Beyond Recruitment: Building a Resilient Home-Based Care Workforceby Jamie Daugherty, Executive Director Workforce challenges are not new for Oregon’s home health, hospice, and home care providers. For years, agencies have struggled to recruit nurses, therapists, aides, caregivers, social workers, and other essential professionals—particularly in rural and frontier communities. What is changing is the number of forces now affecting the workforce at the same time. An aging population is increasing demand for care. Competition for healthcare professionals remains intense. Reimbursement often fails to keep pace with labor costs. Burnout continues to affect retention. Meanwhile, changes in immigration policy are creating additional uncertainty for some healthcare employers and workers. There is an important balance to maintain in this discussion. Healthcare organizations must understand how policy changes may affect their workforce and prepare accordingly. Immigration Policy Is Also a Workforce Variable Immigrants have long played an important role throughout healthcare, particularly in direct care positions. According to LeadingAge, immigrants represent approximately one in four direct care workers and more than 30% of nursing home support workers. Recent changes involving Temporary Protected Status, or TPS, for Haitian nationals have brought this issue into sharper focus. Federal officials recently issued updated guidance concerning the termination of Haiti’s TPS designation. Aging-services organizations have warned that some providers could lose experienced employees and face greater difficulty accepting referrals. The impact will not be evenly distributed. Some organizations may experience significant staffing changes, while others may see little or no direct effect. Oregon providers should avoid making assumptions about their employees’ immigration status or treating workers differently based on nationality. Instead, leaders should recognize immigration policy as one of several external factors that can influence workforce availability—alongside licensing delays, housing costs, transportation barriers, demographic changes, reimbursement, and competition from hospitals and other employers. Organizations should obtain qualified legal or human resources guidance when questions arise about employment authorization, Form I-9 requirements, or other compliance obligations. Workforce planning must always be handled lawfully, consistently, and respectfully. Resilience Requires More Than Filling Vacancies Recruitment remains important, but recruitment alone is not a workforce strategy. A resilient organization can absorb change without immediately reducing services, overloading its remaining employees, or compromising quality. Building that resilience requires agencies to examine how they recruit, retain, deploy, develop, and support their people. Here are several areas home-based care leaders should evaluate. 1. Understand where the organization is most vulnerable Leaders need more than a monthly vacancy count. They should know which positions are hardest to fill, which services depend on only one or two employees, where turnover is highest, and how long key positions typically remain open. Useful measures may include:
This information helps an agency distinguish between a general workforce shortage and specific operational weaknesses it can address. 2. Treat retention as an everyday operating practice Compensation matters, but employees also leave because of poor communication, inconsistent scheduling, inadequate training, excessive documentation, weak supervision, and the feeling that leadership does not understand frontline work. Retention begins with the employee’s first day. A structured onboarding process, realistic job expectations, regular supervisor contact, and early check-ins can prevent avoidable departures. Agencies should also examine whether high-performing clinicians and caregivers have meaningful opportunities to grow. Career pathways do not always require a management title. Preceptor roles, specialty training, mentorship responsibilities, quality-improvement work, and leadership development can give employees a reason to build their careers within the organization. 3. Build local workforce pipelines Waiting for qualified applicants to find an online job posting is not enough—especially in rural Oregon. Providers can develop relationships with high schools, community colleges, universities, workforce boards, veterans’ organizations, and community-based groups. These partnerships can introduce students and career changers to home-based care before they choose another healthcare setting. Agencies can also explore clinical placements, job-shadowing opportunities, apprenticeships, tuition assistance, and “earn while you learn” models when those options are operationally and financially feasible. The goal is not simply to compete for the existing workforce. It is to help create the next generation of home-based care professionals. 4. Remove unnecessary burdens from frontline staff Many healthcare professionals enter the field to care for people, not to spend their evenings completing duplicative documentation. Technology—including carefully selected artificial intelligence tools—may help reduce administrative work, improve scheduling, summarize information, support documentation, and identify workflow problems. However, technology should be implemented with appropriate privacy, security, compliance, and human-oversight safeguards. The standard should be straightforward: Does this tool give qualified professionals more time for patients, families, and clinical judgment? Technology will not replace the relationships at the center of home-based care. Used responsibly, however, it may help agencies make better use of a limited workforce. 5. Prepare for sudden staffing disruptions Every agency should have a workforce contingency plan. That plan should identify essential functions, backup coverage, cross-training needs, communication responsibilities, and the point at which admissions or service areas may need to be temporarily limited. Potential disruptions are not limited to immigration-related developments. Wildfires, severe weather, illness outbreaks, transportation problems, cyberattacks, and the sudden departure of a key employee can all affect an organization’s ability to deliver care. Planning before a crisis allows leaders to make more orderly, patient-centered decisions when circumstances change. Workforce Policy Must Address Reimbursement Providers can improve recruitment, culture, scheduling, and technology, but operational strategies cannot fully overcome reimbursement that does not reflect the actual cost of care. Home-based care agencies compete for many of the same professionals employed by hospitals, health systems, facilities, and other healthcare organizations. When payment rates fail to account for wages, benefits, travel, training, supervision, and regulatory requirements, providers face difficult choices. They may have to limit service areas, decline referrals, postpone investments, or ask too much of their existing teams. This is why workforce advocacy and reimbursement advocacy are inseparable. Policymakers should understand that access to care depends on more than whether a benefit exists on paper. A patient does not truly have access if no provider has enough staff to accept the referral. A Stronger Workforce for the Long Term There is no single policy, technology, or recruitment campaign that will solve the home-based care workforce challenge. The long-term answer will require lawful and dependable workforce policies, sustainable reimbursement, stronger education pipelines, better retention, responsible technology, and workplaces where people can build meaningful careers. Oregon’s providers cannot control every national or economic development. They can control whether they understand their vulnerabilities, support their current employees, develop new workforce pipelines, and prepare for disruption. The organizations that begin this work now will be better positioned to serve patients and families—regardless of what changes next. |