Home Care U - The Hidden Challenges of Running a Home Care Agency (Maggie Keen Pt. 1)

Episode Date: October 9, 2023

New data from MissionCare Collective paints a detailed picture of the parts of home care people that are tough to talk about—everything from racist requests by clients to caregivers being 3x more likely to experience anxiety and depression than the overall US population. Maggie Keen, VP of MissionCare Collective, is here to explain these findings and share ways that home care agencies can navigate the challenges that no one likes to talk about. Download the report: https://www.missioncare.com/provider-study-downloadEnjoying 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 to HomeCare U.

I'm really excited for today's episode. As always, we have part one of an awesome two-part series here with some really cool data, reports, and takeaways for you. We'll introduce our guest presenter and her topic in just a moment here. But first, let me walk through a few housekeeping items. First off, for those who may be new to Home Care U, this is both a live Zoom class and a podcast. You can join the live Zoom classes for free by signing up at careswitch.com slash homecareu.

That's U as in university. We do the classes every Wednesday at 3 p.m. Eastern. You can join live, drop your questions in the chat, and have them answered directly by the people we interview on the podcast, who are always awesome, very knowledgeable experts in the home care space. If you are joining live but would like to listen to the recordings, we always get asked about this. And we always turn them into podcast episodes that you can find as Home Care U. Again, that's using university wherever you get your podcasts. We hear from people all the time telling us how much they love the podcast.

We get people binging it, which would be an interesting binge, but I'm excited about that. Good for you. And it's just really been a fun thing to be a part of as the host. We recently became the top rated podcast in the home care space, and that's really exciting. And we're grateful to everyone who is helping support it. So thanks again for everyone who's joining or listening. And we'll go ahead and get rolling into today's episode. I am really excited to have our friends from Mission Care on today. We'll go into topics in a second, but first, do you want to take just a minute and introduce yourself here? Yeah, happily. I was just doing the math,

Connor, on how long we've known each other, and it's been a long time. I think five or six years we've been together in the industry. So my name is Maggie Keene. I am the vice president over here at Mission Care Collective. I've been in the industry for almost 10 years now, which is wild to say out loud. It's changed a lot. There's a lot of unique, exciting opportunities, I think, and I'm looking forward to dive into some of that today. Mission Care Collective, a mission-driven organization, our goal is to make care better tomorrow than it is today. We know the reality. A lot of folks in the line facing this. I know you've had some great guests join you for past episodes here. We've got folks in our

industry that aren't getting the care that they need. And if we don't solve some of these workforce challenges together, it's going to get worse before it gets better. So we operate a suite of brands. I'll talk more about them later, but my CNA jobs folks might be familiar with where we operate the largest caregiver CNA and home health aid network in the nation. A lot of the data that I'm bringing you here today and for part two is going to stem from the caregivers in that community. And on the other side of the conversation, CoachUp Care is our engagement and retention tool, really helping providers engage their team,

build a healthier workforce. So we've got fewer people walking out the back door. People are inspired and they're delivering more and better care. So really excited to have the opportunity to talk with you, Connor, here today and the team at CareSwitch. So thanks for inviting me. Thanks for being, here today and the team at Care Switch. So thanks

for inviting me. Thanks for being on here today. We're really excited. Yeah. And like you said, you know, it's, I think you were one of my first kind of friends in the home care industry. So it's fun to come full circle here and, you know, build a reminisce a little bit and share what we're both learning. Kind of going from there, as you probably heard, you know, Mission Care does a lot of different cool things. What we're going to focus on today is a report they recently published where they surveyed, well, I won't get into details because I think you'll explain some of that background. But they did a survey of a bunch of home care agencies and people connected to home care and got some really interesting findings that reveal

some hidden challenges of running an agency. Some of these may be surprising to you, some will not be, some it might just be the specific number or percentage that you find surprising. So we'll talk about what these findings are and then what some ways that you can deal with the challenges that these reveal or else just apply what's being learned here. So like I said, this is part one of two. Part two next week, we'll focus specifically on a report from last year on the workforce and caregivers specifically. So definitely join us again for that one. So without further ado, I mean, tell us about this report, what the background is, why you published it, whatever we should understand about the sample size, demographics, things

like that. Yeah, absolutely. So I shared Mission Cares. Our organization has the privilege, frankly, of supporting over 8,000 providers and connecting millions of frontline caregivers to work every year. So we have a sort of unique, I would say, place in our market and in our industry. I was just telling Connor as we were getting ready today, just kind of heavy into conference season, lots of travel, lots of in-person conversations we're having these last few weeks. And

one of the challenges we're seeing is the struggle of business owners, operators, recruiters who can't attract or retain their workforce. Right. And that's a challenge. You can see that physically when you're connecting with folks and hear it on the phone. But we also see the struggles that caregivers face. Right. They can't make ends meet. Many cases, they're forced to leave the profession. And at the end of the day, the worst part is the vulnerable people in our industry who come to our industry desperately needing care who suffer the most. And it's really with that in mind that we've come and run both of these studies. And we have another really neat study coming out here at the end of October as well. But this specific study, and we'll give folks an opportunity to connect to at the end of our conversation as well, but this is called Through a Provider's Lens, a study on home care workforce dynamics from the perspective of the agency. And this was just released in June.

