And to me to me, that suggests that there is like potentially more value in looking at mycnajobs.com as a job site again, than maybe there has been in a few years, especially like you mentioned, with Indeed becoming more expensive. So that, yeah, that was one of the big things that I took from this. Interesting. Yeah, I think just a takeaway for us to reiterate to anyone listening to this is these charts, don't take them at face value.

Make sure you're referencing the acquisition cost and the turnover rates by source. And if you at your agency aren't tracking those, I'd highly recommend that. You know, the source itself is a good place to start, but always be asking yourself and be looking at the acquisition cost of that source and also the turnover rate based off of that source as well. And those three things should be your guiding light. Don't just default by looking at these sources and thinking that's your guiding light. Make sure you're referencing the acquisition cost and the turnover.

That's where the growth and the benefits will come into play when you're tracking kind of the full picture of ROI with these sources. So to keep us moving here, we've got just about 15 more minutes. I want to make sure we cover these last few things. The other thing that you and I noticed, Connor, in the report was the continual trend of agencies turning down new cases due to the employment shortage. Why don't you speak to what we found in the report regarding that? Yes. So this is where we kind of zoom back out and we've gone through some of the more tactical things and we're looking back at like the big picture. And like we've talked about, part of what we think we're seeing is like, hey, there's a little bit of a relaxing in the challenges to get and keep caregivers and like more focused on growing through client acquisition again.

But these last stats we're going to look at here kind of add more color to that, I think, in different ways. So this is for those who like might be like following along, like wanting to look at this, this is 2.15 or like this is chart 2.15 in the study. It's agencies consistently turning down cases due to caregiver shortages. And so there are 54% of the agencies who were surveyed said that they're consistently turning down cases due to caregiver shortages, which is a lot. I mean, obviously, that's over half. And I think a very obvious good reminder of even if things might be getting easier, it's obviously still very difficult, as no one in home care needs to be told or reminded. But having seen various stats like this from different sources over the last few years, this is actually down a little bit where a lot of the other stats I've seen for this and even helped to gather as part of a couple different reports have this number in like

60 to 70. So like in 2021, like I think it was around 70% of agencies said they were consistently turning down cases or had turned down cases in the last like 90 days. And so now we're kind of almost down to 50%. So again, a hopeful sign to me, even though we're getting that by looking at like how bad things are in a sense. I don't have too much to add on this point, to be honest. I think we can just go on to speak about turnover as it kind of plays into what you've just spoken about. So why don't we overview the trends that we've been seeing with turnover and where we're at today with caregiver turnover? Yeah. So this one was interesting. So of all the different recruitment

retention data in here that all kind of says it's bad, but not as bad. This one kind of defies that. This is also probably interestingly, like the most popular data point in the benchmarking study. It's the one that's referenced most. It's the one that people talk about the most. And it's so just the general industry average caregiver turnover rate for the year. And so it was back up to 77% for last year, which is the highest that it's been in like five years and the second highest that it's ever been. It's usually kind of somewhere in the mid 60s. In like 2018, it was like 82%, which is the highest it's been.

If we take the data here at face value, like what it's suggesting is that it's not quite as hard as it's been to hire and recruit caregivers, but it's harder than it's been to keep them. I don't know what like economic factors might explain that. I think that's pretty interesting. That's kind of out of my depth and out of anything I've seen to speculate on that at this point. But that does look like something we can reliably take from the data here. I think it'd be interesting to hear if anyone has thoughts on that.

If you're on live, we'd love to hear what you think in the chat. If you're listening to the podcast, you know, feel free to send in an email or, you know, join one of our next ones and comment on this. But I think there's, there's like something to take from this that probably points to future strategies that we don't fully understand yet and haven't quite landed on. And we'll keep looking at that. I know the simplest takeaway here is time to make sure we put the focus rate back on retention and think about how retention starts, not just like even at the point of hire, but at the point of application. I'll actually give kind of a shout out to our own content for that. So we published a applicant to day 90 retention guide recently, where it's like shows what the early hiring recruitment hiring and like first 90 day

process should be for a new caregiver, thinking about all of it from a point of how do we bring them through this in a way that will retain them. And so that's free. It's, it's, it's on our website. If you just go to faq.careswitch.com, that's one of the top entries there. It'll say like caregiver recruitment plan or retention plan, but shout out to that. And I'll kind of hand things off to you to see what you think, Miriam, and add anything else in here. Yeah. two thoughts. I was thinking, you know, the last three years we saw turnover kind of plateau. It was at that 64% 2019, 65% 2020, 64% 2021. And I was thinking, you know, was that a good thing or a bad thing? Were people holding their breath? You know, after we saw that

