Why home care clients leave, and the four weeks before they say so

It is almost never the missed visit

A missed visit is loud. Somebody phones, the office covers it, the client is annoyed for a day. Agencies handle that well, because they can see it happening.

The account is lost to something quieter: the visit that happened, was fine, and was not good enough. Cut short because the round was running late. Rushed. The worker perfectly pleasant, and the client left feeling like a task on a list.

Nothing about that visit is visible from your office. The schedule says completed. Visit verification says attended. The care note says the care was given, because it was.

Why nobody tells you

• She likes the workerComplaining feels like getting somebody into trouble, and she will not do that over something she cannot quite name.
• She does not want to be difficultThis generation in particular. Being a nuisance is, to her, worse than being rushed.
• The family are not in the roomThey hear "it's fine, don't worry about me" for the same reason you do, right up until the day they see it themselves.

The four weeks

The arc is consistent enough to plan around.

The call you get is not "we have a complaint". It is "we have decided to make other arrangements", which is a decision already taken.

• Week oneA visit is short. She notices and says nothing.
• Week twoIt happens again. She mentions it to her daughter in passing, as an aside rather than a complaint.
• Week threeThe daughter starts paying attention. She is now looking for problems rather than for reassurance.
• Week fourSomething small goes wrong in front of the family. It becomes the reason, although it is not the reason.

The number no office holds

Every agency knows its missed-visit count. Almost none knows how many visits its clients were unhappy with, because nobody asks the only person who knows.

That number is worth having precisely because it leads. Missed visits tell you about last week. Poor visits tell you which accounts you are about to lose.

Ask, without it becoming surveillance

The moment your workforce experiences this as monitoring it is finished — quietly, by people who have plenty of other places to work. Three rules make it survivable.

• Group by client, never by workerA finding is about a visit. If you need to know who was rostered, your schedule tells you, alongside the ninety visits that went fine.
• "I'm not sure" stays unsureA large share of home care clients have memory problems. Rounding an unreliable recollection up to "nobody came" puts somebody's job at risk on evidence that would not survive an afternoon.
• Check your own roster before you ring herWhen the door log and the client disagree, telling an eighty-year-old she has misremembered is how you teach her that reporting anything is pointless. In our experience the fault is usually the roster's.

Ten clients, two weeks, no software

• Pick tenThe accounts whose families ask the most questions. Those are the ones closest to leaving.
• One call a week each"Did someone come yesterday, and how did it go?" Two minutes.
• Write down the answer, not your reading of itCame · came but rushed · not happy · nobody came · not sure.
• Count the middle twoThat is your churn pipeline, and today nothing in your office holds it.

If a fortnight of that turns up nothing, you have bought yourself real reassurance for about forty minutes of work.