Supply of frontline employees is failing to keep up with ballooning demand.
By Jeff Shaw
Jessie Bosshard knows what she wants to do with her life. She wants to work in seniors housing.
Bosshard, who recently graduated from DePaul University with a business degree, began her career in seniors housing at 16 years old and even received some certified nursing assistant (CNA) training. At that tender age, she was shocked to find overworked and exhausted staff, exposing her to the semi-normality of employee stress and negligence in the first community where she worked.
Now 22, Bosshard decided that rather than run away from the industry as many would, she would set about finding ways to fix the problems she saw firsthand in that initial job.
“For a while, I was unable to wrap my head around the current state of senior living,” says Bosshard. “Since then, I have crafted my undergraduate career in a way that would allow me to better understand the only inevitable part of life — the aging process.”
In 2016, as a college student Bosshard accepted an internship at a CCRC in North Carolina where she got a refreshing look at a well functional facility, learning the ins and outs of operations among happy residents and employees. Her choice to continue in the industry despite a bad first impression seemed like it would pay off.
But fresh out of college, Bosshard had no idea where to start. Her business professors and advisors at DePaul weren’t terribly familiar with the seniors housing niche. Despite her experience in the industry, Bosshard was not sure what jobs she qualified for or how to link up with quality operators. She was overqualified for entry-level positions, but underqualified for administrative positions.
Bosshard came across Connect The Ages, an awareness campaign that seeks “to connect five million students and young professionals to multidisciplinary career opportunities in the field of aging by 2025,” according to Amanda Cavaleri, the organization’s founder and CEO.
Of that five million, Cavaleri wants approximately one million to be in the seniors housing field. (The remaining four million range from software developers to architects and include anyone associated with the field of aging.)
Cavaleri helped Bosshard update her resume and LinkedIn page in ways that would better resonate with the seniors housing industry. She also assisted Bosshard with identifying potential employers.
“It is refreshing to have a mentor in the field, and I would love to see Connect The Ages target more universities so that young professionals are aware of this opportunity,” says Bosshard. “I wholeheartedly believe that aging should be comfortable and fun, and so should my next employer. “
While Bosshard’s career now appears to on track for seniors housing, her story may be far too rare. How many others would continue in the industry if they endured such a bad experience as a teenager? How many struggling to find their first job in such a niche industry would simply seek an alternative field with fewer barriers to entry?
Supply, demand out of sync
The demographics are daunting. The U.S. Bureau of Labor Statistics forecasts that the demand for personal care aides, registered nurses, home health aides, food workers and nursing assistants will increase by more than 1.8 million people between 2014 and 2024. Of those jobs, 347,000 will be in the senior living industry, according to Argentum, a national trade association serving companies that own, operate and support professionally managed senior living communities nationwide.
Combined with retirements and workers leaving the industry, Argentum projects that the seniors housing industry needs to recruit 1.2 million new employees before 2025.
The industry has notoriously high turnover rates. The American Health Care Association (AHCA) reported an overall turnover rate of 45.2 percent annually and 52.4 percent for certified nursing assistants specifically in 2012, although those numbers have improved slightly since then. With Baby Boomers beginning to reach retirement age, the disconnect between supply and demand becomes clear.
Sheer numbers aren’t even the only headwinds. Several states have increased the minimum wage, with even more in the process of doing so. While most frontline workers already make more than the prevailing minimum wage in many places, Jim Moore of senior living consulting firm Moore Diversified Services Inc. is quick to note that the higher-paid workers will still expect a commensurate increase.
“People want to write it off and say, ‘I don’t hire minimum-wage workers,’ but the whole wage base is changing,” says Moore. “Employees expect to have an offset over minimum wage because they’ve always had one.”
Several industry professionals worry that the Trump Administration will also reduce one of seniors housing’s major labor pools: immigrants. The administration has talked loudly and proudly about its goals to reduce immigration, and to focus on those immigrants seeking jobs in the tech sector.
“The data suggests we have a real crisis on our hands for caregivers. I’m optimistic that both parties can see the opportunity to obviate that problem with immigration reform,” says David Schless, president of the American Seniors Housing Association (ASHA).
“I would hope discussion of immigration policy would include giving caregivers classification in immigration reform, not just high-tech employees. I don’t think it will happen in the current political environment, but it’s something you’ll see groups like ASHA focus on when the timing is right,” adds Schless.
Cavaleri is optimistic because she believes that reform isn’t necessary for the industry to thrive.
“A lot of people look to immigration to solve the shortages, thinking that young people don’t want to work these jobs. I’ve found that to not be true,” says Cavaleri. “A lot are looking at this issue from a perspective of changing salaries and immigration problems. That’s frankly a waste of time with this administration. But education is not a waste of time. That could actually move the needle.”