We surveyed just shy of 500 home care agencies across the country. 82% of the respondents were owners. I think that's important because I know you've got folks listening live today or on the podcast as well, understanding who was giving us this data. And it was in most cases, executives and owners. And the idea was to provide a snapshot of the current state of the home care workforce in the industry and the challenges that are being faced by home care organizations, right? And we've both been involved in organizations that have published big annual reports. Those are wonderful. But this industry has changed so dramatically in the past few months and years. So putting something out every year is almost dated as soon as you, you know, click print, right? So the idea here was what's happening

now? What's happening this summer, this fall, what are the challenges facing folks in our industry. So represents a diverse group within the sector, lots of different size agencies, primarily small to medium-sized agencies as well. But the idea was, the primary objective was to better understand these workforce-related issues. We know we have to work collectively, so much so that we added collective to our name to drive much-needed policy and innovation change and really address this crisis. So I'm happy to talk more about that, and there's lots of great takeaways from it, but really the urgency to understand these challenges is evident. It's evidence in the conversation we're

having and the folks you're bringing on your podcast as well. But 89% of the surveyed agencies reported turning away care because of these workforce constraints. And 76% said the industry hasn't recovered yet from the challenges facing the pandemic. So we know there's urgency. We know there's a need. And so surfacing this, giving folks like the people joining us and the podcast as well, an opportunity to take this data and turn it into action was really the goal of this report. And the report we'll talk about next week as well. Great. Thanks for the preview. Thanks for the intro. If we have any more questions

about the background of the study or things like that, feel free to drop those in the chat or Q&A box if you're joining us live on Zoom. And as we go through it, just feel free to drop your questions in here and we'll answer them either as we're going or at the end, depending on the question. We love to get your questions. Please drop them in here. So how we'll do this is, I think you said that there are like nine specific takeaways you want to discuss from it. And then we also want to talk about the application. And so that's kind of how we'll structure this class today. We'll go through like the nine most important things from it. And then talk about what's the so what from this, and that should basically do it for the hour that we have. Since I'm sure that we'll get this

question, and it's a good one, how to get the report, it is free. You can download it online on Mission Care's website. So we'll drop the URL in the chat here for those who are joining live. And then for those who are listening, let me just read out the URL really quick. So it is missioncare.com slash provider dash study dash download. And you can download that free. They'll send it to your email. So I highly encourage you to do that. And also email me. So Maggie at missioncare.com. So we'll reiterate that again at the end. But if you want that, you can also email me directly. I'm happy to send you a copy. Awesome. Thanks for that. That may be easier for some. So I appreciate you giving the option there. So let's get into it.

Walk us through the main takeaways. What should people know about what you guys learned from this report? Perfect. Yeah. So as I mentioned, nine key takeaways here. If you, of course, Connor, have any questions, and genuinely anybody in the audience does, get those in. If you're listening to this later and you have questions, shoot us a message.

We always love to talk more about this. And the idea in publishing this report, like all of our studies, is that it's a jumping off point. So we're not going to have all the answers here. The number of times I've said we don't have a silver bullet, right? But I think that this is a fantastic starting off point for these types of discussions. So the first, not going to surprise folks online, the first sort of headline takeaway from the study itself is that we have soaring demand in our industry. We all know that, we're feeling that, but we have a limited workforce. So as I shared, 89% of agencies are forced to turn away care. This is an alarming number of home care agencies, primarily due to workforce shortages. On average, a small to medium-sized agency is turning away 510 hours of care monthly. So that's one of the initial headlines. And when we ask a room, if we're at a conference or we're on a webinar, and we ask folks on the line or in the room to raise their hands on who's turning away care, it mimics that in real life as well, or nearly 100%. So that's really one of the

key takeaways. We know there's people that need care and we know there's not enough people here to deliver it. And that's something that I know keeps me up at night. So that's the first sort of key takeaway. I don't know if you have any insights or any questions there, Connor. Probably not a surprise as someone who's been in the industry as long as you and I have, but now we've got data that backs that up, right? I know that one because I have already cited it in several things that I've written since reading the report, but I guess a couple quick follow-ups on that first. So obviously that's a really high number, you know, pretty interesting, maybe surprising, may not be.

If I can kind of put you on the spot here and test your knowledge a little bit. Thank you. Do you happen to have any like comparison numbers, like something similar from past years, anything like that? It's a great question. And I know you have a history of having year-over-year comparison on that. A lot of our studies that are done annually, some have shared questioning year-to-year and some don't. This is not something I have a study to back up, but I do have 10 years of talking about this with agencies to back that up. This is undoubtedly the highest it has ever been.

