It may seem impossible to remove agency use completely during the ongoing staffing crisis, with 238,000 caregivers that have left the profession since the pandemic began and workforce levels at the lowest that have been in 15 years, according to the U.S. Bureau of Labor Statistics.
Meanwhile, nursing home operators may pay three to four times what they pay their own staff for agency workers to cover shifts.
Strategies like in-house staffing agencies, increased emphasis on overtime and more robust benefits are all being utilized to keep and retain workers – Indiana-based Majestic Care, which used all three of these tactics, has seen success so far, with its Toledo location being agency-free as of February.
With the help of an intensive campaign launched this month targeting registered nurses (RNs) and licensed practical nurses (LPNs) throughout the Midwest with enhanced pay rates, Majestic Care CEO Bernie McGuinness said Majestic Care was able to expand its agency-free initiative at four of its five locations in Ohio this month.
Majestic Care operates 32 facilities across Indiana, Ohio and Michigan.
“Just three, four months ago they were heavy into agency,” McGuinness told Skilled Nursing News. “They were able to eliminate agency without much use of the float pool, as we have just one location and really haven’t grown the float pool in the Toledo market. This was strictly through new hires, and getting the staff to quit relying on agency as a crutch.”
The facility’s executive director Cathleen Voyles-Baden and the team at the Toledo location, McGuinness said, had to rally and change the mindset of staff to look internally and provide opportunities for additional income instead of calling agency first.
“Everyone needed to be on board,” said Voyles-Baden. “We needed all care team members to be on board with this change from the way we had been doing things for several years.”
Agency-free tactics
Majestic acquired the Toledo facility on Dec. 17, McGuinness said, and their team was able to go agency-free in seven weeks.
“As a management company, we strategized about a year ago – what are we going to do differently in this changing work environment, what can we do … to separate ourselves?” asked McGuinness.
The answer was multi-layered, he said, to tackle the new workforce and reshape recruitment and retention efforts.
Branded ‘Majestic Difference,’ McGuinness said the leadership team spoke with nurses and certified nursing assistants (CNAs), soliciting feedback on what they’d like to see from an employer, and why they chose to go somewhere else, if that was the case.
“We focused on making sure that we had benefits that made sense to our care team,” said McGuinness. “We first went to weekly pay throughout all of our facilities. We felt like real-time pay was a priority for our frontline staff. Many live paycheck to paycheck and [we make] sure that they have those funds to take care of their personal needs.”
A perfect attendance bonus of $5 per hour, providing work phones in certain markets, 20% off on affordable housing within 10 to 15 minutes of a facility, and public transport to the location were other aspects of the Majestic Difference program to bring in and keep staff.
“We are expanding the housing benefit for new markets – we’re rolling forward with Fort Wayne, Cincinnati, markets where we have more than one location at the beginning of the second quarter,” added McGuinness. “We also have a discount on child care that we already offer through a large national childcare provider.”
Health insurance for $15 a week, telehealth for full-time and part-time workers as well as their families were yet more ways the program sought to bring more staff on.
Building culture, support and a float pool
While its growing float pool of workers has coincided with its reduction in agency use, McGuinness said a significant use of time and resources was also committed to retaining new hires for the first 90 days.
Nursing homes see the most turnover during that time, he added.
“If we can really wrap our arms around our new hires, make them feel a part of the team … we can retain those nurses,” said McGuinness.
Still, Majestic Care’s float pool of workers has grown to more than 60 full-time members over six months, McGuinness said. The operator uses the reserve of workers in urban markets, including Indianapolis, Indiana and Columbus, Ohio.
A regular LPN can “almost meet” what a floating LPN makes currently, with Majestic’s $5 per hour perfect attendance bonus. Laurel Lingle, VP of Talent Acquisition for Majestic Care, said a floating LPN makes on average $38 an hour at the company while regular LPNs make between $35 and $40 an hour.
Majestic Care pays roughly $85 an hour for LPNs through a contracted agency, said Lingle.
On the flip side, Majestic created a Talent Acquisition Center in order to get applicants in for an interview through talent acquisition sourcers, then analyze that data on a weekly basis to increase the likelihood of converting applicant to employee.
Sometimes that means increasing base wages in certain markets, McGuinness added.
“We’ve expanded our talent acquisition department and we’ve taken a more analytical approach to recruiting. Looking at our applicants, we use some different software to go on different platforms such as Indeed through a partnership with Apploi,” explained McGuinness. “We’re able to track our applicant flow. We increased our talent acquisition, our regional talent acquisition to support our facilities in the recruitment and retention efforts.”
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