Researchers found that scheduling CNAs regularly with the same group of teammates reduced turnover by nearly 25%. 

If nursing homes capitalize on the results of the study, it could go a long way toward cheaply and effectively addressing the nursing home staffing crisis, according to lead author Kevin Mayo, PhD, assistant professor of finance and management science at Washington State University. 

“These findings suggest that managers may be able to leverage part-time CNA scheduling to reduce turnover,” the study asserts, “improving both the quality and cost of care.”

The study also found that giving part-time CNAs one additional hour of work per week could reduce turnover by about 2%. Turnover was increased both by too few hours worked and too many, however, so facilities need to be more cautious in this regard. 

Building cohesive, consistent teams is the most important factor to consider, Mayo said, but nursing homes should consider all aspects of the study to achieve the best results. 

“By both balancing working hours and maintaining consistent teams, healthcare facilities can greatly reduce staff turnover,” Mayo told Newswise. 

Between greater scheduling consistency and tweaking hours worked, the authors estimate that facilities can save 7% of their operating costs with greater employee retention. 

Nursing homes have already felt the pressure to employ more flexible, worker-focused scheduling in response to the staffing crisis. The results of this study suggest that there are large benefits to be gained from this approach, and at very low cost.

Greater retention should also lead to higher quality of care for residents. After analysis of their data, the researchers concluded that CNA turnover had measurable negative effects on care quality that could be eliminated by increased retention. 

The study, published in the journal Manufacturing & Services Operations Management, analyzed data for more than 6,000 part-time CNAs from 157 facilities. 

Other authors included University of Cincinnati Assistant Professor Eric Webb, PhD, as well as Indiana University’s George Ball, PhD, and Kurt Bretthauer, PhD.

Following years of COVID conditions that have often called on staff to work back-to-back shifts and take on overtime they didn’t necessarily want, more nursing home employees are insisting on flexible scheduling. Respondents also indicated that not being able to offer flexible work is a major hiring and retention potential stumbling block in a new economy shaped by the rise of the gig worker.

Overall, 40% of respondents told McKnight’s Long-Term Care News that their workplace had made “some changes, but only for certain employees.” Another 35% said “some flexibility is now available for most employees.”

While that represents three-fourths (75%) of respondents, some 13% said their facility or chain had made no effort “at all” to adopt more flexible scheduling.

“While accommodating flexible schedules can sometimes be a challenge for centers, providers need to change the way they have always done things,” said Kendra Nicastro, director of business development for healthcare recruitment firm LeaderStat. “If you are not adapting and developing new ways to attract candidates — flexible schedules, same or next day pay options, etc. — you will continue to fall behind and recruitment and retention will continue to be a challenge.”

The 2023 survey drew more than 500 responses from directors of nursing and their assistants, and administrators and their assistants. They sent mixed signals about the meaningfulness of their work, their willingness to remain on the job and the changes today’s employers need to adopt to keep them.

Flexibility takes all shapes

This was the first year the McKnight’s Mood of the Market survey specifically asked whether employers were offering flexible scheduling.

But in a separate question about potential changes that would most improve their job satisfaction, slightly more employees chose the option of a more flexible schedule in 2023 than in 2022, rising to 13.7% from 11.4%. Administrators were more likely than nurse leaders to choose the flexibility option at 14.6% vs. 12.3%.

But those numbers are likely far lower than if the survey had been offered to all nursing home staff, explained recruitment and retention specialist Cara Silletto.

“DONs and administrators have the most flexibility in the whole building. They can come and go whenever they want and if their kindergartener kid or grandkid has a 2 o’clock play, they can leave the building and go when most of their staff cannot,” said Silletto, president and chief retention officer of Magnet Culture. “So you’re not going to get flexibility as a top priority for top leaders because they are in charge of their own schedule.”

That said, their buildings’ operations are directly impacted by approaches that try to meet the desire for flexibility among other workers. Just under a quarter (24%) of survey respondents said their facility offered self-scheduling tools for employees; 46%, meanwhile, said their facility had increased part-time opportunities; and 29% worked at locations that offer three- or four-day workweeks.

Notably, 161 of the 500-plus respondents also filled in “other” options that showed, for the most part, a willingness by skilled nursing operators to explore flexibility. Those desired options included the use of 12-hour shifts; PRN schedules (sometimes through an internal float pool); staggered shifts to accommodate school start times and other personal needs; and shift sharing.

Several respondents also noted in terse terms that their owner or corporate leadership refused to be more flexible with scheduling, or that union contracts prevented facilities from offering some options  peers at other locales had found success with.

“The more forward-thinking organizations are utilizing more flexibility strategies. But most companies, honestly, haven’t had the bandwidth to explore more flexibility options. The way they’ve always scheduled, they know it’s not working, and yet, they don’t know what else to do. They don’t know what else to try,” Silletto said. “I think some of them still dig their heels in, and I’m not sure how they’re still operating, to be perfectly honest with you. I think they’re using a lot of agency. And that’s what’s funny too, is there they have the flexibility. They’re just using agency for it.”

Katie Piperata said the leadership candidates she works with are “very much” demanding some flexibility, even if it’s just one day a week at home to catch up on all reports, emails and other non-clinical requirements. But she doesn’t see her clients, meaning nursing home HR leaders, budging much.

“When you’re leading the whole building either on the clinical or ops side, it’s the customer who wants to see you, it’s the customer who is wanting that visibility and that representation. So I get where the client is coming from on that,” said Piperata, workforce architect at recruiting firm MedBest. “But I also get that we’re in this gig worker mentality. People want the flexibility to be able to have a day to get everything done or to work for longer days because staff nurses are able to do Baylor [12-hour weekend] shifts and things that do allow flexibility. So I think we’re just seeing the DON and administrator saying, ‘I want that too.’ ”

Flexibility has limits

Ted LeNeave, CEO and founder of Accura Healthcare, operates 34 skilled nursing facilities in the Midwest. While he’s hearing more requests for flexible and remote work options, he sees some positions for which that’s just not aligned with the business of doing healthcare. For instance, he recently determined a DON asking to work four days a week in the building wasn’t a “good culture fit.”

“It’s not that kind of job,” he said. “We can have flexibility in other areas, but we can’t have flexibility to not be in the facility if your job is in the facility taking care of those people.”

Anthony Scarpino, vice president of talent acquisition for National Health Care Associates in the Northeast, takes a different view. He sees trying to be more amenable to employee desires as one way to avoid costly attrition.

“We don’t see as many people leaving the industry as we see people changing roles for additional pay, a better shift, more flexibility, a better commute,” he said. “I think the whole industry, not just senior living but healthcare in general, is really struggling with this idea of flexibility, particularly with so much attention being given to work from home outside of the industry. … There’s no silver bullet out there.”

He’s exploring adding self-scheduling technology, seeing that as one of the best possible solutions for the company’s leaders as they grapple with the issues. In the meantime, he’s trying to manage job candidates — from leaders to brand new CNAs — who ask for arrangements such as 12-hour shifts.

“We just try to be flexible with them as far as we can within the confines of our operation,” he said. “Whether it’s a 16-hour shift, no weekends, only weekends, days, nights, evenings, those different things. There’s all kinds of different scenarios that we try to piece together to accommodate.”

He’s also open to shorter shifts, especially as an alternative to hiring someone new or turning to agency to fill in-demand slots.

Seeking middle ground

Silletto is encouraging hiring managers to think of their staffs more as members of separate pods; one might be PRN, one might be part-timers; and another could be full-time, traditional eight-hour shift workers who never ask for accommodations. The employer can then work out agreements and pay incentives with each pod to ensure round-the-clock coverage.

“I would say an overarching theme — and employers hate to hear this, but it is a current problem — is fewer people in the workforce want to be told where to be when,” she said. “Offering as much flexibility and as many shift options and start and end times as possible helps it fit into their lives. A lot of people are less tolerant today of sacrificing for work.”

For leaders resistant to demands for flexibility, Piperata suggests testing it first in buildings where there might be less risk.

“If you have a 5-star building that’s performing well and the administrator and DON have been there a while, there hasn’t been a lot of turnover, why not allow something like that?” she asked. “It’s not in a regulatory crisis … I think that maybe they could start to look at it more from a custom standpoint. If your building is doing well, then you can earn this. If these two or three things are met, then this is something that we would work with you on versus just saying, across the board, ‘We’re not doing that.’”

Without more change, recruiting nurses who can find the hours they want in hospitals and keeping entry-level employees who have plenty of options in retail or hospitality will continue to be a slog, Piperata said.

Reluctant providers need to think about how their stance will position them in what will only become a more competitive landscape in the coming years, Nicastro added.

“When candidates see flexible scheduling in a job description,” she said, “they can assume that your building is proactively addressing employee requests for work/life balance and working to stem burnout.”

This is the second in a four-part series revealing the findings of the 2023 McKnight’s Mood of the Market survey. The first appeared Aug. 31. Check back Friday, Sept. 8 for the third installment on workers’ future plans.

More than ever before, providers must personalize scheduling and build programs that speak to individual employees to attract the next generation of workers, skilled nursing and senior living leaders emphasized during an expert panel discussion.

In addition, showcasing the sector’s possibilities earlier and doing so with a broader audience will also be key. Otherwise, demographic shifts threaten to leave nursing homes and other settings short on staff just as demand from baby boomers increases.

“We’ve got to develop more workforce strategy programs. Not every kid has to go to college. Kids need to come into this pathway. This is a phenomenal pathway for a solid middle class existence,” said Dan Reingold, CEO and president of RiverSpring Living in the Bronx, NY, at an early McKnight’s Pinnacle Awards gathering last week. 

“We’ve got to get to sophomores in high school and show them there’s a career path here and get them in a mentoring program. This is what we’re doing on our campus, but we think it has to go nationwide.”

​Reingold was one of six speakers invited to take part in the special roundtable last week. He was joined by  Chris Belford, CEO of Sinceri Senior Living; Lynne Katzmann, CEO and founder of Juniper Communities; Gary Nipper, director of business development for HealthDirect Pharmacy Services; Carl Tabor, president of Avamere; and Ben Unkle, CEO and president of Westminster-Canterbury on Chesapeake Bay. McKnight’s Long-Term Care News Executive Editor James M. Berklan moderated.

Power to the worker

Almost all of the speakers said they were giving employees more say in setting their own schedules. Katzmann said that approach was a natural extension of providing person-centered care, only shifting the focus to caring for employees (whom she calls “associates”) and their lives beyond work.

“They need to be seen as people. It’s not just about a certificate program for moving up. It’s understanding what they want as a human being, as an individual, as a professional,’ Katzmann said, noting Juniper’s recent efforts to roll out “individualized development programs” for more workers as part of a broader human capital program. 

She said her organization and others have leaned into a sales-based approach to recruitment, something they first dabbled with during the early days of COVID-19.

Sinceri Senior Living has also shifted to a marketing approach, hiring recruiters for a number of its 81 buildings, with most of the cost going to corporate. The facilities benefit from more staffing lead generation.

Belford also said Sinceri, which focuses on assisted living and memory care, reduced its agency use by 70% between 2021 and 2022. Much of that was due to a new outlook on scheduling.

“It’s just going to the employees as if they were residents and asking them, ‘What is your need?’ Some employees like four-hour shifts, some like six-hour shifts and some can only work Tuesday, Thursday and Friday because they have daycare then or they have another job,” Belford said. “So we opened up the gamut so they can kind of pick the hours they want to work and we fill the holes as we need to.”

He added that the thinking reflects that of Forbes 100 companies that are starting to entertain four-day day work weeks. He sees no additional costs, and said flex scheduling can reduce overtime and call-outs for illness or other reasons.

Unkle, whose continuing care retirement community has never used agency throughout the pandemic, said others should embrace the idea of marketing jobs in a better light. Like Reingold, he says it’s important to get an early foothold in a market’s talent pool.

“The high school and vo-tech schools are really critical, the tracks that are not college-based,” he said, adding that finding people includes using recently developed technology for targeting ads. “And if you’re geofencing for selling apartments, why aren’t you geofencing for selling your jobs? You’ve got to get off the fence a little bit.”

Among the staffing initiatives the speakers have employed are:

• Scheduling 4- and 6-hour shifts, and allowing workers to come in fewer days a week.
• Creating partnerships with community colleges on specific programs that can help make career ladders more realistic
• Using better technology to improve efficiency and reduce frustration among frontline workers
• Paying former employees who are in nursing school to complete their clinical rotations in their former facilities

Tabor, whose Avamere Living facilities specialize in post-acute, high-needs care, has more clinical demands than many of the other speakers. Keeping CNAs and nurses has remained a challenge for nursing homes across the US.

A former CNA himself, Tabor said his company has made an effort to elevate the role of CNA for those who want to remain in that position. 

“It’s great to move people along, but when you look at it statistically, maybe 10% of those individuals want to go on in nursing,” he said. “We implemented a recruitment and retention program through a vendor technology and we drove our turnover rate in six months from 70 to 50 [percent]. But more importantly, our 90-day turnover rate was less than 8%. Putting effort into retention and engagement programs is the solution.”

Immigration also needed

Several participants also beseeched the government to do more to address demographic demands that cannot be met by a US population that has too few working-aged people to care for its aging population.

“The immigration issue is something we really need to focus on,” said Reingold, noting that New York City sees some 40,000 new people arrive every three months.

“Give these people work permits while we figure it out. They’d help us tremendously. They’re not going anywhere. Let’s embrace them.”

“Long-term it’s the only solution with the demographics,” Unkle said.

Katzmann cited a recently published study by Harvard’s David Graboswki and others that found increases in the immigrant population result in improved nursing home direct care staffing levels, particularly among full-time staff, with little impact on industry wages or the skill mix. 

“They looked at whether the individuals taking these jobs essentially created a problem for other people who might want those jobs,” Katzmann said. “The answer was no, the quality was high and it solved a lot of problems.”