So I think it was not anecdotally, it was not abnormal for myself or my team to talk to agencies five, 10 years ago. You can even see this just in the competitiveness in the market. And they weren't turning away cases or they put a help one inside in their front window and they got the caregivers they needed to fill those roles. I was talking to an agency, a franchisee at a conference last week, and he got the caregivers they needed to fill those roles. I was talking to an agency, a franchisee at a conference last week, and he was sharing that, that he was like, I've been in the industry for 12 years, and he's like, it's the hardest it's ever been. So I think anyone who has that tenure can say probably that they have the internal data, the anecdotal data

to say that it is the highest it's ever been, undoubtedly. And we have data that shows people have left the industry at a record rate. And they're not just leaving home care to go work at a facility or home care to go work at a hospital. They're leaving the healthcare industry, the care industry outright as well. So that's another thing that I think is adding to the squeeze. And I've got some other thoughts on that as we go through these insights, but it's a good question. Okay. Sounds good. Thanks for that. I think the only thing I can add to that, I do remember one stat that kind of helps give context here, which is like back when I was working at Home Care Pulse in 2020. So the really fun year to be working in home care. I think that it was like June or July of that year. So kind of like the peak of the first wave of the pandemic

that we did a survey and learned that I think at that time, it was like 65 ish percent of providers said that they had turned down cases in the last 60 days. So there's a couple of things that make it like not totally comparable to this, but kind of helps to give a picture of like, during that crazy year, it wasn't as bad like this as it is now. So really good information. Let's go to the next one. Yeah. So the next one is sort of two parts, and I'll talk about both of them. So the headlines here are agencies reporting staffing challenges due to race-specific care requests as well as age bias. So we see both racial and age bias in our industry. And again, remember this study is

from a provider's perspective. So these are hundreds of agencies across the country. 79% of agencies report challenges in staffing due to race-specific requests, and 83% of agencies report staffing challenges due to challenges around folks' reluctance to accept younger caregivers. So there's a lot here. We see that those caregiver requests, the challenges that come from that, that adds additional pressure to already strained home care workforces, right? And it's only exacerbated when those specific requests are there. And so the study does, dives in a little bit to the concept of racial refusal. And there's other papers on this and out there that you could access as well. But this is frankly, clients

unwillingness to work with a caregiver of a different race. And it's particularly concerning when we know that 63% of the direct care workforce consists of people of color, many of whom reside in underserved communities. And we'll talk more about the caregiver perspective in our next conversation here, but the findings there underscore the urgent need to address racial bias in home care and ensure equitable access to caregiving opportunities for everybody. And the flip side, when we talk about on the other side of this bias conversation, according to the U.S. Bureau of Labor Statistics, so the BLS, things that I look at for fun. I'm sure Connor does too. When you look at the BLS in 2020, so going back three years ago again, approximately 12% of

healthcare support workers were aged 16 to 24. And so this, again, is worsening the workforce shortage we're already facing in our industry and also hindering the entry of younger generations into caregiving roles. And we know we see this in a lot of different facets of our industry. These roles can often serve as a stepping stone for career development, folks coming in, starting as a caregiver. I just attended a webinar a couple weeks ago where someone was now an executive at a senior living facility, and she had started there as a caregiver. So you can see that as a way to get in the door of a lot of these companies as well. So two big headlines sort of wrapped into one. Definitely, you know, there's lots to discuss here, but data to back that up.

I think it's something that maybe is talked about behind closed doors, now published out there in a study for people to see and start to have conversations around, which is so important. Wow. Lots to unpack there. We unfortunately can't spend the whole thing just packing this one because it's a very important topic and there's so much to go over here. A couple thoughts and probably a question or two. First, I mean, I appreciate the fact that you've kind of drawn the line, not just from the initial challenges this can cause when a caregiver is refused based on age, race or something similar, but the fact that that can cause more problems like with equity and trying to have equity in caregiving as those people then are progressing

up through the industry or trying to, and that this isn't just about one shift. It's about, is it helping or blocking their opportunities, not just to earn their living now, but to continue to move upward in the industry. And I think that's a really important piece that's often missing from conversations about this challenge. So I appreciate you bringing that up. To repeat here, you said that the number of agencies who report having caregiver shortages due to racial requests is 79%, correct? So the 79% of agencies report that, yeah, due to race-specific requests. So you can see in the study, and of course, we'll give folks an opportunity to tap into that, but the study itself. And there's actually a breakdown.

I know we're not focused on visuals. My webinar brain is struggling to not share my screen here, Connor, but it actually breaks it down and says the percentage of agencies who say they have clients who have hesitancy to work with a caregiver of a different race. So it says, you know, 56% say it's a challenge for less than 10% of their clients. 17% say it's a challenge for 10 to 20% of their clients. So it breaks it down even further. The report does itself. So the headline is that this is a challenge and it's only further impacting, impeding their ability to effectively recruit, retain and staff cases as well. My last question with this, and I'm assuming the answer is no or also it would probably be in the report. But is there any kind of breakdown geographically with this data?

Not that was published in the report, nor that I have offhand. I'm sure that play had placed potentially some role in it based on the diversity in the areas that folks were respondents in. I live in downtown Chicago. My neighborhood probably looks different than the neighborhoods of everybody on the line. Right. But yeah, I don't have that data. This is a short answer. I know we've got lots of stuff so we can dive into the next question, but no, it's an interesting answer. So the next one, the next headline, I like to think of this one as the caregiver reality gap. And this one we probably could talk about for a full hour, so I'm not going to, but it does lead us well into our conversation next week. So I'm going to walk a line of sharing some of this

inside and we'll dive deeper in from the caregiver perspective next week. So I'm going to walk a line of sharing some of this insight, and we'll dive deeper in from the caregiver perspective next week. But I think the takeaway here is that we see a lot of agencies overestimating the fulfillment of their workforce amid this mental health and financial struggles that our caregivers face. So the report shares that 73% of home care agencies report that caregivers feel engaged and fulfilled in their work. However, there is a discrepancy here between the agency's perception and the actual experience of caregivers. So the direct care workforce study that we're going to talk about next, really, we're going to talk more in depth about that.

