Grow Your Business by Retaining Economically Fragile Caregivers

Stephen Tweed | February 10, 2022 | Strategic Business Coaching
By Stephen Tweed If you can't attract more new caregivers, then grow your business by retaining the ones you have. According to the 2021 Home Care Benchmarking Study from Home Care Pulse, turnover of caregivers was 65.2% in 2020. We'll get the new numbers in a few weeks when the 2022 report comes out.  In…

By Stephen Tweed

If you can’t attract more new caregivers, then grow your business by retaining the ones you have.

According to the 2021 Home Care Benchmarking Study from Home Care Pulse, turnover of caregivers was 65.2% in 2020. We’ll get the new numbers in a few weeks when the 2022 report comes out.  In the mean time, we keep studying the principles of caregiver retention and applying new ideas to keep the ones we have.  Our particular emphasis this past year has been on improving 90-day retention.

Balance Paychecks with Expectations

One of the three big causes of turnover in the first 90 days of employment is that the checks caregivers receive don’t match their income needs to pay their bills.  As we have explore this situation, we have learned about the principle of Economically Fragile Caregivers. These are employees who are in constant stress because of their financial situation, and any minor disruption of their income causes major trauma.  When a new caregiver comes to work for you, she may or may not disclose how much money she needs to earn in order to pay the bills and keep food on the table.  We have learned that most home care companies have not captured that information and developed a process to match the need with the actual paycheck.

Understanding Economically Fragile Caregivers 

Economically Fragile Workers are employees who’s income hovers right at the edge of their financial needs, and when their paycheck falls short they end up in crisis.  Often times, these Economically Fragile Workers regularly experience financial insecurity which leads to food insecurity, housing insecurity, and transportation insecurity.  We’ve learned that these workers generally do not talk about their financial situation, and they don’t seek or accept help.  They are often elusive, and non-responsive to offers of assistance.  These folks are doing their best to make everyone think they are doing OK.

When the economic bubble bursts, and they are short of money in their paycheck to meet their basis needs, they often run.  Then change jobs, change living arrangements. and isolate themselves. This is one of the great causes of no call, no show for caregivers.  Their rent is due, they are past due on their utility bills, there is no gas in the car, and no food in the Fridge.  They often don’t have the knowledge, skills, and financial awareness to deal with the situation and change their state.

Recognizing Economically Fragile Caregivers

There are some visible signs that your caregivers may be experiencing economic fragility: 

  1. They are the only person working in a multi-person household.
  2. They are driving an older car with unrepaired body damage.
  3. They reply on the Emergency Room for their primary health care.
  4. They have a spouse or children who have been involved with the legal system.
  5. They want to deal with “Cash Only” because they can’t get a bank account.
  6. They have a history of repeated bank overdrafts.
  7. They refuse to enroll in company benefits.
  8. They are enrolled in the Supplemental Nutrition Assistance Program, formerly known as “Food Stamps”.
  9. They have children enrolled in CHIP – the Children’s Health Insurance Program.

As you look at this list, I’m sure you recognize many of your caregivers.  When we paint this picture, we can see more clearly the challenges that our workers are facing.

We’ve learned a lot about this principle from a book called The Talent Pool by Sharon Ryan and Cynthia Tolsma.  Sharon and Cynthia run a very successful company in Harrisburg, PA called Dasher, Inc. and they have written about their experiences employing economically fragile workers.

What Home Care Companies are Doing for their Workers

Providing assistance and resources for Economically Fragile Caregivers is something that our Home Care CEO Forum has been working on, and many of our members have taken action to help their employees reduce the stress.  Some of the things our members are doing”:

  • Setting up an Employee Emergency Fund to help caregivers in short term financial crisis.
  • Providing education on Personal Financial Planning to help caregivers manage their money and their lives more effectively.
  • Setting up systems to help caregivers get the hours they need to earn a paycheck that meets their weekly or monthly financial needs.
  • Providing education for Care Coordinators and Scheduling Coordinators to recognize conditions where caregivers are dealing with an economic issue that could compromise their ability to work.

I love this quote from Leila Jonah in her book, Give Work.

“Dignified, family-sustaining work is indeed more effective in lifting people out of poverty than any aid program because it enables people to experience the kind of freedom, adventure, and independence that people with money take for granted.”

What Are Mastermind Members doing to respond to Economically Fragile Caregivers?

You may be wondering what other companies your size are doing to deal with this issue?  One way to find out is to have regular conversations with leaders in other companies that don’t compete with you.  You can do that be being a member of a Home Care CEO Mastermind Group. You can explore that at






Stephen Tweed
Stephen Tweed, CSP, began his journey as a business strategist in home health care in 1982. Today, Stephen is among the top thought leaders in Home Care strategy and management. He has worked with top 5% companies from across the US. He is a sought after speaker at from national and state association events.

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