Building relationships, skills keep aides at work

Cut turnover by recognizing aides’ priorities

(Editor’s note: This is the first of a two-part series that looks at home health aide retention issues such as training, supervision, and benefits. In this article, experts talk about factors that motivate and retain aides. In next month’s article, innovative programs that enhance aide education and tips on improving retention will be presented.)

You’ve added 401Ks and improved health insurance coverage to your benefit package. You’ve added extra vacation time for employees who stay longer than five years. You’ve also improved job descriptions and made your annual personnel evaluations more thorough and detailed.

This must be enough to attract and keep good employees, right?

Those are not techniques that will improve retention if you’re talking about home health aides, say experts interviewed by Hospital Home Health. The benefits and aspects of a job that will attract and keep an RN are different from the benefits and aspects of a job that keep home health aides, says Patricia Jump, RN, president of Acorns End Training and Consulting in Stewartsville, MN. "It’s hard to get people to acknowledge the hidden rules of class differences, but it’s important to do so in order to understand the factors that motivate home health aides," she says.

"Many home health aides are single parents who are living at or near poverty level and don’t have much education," Jump points out. "Their driving forces are survival of the day, their relationships with other people, and entertainment. This compares to professional staff or middle class staff members who are driven by job responsibilities and achievement," she adds. For these reasons, it is important to look at your agency from a home health aide’s perspective in order to effectively attract, manage, and retain these important paraprofessionals, says Jump.

Four ways to improve employee retention

In addition to recognizing class differences, Jump suggests four other ways to improve home health aide retention.

1. Learn to listen. "We are so busy in home health that we tend to multitask; but if you are talking with an employee, put everything aside and listen," says Jump. Informal talks in the break room or hallway, as well as more formal talks such as meetings or one-on-one scheduled meetings, can all be effective if you focus on what the home health aide is saying, she points out. "If an employee says that he or she doesn’t like the work anymore, don’t just accept it and move on. Instead, ask what did you like about the job before and what has changed?" she suggests. Don’t just make statements such as "We all have bad days."

Pay attention to feelings, because the employee may have been inappropriately touched by a patient but may be embarrassed to admit it, says Jump. By asking thoughtful questions that allow the patient to talk about their reasons for disliking the job, you may discover a situation that can be addressed and resolved, and keep the aide, she adds.

2. Put "people people" in supervisory and management roles. Because relationships are important to home health aides, you should not promote solely on the basis of skill, says Jump. "The relationship with patients is what attracts aides to home care, but it is the relationship with their supervisor, manager, and other co-worker that keeps the aide at your agency," she adds. Keeping home health aides happy and working at their agency is a special talent of HomeCare Options in Paterson, NJ, a home care agency that employs 350 home health aides with an average tenure of eight years.

"Several job satisfaction surveys we’ve conducted show that satisfaction with their supervision is a major factor," says Ken Wessel, MSW, ACSW, LSW, executive director of the agency. To make sure that supervisors are doing their job well from the perspective of the aide, the agency developed an annual supervisory survey.

The survey gives each employee a chance to rate supervisors in several areas including respect of the employee and feedback to the employee. (See survey form.) "This survey gives supervisors insight about the aides’ perception of their supervision," he points out. If the survey identifies some concerns about any supervisor, the supervisor receives additional training, he adds. "This survey and our follow-up actions show aides that we do care about their opinions," he says.

Another way to strengthen relationships is to make sure supervisors have face-to-face time with employees, says Jump. "Supervisors should visit patients at the time aides are there; they should talk with employees by telephone; and they should send thank-you notes or notes of praise to employees who have done something noteworthy," she says. "Also, look for ways to get your aides together. If you plan an inservice, allow a half-hour before the class starts for people to visit and talk," she says. "Make sure, too, that supervisors and managers are there for the aides to see as well."

3. Supervisors should be coaches. Don’t supervise in a punitive way, says Jump. Managers should not look at an employee’s performance only from the perspective of whether or not the aide is following the rules, she adds. "If an aide is having a problem, meet one on one in a respectful manner, and ask him or her to suggest some solutions," she says. "If the solution is suggested by the aide rather than dictated by the supervisor, it is more likely to solve the problem long-term," she says.

Be sure the employee knows what is expected in the job and what consequences there can be, but make sure employees know that one mistake does not necessarily mean dismissal, she points out. Be sure to find ways to recognize positive actions as well, Wessel suggests. His agency has a "Caught you doing something great" program in which supervisors can give employees coupons when they’ve done something worthy of praise. The coupons can be turned in for prizes or saved to accumulate enough coupons to attend the National Association of Home Care’s Home Care Aide Conference. Wessel says that four to six aides attend each year.

Your praise doesn’t have to have a monetary value, adds Jump. "Exit interviews show that one of the biggest reasons aides leave their jobs is that they don’t believe they’ve been appreciated or respected," she says. "A thank-you note, involvement in planning conferences, or recognition at a staff meeting or in-service, shows that you value the aide’s contribution and efforts," she says.

4. Teach aides problem-solving and other skills. Although a home health aide does not necessarily think in terms of developing a career, every aide wants to be as good at the job as possible, says Jump. "One skill that is critical is problem-solving," she says. Professional staff members learn problem-solving skills throughout their education, but aides have not, she explains. Although you can conduct an inservice on the topic, this is a skill that can best be taught one on one, she suggests. "If an employee has a problem with tardiness, walk him or her through the process of getting to a patient’s home," she says. Ask the employee to look at different reasons that contribute to the tardiness and have the employee suggest ways to solve the problem.

Also, teach aides to use past experience to solve problems, suggests Jump. "If the aide has a problem with a difficult patient, have the aide look back to other times with that patient or another similar patient and think about what helped previously," she says.

While it is important to give aides the training needed to develop job skills, it is also important to give them skills that improve their personal life, says Wessel. "We have many Hispanic aides, and more than 25% of Hispanic women drop out of high school," he says.

The lack of education along with the fact that English is a second language to many of his aides was the impetus for several initiatives that make it possible for aides to earn their high school equivalency degree, improve their English, and even receive tuition assistance if they choose to further their education beyond the high school degree. (Editor’s note: This program will be described in more detail next month.)

Because it is not productive or efficient to continually recruit and train new aides, it makes sense to evaluate your supervision, benefits, and training of the aides you have, says Jump. "Too many times, I’ve heard agency managers say that aides are going to leave anyway so there’s nothing that can be done. There are ways to keep aides at your agency, and it’s much easier and less costly to focus on retention rather than recruitment," she adds.

For more information about home health aide retention, contact:

  • Patricia Jump RN, President, Acorns End Training and Consulting, 12021 Shervin St. S.W., Stewartsville, MN 55976. Telephone: (507) 533-6204. E-mail: Web site:
  • Ken Wessel, MSW, ACSW, LSW, Executive Director, HomeCare Options, Two Market St., Paterson, NJ 07501. Telephone: (973) 523-5228. Fax: (973) 523-1224. E-mail: