Spending time at industry conferences, talking with our customers, and immersing ourselves in reading, we left 2025 with these conclusions. There are at least three pain points that seem to be top of mind and shared among those providing care or services to elders in senior living, memory care, home care, hospice and palliative care. Below I will share ideas of how these pain points can be addressed, with special consideration to providing care and services to those with Alzheimer’s disease and other dementias. 

PAIN POINT #1: Ability to Recruit and Retain Quality Staff, at All Levels

We all know there are too few people available to fill the burgeoning job growth in this sector and staff turnover is very high. As an example, there is approximately 79% staff turnover every year in home care. Providing care for those with dementia can be very difficult, often contributing to staffing challenges. Attracting and keeping staff is so important for many reasons. 

How to Address This Problem

One great way to obtain and maintain staff is to have a clear plan to set your employees up for success and to help them to feel valued, safe, and happy on the job. We suggest these methods to accomplish this goal:

1. Create a positive culture. The culture of an organization is easily recognizable and often talked about when job hunting. A positive culture goes a very long way to recruit and retain the cream of the crop. From my experience, these are some strategies that work:
   
   - Treat each team member as you want to be treated - kindness, respect, and encouragement are keys. 
   
   - Get to know everyone that joins your work “family” and personalize the way you communicate to strengthen your relationship. You can create a stronger relationship with your colleagues by getting to know them and personalizing a conversation when appropriate. As example: 
   
   Start a conversation with, "Good morning, Julie. How was your vacation?", then get into the business at hand, instead of solely focusing on the task such as, "Julie please take Mrs. Smith to use the restroom."
   
   - Do your best to understand the realities of what you ask of your employees. I always think about the old adage “walk a day in someone’s shoes to really understand.” One of the best leaders I ever worked for asked all of us managers to do the work of our direct reports for a day to understand what was expected and needed to do their job well. There was so much gained from that exercise. I learned about the barriers they couldn’t overcome without my help. I highly recommend this exercise of shadowing your staff or doing their job to understand if what we ask of them is realistic. This is a powerful way to gain mutual respect.
   
   - Leaders lead by example. Owners and managers must (know and) live the mission and exemplify the values. It is vital to walk the walk and never be accused of saying one thing and doing another.
    

2. Prepare staff with knowledge, skills, and tools to do their job with confidence.
   
   - A recent survey in home care showed less than half of the staff said they are completely prepared to care for their clients, and confidence in taking care of dementia clients rated the lowest. Surveys also revealed staff express great interest in professional development. Preparatory institutions often don’t include much dementia training, therefore this is the responsibility of the employer.
   
   Our Dementia Capable Care training can make a huge difference. Once trained, staff say they feel more confident and competent to provide quality care for those at all stages of dementia and they will have approaches that can prevent and de-escalate distress behaviors, keeping everyone safe. Investing in your staff by improving their dementia care training and behavior escalation skills can help recruitment and retention while also benefiting the person in care and your outcomes.
    

3. Compete with salary. Even if you can’t pay the highest dollar, offering a competitive salary AND rewarding milestones and accomplishments with salary increases (e.g. pay ladder) is important. Salary matters. Do your very best to compete.
    

4. Be innovative with benefits. The basics such as generous time off and 401K matter. But going above and beyond, such as, allowing for flexible work schedules, offering childcare assistance, and implementing a strong employee referral program can really pay off.

The bottom line is those who work in healthcare talk to one another. You want your organization to be top of mind and to stand out above the rest to help recruit and retain staff in a competitive environment. This can be accomplished by initiating the well-rounded, comprehensive “employees first” approach described above. 

PAIN POINT #2: Ability to Keep Clients Out of the Hospital and Emergency Rooms

We heard repeatedly that two key metrics to manage are hospitalization rates and the number of emergency room (ER) visits because these greatly impact costs of care. Healthcare providers seek ways to keep these numbers low.

There is a large population of clients with dementia in senior living and home care. And research has shown one of the primary users of emergency rooms are elders with dementia. They visit emergency rooms more than two times as often as their peers without dementia.

And, a recently published study stated more than 1 in 5 Medicare home health users have unreported dementia which potentially leads to less effective care and higher acute care use (ER visits, hospitalizations) for these patients. 

