Technical School Fastracks, AI, Community Relationships Top 2024 Workforce Initiatives

Nursing home operators, states and federal agencies continue to shift their strategy to meet the demands of the future work environment, as nursing shortages persist and nursing homes face possible upcoming staffing regulations.

Some of these efforts have centered on easing education, training and credentialing. To that end, operators have bolstered relationships with local universities and technical schools by joining boards, working to expand nursing programs and ensuring those who enroll are given every opportunity to graduate. On the other hand, government entities in some states have expanded initiatives – through technical schools – to fast track credentials for clinical staff intending to work in a nursing home.

Meanwhile, others are investing significantly in AI for recruiting purposes so it’s easy to find people to hire and it’s easy for them to find that facility. And efforts to speed up the process to get immigrant nurses is also ongoing with limited success so far in some rural states.

“A lot of our workforce is second income earners. When the economy improves, they tend to leave the workforce as well,” said Neil Pruitt, chairman and CEO of PruittHealth. “There are a lot of creative partnerships that providers can [pursue] to ensure that their workforce is robust.”

Reier Thompson, president and CEO of skilled nursing provider Missouri Slope in North Dakota, said the state opened its own office of immigration, but time will tell what they’ll actually be able to do.

“Immigration, of course, is more of a federal program. We can be the state leader in facilitating immigration to North Dakota mainly for filling jobs,” said Thompson. “If there’s a way that our state can lean on their federal partners, facilitating and doing whatever we can to bring people through and get their visas processed … that’s a new effort that they launched here in 2023.”

Any time Thompson visits with international recruitment agencies, he hears the same thing – that there’s an abundance of people out there that want to work in America, and we just have too many bottlenecks in that process, he told Skilled Nursing News.

On a national level, increased wages at a rate higher than any other health care sector has been a common thread, associations like the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) said. Workforce programs like Careers in Caring aim to help providers attract qualified people to the profession.

Fellow advocacy group LeadingAge has numerous workforce programs for providers including the Fellowship Program for New CEOs, while also keeping an eye on workforce investments from the Biden administration.

Partner referral bonuses have helped the staffing pipeline too. PruittHealth has paid out over $1 million to partners if a staff member stays with them for a set period of time, with up to $3,000 per referral. Getting its existing in-house staff to help recruit, while at the same time trying to be the employer of choice continues to be important, he said.

During the pandemic, workers left PruittHealth if they had comorbidities that made working in a nursing home dangerous for them personally, and sometimes they left the workforce altogether. Now, changing demands and heightened infection control has made the industry a very difficult environment to recruit to, or bring people in from other health care settings. 

Still, PruittHealth’s hiring increased 12% last year – the company is up by about 2,000 net hires. The first quarter looks “extremely promising” as well, he said, with a 24% increase so far this year.

The company maintains its stance on agency use, a philosophy of having zero agency in the years ahead. A couple new contracts have agency that the organization is trying to wind down, he said. In other words, the few agency workers were contracted by the previous owner, or a contractor took over operations.

State and federal initiatives, with LPNs in the middle

In Georgia, Pruitt is encouraged by some programs out there, including a “quick start initiative” that uses technical schools to attract different types of businesses, and ensures the workforce is there.

A program was recently announced where these technical schools will be doing the same for health care, trying to get people up to speed to enter the workforce in all areas, including the nursing home setting.

“A lot of great programs that shorten the time that it takes someone to get an LPN degree or an RN degree, we think is very important,” Pruitt said of the state initiative. “That’s going to take the cooperation from licensing boards, but we are encouraged to see that people understand that is a problem out there.”

Pruitt doesn’t expect hiring trends, when it comes to LPNs, to change given their omission from the federal staffing mandate. It’s been all hands on deck since the pandemic, he said, with LPNs still needed in their buildings.

“Workforce initiatives have not changed in relation to the proposed federal staffing mandate—the rule has not been finalized yet,” AHCA/NCAL said in a statement. “However, the exclusion of LPNs from the proposed rule sends a terrible message to our LPNs as well as our CNAs looking for career advancement opportunities.”

Many in the industry are betting on the legality of the staffing mandate, and it’s long road to implementation, to inform their staffing initiative habits.

“It’s a very interesting environment. And then when you lay on a staffing mandate … typically you don’t put a mandate on when there’s not enough nurses to fill the workforce,” said Pruitt. “I predict [the mandate] to be short lived because it’s ill conceived.”

PruittHealth has, however, increased the amount of medication aides, and certified nursing aides through its ladder program, to really focus on certifying individuals to perform these roles. 

Meanwhile Missouri Slope established a similar training program for CNA certification, Thompson said. The program removes any financial barriers for prospective CNAs, with many hired into the program and getting paid the same hourly wage while taking classes as already certified aides.

Without the program, a new CNA may have to wait a minimum of six weeks before they get their first paycheck, and on top of that they’re starting effectively in an entry level sort of position when it comes to health care careers. “Let’s say you’re certified, well, then you have to get hired somewhere, that’s another two weeks. Then, you have to wait another two weeks for your first paycheck,” he said.

The North Dakota operator was able to reduce its CNA agency usage from about 60% about 14 months ago to 10% today.

Community relationships

In terms of working with educational institutions, supply hasn’t kept up with demand. Pruitt serves on the Board of Regents for a university in Georgia, and supply is a constant problem not just for fulfilling nurses but physicians as well.

Pruitt works to expand nursing programs systemwide in this role and make sure nurses that enter the program actually graduate. Such efforts will be extremely important across the country

“We just simply are not seeing the people entering the workforce match those that are leaving. I think we’re going to have a continued hiring problem,” he said. And, hospitals typically offer higher salaries with higher reimbursement, attracting clinical staff out of universities.

That’s why it’s crucial for nursing home operators to form strong relationships with local universities and technical schools, creating partnerships to increase the workforce.

PruittHealth doesn’t work with unions for staffing initiatives, but that doesn’t mean it isn’t a viable path for workforce initiatives, iCare Health Network CEO Chris Wright told SNN last year. It depends on how deep union presence is in a given state.

At the very least, operator-union relationships can help find middle ground in terms of more realistic staffing mandates, and commensurate funding. Unions and the Pennsylvania Health Care Association last year worked together to find the right staffing ratio and funding in the state.