THE TURNOVER ARGUMENT
The home care turnover crisis
The cost walking out the door every year
Industry data from the Activated Insights / Home Care Pulse 2025 Benchmarking Report. Turnover is down from its 2023 peak, but still critically high, and some agencies exceed 100%.
Down from 79.2% in 2023, still critically high. Some agencies exceed 100%.1,2
Recruiting, screening, onboarding, training, and lost billable hours.3
For a 100-caregiver agency · 75 replacements × $4,000 avg = $300,000.
1 Activated Insights 2025 Benchmarking Report · 2 Activated Insights / Home Care Pulse (2024) · 3 Activated Insights cost-per-replacement estimate
What turnover actually costs
The $4,000 breakdown
Per-replacement cost components for a home care caregiver earning about $16 to $17 per hour.
Job boards, referral bonuses, HR time. Indeed is the top source at 39.3% of agencies.3
Background checks, drug screens, interview time. Only 12.8% of applicants hired.4
Paperwork, orientation, PPE. Agencies with 8+ orientation hours earn $400K more.5
Required certs, skills training, shadow shifts. 12+ training hours = $55K more revenue/yr.5
Coverage gaps, client disruption, overtime. Nearly 80% leave within 100 days.6
New-hire productivity gap is typically 60 to 90 days.7
The math · 100-employee home care agency
Two columns, one decision
Turnover rate per Activated Insights 2025. Optiv Advantage FICA savings based on 7.65% employer rate × average pre-tax salary reduction; employee take-home at 100 × $446.
Turnover reduction scenarios · 100 employees
Retaining 5 to 15 caregivers pays for the plan many times over
Minimum expected · 5 retained
Most likely · 10 retained
With engagement · 15 retained
A 5 to 20% turnover reduction is consistent with documented outcomes when employers implement meaningful financial wellness programs (SHRM retention research). Activated Insights data shows agencies with strong retention programs achieve turnover of 20 to 59% vs. the 75% industry average.
Combined employer value
The value scales with your workforce
FICA recovery plus turnover savings, modeled across three agency sizes. Every tier compounds, every single year.
Annual value
Annual value · this presentation
Annual value
FICA savings calculated at the 7.65% employer rate × average pre-tax salary reduction per enrolled employee. Turnover savings based on the $4,000 average replacement cost (Activated Insights). Plan admin cost estimated at $1,800 to $3,000 per year.
Why caregivers stay
What employees actually receive
Retention drivers · the research
Fewer than 20% of direct care workers receive employer-sponsored health insurance.8 This plan directly closes that gap.
Financial stress is the No. 1 driver of absenteeism and turnover. A $446/yr take-home increase meaningfully addresses it.9
Telehealth 24/7 at $0 copay removes the need to take time off for routine care, reducing absenteeism.
EAP mental-health support (6 sessions per family member) reduces caregiver burnout, a documented turnover driver.
Cancer, critical illness, and accident coverage builds deep loyalty. Caregivers feel genuinely valued and protected.
8 PHI, Understanding the Direct Care Workforce (2025) · 9 Rellevate 2025: ~48% of healthcare staff say financial wellness benefits reduce turnover intent
The bottom line
The employer is not spending on benefits
They are recovering payroll taxes they were already overpaying, while building a benefit package that attracts, retains, and rewards caregivers, compounding in value every single year.
Direct annual FICA / tax savings to the employer.
Combined annual financial gain for each caregiver.
Avoided replacement cost for every averted departure.
Direct FICA savings + turnover reduction (conservative to moderate)
Sources & citations
All industry figures are cited from publicly available research
Optiv Advantage program savings figures are based on Optiv Health Benefits program averages. Individual results may vary.
1 Activated Insights 2025 Benchmarking Report. Caregiver turnover dropped to 75% in 2024, the lowest since 2021 (McKnight's Home Care; Home Health Care News, July 2025).
2 Activated Insights 2024 Benchmarking Report. Industry-wide turnover reached 79.2% in 2023 (Home Health Care News, July 2024; HCAOA).
3 Activated Insights / Home Care Pulse. Replacement cost estimated at $2,600 base (2017, $10.50/hr); updated for the 2025 median wage (~$16.78/hr, BLS) scales to $3,500 to $5,000+.
4 Home Health Care News (2024). Only 12.8% of home care applicants were hired in 2023, a 25% drop in applicant-to-hire ratio.
5 HHAeXchange 2025 Homecare Insights Report. Agencies with 8+ orientation hours had median revenue of $2.4M vs. $2.03M; 12+ training hours = $55K more annual revenue.
6 Home Care Association of America. Nearly 4 of 5 caregivers leave within the first 100 days (2024 Activated Insights Benchmarking Report).
7 Activated Insights / Center for American Progress. Replacing an employee earning under $30,000/yr costs about 16% of annual salary; at $16.78/hr × 30 hrs/wk ≈ $4,186.
8 PHI, Understanding the Direct Care Workforce (2025). Fewer than 20% of direct care workers receive employer-sponsored health insurance.
9 Rellevate Healthcare Turnover Stats 2025. Nearly 48% of healthcare staff say earned-wage access and financial wellness benefits would reduce turnover intent.
10 Optiv Advantage program data. Average employer FICA savings of about $667/employee/year; average employee net take-home increase of $446/year.
Section 125 · Optiv Advantage Plan
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