Bottom line is there is a very high number of clients being served with cognitive impairment, and they are likely contributing to higher rates of hospitalization and ER visits.

How to Address This Problem

From my experience, one of the reasons for this problem is care providers lack the specialized knowledge and approaches to provide quality dementia care. As a result, care and services are generalized and therefore reactive and not in keeping with the client’s true capability level. Implementing a dementia specific program solves this problem and drives better outcomes.

A dementia specialized program includes:

1. Knowing how to identify indicators of dementia & delirium – reduces likelihood of a missed diagnosis most often experienced in the early stages of cognitive decline.
    
2. Ability to assess the stage of dementia- the stage becomes a care road map.
    
3. Being able to create person-centered, dementia stage specific care plans.
    
4. Staff with skills to adapt their approach and communication to the dementia stage to optimize independence and safety. 
    
5. Staff with skills to prevent and deescalate distress behaviors such as anxiety and agitation, keeping all safe. 
    
6. Being able to create high risk prevention plans, anticipating and reducing typical problems seen at each stage. As examples, these are common problems often seen in the dementia population that can be reduced with risk management plans:
   
   - Mismanaged medications.  Taking the wrong meds or doses can create medication reactions and create health problems that lead to use of ERs and hospitals.
   
   - Mismanaged diets. Not having the right amount or type of food and drink each day can lead to significant health problems such as dehydration.
   
   - Weakness and overall debility. Excess disability (disproportionate dependence) and challenges engaging someone with dementia in activity create poor health.  Being sedentary and dependent breeds deterioration of physical and cognitive abilities. Exercise through walking or engagement in ADL and other life activities can keep the muscles stronger and optimize flexibility, range of motion and balance. 
   
   - Problems such as falls and UTI’s often cause elders with dementia to visit the ER. These can be reduced when we anticipate their cognitive challenges and care needs and provide the right amount of human and environmental support.
    

   With a dementia specialty program and dementia capable workforce as described above, you have a strategy to decrease ER visits and hospitalizations.

​​​​​​​PAIN POINT #3: AVOIDING A LOW CENSUS

Providers are competing for more than staff. They are also competing for clients and referrals. Because of the growth in an ageing population, demand for services is growing and we see more providers in most sectors. Competition in some markets can be fierce and census can be too low, impacting profitability.

How to Address This Problem

You can grow census by distinguishing from your competition and creating high customer and referral source satisfaction. Both are dependent upon delivering quality care by a prepared workforce, as described in #1 and #2 above. 

To develop the kind of stellar reputation to stand out above the rest, these things must be a part of your brand and the fabric of your culture:

1. Specialty programs (and teams) to care for specialized, complex populations, such as dementia. Prepare your team with the best dementia training and establish your quality dementia program. Establish and closely monitor program goals and outcomes to ensure you deliver quality care and address gaps quickly. Showcase your dementia care specialization with credentialing.
    
2. The Highest Integrity: Make promises and keep them.
    
3. Collaborative Partnerships: View each relationship inside and outside your organization as a vital partnership, with one reliant on the other for strength and success. 
   Consider all the people that surround the person in care including their families/loved ones and those who work in the care network and at your organization. Each person is a critical piece to the quality puzzle. We are partners in the quest to make life the best it can be for those we serve. 

2025 estimates suggest there are 7.2 million Americans aged 65 + living with Alzheimer’s and other dementias. The dementia population will continue to grow and become a very large portion of senior living, medical home health, and hospice. Non-medical home care will also see a significant increase as families are more frequently choosing to care for their loved one with dementia at home with hired help. 

If your organization prioritizes the recommendations above, you have a plan to help address three key pain points including attracting and maintaining staff, building census in a competitive market, and minimizing the partially preventable ER visits and hospitalizations. 

Providing dementia specialized memory care services, delivered by a dementia capable workforce, steeped in integrity and high standards, is the blue ocean. There is little competition here. Commit to this quality level and a successful, thriving business and the intrinsic rewards of being a real difference maker, can await. 
 

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*Not her real name to protect family privacy.

Originally published in 2017.

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