spike in 2018, and then it came down in 2019, I think we were hopeful for the last three years that we could maintain and then see that drop again. And so my, my just like personal reaction was, you know, we were actually doing okay by maintaining turnover. And now here we are back again, you know, in this disheartened state of, you know, we thought we were doing good by maintaining and now we're back and it spiked again, which is unfortunate, but it's just a good reminder, you know, that the retention always has to be top of mind. We can't let that focus slip for a minute because here we are back again, struggling to retain employees. The other thing that I want to call out is just kind

of a random like thought off the cuff here, which is you mentioned how much we talk about turnover. This data point is referenced everywhere, you know, but it's kind of has this negative connotation of we're not doing enough and we're struggling to retain our employees. It has just this like negative vibe, if you will. And I think we should do our due diligence to find another data point that is more positive and hopeful and more reflective of all the good things that we're doing as an industry, because we talk so much about turnover, but it's kind of like in this negative light. And I want us to, I don't know, push ourselves or if anyone has suggestions or push home care polls, like let's shine more light on all the positive good things that we're accomplishing and not be deflated by this turnover metric that we spend so much time talking and thinking about. So those were

kind of my two thoughts in seeing this. Any reactions to what I've shared, Connor? Yeah, that's kind of interesting. Like, I'm sure the obvious response to that would just be to look at the flip side of turnover, which is retention. And, you know, you can get that just by like subtracting the turnover rate from 100. But I feel like what you're really saying is like, we need more North Star metrics that are maybe more different from anything being thought about very much currently, and are hopeful and point us in the right direction while also being encouraging. And that does make me think of some of the outcome metrics that home care agencies are starting to measure and starting to look at,

but that we haven't really embraced yet as an industry. So things like re-hospitalizations and re-admissions and measuring falls know, measuring falls and socialization and like some of the other metrics that are part of a person's whole health that home care agencies can influence because it's part of the care continuum and a really important part, but not ones that we've really historically valued our ability to influence. And maybe some of those tie in with what you're suggesting as far as the need for new metrics that lead the way and light the way versus only being things to worry over. Yeah, I think that's a good way of thinking about it. The other thing that I want to add, which is maybe a couple layers deeper than we wanted to go with this. I've talked to a lot of providers in my years in home care, and I continue to hear time and time again is that caregivers are looking for full-time work. And that drum has

been beaten to death. And I think, you know, there are ways to solve that. But one of the ways that I just want to offer up in this discussion is sharing caregivers, creating a caregiver marketplace in your own network. This is something that we're starting to talk about more as an industry, but I think it's a little bit controversial. And some people are more open to it than others. But with a lot of large providers, they establish strong relationships with other home care agencies and offer their employees full-time work by maybe working for two agencies. But it's very intentional.

You create the relationship with the other agency and you create a full-time schedule for this employee between your two agencies, because you may not have the cases to offer them full-time work, but with this joint agency, you may be able to. So something that is a little bit farther fetched from this data itself is just speaking to some of the root causes of this turnover and how we can solve it with more holistic, creative approaches. One of those being more of like a caregiver sharing or caregiver marketplace. So I just challenge everyone to not be discouraged by this information, but we all need to challenge the status quo. We shouldn't

become complacent or discouraged. We need to start thinking differently because the employee and the caregiver landscape looks so differently today than it did years ago. So like I said, taking this a couple layers deeper, but something that I've thought a lot about and how we can create solutions from this data. I can hear people getting out their torches and pitchforks and I don't blame them. But also I agree that however exactly it looks like, because there are different ways to do that, it's important that we find the way that works, you know, both for caregivers and agencies and clients to use the limited supply of caregivers that we have as efficiently as possible and also help them as much as possible as they provide for themselves and their families. So I agree.

Absolutely. Well, we're at the top of the hour here. I think we should close by saying, you know, thank you again to Home Care Pulse for providing this rich data set. It is invaluable to the industry at large. And we hope that this discussion has helped you think differently about some of the data points, but also provided you insights on, you know, the trends that are happening inside of home care and how you can utilize this data and leverage it in your agency to make better decisions. To be clear, this episode has been recorded. So we'll publish this recording as a podcast and send it out by email and you can get it wherever you listen to your podcasts. We will also send out a follow-up email if that's all right, Connor, with some of the resources that we've mentioned

today, some that have been published by CareSwitch switch a link to where you can get this report and a couple of the insights that we've shared today in maybe more of a graph or visual format so thank you everyone for joining us live today um we look forward to seeing you back in the weeks to come we've got some really stalwart guests coming down the pipe the next few weeks so we hope you will join us again um in the coming weeks. Thanks, Connor, as well for joining me today. It's always fun to tackle an episode together and we'll connect again soon. Thanks, everyone. That's a wrap. This podcast was made by the team at CareSwitch, the first AI powered management software for home care agencies. If you want to automate away the menial of your day toto-day with AI so that you and your

team can focus on giving great care, check us out at careswitch.com.