Skilled Nursing Must Look Past Schools, Government to Solve Workforce Shortage

Staffing shortages in skilled nursing facilities made national headlines last month, but the dearth of workers and registered nurses have been a headache for nursing homes for years now. Some of the fixes can range from bonuses for hard-to-staff shifts to higher-level partnerships with local businesses and governments.

But one thing is clear: The problem isn’t going away any time soon.

“I think this is the most intense shortage that we’ve seen, and I think it’s the unemployment rate,” Ann Nunn, health services administrator at the Peterborough, N.H. continuing care retirement community (CCRC) RiverMead, told Skilled Nursing News. “A lot of the nurses … are now retiring, and younger staff or younger people may not be going into health care because they prefer to do jobs where they can work from home or they can work for three days a week, or they don’t have to work weekends. People have to be really committed, and there are people who still are. But there are so many opportunities out there.”


LeadingAge, the industry association that represents more than 6,000 not-for-profit senior care providers, sees a similar issue caused by low unemployment numbers.

“I’ve talked to so many people at this point, and what really strikes me is the similarity of the problem across all different providers,” Susan Hildebrandt, vice president of workforce initiatives at LeadingAge, told SNN. “They have problems with recruitment and problems with retention, and it is across the board … Full employment is a huge issue.”

The big picture


Registered nurses (RNs) are the most difficult positions to fill, according to a 2017 workforce survey conducted by LeadingAge. Of the 470 responses from LeadingAge members, 30.6% reported it is “very difficult” to fill the RN position. The situation extended into this year, at least according to a report from Weston, Mass.-based online classifieds company Monster, which found RN jobs were the most popular type of job posted in the first half of 2018.

Other hard-to-fill roles included aides, directors of nursing (DONs), and licensed practical nurses (LPNs), according to LeadingAge’s survey.

LeadingAge launched a Center for Workforce Solutions in June of last year to gather resources for recruitment and retention in a centralized location. The most visited section is one titled “Promising Practices,” which describes programs implemented by various LeadingAge members that might work in other communities, Hildebrandt said.

Another tool calculates the cost of turnover, while there are pre-made presentations available for LeadingAge members who want to talk to students about what’s involved in aging services.

One thing to note is that while the workforce issue is largely the same across providers, the way operators address the problem can vary depending on whether the providers are rural or urban, Hildebrandt noted.

LeadingAge’s Minnesota chapter, for instance, has several rural providers, and among other tools, uses an online content provider for certified nursing assistant (CNA) certification to combat the issues of remote locations.

Urban communities feel the workforce pinch very differently.

“What I hear from a lot of urban communities is that they’re right next door to a shopping center,” Hildebrandt said. “Their issue is not that there’s no one around, but that there are all these different options.”

Solutions small and large

At RiverMead — which has 33 skilled nursing beds and a total of 256 beds across the care spectrum — there are some different incentive programs aimed at getting staff in difficult-to-fill shifts, such as weekends.

Staff members who work every other weekend can get a bonus for picking up an extra weekend, Nunn told SNN, while other incentives exist for working two hours over a scheduled shift. Working more than a certain number of eight-hour shifts per quarter can reap RiverMead RNs, medication technicians (licensed nursing assistants who have gone through a medication program), and LPNs a $200 bonus per quarter.

RiverMead also focuses on providing education for staff, Nunn added, with education centers set up throughout the workplace. Management additionally provides the online program Relias for nurses to reinforce skills, and puts a premium on flexible scheduling.

“One of the things we do when we interview people is try to find out what you are looking for,” Nunn said. “We have a lot of nurses and staff that are in school for various things. So we really accommodate school, and I think that’s made somewhat of a difference.”

Part of that accommodation includes reimbursement for employees if they’re pursuing a degree related to health care, she noted. About six to eight people per year use the tuition benefit, mainly consisting of staffers going to nursing school.

In addition, RiverMead is part of a workforce development group in the Monadnock region in New Hampshire, which encourages colleges to participate in an LPN program and make more education programs available. The CCRC also has a program for licensed nursing assistants — the equivalent of CNAs in New Hampshire — at the local high school.

It’s an example of working with local partners that Hildebrandt said she would like to focus on this year. Along with government agencies, she wants LeadingAge to work with local coalitions such as chambers of commerce to make sure communities are aware of the potential of aging services as an economic driver, as well as a means to care for the aging population.

Hildebrandt also wants providers to start looking at broader demographics for potential workers, beyond just women between ages 25 to 54 and beyond educational institutions — though she stressed that reaching out to schools makes sense. But there are other options, such as local organizations that work with veterans, she said.

“I’m also really interested in reaching displaced workers who might have been in similar sorts of hospital-type jobs like retail, and whether or not it would be interesting to them to work in aging services,” Hildebrandt said. “… I think there are people out there, and it’s just determining what’s the most organized and efficient way to reach those groups.”

Written by Maggie Flynn

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