Nursing home leaders expect non-clinical staffing shortages to have a crippling long-term impact on the talent pipeline and career interest in the space – both on a clinical and supervisory level – as many young people make the choice to enter the workforce via other industries.
Infection prevention protocol and more broadly the tight regulatory requirements the industry is known for are considered barriers to recruiting and retaining non-clinical staff at the moment, especially as industries outside of health care loosen personal protective equipment (PPE) and sanitation demands.
Dietary aides, housekeepers, kitchen staff and recreation departments all fall under the non-clinical banner.
“We’ve had those shortages before Covid and they only got worse after Covid … those areas have not returned either,” said Jay Moskowitz, CEO of Vivage Senior Living.
Roughly 90% of non-clinical employees are in-house for Vivage – the operator has a few facilities that use national contracts for such positions.
For the first time ever, leaders have brought on agency staff, Moskowitz said, mostly for dietary and housekeeping.
Vivage operates 31 facilities in Colorado, and one each in Missouri and Nevada.
Non-clinical vacancies have more than doubled compared to pre-pandemic numbers, according to Scott Laakso, chief people officer for Massachusetts-based SALMON Health and Retirement. Open positions jumped from under 10% to 20 to 25% at this point in the pandemic.
“Staff members have so many other opportunities outside of health care right now,” Laakso added. Such opportunities don’t involve as much regulatory compliance and infection control, he said.
Nate Schema, CEO of the Evangelical Lutheran Good Samaritan Society, said about 300 of 1,400 non-clinical positions are currently open across its 150 locations in 22 states. In other words, one in five positions need to be filled.
“That’s so critical. These non-clinical positions, they’re part of your pipeline, it’s where you identify talent that oftentimes is your future leader or your nurses, your future clinical leaders in your communities,” Schema said.
Good Samaritan has seen this type of career path time and again, Schema said, with lawn mowers becoming executive directors, and dietary aides growing into administrator roles.
“It’s affecting the future of our organization in many more ways than what’s happening day-to-day right now,” noted Schema. “Big picture, it’s a serious issue that we’re working to address right along with all the clinical openings that we are experiencing.”
Non-clinical agency staff
Exorbitant agency pricing isn’t just a clinical staff problem for the industry, leaders told Skilled Nursing News. Operators are seeing in some cases a 35% to 40% markup on rates, along with charges for Uber fees and other transportation costs to get to work.
“Pre-pandemic I’ve never used temporary agencies for those positions, never,” Moskowitz said. “Administrators are in kitchens, in one community in particular. Maintenance people are helping wash laundry because we have to get that done.”
SALMON Health has struggled to fill recreation staff and dietary aide positions. Similar to Vivage, Laakso said the past year marked the first time in the company’s history they have had to use agency staff for dining.
While the operator has lately been able to maintain staff, there have been times over the last 12 months where finding staff to work, pick up extra shifts or work overtime.
Schema said ballooning rates have normalized in recent months for agency staff, going from 1.5 to three-times the normal agency rate to 1-1.4 times that rate. Non-clinical agency staff makes up less than 5% of total agency use at Good Samaritan, although the operator has “a long way to go” from what Schema would describe as a sustainable situation.
SALMON usually hires directly for dining and contracts with a third-party for its housekeeping and laundry.
In order to compete with agencies and other industries, operators have increased base wages across the board for non-clinical staff.
Vivage increased non-clinical wages in February for its facilities between 12% and 20% depending on the position. The move coincides with Colorado adjusting its living wage, which was bumped up to $12.56 per hour in January.
SALMON increased hourly wages for chef positions from $17-$18 per hour pre-pandemic – Laakso said that’s closer to $23-$24 per hour now for this particular position.
While non-clinical wages vary widely for Good Samaritan given its large footprint, Schema said the operator has bumped up wages 20% to 30% since the pandemic began.
Recruiting and retaining non-clinical staff
Many operators for the first time are offering retention and referral bonuses for non-clinical positions – Vivage bonuses are anywhere from $500 to $1500 depending on the community, according to Moskowitz.
Vivage is also working with the state Department of Labor to post job openings and hosting job fairs at shelters for non-clinical positions.
“We’re out of agency because we have a lot of high school kids working for us,” added Laakso. “We’ve offered a pretty lucrative referral bonus up to $1,000.”
Local high schools and culinary programs at technical colleges have helped fill the gap, especially this summer, he said.
There are simply too many pandemic hoops to jump through though, while other industries like hospitality and retail don’t have to adhere to regulatory requirements put on the health care sector overall.
“We’re finding it hard to get those employees who are tired of wearing face masks 24/7 in their work,” added Moskowitz. “Most industries now, most professions don’t require you to wear a mask … even though Covid still out there, as we know.”
Schema says PPE requirements pose a “unique disadvantage” for operators trying to find non-clinical staff.
“We have people that are applying for a laundry, housekeeping, dietary positions and one of their first questions in the interview is ‘well, do I have to wear a mask?’ If you go to McDonald’s or Burger King, we all know what the answer is,” said Schema.
Outside of Covid, the long-term care environment requires non-clinical staff be educated in dementia training, resident rights and other regulatory oversight before they can hit the floor, Laakso said.
That’s another “inherent competitive disadvantage” compared to other industries, Schema added. A lot of prospective non-clinical employees can’t afford to wait two to three weeks to start, they can’t wait to pass multiple rounds of background checks.
“Restaurants and providers here in the upper Midwest, they are literally paying people to come in for an interview. They’re giving them a gift card or incentivizing them to show up for an interview,” explained Schema. “It is a very dynamic time.”
The nursing home work environment has put the non-clinical staff member under more scrutiny than they ever have been before because of Covid, Laakso said.
Still, industry leaders hope high school and college students that start as a non-clinical worker for a nursing home might look at a clinical track, or non-clinical supervisor position to stick with the sector from a young age.
“You just have to be able to show people that within our profession, that there’s a career ladder people can grow into,” added Moskowitz.
Laakso said SALMON has seen some success this way, getting non-clinical staff in the door at a young age, then they see what clinical staff does at a facility and decide to pursue that as a career.
“We’re uncovering every rock and doing whatever we can to get people in the building and interested,” said Laakso. “There’s so many different avenues you can take in health care and post-acute care … you can come in in the kitchen, but you can end up being a nurse someday.”
Companies featured in this article:
Good Samaritan Society, Salmon Health and Retirement, Vivage Senior Living
