The 4R’s of Senior Care: Recruiting, Retention, Referrals and Regulations


The 4R’s: Recruiting, Retention, Referrals and Regulations are truly the pillars of Senior Care. As we examine each “R”, I will do my best to give you practical insights. Some ideas that you can ponder and others ideas that you implement right away.

As you may know, my background was in hospitality, hotel management, prior to joining IPCed and OnCourse Learning.  The service industry has similar challenges to senior care, particularly with respect to recruiting and retention, and I’ve learned a few things along the way that will be helpful. One thing I can assure you is that your training program will make a difference. Look at Waldorf Astoria, Four Seasons or Ritz Carlton… each of these brands is synonymous with award winning quality. Each having exceptional training programs that are customer focused and drilled into their entire staff. And, if you look at leaders in senior care… I bet my bottom dollar that they have incredible orientation and training programs that focus on exceeding expectations and developing cultures of continuous improvement.

Okay, so where do we go from here? Let’s take a closer look at each of these business critical R’s and see if we can’t improve our key indicators as we begin with Recruiting.


Is anyone else worried about where you will find the best and brightest candidates? Unemployment levels are decreasing… demand for senior care services are increasing.  Are you asking yourself, will I have enough caregivers? You are not alone. When asked if owners and administrators are concerned about caregiver shortages, the overwhelming answer is YES! 7 out of 10 in the Home Care environment are concerned and Senior Housing Communities even list it as their #1 threat. WOW!

Here is the reality of our current situation in numbers… 2.5 million caregivers will be needed within the next 10-15 years as the “greatest generation” is rapidly being replaced by the first wave of baby boomers with no end in sight. Feeling better? It’s good to know that you’re not alone, right? So how do you identify and recruit the best and brightest?

One of the strongest messages that we can send to prospective candidates, and we heard it from Anne Lise Gere taking about the Millennials in a recent webinar, is focusing on the “WHY” of caregiving. Providing care is a wonderful opportunity to make a difference in a life.  Caregivers, literally, can change lives, families and entire communities with their positive impact. Many of us have seen that individual who is making a difference because they have chosen to serve and care for those who cannot care for themselves.  There are very few occupations that provide this opportunity to impact so many. It’s your job, as the employer, to promote your “mission” and focus on the rewards of a job well-done.

Challenge Commitment. Don’t sugar the job responsibilities. It’s hard work. At times, it’s dirty, smelly work. It’s not for everyone.  The sooner you can disqualify a candidate that is just looking for a job, the sooner you can find that individual who is committed to making a difference.  Highlight those stories of the client who wasn’t able to get out of bed, eat a full meal, or stand on their own… but through the loving care of their caregiver, their situation has changed.  They are gaining functionality and it was the caregiver who made the difference.  That could be you!  Several of my clients actually assign training and then measures how they do… how fast they complete the assignments and how well they score on the tests. It gives them a very good indication of future success and commitment, plus they will already have some of their training completed before they start.

Invest in Training and Professional Development. Brand your organization as a change agent in your community. Promote your training plan that leads to career growth. Let your applicants know that they can literally advance from a no-nothing to caregiver, caregiver to supervisor, supervisor to manager, manager to administrator and even owner if that is their desire… More and more job seekers are looking for a career path and they will judge you based on your mission and your dedication to quality training.  When you can demonstrate your organized, methodical, quality content and training schedule that provides the opportunity to acquire new skills, learn and grow through regularly scheduled training classes, and apply their knowledge daily caring for clients, becoming a mentor and sharing their success… you have a solid recipe for attracting the best and brightest.  Avoid the “any job” or warm body applicant. Most of us have felt like this was our only alternative… you’re at wits end, you need staff and hiring a warm body seems like it may pay off.  Ask you yourself, are you feeling lucky? Look back, how did this strategy work out in the past. I truly encourage you to avoid a knee jerk reaction and I understand it’s much harder when you’re facing huge demands.    One way to avoid the warm body syndrome is positioning your ad in a way that solicits “the heart of a servant” – if that’s you, then please apply. Craft your want ad with your mission statement, your goal of positively impacting the outcome of your clients or residents. How you will provide the tools and the support if they have the desire.


