Recruiting and Retaining Caregivers: Effective Strategies in a Competitive Environment

Aaron Dun  

You are now listening to Home Care On-Air, brought to you by CareAcademy. Strap in as we dive headfirst into the future of home care and the issues, challenges and opportunities facing home care operators in a post-pandemic world.

Welcome my name is Aaron Dun, SVP of Marketing for CareAcademy, the industry's leading provider of care enablement solutions designed to manage your agency's training and compliance requirements. In today's edition, we will explore how agencies are successfully recruiting and retaining caregivers in an incredibly competitive environment. We will join a conversation that I recently held with Pete Morrissey, home care leader and owner of Right at Home of Gainesville, Georgia. In it, Pete shares a number of key steps he is taking to recruit new caregivers into the market, and to ensure that his care team has the support they need to deliver high-quality care. Pete has a long career at a number of technology company heavyweights before he joined the home care industry. He brings that knowledge and expertise to his operation each day. I learned a ton from our conversation, and I trust that you will too. Enjoy the discussion.

Pete Morrissey  

Good afternoon, everyone. And good morning. My name is Pete Morrissey. I'm the owner and operator of Right at Home - Northeast Georgia. So we operate north of Atlanta, up to essentially the North Carolina border. The agency itself has been in operation for about a dozen years. And we bought the agency about two years ago. So it's well established in the area.

Aaron Dun  

Well, Pete and I were joking earlier about all of the old-school, retro things that we're doing here on this particular chat today. But I think we're just gonna go with, we've had a lot of Zoom over the last 18 months. So you'll get to see our smiling faces here instead. So yeah, I appreciate the quick overview there, Pete. And again, thanks for the time, and thanks for your partnership. Maybe you can share a little bit about some of the clients that you serve, some of the services that you provide, and then really how many clients where you are, north of Atlanta.

Pete Morrissey  

Sure. So first in Georgia, we are licensed, that's a requirement in the state of Georgia. We offer non-skilled care, so essentially home health aides, companion services, and we service three constituents: Our private pay clients, our veteran clients, and also we were approved just this year to start offering Medicaid clients; there are two programs that we service in the state of Georgia.

Aaron Dun  

Well, congratulations on that. I know it's a big deal for you guys. You know, you have a kind of interesting background, Pete. So I'd love to hear a little bit more about, kind of how you landed in this industry. What drew you to the industry and what drew you to the Right at Home franchise?

Pete Morrissey  

Sure, Aaron. Yeah, I'd say a little bit of an eclectic background. But it sort of makes sense. First I went to school at West Point, I was branched aviation. So I flew helicopters for a number of years for Uncle Sam, and then post-military, I was with Pfizer for seven years, I was part of the initial Life Sciences group at IBM. And so I think that sort of helped me from a healthcare perspective to start really learning the healthcare ecosystem. And then later in my career, I was in private equity. I was a vice dean at Columbia Business School, and then was at a point in my life where I really wanted to be closer to home, not travel as much. And it was a little bit serendipitous about why Right at Home - we actually needed services for my wife's father. He was later in his life and needed care. And so we actually found Right at Home, because we needed that help from a consumer perspective. And so, then about 18 months later, there was an opportunity to purchase the Right at Home business we have now and it just seemed a really good fit. My wife had worked at Merck, worked at the American Red Cross, and then I think having been a participant in the ecosystem, in terms of needing help for her dad, it just felt like a really good fit, and it has been. We feel being part of the community, the fabric of the community, as a veteran to be able to service fellow veterans, the mission felt really good and easy to internalize for us.

