Labor Pains

by Jeff Shaw

Senior living communities grapple with a severe worker shortage, responding with innovative approaches and programs.

By Jane Adler

“Help Wanted!” “Now Hiring!”

The urgent signs posted everywhere from grocery stores to job boards reveal the depth of the labor shortage gripping the country. Workers are scarce. But senior living and care is being especially hard hit. 

Long known for having a high turnover rate, the sector faces a number of new challenges. Workers in a healthcare-type setting are afraid of contracting COVID-19. The Delta variant of the virus has only multiplied those fears. Many women, who make up most of the workforce, have left the labor market to stay home to care for young children. Vaccine mandates can make it harder to recruit employees. 

Another possible factor, which impacts all industries, are unemployment benefits. Enhanced federal unemployment benefits ended Sept. 6 even as others remain in place, which could motivate the unemployed to seek work, operators say. 

Senior living providers aren’t just competing with each other for workers, either. Fast food restaurants, big employers like Amazon, and the hospitality sector offer very competitive wages, which are rising. The standard minimum wage, mandated by law in some states and municipalities is inching toward $15 an hour. Higher wages are cutting into profit margins at senior living communities, where wages are the biggest cost. The use of more expensive contract or agency workers to fill empty jobs also hurts the bottom line. 

The worker shortage may not end along with the pandemic. The growing number of aging baby boomers will need special housing and care. But experts forecast a shrinking pool of caregivers in the years ahead (see sidebar).

For now, operators are doing what they can to recruit and retain workers. Special perks and signing bonuses are being widely used. Higher wages, better benefits and career advancement opportunities are common, too. 

Creative approaches are being considered, even profit sharing. 

“Seniors housing operators are all facing similar challenges,” says Lisa Lacy, senior vice president of human resources at Discovery Senior Living, headquartered in Bonita Springs, Florida. She adds that Discovery is implementing both short- and long-term solutions to the labor shortage.

Lacy, along with other senior living executives, recently joined a virtual discussion on workforce issues held jointly by Seniors Housing Business and France Media’s InterFace Conference Group. The panel was moderated by Gary Pederson, executive vice president at MatrixCare, a Bloomington, Minnesota-based software solution developer for continuum-of-care providers. “Workforce issues have been exacerbated by the pandemic,” says Pederson. 

Jobs outstrip worker supply

After a big slump, the job market is gaining some traction. Nonfarm employment has risen by 17 million since April 2020, but is down by 5.3 million, or 3.5 percent, from its pre-
pandemic level in February 2020, according to the U.S. Bureau of Labor Statistics (BLS). The unemployment rate in August was 5.2 percent, a drop from 14.8 percent in April 2020. 

However, job openings outstrip the number of available workers. Open positions at the end of July increased to 10.9 million, while 8.4 million people were considered out of work, according to the BLS. In May, there were 9.4 million jobs open. Healthcare openings increased in July to about 1.8 million from 1.46 million in June, the BLS says. 

Nearly three-fourths of nursing homes and more than half of assisted living communities report that their overall workforce situation has worsened over the past year, according to a June 2021 study by the American Health Care Association/National Center for Assisted Living. 

About 94 percent of nursing homes and 81 percent of assisted living communities have faced a shortage of staff members recently, and more than half of the facilities are actively trying to fill vacant positions for certified nursing assistants (CNAs), licensed practical nurses, registered nurses, dietary staff and housekeeping. In 2020, more than half of facilities said staff in essential positions had quit. 

The current senior living labor shortage is nationwide, operators report. No one geographic region seems more affected than any other. “One hundred percent of my communities say they are stressed about the labor shortage,” says Tana Gall, president at Merrill Gardens. The Seattle-based company operates 70 communities in 20 states.

Short-handed communities rely on staffing agencies to fill the gaps. But it’s a less than an ideal solution. Agency fees cut into the bottom line. Resident satisfaction can also be impacted by temporary staffers who don’t have strong relationships with the seniors. 

Recruitment is a priority

Technology plays a big role today to help expedite the application process. “Posting a job on the Indeed website is not enough,” says Discovery’s Lacy. The company has expanded its use of social media to other outlets such as LinkedIn and Facebook to boost the number of applications.

The application process should be simple, fast and mobile-phone friendly. “The minute someone applies, we want them to be engaged,” says Candace Matsuura, director of talent at Westmont Living based in La Jolla, California. When an applicant responds, the company sends a text or message from a chat bot right away to schedule an interview. The efficient approach also frees up building staff to concentrate on the needs of residents. “Technology streamlines the process,” she says.

Applicant tracking tools are helpful, operators say. 

Software provider OnShift launched a talent acquisition and onboarding system last year. “It gives our customers tools to deliver automation around processes that had been manual,” says Mark Woodka, CEO at OnShift, based in Cleveland. The process can save 24 to 48 hours by speeding background and drug checks. “A lot of candidates may get hired by someone else while waiting for a background check,” notes Woodka. 

Senior living operator Life Care Services (LCS), which manages 144 communities, uses a QR code to recruit and track applications. The applicant scans the code and is linked to online information about the job. “We are using tech to our advantage,” says Donna Boetger, vice president, director of human resources at the Des Moines-based company. The central office manages the system to relieve local communities of some recruiting duties. 

LCS also has a service called Payfactors. It provides technology, data and labor-market insights to help establish equitable compensation practices. “It helps us navigate the pay issue,” says Boetger. 

Merrill Gardens works with the aggregator service Jobalign. It sends alerts of open Merrill positions to all the big job boards. Applicants can apply on their phones. 

An application triggers a message to Merrill’s hiring manager, who sends a rapid response. Gall says that the quicker you get back to someone, the more likely it will result in an interview with a prospective job candidate and move the process along. 

Operators also try to convey to applicants that helping seniors leads to job satisfaction. Messaging and interviews emphasize the mission-driven nature of the work environment. 

“We need to find people with heart,” says Matsuura at Westmont Living. “We are people serving people.” 

Referrals from existing team members are a good source of new workers, operators say. Team members can introduce relatives and friends to a sector they may not have previously considered. Employees working with people they know are more comfortable, which creates a more positive culture.

“Team members’ referrals are our best method of recruiting,” says Gall. 

Merrill Gardens offers a $1,000 bonus to team members who recruit a new worker if the new hire stays 90 days. Two hundred employees have received the bonus in 2021 so far. 

Retention is a big concern

The turnover rate for all assisted living employees increased from 44 percent in 2019 to 53.1 percent in 2020, according to the “Assisted Living Salary & Benefits Report” from the Hospital & Healthcare Compensation Service, an annual study. The national average hourly wage for CNAs was $13.92 in 2020. The report was compiled using responses from 74,400 employees at 1,379 assisted living communities throughout the U.S. 

Since most turnover happens in the first 90 days of employment, operators are retooling their onboarding and training processes. 

Discovery Senior Living recently rolled out a mentoring program. Every new team member is paired with an experienced peer. The mentor acclimates the new hire to the culture and is also available to answer routine questions, freeing up the manager’s time. “The new employee has someone at their level to talk to,” says Lacy. 

Merrill Gardens conducts a “stay” interview with new employees after 30 days. The purpose is to find out how they like their job. If they don’t, perhaps they’d be interested in another position. “If we catch people early enough, we can keep them from leaving,” says Gall.

Operators are focusing on creating careers instead of filling jobs. Career ladders show new hires, and applicants, how they can progress at the organization into positions of higher responsibility. 

Last January, LCS launched an apprenticeship program. “The whole purpose is to grow the person,” says Boetger. Workers are trained in memory care, for example, or leadership. Training is conducted online, at a community college, on the job or through a combination of all approaches. Fifty apprentices are now in the program. “We feel it’s been a success,” says Boetger.

Break rooms are being upgraded to make the workplace more inviting. Operators are also thinking about opening community amenities, such as salons and fitness centers, to workers as a perk. “We are keeping an open mind,” says Julie Podewitz, chief sales officer at Vitality Living in Bentwood, Tennessee. 

Rewards and recognition programs still play a big role in worker retention. Discovery has a team member champion program. Champions are recognized with a special pin and receive a bonus or extra time off. 

Senior living providers are experimenting with creative workforce programs, too.

Earlier this year, Merrill Gardens launched a program called Resident Experience Partner (REP). The idea is a spinoff of an earlier industry trend to hire universal workers who handle many different tasks. 

The REP position is more structured than that of the universal worker, Gall explains. Workers are cross-trained in several areas. A worker might start the day at the front desk, then run the Bingo game, and finish the day with some light housekeeping. 

The system is more efficient, allocating labor where it’s needed, according to Gall. Also, workers in the program have high job satisfaction because the variety of the work keeps them engaged. “The feedback is great,” says Gall. Thirty workers are currently in the program. 

In the wake of the pandemic, employees want a more flexible workplace. Though frontline workers can’t work remotely, operators are thinking of ways to make scheduling more flexible. 

A new type of staffing model might allow workers to accept or decline a shift, or alternatively take a shift at a nearby property run by the operator. Discovery Senior Living is piloting a program with an Uber-style organization. Employees have flexible schedules along with star ratings like Uber drivers.

 “We are all in the caregiving business,” says Matsuura. “Taking care of employees and making their life easier is key to retaining them.”

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