In there, we talk about the fact that home care workers are three times more likely to experience anxiety and depression than the average U.S. population. Over half are on some form of public assistance to financial stress. And caregiver turnover in our industry exceeds, I know the latest home care pulse number is 77 percent. We've seen ranges there, but far exceeds the 60 percent here. Right. So this is there's a lot here to talk about. But I think that that 73 percent of home care agencies saying my caregivers are engaged, they're fulfilled in their work, they're happy, they're satisfied. And yet on the other side, we're seeing these insights from our workforce, these indicators sharing that there's likely a lot of pressure, stress, outside influence potentially on that not being the case. I think we know that we've got a workforce that is committed.

There's a huge sense of purpose in their work, but they're often earning less than they would in other positions with the same skill set. In almost every state, there's a negative compensation, competitive compensation score. So what does that mean? This is my finance side coming out. It essentially indicates that a caregiver could typically earn anywhere from $2 to $4 more per hour in another job with similar or fewer requirements than they're making in home care. There's a lot of layers to this, right? But I think this is another

big takeaway from this study as well. Wow. There's so much in there. Competitive compensation scores real quick. I may have actually just like missed that part of the study. Where can I learn more about that? Great. So in the study there, it's actually as part of that, that headline on page six, we actually also did a competitive compensation study. We released it with the team at Viventium, if you're familiar with Viventium as well. So we could talk about, I can pull it up while we're chatting here, getting folks connected to that. But we actually did an analysis by state of what that looks like.

And there wasn't a single state in the country where that was a positive competitive compensation score, meaning they're making more in home care than they're making elsewhere. So I'll work to pull that up while we're chatting here. But yeah. Sounds good. Yeah, that's really interesting too. Let's keep going. I think the other piece is, and this is, again, I actually just did a webinar on this

with our partners at CareerPlug. So there's a large divide among agencies when it comes to challenges around recruitment and retention. So what do I mean by that? So we asked agencies over the past six months, do you feel that retention has gotten better or worse, right? So 53% of agencies reported worsening recruitment and retention, while 38% observed no change. We also see turnover, I feel like for a lot of agencies, a lot of companies in our industry, people feel like turnover, which is kind of the inverse of retention, right, is an outcome. So we talk with lots of companies all the time. They feel like this is not something they can control, kind of a cost of doing business, right? People are going to leave no matter what I do, right? I strongly beg to differ here. And I think that controlling that, looking at turnover,

measuring turnover, managing turnover, just like recruitment starts during the hiring process. So the study actually highlights this pretty striking disparity, Connor, in recruitment effectiveness. And I think what that does is it emphasizes the crucial role of your internal operations in driving success. So we talk a lot about the right things to measure. And I have some insights on, you know, kind of what gets measured, gets managed, right? Those types of things and putting technologies in place and systems in place. And that's great. But it's also really important that you hire the right folks and you've got the right processes in place and you're doing all the right things there, right? So it was fascinating. And

you'll see more of this in the study. A third of agencies make fewer than three hires from 50 applicants, but 22% make over six. And again, we're thinking they're offering likely a similar benefit set. They're likely paying something similar. The job is likely fairly similar across these 450 plus agencies that responded to the survey. But you've got some that are just doing a better job of getting those folks through the process. So I think that that's fascinating because it shows to people that the same investment across two agencies can yield vastly different outcomes. I love your point there. I have lots of questions on this one, but I think that some of them will

be addressed when we go through the applications of the data. So I'll hold on to those. Let's keep going. Perfect. I think this is a big one. Transportation and child care challenges, and they're triggering call-offs. They're triggering reduced care delivery. Right. So agencies reported really frequent caregiver shift cancellations due to transportation and child care issues. And we see this in the study. And it's really interesting to see as well. Frequently, 29% said they see weekly call-off due to transportation challenges, and 29% say they see monthly call-offs due to child care challenges. So it breaks it down, nice, beautiful pie chart there as well. But we've got 85% of direct care workers are women, many of whom are single parents. And so these obstacles are something that impacts a large portion of our workforce.

This isn't a rarity. This is more common, right? Now, unlike Connor and myself, the folks that can see us are sitting in home offices, right? We are now working from home and people can work remotely like a lot of folks in America or have flexible schedules. Care has to be delivered in person and it has to be delivered punctually, right? And we know that there's limited access to affordable quality childcare. If anyone on the line has kiddos, you've probably experienced this, especially in the last few years. Our childcare industry is facing a lot of the challenges we're facing of finding quality

childcare workers. And that's just continuing to exacerbate the financial stress, the instability of the folks that are in our industry who are in lower income jobs. So a lot here, but I think this is a big headline, something that we should be talking about, thinking about solutions on as well. Thanks for sharing all that. I think this is one of those ones that I don't know if the kind of general topic is surprising to anyone. I think everyone listening to this is probably like, yeah, we get lots of those too. But I think it's important to hear concrete data put to this to highlight, like you said, just how much of a challenge this is. And I think, I mean, from my side of this, like you might have more application here.

