By Christina Shollack, RN, BSN, CCM, CBIS
In the fourth quarter of 2024, caregiver turnover rates reached an alarming 79% according to the Activated Insights Benchmarking Report. This figure is not just a staffing statistic; it is a patient care crisis. For families depending on in-home caregivers to support loved ones with complex medical and functional needs, this level of churn can have dire consequences. High turnover disrupts continuity of care, breeds confusion, and increases the risk of medication errors, care delays, and preventable hospital readmissions. It also erodes trust in the home care system and places additional strain on family caregivers, many of whom are already managing elevated levels of stress and burnout. For case managers, this environment demands more than a referral. It requires advocacy, education, and proactive problem-solving to equip patients and families for success in an unstable environment.
Start With Transparency
The first step is to present the facts. Families are often unaware that the caregiver walking into their home today may be gone next week. By acknowledging the reality of high turnover, case managers can help families avoid the disappointment and resentment that often follow unmet expectations.
Promote Family Readiness
Education is key to reducing caregiver turnover in the home. When families know how to support caregivers and set healthy boundaries, they contribute to better job satisfaction and retention. Case managers should coach families on tangible steps they can take, such as clearly communicating needs and expectations from day one and how to provide prompt, constructive feedback to the agency rather than the caregiver directly. This maintains the agency as the employer and removes the patient from taking on a human resources role.
Families should also know how to navigate issues when they arise. Identifying the point of contact at the home care agency, whether it is a supervisor, scheduler, or nurse manager, empowers families to voice concerns early and appropriately. Encourage families to use agency feedback mechanisms and advocate for continuity when possible.
The home care experience is frequently won or lost in the first 72 hours of commencing care. Before services begin, case managers can help by preparing the family for the realities of shared caregiving. Discuss what a “good fit” might look like, and what compromises might be necessary. Identify expectations like dress code, pets and pet care, phone usage expectations, meal preparation preferences and housekeeping tasks. Emphasize that turnover will happen but with preparation, it does not have to derail care. Case managers should also remind families to balance assertiveness with kindness, courtesy, and empathy which go a long way in building lasting caregiver relationships.
High caregiver turnover is a systemic issue, but case managers play a role in mitigating its impact. By preparing families with education, realistic expectations, and clear communication strategies, we help them build a more stable care experience at home. In doing so, we not only protect patient safety, but we also preserve the dignity of everyone involved in the caregiving relationship.
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Bio: Christina Shollack, RN, BSN, CCM, CBIS, is a healthcare leader with over 28 years of experience in nursing, case management, and executive leadership. As the owner of Cornerstone Case Management & Consulting, she specializes in guiding patients with catastrophic injuries through complex care systems. Christina has led multiple home healthcare organizations, ensuring clinical excellence and operational success. She’s actively involved in professional boards like CMSA Detroit and SCAN Wayne, promoting education and community engagement. With a deep passion for advocacy, Christina empowers teams and patients alike through compassionate care and strategic vision.