In a recent home care sector survey we conducted, staff retention was the second highest concern, just behind recruitment. Retaining staff was in the top three business challenges for 43% of respondents, and it was the number one business challenge for over a fifth.
These findings may not be a massive surprise to many of you, given that the rate of churn in the social care sector is 1 in 3 – twice the UK average across all sectors. Worse still, according to a recent survey by Total Jobs and Care UK, 1 in 3 carers intend to leave the industry altogether in the next 5 years.
So what is driving this?
Why do Carers Leave?
According to Neil Eastwood (who is something of a guru in the social care recruitment and retention space – read his Saving Social Care book (if you haven’t already), reasons for care staff leaving fall into roughly three categories:
- Personal Factors – such as location, health, family commitments and motivation in the role.
- Organisational Factors – such as support, lack of career progression opportunities, lack of training, working conditions, poor appreciation and of course pay.
- Relationships – such as rapport with service users, colleagues, leadership and relationships outside of the workplace.
Most of the Personal Factors are outside of the control of an employer, apart from one; motivation. Motivation is both central to what makes a good carer and critical for retention if lost. Consequently, every possible effort should be made to avoid negatively impacting this.
Motivation is impacted by the majority of factors listed in the other categories, so let’s consider each in turn.
Support takes many forms. This can be as simple as having someone to call on for advice and assistance or having the right infrastructure and resources in place. The vast majority of carers leave within the first few months of a new role, so support for new starters is key to addressing this problem.
Supporting new starters should include a structured onboarding process, with a planned induction, reading, training and shadowing as part of this. Records of completed training and progress could be filed alongside other carer-specific documents, such as their DBS check and and similar admin essentials.
Support can also include the systems a carer is expected to use on a daily basis. Having a clear and easy to read rota, directions to appointments, and automated processes such as timesheet generation can remove much of the stress induced by poor infrastructure.
Opportunities for Career Progression
Career progression in the home care sector is a tricky subject. In other sectors, much is made of the difference in pay grades as careers progress. This is not such a motivation in home care. To provide an example taken from Independent Age’s research – as of September 2015, a care worker with over 20 years of experience could expect an hourly rate just 26p higher than a care worker with less than a year of experience (equivalent to 5% higher). Furthermore, the experience pay gap has reduced each year to only 15p (2%) in March 2018.
Whilst the opportunities for higher pay are limited, recognition of achievement and career progression needn’t be solely locked to financial reward.
Carers should be guided towards behaviours and skills training which will open up opportunities for their careers to progress. A well thought-out onboarding, training and performance review programme can provide the level of opportunity and guidance many carers seek in order to feel fulfilled in their roles. Skills for Care’s Care Certificate can be leveraged as part of delivering a robust induction process.
Onboarding and ongoing training is hugely important to ensure staff performance, quality of care and to develop employee engagement. No one likes being in a position where they don’t know what to do, so onboarding and even mentoring from day one goes a long way to preventing this.
Research indicates that staff are 58% more likely to stay 3 years if there is a structured onboarding programme.
A training programme can provide important feedback and validation against career progression goals for staff. Training sessions also provide an opportunity for managers and care staff to get to know each other better and build a better sense of team unity. Furthermore, training sessions are an excellent point at which to ensure care staff are delivering on business goals for care quality, personal conduct and record keeping – critical for supporting CQC requirements.
Storing training records electronically, for each member of care staff, has the added benefit of making these easily available for reviews and reporting requirements throughout the year.
Carers undertake highly demanding work, so conditions need to support this level of commitment. Hours of work (and days) can seem antisocial at times, so optimising how appointments are scheduled across your roster of carers can make a real difference. Being able to see the last few days’ rota for each carer, at a glance, can help make better balanced scheduling decisions.
Little things, like cutting down on repetitive admin tasks, automating where possible, and even just spending a few minutes having a weekly catch up with each carer can really improve how a carer feels about their job. Combine these with more streamlined ways to communicate rota changes, overtime opportunities and handover notes between calls and your carers will find they can focus more on what they really want to do – caring for your service users.
As already mentioned, Total Jobs and Care UK recently found that over one in three (37%) of carers in social care are looking to leave the sector entirely within 5 years. Another telling finding in this survey was how 59% of the audience felt they could have been more valued by their employer, which would have enhanced their career.
There’s clearly a perception problem here, and care managers need to take the time to ensure their carers feel appreciated. A little appreciation goes a long way in any work, and even more so when the work is physically and emotionally demanding!
Low rates of pay are one of the most frequently cited reasons for leaving a role in social care. Research published in the Hft Sector Pulse Check 2018 found that; “when asked what [respondents] saw as the main factors fuelling the recruitment crisis, low pay stands out as a major factor. 80% of respondents in our survey stated that low pay had the biggest impact on their recruitment efforts.”
It’s tough to tackle the challenge of pay with anything other than more money to pay higher wages. Looking for ways to improve back-office efficiencies and carer scheduling – typically through greater automation and digitisation of processes – can prove to be a viable way to free up additional budget for this purpose.
However, the issue here is retention rather than recruitment. So, we know carers were happy enough with their rates of pay, at least initially (or they would never have taken the role). Perhaps the true concern for many is the perceived lack of salary progression and the balance of time worked to pay received. Better tracking of travel time and costs, ideally electronically, can help address this in part. Other ways of recognising and rewarding experience and career progression, such as long service leave and other perks can also have a positive impact on pay concerns.
Rapport with Service Users
Rapport between service users and carers is central to delivering a high quality of care. Care is more than just the mechanisms of care delivery, it’s about service users feeling cared for. This has never been more obvious than now, when various industries are experiencing greater levels of automation through machines. Robots will never be able to bring smiles to service users faces, share a friendly heart-felt conversation or lend a sympathetic ear in the manner of a human carer.
Continuity of care, through scheduling the same (or preferred) carers to service users, goes a long way to building rapport. Providing handover notes and service user notes/preferences to bring new carers up to speed also helps too. It’s the little details, which are only really possible when carers have enough time with each service user, which make the difference to both service user happiness and carer job satisfaction.
Relationships with Colleagues
It’s not just the relationships with service users which contribute to a carer’s happiness in their role. Knowing their colleagues and feeling like part of a team can have a profoundly positive effect on attitudes at work.
Training sessions and the occasional team evening out, or even lunch, provide opportunities to bond and develop the respect and camaraderie needed for a successful, happy workforce.
Relationships with Leadership
Different leadership styles work best in different sectors. Home care agencies benefit from a far more compassionate and consensus-driven leadership style than many other businesses – perhaps because a personal touch is so central to the work that is ultimately delivered. The best carers are sensitive and people-focussed, and as such they tend to respond poorly to impersonal demands, preferring the respect of a leader who speaks at their level.
Fix your retention challenges and recruitment becomes less of a need, your care quality will rise (through happier and more familiar carers) and your agency will become a nicer place for everyone who works there.
Spending a little time considering each of the points above, putting plans in place to improve each in turn, will pay dividends over time.
I thought I’d leave you with a few words of wisdom, about why retention is more important than ever, from Neil Eastwood (mentioned earlier, and a great influence for much of this blog post).
“In my experience, much of the staff loss experienced by homecare agencies is avoidable, especially in the first 90 days of employment. By using the tips and techniques described in this blog homecare providers will increase the chances of keeping their staff longer. That is more important than ever as recruitment becomes more challenging and the competition for workers grows.”