There is no one way to fill the gap left behind by the more than 400,000 caregivers that have exited the industry since the start of the pandemic.
Nursing homes have implemented a number of recruitment and retainment strategies over the past year to curb the worsening staffing crisis, but it may not be as much about finding the perfect solution as it is finding the right combination of tools to stem the losses.
Kevin McInerney, chief personnel and government affairs officer at Legacy Healthcare, tries to think about staffing strategies in terms of both short- and long-term impact. McInerney also tries to look at direct and non-direct solutions as well.
“So a sign-on bonus would be a short-term, direct example of something that we can put into place and see what kind of traction we can get,” he said at Skilled Nursing News’s Clinical Executive Conference. “There’s no singular program that’s going to solve all of your problems. We try to look at this holistically and the first box we checked was wages and benefits.”
While most operators agree that the crisis goes beyond just raising compensation, McInerney admitted that nursing homes have to make sure that they are at least in “the ballpark” of where everybody else is in terms of wages. But even that can be difficult.
Certified nursing aides’ hourly wages increased 7.13% in 2021, an August Hospital & Healthcare Compensation Service (HCS) report indicated, outpacing a 2020 increase of 4.76%.
And it’s across all positions that operators are having difficulties.
At some of its Kansas City locations, Ignite Medical Resorts lost half of its dietary teams in five buildings after the fast-food chain Sonic started offering a $500 sign-on bonus, according to Jim White, Ignite’s chief culture officer.
Evaluating what matters
One of the few ways McInerney has been able to develop pipelines of new workers at his facilities is by working with local high schools and colleges.
“It’s the only thing that we’ve seen work in the immediate short term. [You] get CNA rotations coming through your building and eight weeks later, you’ve got six or seven of these workers ready to go,” he explained.
But even still compounding factors have forced him to rethink about what matters when it comes to staffing.
In fact, Legacy has been able to best navigate the staffing crisis by going to the staff members themselves.
“You’ve got to start soliciting information from your front-line staff,” McInerney said. “We actually created a couple of subcommittees and headed them up by an administrator.”
McInerney doesn’t think that an overly stern approach is the way to go with a staff burned out after over two years of dealing with the Covid-19 pandemic. Patience for staff behavior may be a virtue operators could better learn.
“I just remember five or six years ago if somebody was late or somebody wasn’t showing up on time, there was a tendency to just write them up or write them out,” he explained. “And now what we’re trying to practice, and it’s been an ongoing struggle, is just getting people to sit down and take the time with those staff and understand what are the dynamics.”
He said more can be learned from sitting down and talking with staff members than penalizing them. It may be that they just need some time off or help solving a problem, he added.
“There’s no one-size-fits-all [way] to solve these things, but it’s really about individualizing these solutions for folks,” he said.
Additionally, over the course of the pandemic, Legacy has partnered with child care providers to provide “back up days.”
“If somebody’s main source of day care falls through, we had centers that could drop your child off and we would pick up the cost to show up to work,” he said. “We got very creative with a lot of different things in a way to try to solve everything.”
Strategies the Chicago-based Ignite has implemented over the past year have included a tiered program that rewards staff for good behavior with gift cards, cash bonuses, Ignite-branded swag and extra PTO time, with PTO cash-outs
White said CNAs remain the hardest position to staff, but he has started to see issues with in-house therapy shortages beginning in January.
“Sometimes the only way to engage with people is through perks or cash,” he said. “You have to be creative, but you have to make sure you’re not putting something out there that’s going to sink your company. It’s a delicate balance because if you put too much out there, you’re going to bury yourself.”
McInerney admitted that the pandemic combined with staffing shortages has really “opened up the pocketbook.”
“We’re two years into this thing and there is very little light at the end of the tunnel,” he said. “You think this is going to be the line – and you’d be surprised at how many times that line has moved over the last two years.”
Creating new roles, new responsibilities
While staffing shortages have changed the role of MDS coordinator for some, they’ve even impacted higher-level positions for others.
“Management roles have changed immensely over the course of the pandemic,” McInerney said. “CNAs, front-line workers, they’re critical, but their jobs have largely stayed the same. In terms of administrators, we’ve changed what we look for in an administrator.”
Rather than relying solely on a person’s financial acumen, McInerney said the best administrators are the ones that are able to best connect with others around them.
White agreed.
“You can teach people how to be financially sound. You can teach them how to run an operation,” he said. “You can’t teach them how to interact with people.”
White said leadership positions at nursing homes have become much more people centric.
“If you can’t interact with staff and motivate them and get them on board for what your vision is, you’re going to fail,” he said.
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