The Senior Caregiver Turnover Problem

Ask anyone who has anything to do with senior care about the biggest challenge facing the industry right now and you’ll get this answer: caregiver turnover.

Why is it such a problem? Have you ever dealt with the elderly? Let’s say you don’t like change — your favorite grocer goes out of business, your dry cleaner moves — annoying as hell but not exactly life-changing. Now imagine it’s the person who helps you with your activities of daily living — the person who bathes you, who feeds you, who wipes your bum — that kind of personnel change can be terribly, well, personal. Now imagine you are elderly, frail, and extremely vulnerable. That kind of change can shake you to your core.

As a senior care employer, caregiver turnover affects the bottom line. It costs to hire new caregivers, to recruit and interview them, run background checks, and train them to care for their senior clients. It costs home care agencies approximately $3,500 to replace one hourly employee.

Turnover rates for private duty in-home caregivers have been steadily increasing, from 39.4% in 2009 to 61.5% in 2014, according to Home Care Pulse’s 2015 Private Duty Benchmarking Study. Annual turnover rate can vary between 60% to 100% from state to state, according to research from the Institute for the Future of Aging Services.

Increasing caregiver shortages for long-term care demands we find out why caregiver turnover is so high and seek remedies to keep quality in-home caregivers happy and on the job. 

There are many theories as to why caregiver turnover is so high. Of course, most studies show that low wages, lack of benefits, and no overtime pay contributes greatly to senior caregiver discontent. Since 2000, there has been a 23% increase in home health care employment, while salaries have remained the same at about $21,000 a year, according to research conducted by the Center for Business and Economic Research at Ball State University.

The National Private Duty Association has said that requiring employers to pay time-and-a-half for overtime could mean that some seniors will have to have more than one caretaker because they require more than 40 hours of care a week, or costs for the family would be so high, seniors would not receive all the help they need.

What would help with in-home caregiver retention, besides higher pay?

We at Caregiverlist hear from a lot of caregivers. Of course, caregivers cite better pay as a big contributor to better care, other factors are also important. Here are some suggestions in-home caregivers have for senior care agencies that would entice caregiver retention:

Offer Ongoing Training
No one wants to feel stuck in a rut. By receiving ongoing training, caregivers feel supported and know that they are developing their professional skills. The majority of caregiver turnover occurs in the first 60 days of employment, most likely due to lack of confidence in being able to provide competent care. Training increases that confidence.

Give Recognition
No one goes into senior care to become rich. Caregivers are interested in helping people and most go into the job because they had experience with family caregiving. A simple “Thank You” and acknowledgement of a job well done can increase caregiver satisfaction.

Provide Mentorship and Community
In-home caregiving can be a solitary endeavor. Of course relationships are built between caregiver and client, but it’s nice to know that one is not alone in the challenges and successes experienced as a caregiver. Providing opportunities to share caregiving stories, brainstorm solutions to common problems, and find professional camaraderie may help agencies retain quality senior caregivers.

If you are a senior caregiver, what would help keep you on the job? Share your ideas in the comments section.

Honoring CNAs During National Nursing Assistants Week

We know the value of the professional nursing assistant. These are the men and women who work tirelessly to assist the elderly and frail under the supervision of RNs and LPNs. For many seniors (especially for those seniors who are aging in place, at home), the best CNAs provide care that greatly increases the quality of life for the most vulnerable of our population.

The 38th annual National Nursing Assistants’ Week runs from June 11-18, 2015 and  kicks off on June 11 with National Career Nursing Assistants’ Day, a day to recognize the dedicated nursing assistants who have committed 5 to as many as 58 years of their lives to the care and well-being of others. This year’s theme is “Nursing Assistants @ the Heart of Care,” Celebrating 38 years as a professional organization for nursing assistants and other direct care workers in long term care.

Now more than ever, direct care workers need to advocate for themselves and their vital importance in the lives of the fastest growing demographic in America — seniors.

William Painter, past president of the board of the National Network of Career Nursing Assistants, urges all professional caregivers to be proactive in making others aware of the indispensable contributions made by those in professional long term care. Here are his suggestions:

  • Use the Language of  Respect and Cooperation on a daily basis when working with clients, coworkers, families and the community
  • Make sure that you and your co-workers are registered to vote.
  • Educate yourself and co-workers about the political issues that affect your jobs and the care you give. (Check news stories. Pay special attention to articles about wages and benefits, overtime pay, parity, staffing ratios, safety on the job, and  job-training.
  • Get to know your lawmakers! Call your legislators. Write letters. Find out who the influential people are in long term care and contact them. Get a small group together and make an appointment to visit.
  • Practice your message and avoid complaining – be assertive and professional. It is your government and your money being spent! Don’t be chicken! They hear from the other “experts”, but if they are ever going to understand how it really is, they have got to hear directly from you!
  • Look for and create opportunities to speak to churches, civic organizations, seniors groups, etc.