Aaron Dun  

Yeah, that's great. That story I think really resonates across the audience. So lightning, I think quite a few people who get into this business have that same sort of personal story, personal journey. And so kudos to you for making that leap. So two years in, anything sort of surprised you? Anything you didn't expect? Or you're pleasantly surprised about? You didn't expect a global pandemic? I'm sure that

Pete Morrissey  

No, I think our timing was horrific in that we bought it in December of ‘19. And then the pandemic started a few months later. But I think one of the first things I would share in terms of surprises, just the sort of the resiliency of our caregivers and our staff is that no one could have predicted what happened. We're still in the midst of this, we're learning how to better navigate through it. But I think resiliency is something that has been so impressive to me. And as you shared, Aaron, each of us who's doing this has some personal story, right? There's a lot of things that we could do in life. But I think that resiliency is really manifested from each of the personal stories that we bring in, why we're in the industry. So that's been a really pleasant surprise. I think there hasn't been a lot of, “Oh, my gosh, I didn't expect this.” With the exception, of course, of the pandemic, but otherwise, I think part of our diligence was making sure we talked to a lot of other owners, both within this Right at Home business system and outside the business, other folks to really get a sense of what we're getting into. And so no, I would not say there have been any major surprises.

Aaron Dun  

I know that you are WellSky users. Was that a decision that you made to bring in? Or was it already in the works, are already part of the business when you joined? And what have you seen from using that platform that helped you with your business?

Pete Morrissey  

Yeah. So first, I would say I wanted to share a little bit of my background, I'm process-driven, process-oriented. So WellSky - ClearCare - I'm sure I'm gonna have some mistakes.

Aaron Dun  

We'll put the dollar in the jar when we screw it up.

Pete Morrissey  

But it was already resident here within the company. But I'm not wedded to a specific tool or requirement. But what we have found is that it's a very robust platform. And as we get into the conversation a little bit more deeply, what I really like, is how you're able to integrate a lot of other toolsets within WellSky/ClearCare. So that was really important to me. I go back, I look for corollaries of my business career. And I look at what we're able to accomplish with WellSky, it's sort of like at IBM, where we had really strong middleware layers, we had a lot of partners that could utilize the platform. And I look at it in a very similar fashion here that it's very robust in terms of both helping to service clients and caregivers.

Aaron Dun  

Yeah. And those are your two most important assets, right? So you mentioned the ability to integrate other tools and other toolsets—we'll talk about CareAcademy and training in a second. But are there other tools that you've integrated so far—if you're using any kind of applicant tracking systems, or to help you in your recruiting or anything else that you found to be useful, even able to integrate it? 

Pete Morrissey  

From an operational perspective, we have integrated billing systems, third-party payers, which has been, again, very helpful, just in terms of efficiency, for ACH credit card, so that's part of the integration system, CareerPlug has been something that helps accelerate onboarding, process, and assimilation of caregivers. The state of Georgia has a very defined criteria in terms of background checks. So, unfortunately, that's not a system that we're able to integrate. But for the DMV checks, we do use an integrated toolset. So all of that, to be able to have the power of touch it, push a button to be able to access some of the non-WellSky systems has really been, I think, one of the advantages that I've seen in terms of business process, really helping to streamline our business approaches, so we can focus on what we talked about a lot is working in the business and on the business to improve efficiencies.

Aaron Dun  

Got it. Super helpful. So, turning now to CareAcademy and how you're using it and how you're thinking about training as part of your recruitment and onboarding processes, and supporting your clients. If I have my timing right, it looks like you made a decision to add your CareAcademy to your training stacks in June of last year. Were you using something before—not the name of a company, but what was the impetus for sort of making a change? And in the height of the pandemic? Were you doing on-site training before and wanting to move online? What was the driver there for you?

Pete Morrissey  

That's exactly right, Aaron. I think invention is, oftentimes, the mother of necessity, or however that saying goes, but we're early in the pandemic, we historically had done quarterly on-sites, monthly nurse, COE training. And so all that dissipated very, very quickly. So we're in a position where, notwithstanding that it's a requirement of the state, I think, more importantly, is just ensuring that we're continuing to deliver efficient and effective training for the benefit of our caregivers, we surveyed the horizon, and we were impressed with care Academy early on. And we continue to be so and I think one of the biggest reasons we went into this in terms of acquiring a platform, was really looking at it through the eyes of the caregiver. And so one of the things that was most important and impressive and continues to be for us, is that CareAcademy is integrated right into ClearCare, or WellSky, but right into the ClearCareGo app. So a caregiver is able to access their required training, right in the ClearCareGo app itself, it's seamless to the caregiver, they're not going into another system, to a website, having to worry about password resets. And that was really critical to us, because I'm sure for a lot of the folks on the phone there are varying levels of expertise from a systems perspective, or it. And so we wanted to utilize a toolset that wasn't designed those who have the most ease of using systems, or even average, but those who might struggle. And so that's where CareAcademy really was impressive to us in terms of how it's integrated, the ease of use, and that was a core component. And so, yes, we launched it in the middle of the pandemic, but it also allowed us to you to have something very positive for our caregivers in terms of engagement, around training, when we were largely prohibited from face to face. So it allowed us to to reengage in a way that we felt was very meaningful.

