The First 14 Days: Where Care and Retention Begin

What home care and healthcare leaders can do now to reduce early exits and protect service capacity.

Healthcare is still hiring, but the labor market is not getting easier. In December 2025, unemployment held at 4.4% and overall job growth slowed significantly compared to 2024. Healthcare continued to add jobs, but at a slower pace than last year, which means demand remains strong while competition for reliable talent stays real.

For home care leaders and operators, this shows up in everyday business pain. Delayed start dates. Uncovered shifts. Overtime. Client cases you should be able to accept, but cannot staff. And the hardest truth is that even when you hire, you can still lose the caregiver before they ever stabilize. Activated Insights reports home based care turnover at 79%. PHI also notes turnover in home care was nearly 75% in 2024.

Why the first 14 days matters?

When a caregiver leaves early, it is rarely because they do not want to work. It is usually because they did not feel prepared, supported, or connected. Confusion becomes frustration. Frustration becomes, “I am done.”

This is not just a home care issue. Harvard Business Review notes that up to 20% of turnover can happen within the first 45 days, and a standardized onboarding process is essential. In home care, where the work is emotionally and physically demanding, those early days are not administrative. They are the foundation of confidence, belonging, and stability.

What caregivers experience when onboarding is fragmented?

When systems and handoffs are not connected, the caregiver becomes the coordinator of their own start. They apply in one place, complete forms in another, get trained somewhere else, and still do not know what happens next. That leads to waiting, repeated questions, missed steps, and a start that feels disorganized.

This is the employee version of operational friction. Deloitte reports that 70% of workers have to enter the same data in multiple systems to get their work done. In home care, that friction becomes real delays and real drop off, especially when instructions are unclear or not designed for the caregiver’s language and context. Leaders feel the impact as slower time to start, slower time to fill, and higher drop off before the first shift.

The Mercer idea that translates directly to home care….

I will be joining Mercer and Rival for a conversation about a modern HR concept called Operating by Design. In plain language, the mindset shift is this. Stop running HR and operations like separate functions that pass problems from one team to another. Instead, design the work around outcomes, with connected workflows and intentional human plus technology teams, so the experience is consistent and trustworthy.

For home care, the outcome is simple. Caregivers start confident, stay longer, and leaders can plan coverage without chaos.

A care first onboarding model for the first 14 days!

This is the framework I use with clients. It is intentionally simple.

1. Day One - Readiness: Before the first shift, the caregiver should know three things. Who to contact. What to expect. How they will be supported.This is where many organizations lose people. The paperwork may be done, but the caregiver does not feel anchored.

Action: Create a one page day one guide and assign a single point of contact for the first week.

2. Week One - Connection: Week one is not about paperwork. It is about belonging and confidence.

Action: One structured check in within 48 hours, and one check in before the end of week one. Use a short guide so it is consistent every time.

3. Week Two - Stability: By week two, the caregiver should feel steady in schedule, expectations, and support.

Action: A manager check in focused on, “What is unclear, what is hard, and what support do you need to succeed here.”

This is where my philosophy comes in. Viviane Care Group was founded on a simple belief. People need people. Technology should make care easier to deliver, not harder to access.

Human and Technology Working Together

Mercer describes building a connected “digital fabric” so workflows end to end, rather than leaving people to navigate disconnected systems and teams. Here is what that looks like in home care.

• Technology should handle reminders, document tracking, training assignments, status updates, and workflow steps that create delays when they are manual.

• People must stay visible in welcome, coaching, expectation setting, and the moments where a caregiver is uncertain and needs a human response.

• Caregivers do not stay because the portal works. They stay because they feel respected, prepared, and supported.

Why this matters right now? For home care businesses, this matters because you are not only competing to hire, you are competing to keep people once they say yes. In this environment, the agencies that win are not just the ones that recruit more. They are the ones that reduce early exits.

When you strengthen the first 14 days, you reduce three expensive problems: early turnover, slow time to first shift, and manager frustration.

Register for the Mercer and Rival conversation here.