A: This is definitely the most asked question at the moment. It seems that the facilities that have had some success have made several specific moves. Meet with your staff, one-on-one and ask where the help is most needed.

Look at your medication pass time and the number and type of meds being passed. See if you can combine some of the med passes, as many facilities have meds every hour, which potentially can keep a floor nurse anchored to the cart for her entire shift. 

Meet with the medical director and other physicians to see what meds you can move, combine or discontinue.

Think about scheduling and hiring nurses for three- , four- , or six-hour shifts. Maybe there are some moms who can work only while their kids are in school — or after the kids go to bed. Or there’s a nurse getting her degree and only has a few hours here and there. Hire them! Give your overworked nurses some assistance!

Same with nurses aides. Perhaps hire some high school students to pass water and ice, deliver the mail, read the mail, make the beds or tidy up the rooms. They may love what they are doing and decide to become certified or even apply to nursing school. Bring them in during your busy times, or activities times. Many high school groups, such as the Future Nurses of America, may be perfect, or approach church youth groups and the Girl Scouts and Boy Scouts.

I know thinking out of the box can be hard to do and hard to be accepted by others, but it could be a way to help you. It bears stating that raising salaries, granting paid time off and offering incentives also helps!

As we start preparing for holiday scheduling nightmares, I am reminded about my family’s experience with members working holidays. My grandmother’s birthday was Christmas Eve, which meant each year, our entire family of cousins, aunts, and uncles would all gather in her little living room to celebrate both Christmas and her birthday all together. Now, because of her special day, she was never open to shifting the date of our celebration if anyone wasn’t available on Christmas Eve.

My older cousin, Crissy, was a nurse. Back then, her schedule would rotate each year and she was required to work Christmas Eve every other year. That meant we didn’t get to see Crissy at the family gathering those years. She had to work and there was no changing their holiday schedule rotation.

Today, the workforce demands more flexible options and I’m certain Crissy, a hard-working, extremely caring nurse, would ask for more options. Perhaps she could switch and work Christmas each year with someone else who didn’t mind working Christmas Eve. Perhaps she could change her shift time so she could both make an appearance at our event and make it to work on time later in the day.

We’ve become so much more flexible as employers in the past decade because the employment market has shifted from giving employers an advantage, such as when it’s hard to find a job, to an employees’ market, when everyone is hiring.

While I spend most of my time training and helping senior care leaders make adjustments to better understand, lead, and retain today’s new workforce, there are certainly times when our staff need to also make some adjustments, and even sacrifices for the organization. The problem today is that many workers do not know what that looks like or the impact on the business when everyone wants to set their own schedules.

In a 24/7/365 profession, we must work together to cover all the needs of our residents. How do we meet in the middle between offering total flexibility and employee choice versus filling all the shifts? What’s needed most is mentoring.

I’ve found today that team members typically have not had exposure to the business leaders’ perspective and haven’t gained business operations acumen unless a mentor has shared that. Simply put, we must educate our team on the impact of their flexibility and choices. They don’t always connect those dots that may seem obvious to you as their boss.

We can’t just say, “We need coverage, so you all have to figure it out.” Instead, approach the problem solving as a team activity saying, “We want to provide as much flexibility and choice for you as possible, and (not “but”) at the same time, we must provide great care to our residents 24/7/365. That means we will each have to work some shifts we’d rather not since not enough people want to work all the holidays, but we’ll limit that as best we can. Who has ideas of ways we could fill this year’s holiday schedule without anyone having to sacrifice too much, including our residents?”

Also, one-on-one, it’s important to expand team members’ business acumen by asking them to put themselves in your (or the scheduler’s shoes). How would they convince their team members to work shifts that aren’t ideal?

Share how you’ve worked holidays, weekends, nights, and other unfavorable times for the good of the team, residents, and community. Then also share the pride and trust you built among your peers at the organization because of that decision. Describe how much dependability means today and exactly what that looks like. Let team members know they can stand out from the crowd and get noticed for the right reasons if they step up in this way.

Instead of judging staff with thoughts like “she should know better,” or “I shouldn’t have to tell her that,” imagine how well your mentoring could bridge the gap and deliver the behavior and scheduling coverage you need most right now!

Are you expecting everyone to follow the rules you had to obey when you started your senior care career, or can we as leaders communicate more effectively moving forward in order to create a better, more flexible and attractive place to work for all?

Workforce thought leader Cara Silletto, MBA, CSP, is president and chief retention officer at HR consulting firm Magnet Culture. She works with organizations of all sizes to reduce unnecessary employee turnover by bridging generational gaps and making managers more effective in their roles. She is the author of the book, Staying Power: Why Your Employees Leave & How to Keep Them Longer.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

The long-term care industry faces a talent crisis. As McKnight’s recently reported, new surveys from the National Center for Assisted Living (NCAL) and American Health Care Association (AHCA) paint a bleak picture. 