The employment opportunities for certified nursing aides and assistants are plentiful. CNAs work in hospitals, nursing homes, assisted living communities, adult day care centers, and in the home through senior home care agencies. Over 2.5 million women and men are currently employed as CNAs.

If you are contemplating a career as a certified nursing assistant, be aware that you’ll need a high school diploma or equivalent, you’ll have to pass a background check and medical exam, and various vaccinations are required, depending on the requirements in your state.
Certified Nursing Assistant training requirements vary from state to state, and there are many CNA schools that will help prepare you to pass your state’s Department of Health certification and licensing exam. Program costs vary widely but some financial aid may be available.

Is a CNA career right for you? Visit Caregiverlist’s Caregiver Training Center to learn more about CNA job duties, take a look at some free senior care training briefs, and take some CNA sample and practice tests.

And if there’s a special Career Nursing Assistant in your life, take this opportunity to thank them for all they do and, moreover, help advocate for respect for their role in quality long term care.

Seniors Behind $300M Heist

They’re calling it Ocean’s 64, the Old Man Heist, and dubbing them “Dad’s Army.”

On Easter weekend this year, a three-day banking holiday, nine thieves made off with one of the largest heists in Britain’s history. In a scene some are comparing to the movie The Italian Job, 73 empty safe deposit boxes were found in the vault at London’s Hatton Garden Safe Deposit. Their missing contents were jewels, gold, and diamonds worth about £200 million ($300 million).

Eight out of the 10 men arrested on suspicion of robbery were in court on May 19 and much was made of their ages — which combined is just shy of 500 years. The oldest of the defendants complained that they had trouble hearing what the judge was saying. Another, it’s been reported, limped so badly that prison guards had to help him to his seat.

I always said 80 is the perfect age to conduct a heist, but these men were no beginners. In fact, in the case of oldest suspect, 76-year-old Brian Reader of Dartmoor, Kent, it was a chance to make the heist into a family business, as son and fellow suspect , 50-year-old Paul Reader was supposedly part of the crew.


  • Hugh Doyle, 48
  • Paul Reader, 50
  • Daniel Jones, 58
  • Carl Wood, 58
  • William Lincoln, 59
  • Terry Perkins, 67
  • John Collins, 74
  • Brian Reader, 76

There’s no doubt it was a professional job, and The Mirror aptly nicknamed the thieves suitably cinematic names — Mr Ginger, Mr Strong, Mr Montana, The Gent, The Tall Man, Moped Man and The Old Man. The job was incredibly intricate and physically challenging. London's metropolitan police released pictures of the scene.

After the thieves entered a side door dressed as workers, disabled an elevator and rappelled down the shaft, while carrying an incredibly heavy and powerful Hilti DD-350 diamond coring drill to get through the vault and at the safety deposit boxes.

While we at Caregiverlist certainly don’t condone unlawful behavior at any age, after reading about so many senior scams and the variety of frauds perpetrated against the elderly, it sure is interesting to see the tables turn and read about some older gentlemen who continue to “work” beyond retirement.

Sunday Dinner Pledge Encourages Family Meals with Seniors

We all know that good nutrition is one of the cornerstones of healthy aging. But for seniors living independently, it can be tedious (and lonely) to cook and eat healthy meals for one. Those who live in assisted living or nursing homes may take their meals with others, but have little choice in their mealtime companions.

In an effort to help promote meals with elderly family members, Home Instead Senior Care, a quality in-home senior care agency, is promoting the idea of establishing a regularly scheduled monthly sit-down dinner with family loved ones.

The Sunday Dinner Pledge is free and all it requires is that you pledge to bring back Sunday dinner with your senior loved ones at least once per month and discover how to make the most of being together. Sharing meals has been shown to help improve seniors’ quality of life.

Make that pledge by July 31 and the Home Instead Senior Care Foundation® will donate $1 to Meals on Wheels America (up to $25,000 total) for each person that commits to regularly scheduling family dinners at Meals on Wheels can then help ensure other seniors will enjoy quality meals through their program.

Food Network celebrity Chef Melissa d’Arabian along with a dietitian for the Home Instead Senior Care network present easy, nutritious recipes, healthy food plans, and detailed shopping lists for those who may need meal inspiration.