Aaron Dun  

Well, just yeah, as you mentioned, sort of in that moment, I'm sure it was very important. So one of the things that we talked about the other day was sort of the importance of being seen as an employer of choice and how that's helping you with your recruiting. If we could do a virtual show of hands of all the people on this call, probably 80% on this call are sort of faced with the same challenge, which is: How do I find enough caregivers? How do I keep the caregivers that I have? And how do I support my clients and expand that, in the face of everything that's happening in our culture broadly, right now in our society broadly? 

So I'd love to dig into that a little bit. How have you really thought about that caregiver culture? And how have you thought about setting yourself up as an employer of choice where people want to go work for and maybe you're drawing people away from other agencies or other independence off the street or people who haven't even been in the industry?

Pete Morrissey  

Yeah, it's a great question. And I think we're all facing this, right? And so I would say one thing is internally, we've chosen to not say we're in this caregiver shortage, so we're living through it, but we don't speak that way. What we say is, what are the things that we can proactively do to be that provider of choice, that partner of choice, and to make it meaningful? So a couple of things that I would share with you, Aaron, that we have tried to be definitive about, as I shared earlier—I'm very process-driven, I believe in benchmarks and KPIs. And so one of the things that I benefited Right at Home from a corporate perspective and was able to get a set of benchmarks across, a myriad set of KPIs, one of which was turnover rate. And so what we do within our business is from those benchmarks, we strive not to be average, but to be best in class, knowing will fail in many of those attributes but if that's what we strive for, then we're probably going to lift the boat overall. 

And so one of the areas that we really focused on is, we were average in terms of caregiver turnover in the first 90 days. And so, we took a step back and after some analysis, we went through a Kaizen—it's actually a really enriching approach in terms of discerning business problems and coming up with solutions. But one of the significant outcomes of doing that analysis was, we decided to create a specific position solely focused on the caregiver in the early days of his or her tenure with the company. So we call the position caregiver coordinator. 

And what we're trying to do is have is to improve touchpoints, and really improve the onboarding and assimilation process. So the role is designed to be a positive, feel-good—it's not dealing with call-outs, it's not dealing with caregiver issues or other folks on the team who deal with that from a day-to-day basis. But this role is really focused on how can we improve the ecosystem for the benefit of the caregiver. And so early data is encouraging, we actually have significantly decreased our 90-day turnover rate by about 40%, which is stunning to us. And I think the data is still early. But what we know is that we have by investing in this particular position, we have increased our touchpoints, we're getting much better feedback, we have a system of using a Google doc where if the caregiver coordinator is evidencing something that's assigned to a staff member, and then there's a due date where that action has to be completed, so that we're trying, again, to deliver excellence for the benefit of the caregiver. 

And we also have launched I'm sure there, again, the owners who are on, team members are on the call, there are myriad programs out there. But we really have also focused on having a benefits package that's meaningful to our caregivers, having PTO policies that are meaningful to caregivers, and recognizing them for their performance. And tying that into things that are important for the company. So for example, we have a monthly caregiver raffle—not everyone is eligible, you're only eligible if you've completed a requisite number of coursework hours of coursework within CareAcademy. And if you've done that, then you're eligible for the raffle. 

But what it has done, I think, sort of helped raise the level of engagement overall, and where we can think we're doing a better job, that the data itself is showing us that yes, the caregiver turnover is improving. And we're just going to just keep that level of sustained engagement, which we think is critical. 