Of the 4,000 assisted living facilities surveyed, 63% are experiencing talent shortages. Almost all of them (98%) have asked staff to work overtime or take extra shifts due to such shortages. And 87% say they have struggled to hire staff, with two-thirds citing “a lack of interested and qualified candidates” as the biggest obstacle. 

Meanwhile, 87% of nursing homes say they face “moderate to high staffing shortages.” Although over 90% of them have increased wages or offered bonuses to attract and retain staff, those measures are not working.

While the NCAL and AHCA petition the federal government for support, what can facility administrators and scheduling coordinators do now? The first step is to rethink scheduling norms in long-term care.

Amidst a shortage, nurses and nursing assistants tend to have more say in how, when and where they work. Indeed, many have turned to travel nursing agencies and talent marketplaces to optimize not just their income but also their freedom and well-being. 

Facilities may underestimate how much damage a rigid schedule can do when attempting to hire healthcare professionals to fill shifts. My team recently interviewed nurses about this issue. 

They flagged several scheduling practices as problematic:

1. Switching caregivers between daytime and NOC shifts frequently and unpredictably. The stress, sleep disturbance and inability to plan for personal and family responsibilities make switching between days and nights unsustainable for most nurses. While many nurses can manage night shifts for three weeks at a time, few can handle the instability of switching every three days. Nurses who raise this issue but feel unheard are likely to seek work elsewhere.

2. Eight-hour rather than longer shifts. Most nurses are willing and able to work a 10-hour to 12-hour shift, but they can’t do two eight-hour shifts in a day. Thus, when facilities only offer eight-hour shifts, nurses potentially sacrifice hours of wages per day, or they struggle to find and afford caretakers for their children for an extra day every week. Plus, longer shifts may enable them to avoid rush hour on the roads and commute less frequently.

3. Demanding “on-call” hours tacked onto already long shifts. Many nurses feel overworked, no matter how many hours in their shift. This leaves them physically and mentally drained. Adding to that load with on-call hours increases the risk of short-term mistakes and long-term burnout — both of which impact patient care. Nurses who don’t feel like they have time to rest and recover will seek out employers who protect everyone from the mistakes that result from fatigue.

The theme here is letting healthcare professionals choose when they want to work. They will not all pick the same schedule. Some nurses have childcare responsibilities and therefore prefer to work overnight when their partner or a family member can watch the children. Some work a second job or attend school. Others want to schedule their shifts to be alongside colleagues who make the job more rewarding and supportive.   

Just offering scheduling flexibility sends a message that nurses rarely hear: “Your needs matter to our facility. We value the skills you offer and the lives you lead outside work hours. We want employment here, whether full time, part time or contingent, to align with your personal goals.”

To be clear, even if every facility adopted this mentality, structural challenges would remain. Nurses are retiring, nursing schools cannot meet the demand for talent, and the cost structure of healthcare has undermined financial models that once worked in long-term care.

Nevertheless, I believe the healthcare facilities whom we serve with our marketplace need to send a powerful message to nurses who have lived through post-COVID healthcare and would-be nurses who have heard the stories. 

Nurses need to believe their workplace experience will improve. Otherwise, many will continue to leave the industry for lower-skilled work that pays better or at least offers much-needed flexibility. To address this talent crisis, let’s solve scheduling first and build from there. 

Wei Deng is the founder and CEO of Clipboard Health. Clipboard Health matches healthcare facilities with nurses nearby, and operates in dozens of U.S. cities. It is backed by Sequoia Capital and Y Combinator. 

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

In the evolving, complicated era of COVID-19, long-term healthcare facilities must adjust to ever-changing needs to reduce risks and improve compliance for both residents and employees. While the pandemic forced some to adapt to virtual working environments, many in healthcare simply have not had that option. But there are ways facilities can continue operating while providing safe, efficient and practical solutions to training, scheduling, and maintaining compliance. 

By fine-tuning best practices, long-term care facilities can meet ever-evolving regulations while reducing both administrative and safety risks. To do so, facilities need to ensure their most basic administrative processes are as efficient and streamlined as possible. This includes critical areas such as employee training, scheduling, safety and communication to ultimately ensure the highest level of compliance during the pandemic — and beyond. To achieve this, facilities must:

• Take a coordinated and virtual approach to prioritize training and safety, when able
• Virtually empower staff while optimizing operations and meeting staffing needs
• Open communication channels and utilize touchless technologies

Here are four ways automated workforce solutions can ensure compliance at long-term care facilities.  

• To ensure efficient and timely instruction, healthcare management companies should focus on customizable learning management software for training and services, guaranteeing continuity of education requirements. Mobile apps can also help employees access company-wide resources, managing tasks such as training, leave, time, attendance, and report work progress. Companies can also onboard and train new hires virtually by allowing them to use a computer or smartphone. These are key ways to continue meeting education and training requirements for healthcare professionals. 

• To ensure business operations run smoothly and safely, long-term healthcare facilities should prioritize touchless technologies, such as video conferencing and thermal temperature readings. Encouraging employees to adhere to distancing and occupancy regulations will help minimize physical contact and prevent compromised business operations. Employees should also be encouraged to use self-service options to report safety risks and access smartphone resources for training tasks. These efforts underscore that you’re mindful of COVID-19 safety for facility management, staff, patients, and families. 

• To give employees more control over their schedules, use technology to help maintain appropriate and qualified staffing levels and availability. Maintaining schedule flexibility is key to employee success during this pandemic. Software that organizes and personalizes schedules with staggering shifts, break times and extended work hours will help limit overtime costs and gaps due to illness or unplanned absence. In turn, this will improve costs, minimize turnover and boost productivity and morale. Distribution and access to statistics and data reported to the Payroll-Based Journal (PBJ) system can also help e facilities with staffing needs. Additionally, using PBJ data, the Centers for Medicare & Medicaid Services can approximate facility needs and help support local, state and federal agencies’ response to preventing and controlling the transmission of COVID-19. 

• To better communicate with employees, keep them updated on any changes and provide a channel to executive leadership. Utilizing communication tools like instant messaging and group chats will help employees feel aligned with leadership on what changes and updates are going on. Keeping employees well-informed and integrating channels for employee feedback will also provide a sense of commitment and support during an uncertain time. 

Practical and flexible approaches to company-wide precautions and policies will help employees embrace changes and ensure business operations continue running efficiently, even with staff and availability challenges. Traditional methods and practices may no longer be an option for long-term care facilities. There must be a focus on innovative virtual strategies and techniques to ensure compliance with new and changing regulations during the COVID-19 pandemic. 

Joe Palladino is a senior solutions consultant at Ascentis. He has spent more than 20 years helping organizations meet their business needs by applying services and technology best practices.

“At the end of the day, engagement matters and it matters when it comes to turnover,” said Beth Baerman, a workforce management expert with Attendance on Demand Inc. 

Baerman’s comments came during a webinar hosted by the American College of Health Care Administrators for its annual Convocation & Expo. The session focused on increasing nursing home employee engagement and retention. 

She noted that recent research has shown that vacancies among all positions in long-term care have risen from 19% in 2018 to 23.5% in 2020. A recent Health Affairs study also found that median turnover among nursing staff was 94% in 2017 and 2018. 

High turnover rates do impact the bottom line, she stressed. It’s estimated that the direct costs to providers for replacing a certified nursing assistant is $2,000. 

“When you’re talking turnover of over 100%, that is a lot of money, but it’s more than just that,” Baerman said. “Another way to look at it, which is also mind-boggling, is just a 10% reduction in turnover can save for an organization … which seems to me to be a pretty achievable goal.” 

The first step for operators is to increase the amount of engaged employees they have on staff. Baerman shared data that showed the turnover rate among disengaged employees (40%) is more than double the rate among engaged workers (18%). Additionally, disengaged staffers are also absent more days than engaged workers. 

Data from long-term care workers shows that 66% of highly-engaged employees plan to stay with their organizations and just 2% are actively looking for another job. Just 12% of disengaged workers plan to stay and 23% are looking for another position. Moderately engaged workers, fall in between: 36% plan to stay and 8% are looking for another job.

Top reasons long-term care workers leave their organization, or the industry entirely, include not feeling supported by their managers, large workloads, tough work schedules and lack of support from colleagues. 

Baerman explained operators must commit to improving communication with employees and help foster strong, trusting colleague relationships to improve retention. Updating the scheduling process can address both issues. 

Operators should consider learning preferable worker hours for employees and then schedule from that,, instead of making standard and predictable schedules with times that don’t necessarily fit their needs, according to Baerman. Utilizing different workforce management systems and phone applications also fosters self-scheduling among staffers. 

She added that making it easier for workers to switch shifts among themselves or to take requested time off also can improve employees’ opinion of an organization.

Other “high impact changes” that reduce turnover include cross-training among different types of staff members, allowing a variety of people to plan social events in facilities, and recognizing which workers want extra training and/or education. 

“If you can change the way you work, change some of your practices, how you schedule employees and bump that 23% disengaged even to moderate engagement, we see a huge drop in actively seeking another job. Right there we’re addressing turnover,” Baerman said. 

