Why Healthcare Organisations Are Losing Their Best Caregivers — and What Comes Next

Across the home care and healthcare support sectors — in the UK, US, Canada, Australia, and Europe — the same conversation is happening in board rooms, staffing departments, and HR teams: we cannot hold onto our best people. Caregivers with five, eight, ten years of experience are leaving. Some retire early. Some leave the profession. And increasingly, the best ones are going independent.

Most organisations frame this as a staffing crisis: not enough people entering the sector to replace those leaving. This framing is partially correct — but it obscures the more important truth. The supply of people who want to do care work is not the primary constraint. The constraint is the supply of people willing to do care work under current conditions.

That distinction matters enormously for what you do about it.

Why the best people leave first

The caregivers most likely to leave agency employment for independence are not the weakest performers. They are consistently the most experienced, the most skilled, and the most professionally capable — the ones with deep client relationships, reliable attendance records, and the trust of the families they serve.

This is not a coincidence. It is a direct consequence of how agency employment treats competence. In a flat-rate wage structure, experience is only partially rewarded. A caregiver with ten years of complex care experience typically earns only marginally more than someone who qualified last year. The ceiling is low and visible from the start.

For caregivers who know their value — who have families asking for them by name, who can manage clinical complexity that a newer worker cannot — the agency model offers no mechanism to recognise that value financially. Independence does.

The scale of the shift — and what the numbers show

The caregiver independence trend is accelerating across all major markets. The drivers are consistent regardless of country:

These figures interact in a compounding way. High margins drive low wages. Low wages drive turnover. Turnover drives recruitment costs that further compress margins available for wages. The cycle is self-reinforcing, and it accelerates as more experienced caregivers become aware of the alternative.

What organisations are getting wrong

The most common organisational response to rising caregiver attrition is recruitment — spend more on sourcing new people to replace those who leave. This response addresses the symptom, not the cause, and it is increasingly expensive as the pool of caregivers willing to work under agency conditions shrinks.

A secondary response is training investment and career pathway development — building certifications and advancement structures that give caregivers something to work toward. This is more promising, but it still operates within the fundamental constraint: wages that do not reflect the value of the work, and schedules that remove any sense of professional autonomy.

The organisations that are getting ahead of this are asking a more fundamental question: what would we need to offer to make staying more attractive than leaving? The answer typically involves three things:

• Compensation that reflects experience non-linearly. Not incremental annual increases of 2%, but genuine recognition that a caregiver with a decade of complex care experience is worth materially more — and pays it accordingly.
• Schedule autonomy. Giving experienced caregivers meaningful control over their working patterns, client selection, and the ability to say no without penalty.
• Professional identity and recognition. Treating caregivers as skilled professionals with expertise, not as interchangeable units of labour supply.

The organisations that will adapt — and those that won't

The home care and healthcare support sectors across all markets are stratifying. At one end are organisations treating the caregiver shortage as a supply problem to be managed through recruitment, rostering technology, and labour market positioning. At the other end are organisations recognising that the model itself needs to change.

The latter group is smaller. But they are building practices that make caregivers want to stay — and in some cases, building hybrid models that allow caregivers to work independently while maintaining a formal relationship with the organisation for insurance, professional development, and client referral.

What this means for organisations considering a KerlHive partnership

KerlHive is building the infrastructure for independent caregiving at scale — the professional verification, matching technology, and operational tools that make it viable for caregivers to work independently and for families to find them with confidence.

For healthcare organisations, this creates a partnership opportunity rather than a competitive threat. Organisations that refer their best independent-leaning caregivers to KerlHive — while maintaining a referral and support relationship — retain the professional connection after the employment relationship ends. Those who treat independence as something to prevent will simply lose the relationship entirely.