And another part of your question was: Who are the caregivers that we're looking to hire? And I've long—it's just a personal bias, but we are not wedded that we have to hire someone who has come from the industry, comes with experience. We're more interested in: Do they bring the requisite qualities that are hallmarks of what will make a good caregiver? And then we can help improve skills, we can put them in situations where their skill set can grow over time, given the myriad number of customers where we have the clients that we have, and the type of needs they have. So I think another thing we've done is really open the scope of who we are looking to hire. Of course, folks who bring requisite experience or relevant experiences are fantastic. But we also are very excited to talk to folks who have an interest and a personal story for why they want to get into the industry. And we found really good early successes with that approach. 

Aaron Dun  

Yeah, I'd love to dig into that a little bit more. I think I've talked to a number of folks in the industry in some agencies who take your approach, which is, hey, you know what, we need to expand the number of, the pool of people that we can bring in. Other agencies are maybe a little more reticent. But have you done anything different to support people who are new to the industry as they come onboard, or to make sure that they have a high-quality experience? So that's the first question. And the second question is, where do you go to find these people? You mentioned some qualities: Interest, personal story. So then is that an Indeed ad—that's probably a pretty interesting Indeed ad—or is that sort of going out and doing something more in the community?

Pete Morrissey  

Yeah, so the first is, what are we doing to try to have demonstrable evidence that we're having, we're supporting more strongly for maybe for a caregiver who doesn't have that typical year, that historical experience. So a couple of things. I've talked already about the caregiver coordinator; we also create a position called caregiver trainer. 

So what we do for that, let's say, inexperienced caregiver, once he or she has gone through the requisite training, and is now qualified to be out on the field? We've made an investment in that in that role also, where that first day, that new caregiver has a highly skilled and qualified caregiver with him or her. And so what we're seeing actually is, it's actually had multiplicative benefits, because it makes that less-experienced caregiver feel much more comfortable in terms of, how do I go into the client for the first time? How am I introduced, so I'm not alone? I have a really qualified partner. 

And what we didn't expect in terms of another benefit is: The clients love it. Because what we're able to say to the client is, “You're meeting another caregiver.” It may be the case that if it were Pete, for example, if Pete your primary caregiver is not available, then perhaps it could be Mary, who's here today to help coach, train, and guide. And so it just helps build cohesion and confidence from both the new caregiver perspective and also from a client perspective. 

So that's, I think, two differentiating vectors that we've implemented, having that role of the caregiver coordinator that I've described earlier, and then having that new person engage with an experienced caregiver on that shift—understanding, it's not profit, they're not profitable for us. But in terms of the long run, what we've seen is tremendous benefit in terms of, I think, accelerated engagement and assimilation that new caregiver into new environments.

Aaron Dun  

That's great. You answered one of my follow-ups, like, how do you afford that? But maybe you can't afford not to?

Pete Morrissey  

Well, if I could go back again, I developed a five-year business model. We look at it routinely, but what I would share with you without going into a lot of detail is that we had a very aggressive growth target in our first year of ownership, and the second year will exceed those growth targets, and might maintain the margins that we have set. So again—I think you've said it correctly, Aaron, is that in my mind, failure to invest upfront would have caused higher turnover, and would have been the typical spiral that that this business had been seeing. So, yes, it's an extra cost upfront. But I think the cost we're seeing is justified very, very quickly. So the return on that investment upfront is really paying dividends very, very quickly.

Aaron Dun  

Yeah, that's great. You know, another agency that we've talked to talks about caregiver mentors, for people who are just starting out with them, as another way—sort of sounds similar to the coordinator idea, which I think I think is a really, really great idea, and there are a lot of different ways to come at that. But it's great that you're seeing results. 

And so one of the questions that came up from the audience is actually around your caregiver coordinator. So you created a role? How did you go find that? Did you find somebody from within the business to go do that? Or did you have to go recruit that from the market? Also, how you were able to source? 

