How Providers Can Overcome Competition for SNF Employees

The demand for frontline caregivers is no secret in the skilled nursing industry, as many providers often report facing challenges in recruiting amidst the nation’s growing aging population—ultimately brewing a perfect storm of supply not meeting demand.

In fact, by 2030, job openings in the long-term services and supports (LTSS) sector is slated to “grow substantially,” as positions like counselors, social workers, community and social service workers, home health aides and personal care aides will be in high demand, according to a 2017 report published by Washington, D.C.-based research firm LeadingAge.

But keeping the pipeline full of qualified talent has been the main challenge, according to Natasha Bryant, managing director and senior research associate at LeadingAge. In addition to this hurdle, managers are also grappling with retaining talent, leaving the industry to face a “high turnover rate,” she added.


“Once [providers have] found an applicant and employed them at the organization, there is a lot of turnover, which can affect not only other staff members who may have higher workloads because of vacancies and not having enough people to do the job, but it can also impact the quality of care provided to residents,” said Bryant.

Outside opportunities

The high rate of turnover in the skilled nursing industry is well-documented. The overall median turnover in SNFs was 43.9% in 2012; among direct care staff, certified nursing assistants (CNAs) had the highest median turnover at 51.5%, while licensed practical nurses/licensed vocational nurses (LPNs/LVNs) had the lowest turnover rate at 36.4%, according to a report published by the American Health Care Association.


The reason for attrition varies. Some leave the profession because they find it stressful, while some might find that their schedule does not meet their needs or expectations, according to Bryant.

“[Skilled nursing] work is physically and emotionally demanding,” she said. “It’s not an easy job to do, and for some people, it’s not the right fit for them.”

So where is talent going? Some migrate within the industry.

“There are people who will go to jobs in other sectors of healthcare; so, they may leave and move into hospitals, which sometimes have a higher pay than the long-term care sector does,” said Bryant.

On the flip side, some talent may end up leaving the health care profession, altogether.

“If you’re looking at the frontline staff, some of them … might go into manufacturing or they may go [work at] McDonald’s where they could make just as much money as they do working in long-term care [and not] have the physical and emotional demands of the job,” said Bryant.

Wage disparity

Frontline caregivers flocking to entry-level, unskilled jobs outside of the health care industry can be driven by several factors; but chief among them is the wage disparity, explained Bryant.

This is realized both nationally and on the local level. According to a 2016 report published by LeadingAge Wisconsin, skilled nursing providers in the state reported “a median hourly salary starting wage for personal caregivers of $10.75, compared to $12.00 for local, non-health care employers seeking unskilled, entry-level workers.”

On the national level, citing Public Health Institute statistics, the median hourly wage for nursing assistants is $11.87, while the median annual income is $19,000, according to Bryant.

Offering a competitive wage against fast-food restaurants and other low-skill workplaces can be difficult for many providers, as long-term care is often tied to reimbursement from Medicare and Medicaid, explained Bryant.

“If they’re not getting high reimbursement in a policy area, that can be challenging for them to pay their workers a competitive wage,” she said.

Investing in talent

According to LeadingAge Wisconsin’s 2016 report, 24% fewer skilled nursing professionals in the state applied for CNA certification between 2012 and 2015, while the number of CNAs in the state renewing their certification dropped by 5,431 in the same time span.

Encouraging and, perhaps most importantly, investing, in talent to pursue such designations and continuing education might be the silver bullet that will stop the turnover crisis, explained Bryant.

“We need to make sure [frontline staff] are getting the skills that they need to care for this population—not only their clinical skills, but also their interpersonal skills,” she said.

Empowering these workers goes beyond monetary investment, as trust and advancement are also key pieces of the puzzle. This can be particularly helpful for agencies whose hands (and budgets) are tied by government reimbursements.

“What is in their control is the culture in the workplace environment and … really valuing that front line worker, seeing their job as a professional job and not just someone who is replaceable,” said Bryant.

Autonomy and involving these frontline workers in the decision-making process also plays a key role, especially considering their one-on-one contact with patients on a day-to-day basis.

“They spend probably 80-90% [of their time] providing care to the residents [so] they have the most contact,” said Bryant. “Empower them by giving them input into the decision-making and care planning [process].”

Giving frontline staff a seat at the table and realizing their value can become the first step in helping agencies clear the turnover hurdle, according to Bryant.

“I think we need to change the image of what they do; then, these organizations can be considered an employer of choice where people want to work,” she said.

Written by Carlo Calma

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