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* 1. Please select the services your agency offers.

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* 2. How severe are the staffing shortages for your agency?

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* 3. Please rate the difficulty you've encountered recruiting/retaining staff.

  No difficulty at all Extremely difficult N/A
RNs
LPNs/LVNs
APRNs
CNAs/HHAs/Personal Care Aides
Caregivers/Homemakers
Physical Therapists
Occupational Therapists
Speech Language Pathologists

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* 4. What is your approximate annual turnover rate for each discipline? (please enter a percentage or NA)

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* 5. If you've been forced to turn down referrals due to staffing shortages, please indicate approximately what percentage.

0 100
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 6. What factor(s) do you think are contributing most to your workforce challenges right now?

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* 7. Please indicate reasons staff give for leaving your agency. Check all that apply.

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* 8. Has your agency hired foreign workers through work-based visas?

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* 9. Do you have specific ideas about how federal (Congress, CMS, HRSA, Dept of Labor, etc.) or state policymakers could help address the workforce challenges care-in-the-home providers are facing?

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* 10. Please share any additional comments.

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* 11. Please provide your contact information. Your information will not be shared.

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