Pete Morrissey  

So yeah, I had a manager a long time ago, and I won't share how long ago, but a long time ago, who had some good advice. And he said, Pete, interview 10 dogs for a position, and you hire the top dog, you still hired a dog. And so that really resonated with me long ago, and still does today. 

And so to answer your question, we just developed a job description. We posted it internally within the company, and then posted it on all the walls, all the usual suspects in terms of the job boards. But to answer your question, we cast a really wide net. And so for that role, we actually looked at over 200 resumes. And so we were kind of blown away just in terms of the volume of resumes. But we really applied, we believe, a diligent process of going into this a priori and meeting, we didn't have a presumed solution of what the outcome was going to be. We wanted to cast a wide net. And we wanted to bring someone in who we felt obviously was going to be the right and best fit. And it's interesting that—and I know it's part of my bias. There's no question that I highly value team members who bring relevant experiences that are not specific in home care or health care, but may have relevant experiences that they can bring because it allows them to look at a problem perhaps through a different lens. And so that's exactly what we were able to do. The person who's in the role had done fundraising, had done a lot of client services. And that was really was important to us as we delve into this, as we really look at this role as a customer service, the customer being the caregiver. And so by casting that wide net, being pretty prescriptive in what we were looking for in terms of attributes, it really helped us hone in on who we felt was going to be the right and best person.

Aaron Dun  

Great. Thanks for sharing that. Love to sort of come back to thoughts on finding people who are new to the industry who might make good caregivers.

Pete Morrissey  

Yeah. So I don't think I'm going to share anything earth-shattering, but there might be a pearl or two here. So one thing that we really doubled down on is the old adage of “the best referrals come from within.” And so we have reinforced our referral bonus program. In fact, Aaron, it's ironic, I was just speaking with a caregiver about an hour before the call today, and I said, “Can you just share with me again our referral program bonus?” And she couldn't, it didn't roll off her tongue. And I said, “That's a shortcoming of us as a team.” And when I shared that with her, she's like, “Oh, my gosh, I immediately have someone in mind.” 

So, we have tried, and we—obviously by the example I'm sharing—have got work to do, but that internal referral program has been very helpful to us. We have been working more diligently with our local CNA schools. And while they're in high demand, what we are doing very specifically, I was afforded the opportunity to sit on one of the boards of one of our local CNA schools. But what we tend to do is, it used to be that I would go in and talk about it, but now we go in with a different team of four former caregivers who are staff members. Now, my wife, who is co-owner, has been a caregiver, she's a Red Cross certified first aid instructor. So we try to talk to prospective CNA students from a perspective through their lens as a corollary to that.

Aaron, I would share also that we have launched a tuition reimbursement program that has also, through word of mouth, grown, and we've gotten folks who were interested, were working for other companies and saying, “Wow, you can help me get my CNA license? I'm more interested in being here.” So the thread I'm on now is that we want to be seen in our community as the provider of choice. 

And it's not just about “Is our pay rate higher?” It's about, “Do we have the culture and the approach where I talk consistently and constantly with our caregivers, that we hold our clients in the highest regard?” And they all nod in affirmation, and say, “Of course we do.” And I say, “And we also hold you, our caregivers, in that same high regard. One without the other, we don't have a business.” And so we try to live that example. 

And what we talk about internally is if the decision we're about to make as a staff member, if that's not a benefit, if you can't answer immediately “yes” to the question, “Will this benefit our caregiver? Our client?” If the answer is not a definitive “yes,” then probably pause on what you're about to do and ask yourself why. 

The next thread I would say is we're working much more closely with our employment centers of the Georgia Labor Department. They have been wonderful sponsors for us. I won't say that it has increased the the top of the funnel in terms of applicants by 30%, but what it has done is it has increased it by about 10%, which is not trivial in today's environment, in terms of finding a another potential source of caregivers for us. 