But I think the only thing I would say here is that while this is like far from a fix, it does affect how you might handle these in your agency. The best approach that I've ever heard to handling call-offs is that it should start by looking into the caregiver's well-being first and checking in from a benefit of the doubt standpoint, because very likely it's something like this that results from the challenges they're facing. They get in the way of their work and not just, you know, for some reason, not, you know, wanting to be there. And it sounds obvious, I think when it's said out loud like that, but it's very easy when there's pressure and it's last minute and someone calls out. It's very easy and natural to want to react differently. So I appreciate you guys and the report for highlighting the

challenges that are often lurking behind the scenes in call-outs. I think on that, one thing I'll just say on that, because I think I regularly challenge my clients and partners to step into their caregiver's shoes and think about the challenges that they face when they wake up in the morning, because they're probably different than the challenges that owners, recruiters, leaders in your organization face, and how things like having your car break down or having your child care fall through, how they impact a caregiver are very different when we look at socioeconomic challenges. And we're gonna talk a little bit more about this next week,

so I don't wanna dive too deep. But yes, a lot here, good to shine a light on it for sure. Building on this is when we think about how do we get more people into the industry? So I talked about this being something that keeps me up at night, folks leaving, right? We see that the experience and education requirements, prerequisites in home care are really magnifying this shortage that we have. So things like the desire to only recruit

individuals that have a high school diploma or prior experience working in care. Those are all things that just intensify the shortages that we're already seeing. So I'll give an example. 58% of agencies require a high school diploma or a GED to get to work. It's estimated, though, that 20% of caregivers don't have one. So we know that well-qualified caregivers are essential. We know that they need to provide outstanding care, right? But we're limiting an already limited labor pool. And I think this is just something to step back and think critically on. We know we don't have enough people coming into the industry. The challenge is the people that are leaving our industry in

many cases are experienced workers. There are folks that have been in the industry for a long time. We talk about burnout. We talk about a lack of engagement, why folks are walking out the back door. So I think this is an opportunity to reevaluate our strategies, to think about how are we training future caregivers? How are we broadening or expanding our workforce? Now, the positive thing here, and again, hearkening back to your previous life, 70% of direct care workers want more training, and 85% of agencies are open to providing it. So I promise that Connor didn't bring me on here to be the doom and gloom guest, but there's

an interest in growth and development, and agencies are interested in available to provide it. So I think facilitating that is the name of the game here as well. Love it. Totally agree. I'm hearing all the same things, just don't necessarily have the numbers with it. So thanks for sharing that. All right. Last two here. I know Connor and I both, Connor, I'm usually the one tapping the watch. so I appreciate that, Conor. Conor's on the receiving end there. So agencies overwhelmingly were optimistic on growth. So one of the big takeaways, industry's growing, opportunities to grow, my agency, all positive. But we saw from the report that 40% report deteriorating client service.

So they were strongly confident in their ability to grow this year, agencies were, despite these workforce challenges, right? But we did see, even though there were some concerns around that, 18% of agencies reported notable improvement in client servicing. And I think one of the things to think about here is our industry is accelerating, right? We're seeing all this growth. We're seeing all these new companies coming into our space. We know that's important. And there's really, we have a seat at the table we've never had before. And there's very positive outcomes of in-home care. There's also an opportunity here to work towards stabilizing our workforce to even further improve the in-home care experiences of our clients as well.

Yeah, I mean, that's, I strangely don't have anything to add or have any questions here. That's interesting. Yeah, go on. I think it is. I think it is. And the last one here is we see, and I think we all see these, the same headlines of the raising of wages, right? Agencies are raising wages in our industry, but they're still struggling to compete with other industries. And I'm sure that while I can't see everyone on the line, they're probably nodding their heads as well. We're hearing this at conferences. We're hearing this when we are on webinars, right? The median hourly wage for U.S. direct care workers

stands at $13.56. And that translates to a median annual income of just over $20,000 a year. So that's, you know, that is not livable, right? And we know that there are, we've seen some wage rate growth in our industry. We know that's also struggled to keep up with inflation and still in many cases remains uncompetitive when we compare it to other occupations with similar requirements. So things like retail or customer service

positions, food service, and that's those low wages are not the whole conversation here, though, right? They're just part of it. And we saw actually that 95% of private pay agencies as part of this reported wage increases in the past year. But we know, and there's some folks on the line or folks that'll be listening later, Medicaid funded agencies continue to face these challenges, and all agencies find it difficult to compete with those other industries as well. So we know that wages are part of job satisfaction. We know they're part of recruitment. We know they're part of retention in this workforce. So addressing this is going to be crucial to the growth and stability of our workforce as well. This is a huge one. And just for those listening who might be thinking a lot about compensation, pay strategies and things, one resource that might be super helpful for you

is CareSwitch's compensation report. So earlier this year, we surveyed around 600 agencies, I think, and got very detailed pay data for their caregivers, their staff, the different positions on their team that don't just have the amounts they're paid, but like how they're paid, you know, are people in the office being paid salary? Is it performance-based? Is it hourly? Is there commission? Things like that. And also how much compensation is being given to the owners and so you can find all that um for free at careswitch.com compensation dash report i should also mention it's all filterable by state and agency size you can say you know what what do agencies in my revenue range in California pay this position? Things