The website also features 10 conversation starters to help eliminate those awkward dinner table silences. Topics include family name origins and what’s on your bucket list. Along with topics, the website includes Action Items to help prep for the next dinner.

“It’s not about making the pledge, it’s more about just spending time with your family,” Sheryl Brown, community resource coordinator of Home Instead Senior Care in Fremont, Nebraska told the Fremont Tribune. “It’s also a great way from an intergenerational standpoint for the younger kids to learn about the experiences and the lives of older Americans and family members we have living close to us. It helps bring family together when you can have those conversations.”

Caregiverlist agrees. Bring back the Sunday family dinner!

Cartoonist Draws from Life of Senior Care

I love graphic novels. I spent summers at the lake reading Charlie Brown paperbacks. As the mother of an 11-year-old boy, I’ve seen my fair share of superheroes battling villains. The Diary of a Wimpy Kid series made Jeff Kinney a household name (at least, in my household.) But as much as love those books, no graphic novel ever spoke to my adult reality. Until now.

The ever-fantastic New Yorker cartoonist Roz Chast has produced a memoir of her life as a senior family caregiver. In Can’t We Talk About Something More Pleasant, Ms. Chast recounts the relationship she had with her parents during the final years of their lives, and with it she makes the exasperating, devastating, depressing, inevitable decline insightful and, yes, funny.

The only child to older parents, Roz Chast had heard stories about her family's perseverance through difficult lives including immigration, the Depression, World War II, and the Holocaust. Little wonder her parents just don’t want to face, or even talk about, death. Ms. Chast alone has to face that point when her parents were too old and frail to care for themselves in their Brooklyn apartment.

She tried to be the “perfect daughter” by coming in and cleaning, but her mother wasn’t receptive. As Ms. Chast puts it in her book, I wasn’t great as a caretaker, and they weren’t great at being taken care of. She shows the dichotomy of her feelings in a panel called Gallant and Goofus — Daughter as Caretaker Edition, where, on one hand, her Gallant says she “Treasures the time spent with her parents because she knows that soon, they’ll be gone,” yet her Goofus admits that “Mostly, when with her aged parents, wishes she were somewhere else.” Not only do I recognize this in the feelings I have toward my aging family, I also recognize that these are feelings my children will have some day toward me as well. Heady but funny stuff.

What follows is the requisite move into assisted living, along with her parents’ push-back, her mother’s decline as a widow, the double-edged sword of finding a great caregiver (shouldn’t a child be her parents’ best caregiver?), and, of course, the inevitable end, all handled with compassion (for her parents as well as herself) and humor. 

The best artists create in order to let us know we are not alone in our experiences and how we feel about them, especially if those feelings are difficult to confront. Roz Chast gives the reader an opportunity to see the universal challenges of caring for elderly parents in four-color panels.

The New Yorker as published a good number of sample panels on their site. Or you could just go ahead and buy the book. Read it for yourself, then leave it for your kids to read.

Senior Caregivers: Check Food Expiration Dates!

I hate waste, especially when it comes to food. But while spring-cleaning my mother’s refrigerator and pantry, I was more than happy to toss those foods whose expiration dates have come and gone. However, because of my near-pathological hatred for throwing away food and the fact that my mother lives on a very fixed income and can’t afford to replace perfectly good food, I decided to do a little research and see which of the foods were salvageable.

The rule of thumb is that the more processed a food is, the longer you can extend its expiration date. While it might not be at its optimum for taste, it doesn’t necessarily prove hazardous. Those foods with lower-to-no water content (like dried pasta, crackers), dry formulation (like cake mixes), and shelf-stable because they have been heat treated (canned foods) can be safe well past the package expiration date.

Seniors should still be careful to make sure not too much time has passed, however. In an extreme case of ingesting food well past its prime, a grandmother in Italy recently sent herself, her husband, their son, and their grandchildren to the emergency room  with food poisoning after making hot chocolate with chocolate sachets that were purchased in the 80s — 25 years out of date.

Seniors should try to buy only what they will eat in a relatively timely manner. Sometimes seniors will buy more food than they can possibly consume because they don’t get to the grocery store as often, so they’ll stock up. While not an issue with sealed pantry goods, it’s not a great idea with meat and dairy (unless it’s well-wrapped and put into the freezer.)

Older people are at greater risk for serious foodborne illnesses because of their lower immune systems. Contaminated foods make you sick within a few minutes or up to a few days after eating. Nausea, vomiting, diarrhea, stomach pain, headache, fever, and weakness are some of the signs that you should see a doctor right away.