And then, of course, all the typical—the Indeed, the myCNAjobs, where everybody is, so and then the last thread is, I'm a strong advocate of communities. And so what we look at within our caregiver pool are communities, and so where we have, perhaps, a community that we think that we can do a better job of, or should be doing a better job of access in the marketplace. I'm asking our caregivers for their help and their insights, and would they be willing to make inroads? Would they go to any meetings? Do they go to any social or religious events and would they be willing to advocate for us? So that's not with every caregiver, but for the select ones that we've engaged with; what we're seeing is much stronger inroads to very select communities. And that's been really refreshing and rewarding to us, to have both, let’s call it a broadcast approach and also be trying to get some more rifle shots from a community driven perspective.

Aaron Dun  

Thanks for that detail. And I think that the nuggets in there are useful—earth-shattering? Who knows, but I think that sometimes it's just, even if you don't feel like you're breaking ground, it's good to know, if someone on this call is doing all those things, and you know, “Great, I'm not missing something.” 

But I really liked what you said there about digging in and engaging the community in finding people where they're at. And you mentioned you would pay tuition reimbursement for CNA—is that full reimbursement for their CNA training, or partial? Or how would you structure that?

Pete Morrissey  

Great question. And we struggled with it, right? Because I'm a firm believer in edit versus compose. I think there's some wonderful examples out there already. So we gathered a lot of data about different approaches, some that work, some that didn't. So, to answer your question, one of the biggest things we had to overcome was, how would we be willing to pay for someone's education, and then make sure we could retain them?

Albeit, yes, you can sign all the legal documents, but I wasn't interested in going back and trying to recapture money for funds we paid. So pretty simple approach and straightforward, is that we will contribute up to 50% of what the CNA tuition is, and the way that that 50% tuition is remitted to our caregiver, to our employee, is that they finish the school. And then we have a contract where we have an agreed-to dollar amount that they're reimbursed. And as long as they go to school, they come back, and they're employed by us, then they are remitted that on a weekly basis. 

So our view is, it's a school—I'll make it up: If it's $1,000, our commitment is $500. And you receive that $500 on a weekly basis. And as long as you're gainfully employed, you'll receive it. And if you choose to go work somewhere else, then perhaps we've reimbursed for a month's worth of school. But that is what it is. So I'm not saying it's perfect, Aaron, but what we felt is, it's a good way that caregivers understand that, yes, I've got to put the money upfront. I know the company is going to offset 50% of that, as long as you continue working with them. And it's been a pretty good engagement so far.

Aaron Dun  

Oh, that's great. That's great. And maybe can just remind us, I know, we covered at the very beginning, but as few people joined late, just remind folks, how many locations do you have? And how many direct care workers do you have on staff?

Pete Morrissey  

Yeah, great question. So we operate north of Metro Atlanta. So northeast Georgia, and we have—I won’t get totally specific, but I'll say 100 clients and about 120 caregivers.

Aaron Dun  

Got it. That's great. It certainly helps people sort of map your scale to their scale, I'm sure. 

Looking ahead to 2022, what's the biggest issue right in front of you, as you look ahead to next year?

Pete Morrissey  

Well, I think the obvious is, are we going to see any diminution of the pandemic? We're getting ready to hit cold and flu season again. So obviously, that's there, I would tell you from a personal perspective, we have aggressive growth goals. Again, our investment thesis for purchasing the business two years ago remains intact—in fact, have been accelerated, frankly, because of COVID. We all know, more and more folks want to be at home. I don't know, who knows what legislatively will happen. But to answer your question, what we're planning for is a pretty aggressive revenue growth target in 2022. 

And what are we doing to meet that requirement? From a caregiver perspective, we've done a lot of work on what I'll call the internal plumbing operationally; we're now poised for top-line growth. We have a pretty good model to scale that in terms of our internal costs; it's now just continuing to refine and access more and more caregivers. So I'm really bullish right now, Aaron, and given the last two years of growth that we've demonstrated that's in the books, I'm really bullish on where the future's heading, particularly that we just added another arrow in the quiver from a revenue source. So it's going to be caregiver access to support our significant growth that we've seen and continue to anticipate.

Aaron Dun  

And that closes today's podcast. Thank you to our guest and thank you to you our listeners. Please visit www.careacademy.com to learn more. Be sure to subscribe for future updates wherever you get your podcasts, and five-star reviews are always appreciated!