Meeting Labor Issues with Five-Star Solutions

Will the shortage of healthcare workers restrict the long-term care industry’s ability to meet quality standards?

By Conner Girdley

With the convergence of the growing elderly population in the United States and a steady decrease in the number of available healthcare workers, there is an impending shortfall. 

There are strategies providers can implement today to meet this challenge. There are also proactive solutions some long-term care (LTC) facilities have already assimilated into their facilities. Many of these strategies are no- or low-cost answers that are having an immediate impact on employee morale and retention. Even more appealing is that these strategies are simultaneously delivering a more patient-centered focus, which results in better service and ultimately will positively impact five-star ratings. 

For LTC operators and developers, one clear message is emerging: creating a supportive, collaborative relationship with employees keeps turnover rates low and ensures quality service. Treating employees with compassion creates compassionate workers. 

An overburdened industry

On paper, the numbers do not look promising for LTC facilities looking to secure enough workers for their facilities. 

By 2030, the number of people over the age of 65 is expected to double, putting more strain on our already overburdened healthcare system. The U.S. Bureau of Labor Statistics reported that an additional 1.1 million home health aides and nursing assistants will be needed by 2024, while the population of potential workers available to fill these jobs will increase at a much slower rate. 

“The No. 1 issue with healthcare is drawing people to work in our profession and then keeping them,” says Deborah Meade, CEO of Georgia-based Warner Robins’ Health Management. “It’s tough to compete when people can flip hamburgers for more money than what we can pay our certified nursing assistants (CNAs).”

Fewer people are choosing healthcare fields because healthcare facilities are frequently understaffed, leaving employees overworked and underpaid for work that is both mentally and physically draining. Also, the five-star rating system requirements are putting more demands on healthcare workers to do more with less. 

“Instead of balancing to the penny, we have to balance to the halfpenny, leaving very little left over for employee benefits, bonuses and salaries,” says Meade. “However, this may be a difficult profession because of all the rules and regulations, but it is also extremely rewarding.” 

Start with the employees you already have 

When factoring in the time it takes to recruit, screen and train new employees, and the potential disruption in the continuum of care for patients that results from high turnover rates, it makes sense to work with the employees you have. Also, high turnover rates leave a negative impact on employee morale, productivity and quality. Retaining employees becomes extremely important. 

The question is: how? 

While “show me the money” may have been the axiom for Jerry McGuire, employee satisfaction is rarely about money. A survey done by CareerBuilder found that the No. 1 complaint among healthcare industry staff was “lack of job advancement.” More than half the workers surveyed indicated “they would stay with their employers if they could move into new positions.”

At Tara Cares, an administrative support company for the seniors housing industry, employees are given the opportunity to take classes and gain specialized training through their own Tara University, an online education portal. These courses are specifically designed to give employees the opportunity to earn licenses and certifications. 

Also, the career ladder program at Tara Cares enables staff to gather the training they need to move to higher positions. The housekeepers can train to become certified medical audit specialists, for example. This approach allows Tara to give employees the opportunity to grow, while also securing their future workforce. 

“We do not want to be reactive if a position becomes available,” says Tony Wehunt, regional vice president of Tara Cares. “We are preparing the workforce to meet our future staff needs.”

Providing employees with opportunities to expand their skills and education not only helps employees feel more valued, but also increases the quality of the staff, making a positive impact on the quality of care provided to residents. 

In addition to career advancement, the CareerBuilder survey found work overload and low salaries as causes for job dissatisfaction. Meade believes that “the staff will aspire to whatever expectation the leader gives.” 

Satisfaction begins with communication

Wehunt believes that “employee satisfaction is, and should always be, a moving target.” The key is to create a pathway so that employees have a voice, and validate what your employees are telling you. 

“More than 10 years ago, we wanted to find a way to differentiate ourselves,” Wehunt explained. This led to the creation of an Employee Retention Committee. “This gives everyone an opportunity to voice their concerns, and keeps us informed of ways that we can continuously satisfy our employees.”

Contrary to most policy meetings, where the department heads meet and dictate the new rules, these meetings are comprised of employees at all levels. Wehunt wants employees to know how important their input is, because “they are the front-line employees who work directly with our patients.” 