“The way you schedule can demonstrate the organizational support that you provide to your employees,” she added. “It provides empowerment and self-direction and communicates with employees that they have a say.”

Workforce shortages are well understood challenges of the healthcare industry. However, the skilled nursing industry has always been hit the hardest. This market is characterized by tight margins and facilities facing the challenges of limited workforce availability with limited resources, inefficient processes and very basic technology — often little better than pencil and paper.

Many industries, including acute-care settings in healthcare, have modernized and implemented intelligent workforce management solutions and processes, resulting in greater efficiencies. But nursing homes have lagged significantly. Though it will take time and require a patient and careful approach, it’s time for the post-acute world to integrate and modernize its workforce management processes in order to not only survive, but thrive, going forward. 

The ongoing nursing workforce shortage

The United States has been experiencing a growing gap between the available nursing workforce and the demand for nurses in acute and post-acute care, and this is expected to worsen as aging generations and increasing burnout drive nurses into retirement. This challenge is further compounded by the fact that nursing schools have not been able to keep up with ever-growing demand. 

As the supply-demand gap continues to widen in post-acute nursing, facilities have had to resort to such extremes as forced overtime and wide-scale reliance on costly outside staffing resources. The nursing home industry is facing a real crisis amid the perfect storm of low margins, high-stress and rampant burnout. 

Workforce shortage compounded by COVID-19 

The pandemic shed harsh light on chronic workforce problems, including insufficient training and staffing levels in nursing homes. These challenges have been consistent across the healthcare continuum, however other sectors have been able to respond more appropriately to the demands of the pandemic by using modern staffing and workforce management technology. 

The more sophisticated the approach, the more productivity the organization can get out of their existing workforce, while reducing burnout and improving quality of patient care, and post-acute nursing will need to embrace these more sophisticated approaches to meet the many workforce and market-based challenges it faces.  

What does good workforce management look like? 

Good staffing and workforce management require a multipronged, integrated approach that focuses on staff sourcing, optimal allocation of staffing resources and training:

• Nursing home facilities must leverage technology intelligently to match available resources to the demand of shifts that need to be filled. 
• Sophisticated analytics and AI can help to ensure shifts are filled with the most appropriate staff in terms of training and cost, and to minimize burnout, while addressing other relevant variables like seniority and union rules. 
• Ensuring each staff member has the appropriate education qualifications to work in a facility and the certifications and training to fill specific roles and responsibilities is also critical.

When executed strategically, these three buckets are very synergistic. If one or two buckets are leveraged, but not the third, it may result in filling a staffing slot with someone who is underqualified, or over-investing in outsourced staffing agencies. In a perfect world, technology, staffing resources and education work together in harmony, ensuring that all shifts are filled with the most appropriate candidate possible. 

Achieving optimal workforce management 

Understanding the key elements of effective workforce management is an important first step, but knowing what to do and finding the time and resources to do it are very different things, and just the idea of embracing advanced workforce management best practices can often be daunting. It’s important to know that nursing facilities do not have to do everything at once. Most organizations will benefit from taking things slow and working one step at a time as their organization and culture acclimates to new ways of working. Ultimately, these organizations can make steady progress and see incremental improvements until they are finally enjoying the full benefits of advanced workforce management technology and best practices. 

The first and most critical step on that path is capturing basic data on utilization and resources. Until organizations get off of paper and paper-equivalents (looking at you Excel), the essential information required to support more advanced practices will remain inaccessible.

Digital scheduling and staffing software will not only track internal employees, but also any outside or per-diem staff. Super-sophisticated scheduling systems with overwhelming features and capabilities are not required at this stage. A simple digital scheduling system that has some capability to engage workers with conveniences like text messaging will start to give post-acute care facilities the engagement and data necessary to ultimately transition to more advanced levels of analytics-driven improvements.

Another critical early step is organizing and optimizing staff training and onboarding. Organizations typically have big gaps in certain skill and certification requirements, and using digital tools here can achieve a better understanding of staffing inventory and onboarding. Knowing how long it takes to bring new staff online, where the biggest gaps in available skill sets are and getting measurable feedback on the quality of training resources all represent major advancements in workforce management efficiency. 

With this data compiled and analyzed, organizations can start to identify root-causes of inefficiency and ways to enhance current processes. This includes leveraging data and technology for a more sophisticated approach to addressing issues like integrating temporary  agency staff into unified scheduling systems. 

Once the available staffing resources are evaluated holistically using digital tools, organizations can further increase the sophistication of their workforce management process, with techniques like:

• Calibrating overtime and other incentives for filling shifts using AI and predictive modeling 
• Building in rules to improve patient satisfaction and safety, while reducing burnout
• Automating regulatory and union compliance 
• Optimizing use of gig-model staffing resources to decrease mandatory overtime and outsourcing costs
  • This can include creating on-call pools – a strategy that improves outcomes by emphasizing care team consistency.