Okay, now that you’ve hired the best… how do you keep them from heading down the street? Many in the industry think that high turnover is just a fact of life.  I’m here to tell you that high turnover, even 30% or more, doesn’t have to be that way… and frankly, the impact of high turnover can be devastating, even fatal for businesses. Sure, there are the hard dollar costs (or potential savings if you can retain a higher percentage) for turnover. Think about it… better yet, add up the costs, in terms of both time and money… and time is money, so be honest in factoring in the wages toward each of the hiring and onboarding activities, not to mention the potential negative effects on your clients or residents. Your reputation is at stake. Do you want to be known in your community as the leader in the market, the employer of choice because your team is always there and provides the best care? Or, do you want to be “brand X” that everyone else is talking about and you may never hear it to your face but your business will suffer… suddenly, clients move out, phone calls and appointments go unreturned, revenue and billable hours begin to decline.  When you are unable to care for those entrusted in your care, then the end is near. Maybe you are facing this situation and saying to yourself, how can I change?  What must I do to right the ship and turn this thing around. There is hope. You can make a difference and no matter if you are new and building your reputation, you have a spotless reputation or your reputation is somewhat tarnished… here is what you can do to get it under control.

Become the Employer of Choice! Invest in your people. You can see the stat’s.  Almost 7 out of 10 caregivers want a formal training program. I love the Gallup polls that measure employee engagement. They look at stats on whether employee’s basic needs are being met, are they valued and appreciated by their supervisor, is there a culture of personal learning and growth, and are there co-workers and friends who share the “mission” or commitment of the organization?  All of these things are important and they can all circle back to your training practices that will help mold and shape your culture. Many of you have a FEAR… what if I invest in my people, train them to be the best caregivers and they leave? They go down the street to a competitor. What then?  May I suggest that we will explore ways to retain them, knowing that everyone will not stay, some will go, and we can only wish them well… but we will work our tails off to keep them.  Stay tuned. And consider, what if we don’t train or we only provide the minimum to get by, and they stay.  Is this strategy going to help us build our business?  Are we positioning ourselves become the employer of choice?

It’s the whole package that determines whether or not your best and brightest stay. Let’s look at some ways we can reduce turnover by focusing on these three key areas:  salary and benefits, scheduling and life balance, and opportunity for advancement.

What can I say about salary and benefits?  Be competitive with wages and care plans. There are plenty of surveys, including well-respected Gallup polls, that rate other items ahead of compensation when it comes to employee satisfaction, but salary and benefits are important. Be competitive within your market… don’t be the cheapest, but you don’t have to be the leader, be fair, be competitive. For some of you, that may mean changes your current structure of compensation packages. Do an annual wage and benefit survey to make sure that you are truly competitive.  Then work hard on other areas that can make a difference for your staff.

Scheduling and life balance issuesWorkplace flexibility is becoming a major factor in retention strategies. If you can highlight your commitment to a flexible workplace and your ability to accommodate life’s demands, you will set yourself apart. Don’t get me wrong. Reliability and dependability are critical to your success, so flexibility doesn’t mean that you tolerate unreliability. What you can do is allow your staff greater flexibility as they demonstrate their commitment to you and those entrusted in their care.  What does look like? Get creative. Perhaps, you have an employee that is really dedicated to knowing, understanding and working with clients that have a particular condition, such as diabetes, Parkinson’s or dementia… offer them added training on their chosen topic, then give them first choice for new clients with that condition. Give scheduling preferences to those who produce 100% time and attendance records during the previous month or pay period. Offer rewards or bonuses for dependability, covering shifts or added responsibilities.  If you can incentivize positive behaviors and promote these ideals to your staff, then everyone will be rewarded. Your team gains some tangible benefits and recognition, and you create a positive culture that rewards the behaviors you desire.  When we talk about flexibility and scheduling, it’s critical to clarify the importance of how your employees’ work schedules impact their clients’ well-being, and their co-workers and your company’s reputation. Investing in your employees’ happiness with flexibility in scheduling will pay dividends in client satisfaction as well as their loyalty to you… their employer.

Opportunity for Advancement. I want to wrap this in with employee engagement, so let’s put ourselves in our staff’s shoes. Why do I stay there? Do I have a good relationship with my supervisor? Depending on your care setting, you may have to work a little harder on this one. Each supervisor should schedule weekly or regular one-on-one meetings with everyone on their team. This opportunity for connection, developing relationship and understanding your staff is huge. This is your opportunity to chat about wins or positive outcomes – celebrate with them.  It’s also valuable time to uncover frustrations or obstacles to their success, so you can create a plan to mitigate or remove issues or barriers before they become “unfixable” in the eyes of your employee. This investment of time into your team will build loyalty as you appreciate their effort, learn from their experience in the field and commit to continuous improvement.  By the way, this process should start at orientation, where you set the tone for expectations and future opportunities.  Offer a 30-60-90-day training plan with goals and benchmarks. Tick off each accomplishment on a checklist. Gain feedback on the process and set semi and annual goals with review dates to keep each employee learning, growing and striving to accomplish more, take on more responsibility as they demonstrate their commitment to your mission that rewards their efforts with clear direction, and a career path with promotion and advancement opportunities. Set that roadmap from the get-go, then support and measure their progress. You may be surprised by how fast some of your employees advance.


