Across the healthcare industry, workforce attrition remains one of the most persistent and costly operational challenges facing HR and operations leaders.
Annual turnover in home care reaches 77% (PHI National, 2025). CNA attrition in long-term care runs between 50 and 65% annually (AHCA, 2025). Sign-on bonuses, referral incentives, and wage increases have not moved these numbers in any meaningful way.
The reason most interventions fall short is that they are designed to solve the wrong problem.
What Exit Interviews Don’t Capture
When employees leave, organizations rely on exit interviews to understand why. The data is, by design, incomplete. Departing employees have little incentive for candor and real risk in damaging professional relationships — so they give the answer that ends the conversation cleanly.
Research tells a different story:
- A 2025 Mercer survey found that 41% of employees who departed within their first year cited financial stress and cash flow constraints as a contributing factor — ahead of compensation, management, and career development.
- PwC’s 2024 Employee Financial Wellness Survey found that 52% of full-time employees report financial concerns have negatively affected their job performance.
- Among hourly healthcare workers — with limited savings and variable income — both figures are higher.
Financial instability between paychecks is one of the leading drivers of voluntary attrition in the hourly workforce. It rarely appears in exit data.
The Pay Cycle Gap
The biweekly pay schedule is an artifact of administrative convention, established when manual payroll made more frequent payments impractical.
That constraint no longer exists — yet the schedule persists, creating a recurring gap between when wages are earned and when workers can access them. The consequences of that gap are well-documented:
- 37% of U.S. adults cannot cover a $400 unexpected expense without borrowing (Federal Reserve, 2024) • 59% cannot cover a $1,000 emergency from savings (Bankrate, 2025)
- 12 million Americans use payday loans annually at an average APR of 391% (CFPB)
- Workers in active debt cycles show turnover rates twice those of financially stable peers, alongside higher absenteeism and reduced performance (PwC, 2024)
The American Payroll Association attributes more than $500 billion in lost annual U.S. productivity directly to employee financial stress. These figures represent missed shifts, errors in patient care, and the operational drag of a workforce managing financial crisis on the clock.
Why Traditional Benefits Don’t Close the Gap
Healthcare employers invest heavily in employee benefits — health insurance, retirement plans, tuition reimbursement, and employee assistance programs.
But most share a critical limitation: they have no presence in an employee’s daily financial life.
Consider the actual engagement reality:
- Health insurance: reviewed primarily at annual enrollment, accessed during illness • 401(k) / retirement plans: engaged once or twice per year at best
- Employee assistance programs: utilized by approximately 3–6% of eligible employees (IAPA, 2024)
- Tuition reimbursement: relevant to a subset of the workforce, accessed annually at most
None of these benefits are accessible to a caregiver who needs $200 on a Wednesday.
Glassdoor research finds that 80% of employees prefer improved benefits over a pay raise — but only when those benefits are relevant to their daily lives.
PwC (2024) found that 73% of financially stressed employees are more likely to stay with an employer that actively supports their financial well-being.
The question is whether your current package reaches them at the moments that actually drive retention decisions.
Earned Wage Access: A Structural Solution
Earned Wage Access (EWA) allows employees to access a portion of their already-earned wages before their scheduled payday.
It is not a loan, carries no interest, and creates no debt. It simply removes the artificial delay between work performed and pay received.
The retention outcomes are consistent across the research:
- EWA users report overdraft fee reductions of 40–65% within 90 days of adoption (Financial Health Network, 2024–2025)
- Adoption rates reach 30–60% of eligible staff — regularly exceeding 401(k) enrollment rates (Mercator Advisory Group, 2025)
- 95% of employers offering EWA report a positive impact on retention (Hanover Research, 2025)
- 73% of financially stressed employees say they are more likely to stay with an employer that supports their financial well-being (PwC, 2024)
Keeper is an Earned Wage Access platform built for healthcare and hourly workforces. It integrates with existing payroll and time-and-attendance systems, and requires no changes to current payroll processes.
The employer cost is zero — no setup fees, no monthly charges, no administrative burden on HR. Employees access earned wages through a mobile app between shifts, after long days, or whenever they need it.
For healthcare organizations competing against per diem platforms that already offer same-day pay, EWA is not a supplemental perk. It is a direct response to the structural gap that is quietly driving your workforce out the door.
Your employees have already earned their next paycheck. Keeper makes it accessible. Schedule a free demo and see what Keeper can do for your team.