The U.S. Department of Agriculture’s Food Safety and Inspection Service and the U.S. Department of Health and Human Services’ Food and Drug Administration has issued a booklet entitled Food Safety for Older Adults. In it, they cite the statistic that 48 million persons get sick, 128,000 are hospitalized, and 3,000 die from foodborne infection and illness in the United States each year. Many of these people are children, older adults, or have weakened immune systems (Centers for Disease Control and Prevention.)

Senior caregivers can proactively help their senior care recipients by learning more about food safety. And if there’s any food in the house that’s been there from before the fall of the Berlin Wall, I think it’s safe to say, “Toss It!”

California Caregivers Still Waiting for Overtime Pay

Many senior caregivers in California are waiting for their promised fair wage and overtime pay.

Back in January, United States District Judge Michael J. Leon ruled that in-home care workers are essentially companions and thus exempt from the Department of Labor’s mandated minimum wage and overtime pay for hourly workers. This is great news for third party employers like the Home Care Association of America, who state that if wages go up, so must the cost of care billed to seniors and their families.

California has one of the most stringent overtime pay laws in the nation.  According to the Department of Industrial Relations, a California employer must pay overtime at 1.5 times an employee’s regular rate of pay for any hours over an 8 hour workday or over a 40 hour workweek. Double-time is paid for hours over a 12-hour work day or when an employee works the 7th day in a week. The minimum wage in the state of California, as of July 1, 2014, is $9 per hour (an increase from $8), and an increase to $10 per hour is scheduled for July 1, 2016.

As reported on, more than 400,000 California caregivers are waiting for the ruling to be overturned. Until then, they are making 2014 wages with no overtime compensation.

It is an unfortunate debate, as in-home senior care workers make it possible for the elderly to stay at home and age in place. Even with minimum wage and overtime compensation, the in-home senior care industry saves families (and the state) money considering Caregiverlist’s® recent California Nursing Home Rating and Cost Index puts the average cost of a private room in one of the 1,320 nursing homes in that state at $257.57 per day, with some of the higher-end institutions charging over $400 per day. Of course, in-home senior care provides the one-on-one care that many elderly respond to best.

We at Caregiverlist, along with  the more than 400,000 caregivers, entreat California’s Governor Brown to fulfill his original commitment to treating in-home caregivers to the same benefits as all other hourly workers in California. The funds are already in the budget and cannot be used for other purposes. All of California’s in-home care workers anticipate the ruling to be overturned on appeal.

Chefs Make Housecalls for Seniors

One of the reasons a senior may finally choose to move into assisted living is for the meals. The elderly who live independently may decide that by the time groceries are bought, pots and pans are put on the stove, food is plated and plates are cleaned, it’s just too much trouble to cook for one. Many times seniors will microwave some high-fat, high-sodium, prepared and processed food. Not good for nutrition and certainly not good for the soul.

Chefs for Seniors out of Madison, Wisc. has been getting a lot of press lately, and with good reason. Their mission? They want seniors to stay independent a little longer by offering a service dedicated to improving seniors’ lives through food (emphasis theirs.) They’ve recently been featured on NPR and in Senior Housing News. The family-run company staffs vetted, licensed, professional chefs to come to shop and cook for seniors, right in their own homes.

Whole, healthy, homemade food is of course preferable to industrial, processed, mass-produced food stuffs. But taking a meal is so much more than the simple act of eating. Taking every meal alone, no matter how nutritious, delicious, and convenient it may be, can be a lonely proposition for those who are used to communal meals.

Perhaps with Chefs for Seniors, the community is had in the making. Owners Barrett and Lisa Allman, as well as their son Nathan, seem to understand that the relationship between a seniors and their caregiver (in this case, the person preparing their meals) is important and consistency is an issue. Outside of special circumstances, the company tries to maintain that unique client/chef relationship.

“Routine is important for seniors, so we try to keep the same chef coming to their home every week,” Allman told Home Health Care News’ Jason Oliva.

The chef can visit twice a week, weekly, or bi-weekly, based on the senior’s need and preference. After an initial consultation, a senior-specific menu is prepared, a chef is assigned, and then the culinary friendship is forged.

Like many senior care services, this one was born from family need. Allman told NPR that the inspiration for Chefs for Seniors was his wife's grandmother. She entered assisted living ten years ago, when she could no longer cook for herself. The family knew she could have stayed in her own home longer if she had access to nutritional and tasty meals.

But don’t give up on senior communities. Many assisted living facilities have also discarded the notion of industrial food for their residents. Chefs like Carol Koty at Lockwood Lodge at Masonicare at Newtown are providing restaurant-quality meals to the seniors for whom they cook. Caregiverlist recommends you thoroughly check into all your senior care options, from in-home care, specialty care (like Chefs for Seniors), independent and assisted living, and nursing homes for your specific eldercare needs.

