American Speech-Language-Hearing Association

Home Care Recruitment and Retention Considerations

Working in a home health environment presents unique challenges to both the SLP and the administrators trying to recruit them. Documentation requirements are different in home health (OASIS, daily notes) and the very nature of home health requires that an SLP be independent and willing to travel, often many miles each day. Probably one of the greatest challenges for recruitment is the fact that there is often not a full SLP caseload available and agencies may only offer a part-time or PRN position without paid benefits. There are many SLPs working in home health that do so as a "second" job in the evening after working a full day somewhere else.

The 2007 Health Care Survey asked the following question: "What are the greatest challenges you face in health care?" In rank order, respondents from home health/client's home reported the following challenges:

  • Paperwork (clinical and reimbursement; 61.7%)
  • Insufficient reimbursement (for clinical services; 39.4%)
  • Keeping current with advances in clinical information (33.4%)
  • Unsatisfactory salary/benefits (22.3%)
  • High productivity requirements (22.3%)
  • Managing caseloads at multiple sites (20.3%)
  • Resources to respond to diversity within caseload (14%)
  • Not being valued by other disciplines/administration (12.0%)

In 2009, respondents were asked about undesired changes they had experienced in their work environment over the previous year. This question was asked, in part, because of the challenging economic times. In rank order, respondents from home health/client's homes reported the following:

  • None of the above (50%)
  • Increase in caseload/workload/productivity (19%)
  • Reduction in salary or benefits, without changes in hours (15%)
  • Increase in the number of sites served (11%)
  • Reduction in work hours (8%)
  • Increase in work hours (8%)
  • Reduction in caseload/workload/productivity (7%)
  • Conversion from salaries to hourly or PRN pay (2%)
  • Replacement by support personnel (2%)
  • Job loss/layoff (2%)

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