like that. So very useful. Just wanted to shout that out real quick. Let's go to the application of all this data. You've shared a lot of awesome stuff here. I think this is really good. Some surprising, some not. At the end of the day, I think everyone's asking, so what do we take from this? What do we do as a result of this? Let's talk about that, I think everyone's asking, so what do we take from this? What do we do as a result of this? Let's talk about that. I think there's a lot here. Again, I want to reiterate, this is a jumping off point. So I appreciate more and more of these conversations. You know, the study we're going to talk about next week, we released almost a year ago in partnership with NAC, and there's still so many people that have not seen it. And I think that's the, you know, how do you get this in front of more folks? How do you have more

of these conversations? So I appreciate the opportunity to do that here today, Connor. So a big piece I think is focusing on recruitment KPIs and internal recruitment operations. And I started with, I'm sure the most fun and interesting takeaway, KPIs, everyone's favorite, favorite three letters as well. So I think you get what you measure, right? And so I think as a result, you need to be careful what you're measuring. So example of this, if you only hold your recruiter accountable for a certain number of people, a certain number of hires in the door, you can't always assume that you're going to get people who stick around, right? There's almost always unintended consequences with what you measure. So, it challenged folks in the line when you think about KPIs to think

about what you're measuring today. And the reality I shared is that there's this great divide in results among agencies. And as you dive into the study, you'll see that sort of perfectly split pie chart. And you've got those folks that are a third of which are getting one or fewer calls back from every group that every 100 people they call. And on the flip side, you've got the other third that are getting four or more people back. And it's not because it's pay, it's because of approach. It's because of approach. And I think if you think on the line, how many thousands of people I've had the privilege to speak with or connect with it at a conference or on a webinar, there's so many things that feel

like they are not in your control when it comes to the workforce challenges. They feel out of our control. This is something that is in your control because I know likely folks online can't snap their fingers tomorrow, can't automatically pay more, right? But you can determine what you're measuring and who's accountable for each KPI in your office. And overwhelmingly, agencies often set one goal, the number of hires they need, right? But the challenge is agencies are losing people throughout that whole process, all throughout that funnel. So you've got to measure things

like application to contact rate, contact to interview rate, right? I can and will and have had whole conversations just about these KPIs, but looking at time at each step, all those different things. But I highly encourage you to focusing on what you're measuring today, what you're saying, what you're doing, looking at time at each step, all those different things. But I highly encourage you to focusing on

what you're measuring today, what you're saying, what you're doing, and combining those processes and people in your office and pairing those with technology as well. Love this. Are there any more specifics you can give on first, what KPIs they should consider measuring? And then second, kind of as a more general guideline, how they can go about deciding which recruitment KPIs they should consider measuring. And then second, kind of as a more general guideline, how they can go about deciding which recruitment KPIs they should use. Yes, I think there's, again, we could and have talked about this a lot. I just did a webinar looking at this actually as a deep dive. So I think it depends on what you want out of your business. And most people on the line are going to say, I would like to grow my business, right? So most

people on the line joining us are going to say, I'm high volume hiring. I'd like to hire as many people as I can. Things to look at there. Interview to offer, right? So the number of interviews to the number of offers that you're making, right? The higher the number, generally indicating the higher quality of the interviews and the candidates tend to be. Two more. Offer acceptance ratio. So the ratio of offers accepted to the number of offers you're making. A lower rate here might suggest that something is off with your compensation, your benefits, your company reputation, right? So you're making offers.

Are they being accepted? And then application to interview. So looking at everyone loves lots and lots of applicants. How many of them are actually making it to the interview? The higher the number here, likely the more relevant and valuable your applicants are as well. So those are three I would be looking at. That makes sense.

And I would assume here that the benefit of tracking those specific ones you named is that that makes it easier to dial in on which part of your recruitment process needs help the most. You got it. Yeah. And the holy grail here for everybody is who makes it to the first shift. Yeah. Right. That's what I mean. I'm, I'm, I am still surprised 10 years into this, how many companies hire caregivers, share their hiring numbers, and then share how many of those never even make it to the first shift. Right. So there's opportunities positively for everybody listening to make improvements in their recruitment process. Even if you think it's great, it can always be better. I totally second that. Let's go on with the applications. Lots of good stuff in here. Lots of absolutely that. Let's go on with the applications. Lots of

good stuff in here. Lots of, absolutely. There's lots of stuff here for sure. So I think a big takeaway here, we had that shared that 77% of agencies report they feel their caregivers are satisfied and fulfilled. We know, and we're going to talk more about this, good tee up to our conversation next week. We know caregivers are struggling financially. Nine times out of 10, if you ask a caregiver who they think their boss is, they say it's the scheduler or the recruiter, not the company, right? Not the agency owner. They think it's the scheduler. This is a population that's craving pathways out of poverty. They're craving connection with each other. Caregivers that are engaged with their company and with each other are less likely to leave. Right.

