Caregiver Tammy Hynicker pushes Ann Enck in her wheelchair inside Enck's Ephrata home.

Tammy Hynicker loves her job, for the most part.

Hynicker works for Independent Living Services, providing in-home personal care to the elderly and adults with disabilities.

“I find my job rewarding, because I have the chance to assist consumers with the things we do daily for ourselves and take for granted,” she says.

“I also like hearing from the consumers how much they appreciate what I do for them. It makes me realize how important we are to them.”

But Hynicker, 45, a seven-year employees, isn’t wild about every aspect of her job.

“Some of the stresses of the job are dealing with (the consumer’s) family and the progression of the consumer’s disease or disabilities,” she says.

“Learning new levels of care and figuring out the best way to help consumers based on their needs and abilities to assist or not is also stressful.”

Stress is one of the factors that contributes to an incredibly high turnover rate in the caregiver industry.

The turnover rate is not only an issue for the caregivers, but also for  providers and consumers.

Providers are constantly scrambling to fill vacancies, spending large sums of time and money on recruiting and training.

Consumers are having to frequently adjust to new caregivers who are hustling to learn their needs.

But Lancaster-based Independent Living Services is trying to stem the tide, by launching initiatives to combat   burnout among its 175 caregivers.

The initiatives — which include more hours, better training and more support — are hoped to cut its annual turnover rate from 60 percent to 40 percent.

Independent Living Services is a division of Accessing Independence, which is an entity of the United Disabilities Services Foundation.

Spearheading the effort to reduce turnover are Shari Franey, executive director of Accessing Independence, and Byron Boyd, program director of Independent Living Services.

“We recognize that there was a need to do something,” Boyd says. “We took a look at the industry and saw a high level of attrition and burnout.”

Turnover on the rise

Caregiver turnover rates have risen steadily in the past few years, from 39.4 percent industry-wide in 2009, to 61.6 percent in 2014.

The figures come from a study released earlier this year by Home Care Pulse and the Home Care Association of America.

“These are traditionally jobs that are underpaid and underappreciated,” says Boyd.

“The people who do these jobs are providing a service and fulfilling a need, but the reimbursement rates are miniscule, especially compared to working in a hospital setting.”

And, he adds, personal caregivers are performing intimate care, often for people who wish they didn’t need help, which can add to stress on the caregiver.

“You’re asking people to accept a stranger into their home for a service they need, but don’t necessarily want,” Boyd says.

To start their initiatives, Franey and Boyd are focused on finding and retaining quality caregivers.

“We need to find the person whose purpose matches ours,” Franey says.

“For our best caregivers, this is really about a mission for them, instead of a job. If we can find these people, that will alleviate the number of people that leave us voluntarily.”

Holistic approach

But their strategy goes far beyond the hiring phase. Franey and Boyd are using a holistic approach. They want to do what they can to convince caregivers to stay on the job.

“If we want to retain quality caregivers, we have to be able to provide hours,” Franey says.

So the agency plans to provide full-time jobs even though it will cost more in salaries and benefits.

“We’d rather put money on the back end and retain really good people,” she says. “We want to be able to offer full-time work for our caregivers so that will cut down on a caregiver needing a second job.”

Boyd adds that spending money on the back end will reduce the upfront expenses that go into traditional recruitment methods.

“A lot of money goes into recruitment — job fairs, ad placement, background checks, drug checks,” he says.

“All of this money goes into hiring people who may not last 90 days and then we have to start all over again.”

Franey and Boyd are also working hard to make sure their caregivers have the support they need to do their job well.

“We created a lab in both of our facilities,” Franey says, noting that Independent Living Services also has an office in Tamaqua. “We’re offering hands-on training.”

The lab, which opened in September, shifts the focus on training away from just communicating what needs to be done to an active learning experience, where caregivers can see firsthand how to do many of the tasks their job requires.

“We need to make sure they feel fully confident in what they are going to be doing in the home,” Boyd says.

Safety mentors

To better support caregivers, Accessing Independence also has started a safety mentor program.

“They work between the clients and the personal care attendants,” Franey says. “When a caregiver is going into a new home, safety mentors look at the home for safety issues, offer training on what is the best way to take care of the client and evaluate caregivers.”

In addition, the agency has created a transitional care attendant position for experienced care attendants.

“When we get a new client, this is the first person to go out to that person and assess their needs — everything from what they like to eat to how they like their house arranged — and then they bring in the long-term care attendant and transfer their knowledge over,” Franey says.

The mentor and transitional care attendant positions also offer a career advancement track for personal care attendants, which is rare in the industry and provides another attractive reason to stay with the company, she says.

Hynicker, who is a transitional care attendant, says the position allows her to provide a better level of care.

“It’s allowing one person to become familiar with a new consumer and their level of care and then train the caregiver with more specific care for that person, rather than general training,” she says.

To gather feedback on their initiatives, and to show appreciation to their staff, Franey and Boyd have organized quarterly employee satisfaction days as well.

“We have food and a celebration and some training, too,” says Boyd. “We also use the time to solicit feedback from our (personal care attendants) and give them company updates. The field staff and the office staff can feel like two separate teams and we want to work as one cohesive unit.”

Although they only launched the initiatives in the last few months, Franey and Boyd are optimistic that they can reduce turnover rates for their agency.

“I would like to see us at a 40 percent rate in a year,” Franey says.

Chuck Manners, board chair for Accessing Independence, says the board has fiscal oversight of the agency and supports the need to improve the quality of care while being financially responsible.

“We’ve looked at the numbers and understand the costs of constant recruiting and turnover,” he says. “It’s either, continue to do the same thing and expect a different result, or try something new and see where it takes you. We think this has a lot of merit. We’re very optimistic. Byron and Shari are really bringing a lot of good ideas.”

Boyd points out that the initiatives are a work in progress and that the agency is striving to continue to improve.

“Nothing we’ve come up with is coming straight from us. We’re asking the (personal care attendants): What do you want to see? What can we do better?” he says.

The bottom line, Boyd says, is to focus on improving the satisfaction of both the client and the caregiver.

“If you want happy and satisfied consumers,” he says, “you need happy and satisfied employees.”

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