Catching them young
Education is a multi-layered issue for seniors housing. For instance, student loan debt is hurting many young workers’ ability to get their career started, says Cavaleri. An education strategy, or even incentives from seniors housing operators, could reduce this burden.
In order to appeal to young workers, operators will have to think outside the box, says Cavaleri. For instance, many potential nurses don’t obtain their CNA designation because of the time commitment required. Classes require too much dedication, or only occur during times when the person is already working.
A CNA designation demonstrates a certain level of knowledge and ability with caring for patients, which can accompany more responsibility and a pay raise. Requirements vary from state to state.
For example, in Washington, to earn a CNA designation a person must complete 85 hours in a state-approved training program, take a competency exam, and undergo HIV/AIDS training and more. Most states require continuing education (usually 12 hours per year) to hold the certification for longer than two years, as well.
“Maybe these communities need to start doing their own CNA training,” says Cavaleri. “Do it every other weekend for two months. I’m sure these students would love to pursue that.”
Cavaleri even suggests operators put a young student on the board of directors to ensure that a youthful perspective is heard and understood.
The seniors housing industry must reach out to students in high school and college. Seniors housing communities are a great place for students to earn their required amount of volunteer hours or complete internships, notes Cavaleri. But it’s extremely important to pay interns, she adds. Paid interns are much more likely to become full-time employees later down the road.
“When we don’t offer paid internships, we’re devaluing the industry. The interns need to be paid. You’re just not going to get quality folks and folks that want to stay in the space if you’re not exchanging value for their time and energy,” insists Cavaleri.
High school outreach is one of the biggest keys to getting a better pipeline of new employees, according to Paul Williams, vice president of professional development and education for Argentum.
“Most people aren’t aware of the types of jobs available to high school-level students. We have people that can work on the dining staff. There are a number of high schools around the country that have CNA programs, where students can work with seniors as direct caregivers. We have to have exposure points through guidance counselors to let students know about this.”
Of course, getting a young worker in the door doesn’t mean much if the operator can’t retain that employee. One of the largest struggles the industry faces is that workers don’t have a clear career path, leading to a stereotype that the industry is full of “dead-end” jobs.
For instance, a high school student might take a job in dining, but not realize that there are advancement opportunities within the department or in other areas of the community. A worker may have a CNA certification, but not realize that there are further certifications that could help further that person’s career.
“We want to ensure, at the entry level, that people are getting the training they need,” says Williams. “Also, once they’re in, we have to make sure there’s an ongoing professional development plan in place. We get them the training they need for the job today, but also see the progression they can follow in their career. This creates a clear career path with ways to advance in the industry.”
Moore suggests that many operators don’t do enough to minimize turnover, despite how costly it is for the industry. He will often have clients calculate the cost of an employee leaving, which gives the operator a whole new perspective on why retention is important.
Calculating cost of turnover can be complicated and varies from community to community. It includes such factors as the time/cost of training, costs of recruitment, overtime paid to employees filling in for someone who left, and benefits paid to an employee who left.
“When they compare average turnover with the cost, operators will become more motivated to invest in things that will reduce turnover even though they cost money,” says Moore. “Turnover is an expensive item, and it’s probably going to increase.”
Many older workers will want to work past the traditional retirement age of 65, but fear age discrimination, adds Moore. This is another area where a smart approach can help retain a longtime employee.
“We need to give these older people recognition and information that says we value your experience and we need your experience. There are not enough young people to fill the demand for employment.”
Other innovative solutions
The fact is, labor costs are going to go up, says Moore, due to wage pressures, inflation and benefit cost increases. Since labor expenses can only be controlled to a certain extent, operators must reduce costs elsewhere to make up the difference.
“The senior living industry really needs to sharpen its operations to compensate for things we will not be able to control,” says Moore.
Another approach is to make existing employees more efficient, so that fewer workers are needed. Software and other technology solutions can help achieve that goal, according to Schless.
These solutions include everything from making sure the necessary number of employees is working at any given time, to setting up the most efficient walking route for an employee to visit residents.
“At the end of the day this is a business and very labor-intensive,” says Schless. “There are certain areas where labor may be reduced by staffing efficiencies and technology.”
There are many good operators coming up with effective best practices for staffing. But how do operators communicate those best practices to the rest of the industry to create the proverbial “rising tide that lifts all boats?”
LeadingAge, a seniors housing industry association serving nonprofit operators, is working on a remedy. The program is called the Center for Workforce Solutions, and will archive best practices that LeadingAge gleans from operators around the world.
The program is still under development, but Susan Hildebrandt, the association’s vice president of workforce initiatives, has high hopes for its future.
“LeadingAge is looking for a way to spread these promising practices. We need to make them easily replicable for all sorts of communities,” says Hildebrandt. “Operators are really busy. They don’t have the time to find out what someone’s doing on the other side of the country. We plan to offer that to them using a simple menu.”