We see that through CoachUp Care. They're 400 to 600 percent less likely to leave. So part of solving this workforce crisis is bringing more people into care. But the lowest hanging fruit for every company on the line today is keeping people already in care here. And that starts with engagement. So I had a woman stand up at a conference in Chicago a couple of weeks ago I was speaking at, and she said, someone who's worked for me for one shift is more valuable than all the applicants in the world. Because I've already got somebody through that whole process. I've got them bought in on what I'm doing and my mission and my vision. And she's worked one shift. I have to get

her working that second shift, that third shift. I have to keep her around. So I think shifting our thinking around employees as people versus employees and caregivers as commodities is a big shift for us as an organization, as an industry that we need to be thinking about here as well. Totally agree with all that. I guess my kind of two follow-up questions here, and again, I'm going to test your knowledge a little bit. So I'll kind of ask these both because you can see how they're differentiated. So if I'm listening to this podcast and I'm like a fairly recent agency owner, you know, we're still in our early years and there's lots of things we haven't tried yet, lots of low hanging fruit.

What's something I could implement today in terms of helping engage my caregivers and the other things you've talked about here that I might not be doing? And then second to that, kind of the much larger version of this for an agency that's very established, maybe it has a large regional footprint, been around a while, pretty successful. What's a type of initiative here that they may have the resource to implement that statistically they probably haven't implemented that they need to the resource to implement that statistically they probably haven't implemented that they need to think about doing. And I know this wasn't intentional, Connor, but with all humility, I would say coach up care. So one of our solutions that we've brought to

the industry in the last couple of years focuses on just that. So whether you're brand new or you've been around the block, so to speak, CoachUp Care is focused on engagement and retention. I say this truly with all humility, what we are seeing across the board, we just had a recent release on this as well, is decreased turnover, increased engagement, increased retention across the board, satisfied employees lead to better continuity of care. They lead to happier clients. They lead to better client satisfaction scores, caregivers picking up more hours, right? More revenue for the organization. And so I think whether you're new or whether you've grown a business here and you're looking, if you're not focusing on retention fundamentally as a key metric in your organization, you're

missing out on revenue. You're missing out on a growth opportunity. You're also missing out, I think, on a competitive advantage because focusing on retention still is new. It still is novel for our organization. Nine times out of 10, you ask a room full of people, everyone raises their hand and says, the hardest thing for them right now is to recruit. But as an industry, I think we have been trying for too long to recruit our way out of a retention

problem. And we have a retention problem in our industry. CarePulse just shared 77% turnover this last year. Agencies always think they're growing when they're recruiting more people. But if they're just backfilling those cases or just filling out those turned over roles, they're not growing at the rate they could be. So humbly, it's a tool that we offer. I think there's lots of things in there you can be doing. Calling your caregivers, asking them simple questions like, are you getting the hours that you need? Are you happy? How was your week? I have a client who asked that through CoachUp Care. Are you having a good week? As simple as that is, but they're craving that connection to you

and your organization. Finding a way to facilitate that, I think is key. So it sounds like maybe a good response here is to have a systematized plan of how you'll communicate with your care team on an individual basis and what that looks like and make sure that that's being followed consistently to kind of optimize your ability to engage and influence your caregivers. Is that? Yeah. Yeah. I mean, five years ago, my number one retention tip would have been to call your caregiver, call your team, connect with your team, create. It's hard to do that at scale, which is why I bring up CoachUp Care as an example. But connect with them, recognize them.

The reasons people are leaving is because they don't feel connected to the organizations that they serve. And these are people with hearts of gold who are caring for our clients and our seniors but they don't feel that connection they don't feel that engagement and I think that's a key part of ongoing retention and success in our industry as well. Thanks for that and also thanks for your candor there. For those who are listening who are interested in CoachUpCare we'll answer a few more questions about that like right at the end of the episode in the next five or 10 minutes, we do have a few more things to get through before we come to that. Briefly, I want to highlight one thing you said that I think is really cool and deserves to be

repeated, which is that as an industry, we have been trying to recruit our way out of a retention problem. And I get that it isn't always retention. There is a big recruitment problem too. But I think you're 100% right that it can become easy to view it simply as a recruitment issue when so much of it is also retention. And that can be easy to kind of avoid because often the solutions to turnover are less straightforward than the ones to recruitment sometimes seen would be my opinion. That being said, let's continue through with what you've got here. I want to make sure that we get through. I'm watching the class. I knew Connor and I would have no problem filling in an hour of time. I think a big one here, and I may jump around a little bit, but two big ones I want to make

sure we talk about. One is inviting new people into the industry and elevating your team. So again, something that we all need more caregivers in our industry, we need a pipeline of people coming in. And younger caregivers are part of that group. They're not the entire answer, but I think it's a multifaceted challenge

and when we can truly leave no stone unturned. And this is certainly a group of people that would need to focus on getting the right skills, right? We see that there can be some families with a reluctance to work with a younger caregiver, thinking they're not as qualified, et cetera. They're maybe, you know, leaving a doctor's office or a hospital. They're expecting a nurse or someone with a higher level of qualification and certification. We need more formalized training. We need development, on-ramping programs, getting people up to speed, setting them up to be successful. It's another big reason we see people leaving. It's a big reason we saw people leave during the pandemic. They were thrust into roles without the training or support that they needed to be successful. And we're not surprised, right, then why they would leave as well. So

