Finding a Structural Solution to Skilled Nursing Staffing Woes

Retaining a staff of talented, motivated employees has remained one of the most vexing problems for skilled nursing operators, as a recovering economy has drastically increased the competition for the best workers.

One SNF provider has successfully turned to a clear organizational structure for an answer, while some other senior housing providers have taken even more novel approaches, according to a panel discussion featuring industry executives at the Senior Housing News Chicago Summit last week.

Strength through structure


Looking for a way to analyze its staff’s performance, the team at Covenant Retirement Communities decided to implement detailed workforce management software for its skilled nursing employees. And the results, according to vice president of human resources Michelle Kozloski, were revealing.

“When you have a system like Workday, a lot of things become very transparent that you really never knew about before,” Kozloski said, emphasizing the importance of data in Covenant’s operations; the panel discussion itself was sponsored by OnShift, a Cleveland-based software provider that offers workforce management products.

For the Skokie, Ill.-based Covenant, which provides a full continuum of services from residential living to skilled care to hospice services, one of the most striking findings had to do with staff structure: In certain skilled nursing settings, some supervisors could have upwards of 80 people reporting to them, leaving little time or opportunity for personal employee development.


“How do you create a relationship between a manager and an employee when there’s 60 people?” Kozloski asked, adding that in many cases, skilled nursing employees may not have had supervisors dedicated to their career growth — only clinical overseers responsible for large swaths of staffers.

“We will be very specific about supervisors, because those named supervisors right now are clinical,” she said. “They’re not necessarily motivating their employees, although I guess they could be.”

Millennial motivation

Employee motivation and career growth were two main themes, especially given their perceived value among millennials — people born between 1980 and 2000 who have increasingly become a dominant employee demographic in skilled nursing and other health care fields.

Lisa Rogers, director of human resources at the Chicago-based Pathway Senior Living chain of independent, assisted living, and memory care senior housing facilities, related the story of her teenage daughter, who seemed more concerned about helping the kindergarten students she worked with than getting her first paycheck.

“They don’t think about the next dollar they’re going to make,” Rogers said during the panel discussion. “They’re thinking about the next thing that they can improve upon.”

That’s why Pathway chooses to invest heavily in training new staff. Instead of the old-school paperwork dump followed by an abrupt start to a new employee’s first shift, the company has a multi-day training program that focuses on making sure workers feel comfortable in both their surroundings and tasks.

Rogers compared Pathway’s on-boarding process to inviting a guest into your home — before you sit down and chat, you show them around, offer a drink, and then eventually get down to business. The same thing applies at Pathway, where supervisors make sure employees receive the lay of the land — down to the location of the bathrooms and helpful back-door exits — over a training period that can last for up to 21 days, depending on the role.

“It really helped the new hires understand that we care about you, and you knowing where everything is, and how to do whatever the skill set is,” Rogers said.

Red-carpet treatment

Gardant Management Solutions, a Bradley, Ill.-based senior housing company, takes things a step further by literally rolling out a red carpet for its new employees, according to chief operating officer Julie Simpkins.

Simpkins told the audience that she got the idea after sitting in on administrator training sessions and discovering that they were bland affairs focused primarily on a thick policies-and-procedures binder. Now Gardant eschews the binder in favor of an in-depth introduction process, starting with a red carpet lined by cheering employees. New administrative hires then meet with the CEO, the president, and Simpkins on consecutive days, followed evaluations at 45 and 90 days in which both employee and employer discuss their performance so far.

It’s all part of reducing churn at the administrative level, which the panel agreed was a key concern — especially given the key role that administrators play in promoting an overall positive culture.

“When you talk about culture, culture lives in that leader within your communities,” Simpkins said.

Written by Alex Spanko

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