There is a huge delta in the market between post-acute workforce demand and what is actually available. The pandemic has only worsened these challenges, exacerbating the consequences for patients and staff. By embracing more sophisticated workforce management practices and technologies, the staff sourcing, education, and scheduling processes in the nursing facility can be dramatically improved, yielding benefits for patients, staff and the bottom line. By taking small steps and building on small victories, organizations can reasonably tackle these ongoing and chronic issues at a pace that is comfortable to them. 

Rachel Schiff is the senior vice president of product management for IntelyCare, a leading intelligent workforce management solution for post-acute facilities.

Despite an ongoing evolution of employee time-tracking solutions, many long-term care organizations still rely on antiquated time clocks that do little more than record a worker’s comings and goings.

Consider what you’d miss out on if you only used your mobile phone to make and take calls. Like smartphones, new time clocks far exceed their original function.

Next-generation time clocks can transform an organization’s employee management practices and advance key goals in several ways:

1. Safeguarding residents and employees from viruses

Every day, skilled nursing and assisted living employees care for society’s most vulnerable citizens. Unfortunately, history demonstrates how susceptible staff and residents are to healthcare crises. Most recently, the highly contagious 2019 coronavirus wreaked havoc in thousands of senior care facilities, compromising staff and resident well-being despite operators’ best efforts. The pandemic demonstrated just how rapidly germs can spread, sending facilities into lockdown and institutionalizing rigorous infection-control procedures and employee health checks.

With the right technology, facilities can limit the spread of contagious disease without deploying costly manual efforts, like scrubbing high-touch time clocks every time someone punches in or out or hiring additional staff to take temperatures of incoming employees.

Contactless time clocks and technologies enable workers to punch in or out of work using a QR code, limiting the risk of disease transmission through contaminated surfaces. This method can be six times faster than traditional time clocks, reducing long employee lines when shifts change and making it easier to social distance.

Additionally, thermal-sensing time-tracking features automatically take employees’ temperatures while they stand in front of the time clock, even if they’re wearing a face mask. Seamlessly integrated with a workforce management software system, automatic temperature screening enables operators to quickly identify and flag at-risk employees before they interact with other employees or residents.

2. Automatically enforcing attendance policies  

Minor attendance violations can add up to major expenses over time. 

When part of a fully-integrated workforce management system, time clocks can automatically compare a new punch against the employee’s schedule and restrict early, late and unscheduled punches. Employees who arrive early must wait to punch in, while those who are not scheduled to work must obtain approval before they can punch in. Additionally, workers can no longer cover for tardy or absent co-workers by entering their colleague’s badge ID and access code. Advanced time-tracking systems can automatically confirm a worker’s identity during the punch process though biometric recognition capabilities. Paired with an integrated QR code, a time-sensitive window prohibits employees from entering their information early or for a colleague. 

3. Boosting employee engagement

Interactive, intelligent time clocks show employees their needs matter before they enter the workplace, by providing the flexibility they need to get their workday off to the best start. Of course, touchless access helps ward off germs and demonstrate facilities’ commitment to their health. Meanwhile, mobile apps grant anytime-anywhere access to scheduling and other key data. 

Balancing work and life responsibilities represents one of the biggest challenges all workers face, especially healthcare staff. They routinely work rotating, double and split shifts, with many long-term care employees also juggling shifts at different facilities.

Integrated mobile workforce management systems and time clocks give employees access to schedules as soon as they are created. Employees can view up-to-date schedules, swap shifts with co-workers and submit or view requests wherever they are. 

Consolidating workforce tools on one platform helps employees focus on the important work ahead of them, rather than jumping through hoops just to get started.

4. Promoting full staffing

Creating schedules that support PPD census values is critical to ensure proper staffing. But when resident populations and needs change, you must adapt quickly. Software that’s purpose-built for post-acute and long-term care facilities can automatically populate schedules that support Centers for Medicare & Medicaid Services policies and notify administrators of potential violations.

When it integrates scheduling and time tracking on one platform, the system can match live attendance data with worker schedules to expose gaps in real time. Administrators can use at-a-glance views of staffing for multiple facilities to identify gaps. The workforce management system then can display who is qualified and available to take the open shifts, as well as who can work without incurring overtime.

The right workforce management system and time-tracking capabilities can benefit your entire organization. Be mindful when surveying your options and make sure to pick a solution that helps you to protect your employees and residents, meet compliance requirements and encourage employee engagement, all while reducing costs.

Jim Pirraglia is vice president of product and strategy for SmartLinx.