The first 90 days of a home-based care worker’s employment serve as a critical tipping point for retention, and industry leaders have found that transparent onboarding process and early engagement practices ca helps new workers feel prepared for work that can often feel isolating.
Leaders from TheKey, Elevate Home Health and DispatchHealth said retention efforts must begin before a caregiver’s first day, with clear job expectations and a high-touch hiring process, then continue through early training, connection with managers and reinforcement of company culture.
Emily Crater, chief people officer at TheKey, notes providers should not rush to put caregivers to work in clients’ homes just because of the labor shortage.
“There is a dire need. We needed this person five weeks ago. We have them now,” Crater said. “So it’s, ‘Well, that stuff can wait. I just need them out in the field starting to see patients tomorrow.’ Those things rarely, rarely turn out well.”
TheKey, based in Delray, Florida, offers home care, memory care and other specialized services across 29 states and in Canada. The company has also told HHCN that it plans to expand its home health offerings throughout 2026 and beyond.
Effective retention includes implementing strategies well before the caregiver’s first day, requiring a robust pre-hire process. As an industry competing with service and hospitality industries, the pre-hire process must be high-touch, thorough and flow easily, Crater added.
The pre-hire process should clearly establish expectations, said Katie Wiseman, vice president of clinical operations at Elevate Home Health.
Setting expectations should include transparency into all elements of a job in home care, Wiseman said. While home care offers caregivers more autonomy, it’s also lonelier compared to other more structured, controlled environments, she said, like a hospital.
“If we weren’t transparent at the very beginning about what they’re walking into — being transparent about what is happening, what the expectations of the job, what a day in the life is really like — if that’s not clear from the very get-go, we’re running a really high risk of turnover early on,” Wiseman said.
Elevate, owned by Covenant Care, offers home health and home care services from six branches across California.
At DispatchHealth, leaders are focused on shifting onboarding from a process to an “experience,” according to J.T. Hedges, chief people officer.
“That experience is different depending on your role in the organization,” he said. “For our providers, that’s an opportunity to provide a well-structured early experience with the company that’s supported, it’s purpose-driven, and it’s helping ramp to ultimately being more in that independent stage of providing care in the community. … That is what’s going to help us drive retention.”
Denver, Colorado-based DispatchHealth is a leader in hospital-at-home services. The company merged with fellow hospital-at-home player, Medically Home, in 2025.
First day and beyond
With the prep work of expectations in place, providers must then ensure that a caregiver’s first day on the job is informative and engaging. Some of the earliest priorities should be establishing early connections with leaders and team members, said Hedges. Otherwise, new hires may feel unprepared and unsupported, which could cause them to question their decision to join the organization.
“In my view, culture is one of the strongest predictors of retention,” Hedges said. “There are things we can do to help build culture… and that’s reinforcing mission, purpose, a strong understanding of what the organization believes, why are we here, who are we serving, very early on. And then making sure that the alignment stays consistent.”
A worker’s first day should include education about assigned tasks and ensuring the use of provided educational materials, according to Crater.
“If you think about that first day, imagine them going home to a spouse, a partner, a family member and them getting asked the question, ‘How was your first day?’ and you want the answer to be, ‘Oh, it was amazing! Everyone was so nice. You know, I learned so much. I know what I’m doing tomorrow. All my equipment was waiting for me.’ That’s the goal from day one,” Crater said.
A positive company culture, first introduced on day one, must be continually reinforced throughout a worker’s first three months.
“Culture is so critical, and I think that’s got to be embedded in that first 30, 60, 90 days as a priority,” Wiseman said. “That red carpet in, that welcome — they feel important and valued, and that continues throughout their tenure with the organization.”
Soliciting worker feedback and recognizing contributions are also essential to long-term retention. For Hedges, long-term retention is built on workers’ purpose, growth and recognition.
Elevate lowered turnover by 10% quarter-over-quarter through engagement exercises and responding to caregiver feedback, Wiseman added.
“We’ve really committed over the last couple of years to create that job embeddedness, where the more connected they are to you as their leader, as their hiring manager, the more they’re connected to the organization and the mission, the more embedded they become in that job, the more they feel valued, the more they feel they belong,” Wiseman said.