“Once we learn what our employees need, we can then strategically look at what we’re able to do. Sometimes, the solution can be as simple as ensuring there is an adequate supply of pens and paper within the nursing station.”

But the consequence of not knowing about this need and other employee concerns would have far-reaching negative effects regarding employee morale and retention. “A small investment in a pack of pens brings a high return in helping us to retain the great employees we have.” 

Health Management also understands that the cornerstone to its success is rooted in improving employee communication. “We started by making our employees happy so that they would be willing to abide by a patient-centered focus,” says Meade. 

To start, Health Management appointed a spokesperson from every department to regularly meet with all of the department heads. 

“This was a culture change within itself,” says Meade. “Suddenly, every employee had an opportunity to be heard. It was important for the CNAs to know how valuable they are to us, and that the ideas that they bring to the table are very important to us.”

During these meetings, employees collaborate to solve problems. Some of the changes were as simple as adjusting the bath schedule to accommodate patients on a dialysis schedule. Without the input from the CNAs, who know the patients’ schedules, this detail would have gotten missed in the initial planning stages. “It’s all about: am I appreciated? Am I recognized? And am I making a difference?” says Meade.

Adjusting to demands

Matching workers’ hours with the available workload can be difficult in LTC facilities, especially in locations where there are three shifts, 24 hours a day, 365 days a year. But Meade has found some creative ways to make concessions for employees who are attending classes. 

By adjusting the times that the shifts start, adding new shifts and offering part-time positions, Meade can make it work. “I can ensure we have enough staff to hit our peak times, accommodate the lifestyles of our employees, and reduce costs, all at the same time.” 

Some LTCs have learned that by focusing on retention, recruiting almost takes care of itself. Word quickly spreads about employers who rarely have openings because employees have a good track record of staying and advancing up the career ladder.

Local technical schools, colleges and universities are an important resource for new employees. Both Health Management and Tara Cares ensure visibility within the schools so that they can keep the flow of applicants active. Meade actively recruits people who might be a good fit for Health Management, offering positions to people by asking: “I see potential in you. How would you like to come work for us?” 

Millennials, people born between the early 1980s to about 2000, are a significant source of healthcare workers. Attracting and retaining them involves recognizing that Millennials have strongly felt values. They are drawn to organizations that have a cause or mission, or a special challenge, and want to feel as if they’re contributing to something greater than themselves. 

“We are finding that the Millennials are attracted to training, opportunity and education, so we are working hard to make these opportunities available to our employees,” says Meade 

Technology is another modern factor that has the power to alleviate the burden on clinicians and give workers tools to do their jobs better. While any clinical decision is always made by a doctor, digital-based healthcare can help workers interact with more patients. Wearable devices are an important strategy to improve care delivery while supporting prevention and management of chronic care, at potential low-costs, in a competitive environment. 

The advent of electronic health records, accountable care and insurance regulations have placed a higher burden on staff to maintain, upgrade and manage these electronic systems. At the same time, there are many administrative tasks that can now be automated. By investing in processes and systems that remove humans from the equation, LTCs can reduce the number of people needed to run the facilities and reduce the number of human errors.

The bottom line

To meet the growing healthcare worker shortage, LTC facilities can build camaraderie that can raise job satisfaction, serving as a tether to keep workers from leaving. LTC facilities must begin to look for ways to help employees feel valued, which is a quality that will be reflected in the way they treat co-workers, as well as patients and their families. 

Creating a stronger social environment, encouraging employee engagement and recognizing employees are vital to meeting the demand for healthcare workers and will simultaneously attract new residents.

As LTC facilities shift their focus toward employee-centered initiatives to become more attractive places to work, they are finding that these strategies have a dual benefit: they boost quality levels of care across all levels, in addition to ensuring appropriate levels of staffing. 

Ultimately, these efforts are a natural extension of many of the same initiatives LTC facilities must focus on for their five-star quality initiatives. 


Conner Girdley is a vice president with Lancaster Pollard and is responsible for the Georgia and Tennessee markets. He has acted as an advisor or underwriter on transactions in excess of $3 billion.

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