mentoring programs, working with somebody here, showing them they can do the job and making sure that they're trained well to do it, I think is important as well here. So this goes back to what I think was in our kind of second takeaway about the number of agencies who are seeing clients reject caregivers due to their age. Do you have any specifics around what that looks like? I mean, like when we say younger caregivers, you know, who is that referring to? Are there typical age groups that are most likely to be refused by clients? Like, is there any more detail you can give there? I don't have too much around the specific age group. I can tell you that, again, that insight from the BLS is that just as a couple years ago, you know,

one in 10 healthcare support workers were between the ages of 16 and 24. So there, it is a part of our population today. And we see folks, you know, using this as a way to come into the industry, right? Healthcare at large, I can't tell you how many nurses you talk to who started off as a med tech or a CMA or a CNA. So I mean, it absolutely is a pathway. And I don't think I have the insight that you're looking for there, the staff that you're looking for specifically. But the study itself does break down the percent of agencies who see it's a challenge for 10%, 15%, right? 20% of their clients. So you can see that additional detail as well. Gotcha. Thanks for that. That does help. I think you said you had like one more application.

One more. I just want to take away a key takeaway. Sounds good. There's a very unique opportunity right now for agencies to get involved locally, state level, federally. There's great National Association of Home Care and Hospice, NAC, HCAOA, the Home Care Association of America. Washington needs to hear more voices and stories about the challenges that caregivers and your companies are facing every day. Our CEO recently had the privilege of speaking on Capitol Hill this spring, meeting with Congress people, and we can share firsthand that many people confuse caregivers with nurses. They don't understand that nursing funding doesn't trickle down to home health aids, right? There's this sense that agencies are making higher profits than ever before, right? Our industry is complex with many nuances, and that makes advocacy actually even more critical. I don't think there's another industry that has more confusing acronyms than we do in home care and in health care.

Right. So I think the there's an opportunity here with us in the spotlight. Our industry is getting much needed attention. We need to ensure that the people setting policy understand who caregivers are, who agencies are, and the impact of turning away cases as well. So that's my, there's lots more we could talk about here, but I think that's an important takeaway I wanted to impart today. I like how you said that. Just to kind of repeat what I think was the most important thing I got from that is as an agency, if you want to see more legislation that takes into account the fact that between caregivers and nurses and the rest of healthcare continuum, get involved in your state and local and national home care associations. Is that a safe takeaway from that, Maggie? It is a safe takeaway. I think everyone has a voice and they should use it. Okay. Thank you. That's well said. I think that's a good place to end

with that part of our content for today. Before we wrap up, I do want to give you a chance to talk a little bit more about Mission Care and its companies. So let's just briefly kind of give us a bit more information about what each of your companies do, how they help agencies and how someone should get in contact with you if they want to learn more about them. Yeah, absolutely. I talked a little bit about this at the beginning, but Mission Care Collective is really think of us as a workforce solutions partner. So again, on the MyCNAjobs side of our business, we operate the largest network of frontline healthcare workers. So think LinkedIn for caregivers, CNAs, and home health aides. So we can help plug in directly to an applicant tracking system you have today. If you are measuring some of those things I talked about, we can help you connect with the largest workforce in the country. So get your brand in front of those folks when they're looking for

their next opportunity as well. On the other side of the conversation, I already talked a little bit about CoachUp. It is something I'm very passionate about. I've been in the industry for 10 years. It's an exciting innovation. I think it gives really an owner, an agency, the tools and the framework they need to be able to not only retain their team, but see, get ahead of turnover before it even happens. Engage your team, build connections and relationships with your team. And I think most importantly, build a healthier workforce that can deliver more and better care. And then Mission Care over overarchingly brings partners and organizations together to drive change. And this is where we run studies like this and the one that we're talking about here today. So if you're looking for

a recruitment and retention partner, you can feel free to email me directly, maggie at missioncare.com. You can check out all of our brands and solutions at missioncare.com as well. Feel free to connect with me on LinkedIn, Maggie, and then Keen is my last name as well. But value and opportunity to help you expand your impact that you're making in the industry as well. So thank you for having me, Connor. I'm excited to continue our conversation, but there's lots here. And I know you shared some of the links to the studies as well. Thank you. This has been really interesting, really insightful. I'm really excited for next week's too. Do you maybe just want to give people like the teaser trailer of like what we're going to talk about next week? I like it. Yes. Next week's episode, right?

How to sharpen your recruitment marketing with the seven caregiver personas. So we released a fantastic study. I say that with all humility, all of our marketing folks on the line will love this. Owners in this. We did a deep dive into our workforce. So we're going to share some really interesting demographic insight, but we're going to dive deeper into the seven caregiver personas working in our industry today and talk really specifically about how you can take this information to upgrade your recruitment strategy in the months ahead. Awesome. That was a good teaser. I'm really excited for it. The first time I heard this presentation as a marketer and someone who has listened and read a ton of the

content in home care, I felt like this was one of the more unique and interesting and actionable things that I'd found. So please join us again next week. Just as a reminder, this is both a live class and a podcast. You can register for the free classes every Wednesday at careswitch.com slash homecareu. And then you can also listen to the podcast wherever you get your podcasts as homecare U. So thanks again. We look forward to seeing you all next week and have a good week. 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-to-day with AI so that you and your team can focus

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