Referral marketing.  Word of mouth. Buzz. People talking about you and your team. Reputation. How can you increase referrals?

First, identify you key referral sources that may include past and current clients, discharges planners at medical centers or rehabilitation facilities, government waiver programs, or geriatric care managers. You may have other sources, like elder law attorneys, grief counselors, social services, faith-based services to seniors, or even bulletin boards at the local grocery store. The key is to ask prospects how they heard about you!

Second, track your conversions.  Keep a record and review your results monthly. Note trends (upward or downward) and create action plans that may include advertising or other activities. When you do activities, focus on those that build and enhance your reputation in your community. Everyone on your team should be promoting your business… asking, if they know anyone who might benefit from your services.

Review your business plan and make sure that you are reinforcing your MISSION. Creating positive outcomes for your clients!  Here’s how we achieve more positive outcomes than our competitors… better trained, better equipped, more motivated to accomplish the best possible care and reinforce your mission at every potential moment of truth (prospect or client interaction).  Oh, yea… 83% of clients are WILLING TO PROVIDE A REFERRAL but only 29% ACTUALLY DO. ASK FOR THE REFERRAL. That means that you may have to hire a business development or community outreach person, if you can’t commit to getting out of the office for calls, meetings, events and relationship building in your community with key referral sources and future prospects.

Now, I’m going to switch gears a little bit and share some staggering statistics and try to get you thinking outside the box.  Beyond the traditional methods. The Family Caregiver… and there are an awful lot of them (estimated to be one out of seven or eight Americans).

As some of you know, I was the primary caregiver for my mom. She was diagnosed with dementia, so my wife and I brought her into our home to care for her… until we realized that we physically and emotionally could not provide the level of care that she needed. I’m going to talk about the family caregiver and how you can support the family caregiver. Some of you will say or think… why do I want to support or help the family caregiver?  Won’t that just lessen my chances to provide care? If I give them education, some basic practical applications, tips and point them to other resources… they will never need me.  Let me tell you that nothing is further from the truth.  The truth is that by supporting the family caregiver, you become their trusted advisor.  You can create the resources to become a trusted advisor and offer a supporting role in a variety of ways within your local community, including speaking engagements.  The bottom line is that when they come to that point where they can no longer care for their loved one… and they will. If you’ve positioned yourself correctly, most will call YOU because you were there for them. Trust me, it might be 2 days, 2 weeks, 2 months or 2 years… that day WILL come and you will probably know about it before they do. They’ll be at their wits end, not knowing what to do or where to turn.  Will you be there for them?  Where can they go for help? 

At minimum, compile and offer resources in your marketing materials, assessment packages, website and make sure that your entire team knows how to share basic information that will help the family. The goal is to connect with the family caregiver and the families BEFORE they even know they will need you. If their loved one hasn’t gone through a hospital or rehab center discharge… how do you connect?  Where are they and how do you find them? We’ve developed a tool called the Family Learning Center this is quite remarkable and generates those connections. You can build your own catalogue of resources that support families. I can’t overestimate this opportunity… the sheer numbers of family caregivers. The huge need they have to be supported. The void in the marketplace to provide assistance for families. YOU CAN MAKE A DIFFERENCE!


Regulations. Compliance. Changes. New Laws, new rules, new reg’s. How do I keep track? It’s gives you a headache just looking at this, doesn’t it? Compliance is critical. What happens if you are out of compliance… at minimum it creates more work: writing, submitting and executing plans of correction. At worst, it’s all that and a heavy fine.

Local reg’s, State & Federal, plus your own certifications of licensure. It’s a full time job to keep track of existing requirements and ensuring you and your entire team are in compliance. There is legislation pending in more and more states with stricter guidelines, more rigid regulations and get ready… for those of you in areas where your regulations or minimal or non-existent. The times they are a changin’. Will you be ready?

Last year, we saw the largest fines levied in our industry. Lots of HIPPA violations for data breaches by large healthcare groups, but down on our local level, fraud, fines and more and more… public records of violations publicized. Media loves this stuff.  How do you protect yourself? I know it sounds like I keep repeating myself, but training is the key. Think of your training as the ounce of prevention that will yield a pound of cure.  The consequences of regulatory violations are not limited to more work and fines.  Your reputation is at stake. Reputations take a long time to build, but can be crushes with one bad review or one serious violation.  Here’s what you can do.

  • Know the regulations (local, state, federal)
  • Manage certification requirements
  • Join associations
  • Participate in legislative affairs
  • Anticipate future regulations based on trends
  • Implement training programs in advance           

So, what do you think about the Four R’s of Senior Care?  We’ve reviewed Recruiting, Retention, Referrals and Regulations… you may have some ideas, so be sure to send me your thoughts at  Thanks for keeping the conversation alive!

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