The Four Reasons Caregiving Organizations LOSE Clients

Let me preface this blog by stating the obvious: Losing clients is not good for organizations in the caregiving business. Duh, I know. Don’t tune out yet, I promise to say something of value soon. While there is one obvious circumstance where losing clients is a natural part of the caregiving world, losing clients outside of that natural process is more than just bad for the bottom line. It’s a sign that there might be bigger problems within the organization.

In order to identify those problems, their causes, and their solutions (they won’t all be what you think), let’s take a closer look at four main reasons caregiving organizations lose clients. In no particular order, they are: death, admission to a hospital or higher level facility, leaving due to issues with quality, and inability to manage the complexity or acuity of the client.?(What about money? Clients might say they are leaving for financial reasons, and, of course, sometimes that is true. It’s more likely though that clients are leaving because they are unhappy or can’t see the value in a service that doesn’t seem to be living up to the hype. But, let’s put a pin in that topic. It’s worth it’s own dedicated entry.)

So… death. Of course, this is the inevitable end for us all. It’s that one natural part of the caregiving world I alluded to earlier, and it’s probably the way most caregiving organizations prefer to lose clients. To be clear, I’m talking about a true best-case scenario here. The person lives their longest, highest possible quality of life and passes gently in their sleep, surrounded by loved ones. In this situation, loss of a client due to death means the organization was able to help that person to the end of their days, which is nothing less than an honor and a privilege. But…. What if that death is due to a preventable cause? A fall or injury? Sepsis from a decubitus ulcer or UTI? Aspiration pneumonia? If clients of a caregiving organization are passing as a result of these issues, it’s likely that some if not most of them could be prevented with the provision of a high quality, strategic training program. Because?preventing these issues isn’t rocket science. It’s actually fairly straightforward in most cases. We simply need to share that knowledge with the caregivers who are in the best position to prevent, observe, and report new problems.

Okay, second cause: Admission to a hospital or facility. Of course, there are many reasons why someone might need to be admitted to a hospital or to a higher level of care that are out of the caregiving organization's control. Heart attacks, strokes, degenerative conditions….. BUT…. There are plenty of admission reasons that are HIGHLY PREVENTABLE. According to the CDC, there were over 9 MILLION fall related injuries in 2016. According to a study from OIG documenting adverse events in long term care residents with Medicare, 59% of adverse event infections were considered preventable, and over 87% led to hospitalization. Of those, an estimated 71% of all UTIs were deemed entirely preventable. And if it’s preventable, we can train caregivers to help do just that. I promise.

Now….. quality. This one requires a little more depth, because quality issues can often be separated into 2 distinct complaints. The first: missed shifts/caregiver availability. While there is evidence that improved caregiver education can keep caregivers with organizations, there are often economic and logistical barriers that can prevent caregivers from making it to a shift. Many caregivers have difficulty accessing reliable transportation, and many are also parents who deal with the same child care issues all parents struggle with. Because of the nature of these barriers, you might be surprised to hear that my recommendations for missed shifts are not centered around education and training (shocking, I know.) Pragmatic solutions for these logistical challenges could include investing in a small budget for ride sharing when caregivers have car trouble, child care programs for caregivers with sick kids, scheduling a floating aide in residential facilities, or simply having a reliable caregiver on-call. All of these are options that can significantly cut down on missed shifts.

The second quality complaint is based on different factors entirely. Clients and/or their families leaving because caregivers don’t know what to do. Talk to just about anyone who has ever had an older relative (yes, that’s basically everyone) and you’ll hear nightmare stories about caregivers causing injuries, or not knowing how to provide basic care. I’d reckon many home care owners were driven to open their businesses as a direct result of a poor care experience. Heck, my own grandfather-in-law (one of my favorite people who ever walked the Earth) had his PEG tube torn out because his caregivers didn’t understand how to properly secure it. Seriously. Bad.?

The point here is not to shock you with awful stories, or badmouth caregivers. It’s actually the opposite. It’s to highlight the obvious fact that when we place caregivers in difficult situations, without providing the ESSENTIAL knowledge to navigate those situations, THINGS. GO. WRONG.?

So, if quality is a common complaint, or if you have clients leaving and you’re not sure why…. There’s an excellent chance that the current level of training your caregivers have is low quality, inconsistent, or both. And let me be clear. CAREGIVERS are NOT the problem. They are busting their butts. The lack of strategic, high quality, consistent and accessible TRAINING is the problem.

This leads us pretty squarely to number 4 on the list. Clients who are or who become too complex for the caregiving organization’s workforce. Now, I am NOT suggesting that non-skilled caregivers act in the role of nurses, therapists, or other skilled providers… BUT, I am going to point out the FACT that when the nurses, therapists, doctors, and everyone else leaves and goes home…. The only one left standing is the caregiver. The “skilled” providers are gone, but the caregiver is left holding the bag. They still have to clean that person, feed that person, move that person. And so when caregivers and caregiving organizations find themselves in over their heads, they are forced to either tell the client they cannot meet their needs, or put caregivers and clients into the precarious position of crossing their fingers and hoping for the best. Neither one of these options is good for the client, the caregiver, or the organization! Providing the correct level of training is the only real solution to protect all three.??It is not only unjust for the caregiver but potentially disastrous for the client (and organization) to leave a caregiver without the requisite skills to perform those jobs safely.

....Heavy... I know. I promise I'm not always such a Debbie Downer. But, in all my life experience - As a therapist, as a business owner, as a mom and a wife - I've never once solved a problem by pretending it didn't exist. And these problems CAN be solved. If you see these problems in your caregiving organization, reach out to me. I'm here to help.?