Skilled Nursing Leaders Share Winning Hiring, Retention Strategies

The workforce crisis in skilled nursing can often seem like a problem without an immediate solution: There are only so many qualified workers in any given area, and with unemployment at record lows, competition for competent candidates hasn’t been this fierce in a generation.

Plus, with reimbursement and regulatory pressures, skilled nursing operators often don’t have the ability to compete on wages, forcing them to find more creative ways to hire and retain good people.

After a pair of skilled nursing operators topped a recent list of the best places to work in senior housing and care, Skilled Nursing News decided to reach out to some of the honorees to find out their secrets to success. And while each strategy was unique, the formula frequently included respect, recognition, and competitive benefits.


At Generations Health Care, which took the number 12 spot on Great Place to Work’s list of top employers in the senior space, director of operations Steve Black says workforce issues have been at the heart of the 27-facility chain’s growth plans.

“We’ve never grown faster than our personnel,” Black told SNN. “We would not acquire another building until we know that those buildings were operating at a very high level, and that we would have the resources necessary to put in our next building.”

The Santa Ana, Calif.-based operator extends that philosophy to upgrading its physical plants, reasoning that one intangible key to hiring and retaining good people is creating an environment where people actually want to work.


“We want our employees going to work in a facility they can be proud of. We preach quality — well, quality’s on many different levels, but aesthetics is certainly one of them,” Black said.

The concept of reinvestment is also an important strategy at the Chaparral House in Berkeley, Calif., which spends about 65% to 70% of its total operating costs on staff according to chief operating and financial officer Chuck Cole. Part of that comes from the Chaparral House’s status as a non-profit, which allows management to pump funds normally earmarked for profits back into its people. As a result, Cole reported a solid relationship with the facility’s unionized workforce.

“Because our goal is to provide for our employees the best that we possibly can, they rarely have to push us to try to give annual raises and to make sure that our employees are well cared for,” he said.

The facility’s benefits for employees include fully covered health and dental insurance, as well as a $10,000-per-year life insurance policy. But Cole, like many others in the skilled nursing industry, stressed that it’s not just money that employees seek from the long-term health care space. Chaparral offers a rigorous administrator training program for aspiring leaders who need to complete their practicum requirements, and also routinely hosts licensed practical nurse (LPN) students looking to explore opportunities in the nursing home space.

For the certified nursing assistants (CNAs) on staff, Chaparral provides handheld devices that allow them to input key patient data and provide more detailed support for doctors and other caregivers.

“We try to empower our CNAs to understand that they’re not just here to do some of the more mundane things of caring for people, but that their input — with regards to their observations and assessments — is also critically important,” Cole said.

For Gurwin Jewish, which took the number-one spot on the Great Places to Work list, employee empowerment starts with greater integration between staff at its adjacent nursing and assisted living facilities in the New York City suburb of Commack, on Long Island. President and CEO Stuart Almer established joint meetings between the two teams shortly after taking the reins of the company in January, and he told SNN that the increased collaboration is already paying dividends in both internal employee satisfaction and census.

“Everyone hears the same message — the same consistent mission and message. And we’ve really done such a good job with our outreach that we’ve kind of blurred the lines from a marketing perspective,” Almer said, adding that the two facilities are at an all-time occupancy high.

Almer also pushed back on the idea that the workforce crisis could be solved by simply providing higher wages, noting that employee recognition efforts — including a robust employee-of-the-month program and cash awards for loyal workers — have helped to boost retention at the facility.

“I believe everyone feels very good about where we stand and the future, so I don’t think people [would] leave us whether our benefits were the best or not the best,” he said. “I think they stay here because they like what they have here.”

Written by Alex Spanko

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