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Rising salaries increase importance of retention
Nonmonetary efforts attract and keep employees on the job
The good news for respondents to the 2004 Hospital Home Health Salary Survey is that 85% of survey respondents saw their salary increase between 1% and 6% in 2004. Even better news for 10% of respondents was the 11% to the more than 21% increase they received. (See chart.)
What’s the bad news?
The bad news is that home health managers are having to face increasing salaries at the same time they try to attract new employees and deal with shrinking reimbursement. Experts interviewed by Hospital Home Health point out that there are ways to recruit and retain employees without resorting to salary wars.
Judith Walden, BSN, CHCE, director of Castle Home Care in Kaneohe, HI, admits that she is fortunate in many ways. "We have little turnover and we are continuing to grow," she says. "We do not offer financial incentives to attract new employees, but we do pay at the same level as the hospital, and we offer flexible hours and good benefits," Walden explains. These benefits, along with little competition in her area, have made it easy to fill positions as her staff size increases, she adds.
Does hospital affiliation help?
Hospital affiliation can be a plus when it comes to offering benefits, as 40% of survey respondents who report hospital affiliation can attest. The other 60% of survey respondents report that they work in freestanding agencies. Ownership or control of home health agencies represented in the survey ranged from 5% owned by colleges or universities; 10% controlled by state, county, or city government authorities; 35% owned by a for-profit entity; to 50% operated by a nonprofit corporation. The greatest percentage of respondents, 45%, are located in the Midwest, and 30% are located in the West.
"We offer a traditional benefit package for full-time employees that includes health, dental, life, and disability insurance along with a 401K plan," points out Lawrence M. Leahy, MHA, CHCE, vice president of business development for Foundation Management Services, a Denton, TX-based company that owns and manages home health and hospice agencies. "We have seen a reduction in our home care staff and our administrative staff, but our hospice business is growing. Turnover throughout our agencies is moderate but more prevalent within the home care agencies," Leahy adds.
Why do staff members leave?
The major reason for employees leaving their agencies is movement out of the area, according to Walden and Leahy. This is an issue rural agencies deal with on a regular basis. Only 15% of survey respondents are located in rural areas, with 10% located in urban, 25% in suburban, and 45% in medium-sized cities.
Neither Walden nor Leahy report any problems finding new employees because their agencies have excellent reputations as employers within their communities. "We occasionally use newspaper advertisements, but our reputation means that word-of-mouth advertisement about openings works best," Leahy notes.
Because her agency offers competitive benefits and salary, Walden also points to word of mouth as the best way to attract new employees. "Our best recruiters are our current staff members who have friends in other home health agencies."
Employees who can handle their jobs
Even when it is easy to fill positions, it is important to make sure you are getting employees who have the experience and skills to handle the job. Salary survey respondents carry impressive credentials with 25% holding RN licensure and 20% holding graduate-level degrees. (See chart.) Years of experience also are present in survey respondents with 20% reporting between 10 and 12 years of experience in home health and another 25% reporting between 13 and 18 years of experience. (See chart.) When asked how long they have worked in health care, 45% of survey respondents report more than 25 years, and 30% report between 13 and 21 years of health care experience.
Even if your agency isn’t experiencing high turnover rates, look carefully at your staff members’ ages to predict future turnover. Only 10% of survey respondents report their age as younger than 30, while 20% report their age as between 36 and 40. (See chart.) The most significant response to the question asking age was the 45% of respondents who indicated that their age was between 46 and 50.
Income levels follow age and experience with 50% of survey respondents reporting incomes of $70,000 per year up to $130,000 or more annually. (See chart.) Thirty-five percent of respondents reporting income higher than $70,000 carry the title of vice president/executive.
Offer your staff opportunities to advance
One of the keys to retention of good employees is offering them a chance to advance in responsibility, education, or professional certification, according to Leahy. "We offer internal continuing education unit programs, career ladders for all staff members, opportunities for staff members to develop new programs, and support of professional certification," he notes.
No one promotes home health as an easy job if they want the new employee to begin work with realistic expectations. In fact, only 30% of survey respondents report working 40 hours or less each week. (See chart.) The majority of respondents, 60%, report working between 41 and 60 hours per week, while 10% report working more than 65 hours each week.
Leahy’s agency is up front with new employees. "We describe our culture which includes hard work, but we also offer fun and a management team that promotes friendship," he states. Perhaps the most important aspect of working with Leahy’s company is that employees do participate in decisions that affect them, he points out. "Our company is supportive of the individual, and we have developed a team approach to accomplishing our goals," he says.
Leahy also points out that sometimes you have to keep your eyes and ears open to find good employees. "I am involved in a start-up hospice in rural Texas and have not had to advertise for any positions," he notes. "For example, while negotiating a contract for inpatient services, I found out that the administrator’s wife had tried to volunteer numerous times [for] our major competitor. I had lunch with her and found out that she had not only been a hospice volunteer but had also been a volunteer coordinator for a large hospice in Central Texas," he explains. "Needless to say, she is now our volunteer coordinator," Leahy concludes.
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