Japanese Seniors to Get 5 Million iPads

Apple and IBM are partnering with Japan Post to provide 1,000 seniors with free iPads for six months beginning in October. If successful, the program could increase senior users to five million by the year 2020. iPads will be equipped with IBM-produced apps specifically geared to the elderly such as reminding seniors to take their medication, help them keep in touch with family, and assist them in finding local senior services in an effort to improve the quality of life for Japan’s senior population.

Apple CEO Tim Cook, IBM CEO Ginni Rometty and Japan Post CEO Taizo Nishimuro (who is almost 80 years old) announced the program in New York on Thursday. Japan’s elderly make up 25 percent of entire population. That’s about 33 million seniors. That number is projected to grow to 40 percent over the next 4 decades.

Japan Post Group, a government-owned postal service, bank, and insurer will train 400,000 of its employees on the iPads. They in turn will deliver the devices to the elderly. Currently, Japan Post service workers make elderly wellness checks and reports back to the senior’s family. This “Watch Over” program costs families $1,000 yen, or $8, monthly. It is not known if the iPad program will increase those costs.

“This initiative has potential for global impact, as many countries face the challenge of supporting an aging population, and we are honored to be involved in supporting Japan’s senior citizens and helping enrich their lives,” Apple CEO Tim Cook said in a press release.

According to the World Health Organization (WHO), the proportion of people aged over 60 years is growing faster than any other age group in almost every country. Between 2000 and 2050, the proportion of the world's population over 60 years will double from about 11% to 22%. The number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period.

Mashable gave us a peek at the iPad interface which includes large buttons, an emergency call capability, and other senior-friendly and senior-empowering features.

Image: Mashable, Lance Ulanoff

The proposed iPad program certainly can’t take the place of a one-on-one in-home senior care, but for millions of independent older people, especially with those whose families distance care, I think it will be a great care supplement.

A New Kind of Assisted Living

The term “Assisted Living” is the most one of the most Googled senior living search trends. Although aging at home is the preference of many seniors, if there are no family caregivers available and no in-home caregivers, that solitude can be an awful thing. Those who have chosen assisted living report a high degree of satisfaction with their senior living choice.

However, Baby Boomers, those born post World War II — between 1946 and 1964, are defining a new way of aging. They are living longer and more actively so it makes sense that they would seek to establish a new kind of senior living dynamic. When living alone and aging in place is no longer a viable or preferred option, they are choosing to age in communities of their own design.

Marianne Kilkenny is one such advocate leading the charge in bringing forth a new aging community model. She created and founded Women Living in Community (WLIC) in 2007. What began as a simple website has grown into a movement. WLIC brings together individuals, families, and professionals who are changing the face of senior housing options. The vision is to move from the standard aging elder institutional settings like assisted living housing and nursing homes to communities where neighbors care for each other.  

“Aging in Community is more than shared housing. It’s refocusing our outlook on aging from one that is medical and healthcare-centric to one that focuses upon community," Ms. Kilkenny writes on her website. "Wellbeing is more than healthcare; it’s emotional care and that kind of care comes from being surrounded by people we know, love and trust, not just by nurses and planned activities.”

Ms. Kilkenny has also authored Your Quest for Home: A Guidebook to Find the Ideal Community for Your Later Years. The workbook details the options for resident-created communities that might include co-housing and “pocket communities” where residents look after each other, care about each other, and support each other.

As with all senior living options, there are challenges to the model as well. Traditional assisted living provides planned activities. Unless a resident is proactive about getting yoga instructors to come to a central community location, or hire a van or bus to take groups on cultural outings, those perks won’t be available to those seniors who are unable to get out and enjoy these experiences on their own. More importantly, what sort of medical attention is available onsite?

I also think one of the keys to the success of these communities is to make sure they are multi-generational. If everyone in the community is aging together at the same time, how good is your brother’s (or sister’s) keeper when you are both in your 90s and need the same level of attention and help with the activities of daily living? And one of my biggest beefs with institutional aging settings is the age-segregation that naturally occurs.

I’ve always liked the idea of a Golden Girls kind of living arrangement where I wind up co-housing and cracking wise with a group of girlfriends (women generally outlive their male spouses.) Of course, these alternate retirement communities are not just for the ladies. NBC Nightly News filmed a shared housing model in Asheville, NC. featuring four women and one “Golden Guy”.

What do you think of this alternative to existing assisted living and nursing home models? Do you think this might just be the future of an aging society? What do you think would make this interesting atypical retirement community work even better?

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