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Set Your Caregivers Up for Success: Q&A with Aishling Dalton-Kelly, Part 1

Analysis  |  By Jasmyne Ray  
   February 24, 2023

High turnover of nonskilled caregivers in their first 90 days with an agency can be attributed to lack of attention and communication by leadership.

More than half—57%—of caregivers quit within the first 90 days of working for an agency, according to a report by MissionCare and the National Association for Home Care and Hospice. They're also seven times more likely to live at or below the poverty line.

Healthcare’s dire staffing shortages extend to unskilled workers, which means private duty agencies also are struggling to recruit and retain caregivers.

Aishling Dalton-Kelly is a private duty consultant, as well as president and CEO of Aishling Care Academy. Having previously owned an agency, Dalton-Kelly understands the importance and necessity of setting caregivers up for success and helping them see a future for themselves within an agency.

This transcript has been lightly edited for brevity and clarity.

HealthLeaders: What is something that should be included during a caregiver's training that isn't?

Aishling Dalton-Kelly: There isn't a history or discovery component for caregivers to understand the generation that they're taking care of. I think that’s a big issue because they don't always understand seniors and sometimes, they don't always see the genuine quality of knowledge they have because of ageism. They just look at the person as being old—"“They're just not useful anymore”, which is not true. If someone has some form of dementia, they've lost themselves.

HL: Is there a particular demographic that performs well as caregivers?

Dalton-Kelly: The demographic of people who do this work are very compassionate people, and you have to have that compassion first, not the skill set. You must want to take care of people, otherwise your work is very task-focused. If you don't understand the person you're taking care of, the relationship is never going to grow. Caregivers who do a wonderful job in the home and attract clients to their company, are able to do so because they're relating one-to-one with their client. They're able to communicate physically and mentally, and understand the person's background and what their needs are that day, in addition to delivering the traditional caregiving services in a very compassionate way.

We have caregivers from different cultures who have come to the United States and they're here to better their life and provide a better life for their family back home. In Nigerian culture, they look at their seniors as very special people. Caregivers from the Philippines are very dedicated to caring for their seniors. They come here and they want to be able to provide the best care.

HL: The percentage of caregivers who quit within the first 90 days is 57%. What do you think is the reason behind this statistic?

Dalton-Kelly: Oftentimes agencies will just hire a body because they need a person, but they're not hiring a caregiver. They're somebody who needs a job, somebody who needs the money, but they don't understand the job that they're going to do. Caregivers that do what I call the grunt work, the hard work, day-to-day care of our seniors, and they're not paid enough.

HL: What are some ways agencies can support the caregivers from the beginning?

Dalton-Kelly: In Illinois, we have certain units that we must train the caregiver in, like dementia. You have to pay a caregiver to do that training whether they do it at home or in the office. Imagine investing all that money, getting them to do it by the date that’s required, but along that journey you never actually sit down with them to see how it's going and get to know them, and how you can help them be successful.

With my agency, I used to tell employees to take their manual home and digest it, and that if they did, they'd be successful, and if they didn't, they'd be fired or quit because they didn't follow the policies and procedures. I always made the communication clear from the get-go because home care is a very serious business. You're taking care of somebody's life whether they're sick or not.

As an employer, you must understand what your potential candidate wants. We need to sit with them and get to know them or we'll lose them.

One program, which I've never seen implemented, would be to have someone who's been on the job six months be a mentor to them. Caregivers do well talking to one another; they don't do well talking to the owners of the agency. They say the office staff don't understand what it's like in the field. That is the No. 1 complaint I hear.

And then the question to ask is, “How do you show them?” It must be more, and it must be deeply rooted. We must show them we respect them.

Editor's note: This story has been updated. Look for Part 2 of this story in the coming weeks. 

“As an employer, you must understand what your potential candidate wants. We need to sit with them and get to know them or we'll lose them.”

Jasmyne Ray is the contributing editor for revenue cycle at HealthLeaders. 


57% of caregivers quit within the first 90 days of working for an agency.

Agencies should equip caregivers with the materials and information they need early on to ensure their success.

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