This article is sponsored by KARE. This Q&A is based on a Skilled Nursing News virtual Staffing Summit discussion with Charles Turner, CEO of KARE, Jalene Carpenter, President and CEO of the Nebraska Healthcare Association, Lori Porter, Co-founder and CEO of the National Association of Healthcare Assistance (NAHCA), and Dr. Jacquelyn Kung, CEO of Activated Insights. The Q&A took place on June 15, 2022. The article below has been edited for length and clarity.
Skilled Nursing News: It’s my pleasure to be moderating today’s webinar: Evolving Workforce Dynamics and Potential Legislative Impact. I’m very excited to be joined by a mix of data-driven companies and advocacy organizations for today’s discussion.
Now, Jacquelyn, we can start with you. Activated Insights has discovered through extensive research that the skilled nursing industry is getting fewer applicants and lower trust scores than other industries. Can you elaborate on this research and your findings about how the workforce is evolving?
Jacquelyn Kung: Let’s first ground ourselves in terms of what data we’re talking about. As many people on this webinar know, Activated Insights runs the Great Place to Work program for senior care. Of course, that includes surveying a lot of SNF employees as well. In the last twelve months, we surveyed over half a million residents, patients, and employees in senior care.
That’s the data we’re talking about. In addition, Great Place to Work has surveyed over 100 million people worldwide in all sorts of industries. That’s also the data that we’re going to be pulling from today. The root of this is that we have a problem. That’s why we’re here today.
Turnover in the SNF sector is well over 90%. This has gone up during COVID. We have indications that it’s gone up more than 20% during and now with COVID and the aftermath. Why is this a problem? Of course, it affects the quality of care. What’s in it for all of us working on these issues, especially providers in the front line? Looking at how we can increase engagement in the workforce means better customer satisfaction scores and higher CMS star ratings.
On average, SNFs around the U.S. are just over three stars. The best SNFs in terms of engaged workforces are between four and five stars on average. That’s what’s in it for all of us. Better care for our seniors. Let’s actually break this problem into three parts. It’s around recruiting, retaining, and growing our staff.
If we go on to recruiting, compared to other industries, we are hiring folks that are looking at jobs and roles in other industries. Compared to other industries such as hotels, hospitals, retail, SNFs average in the 5 to 20 some range in terms of number of applicants per role, which is not great.
However, the good news is that some SNFs are standing out as employers and their staff are referring friends more, and they are actually getting more applicants than the average retail, hospitals, and hotels. The takeaway here is how do we stand out? We need an external indication.
That’s why we started this initiative with Great Place to Work Institute to certify folks in our sector. Certification cost is not an issue. We’ve made it that way, and it does include surveying your employees, and 7 out of 10 of them, or more, say that it’s a great place to work and it’s very accessible. When providers have done that, we have seen a nearly 20% increase in the number of applicants because you’re able to put it on, Indeed and on your Glassdoor rating.
Now let’s look at retaining. In terms of engagement scores, Great Place to Work index is called the trust index. This is a 0 to 100 scale score where it measures trust and here’s how it ties to engagement. If you have higher trust, you trust your workplace, you don’t fear as much. You don’t fear being let go or punished because of an idea and so you’re more engaged.
In terms of the Fortune 100, Great Place To Work Institute fuels the Fortune 100 rankings. That benchmark is at an 87. The best across our industry in post-acute care, which includes at home care, senior living, and SNFs, is a 78. SNFs alone average, in mid to low 70s on this scale. Again, not great news. However, the good news is that our industry over indexes the best in the Fortune 100 across all industries.
Specifically, our staff say that this is not just a job, there’s special meaning within our work. We have a bunch of carers in our space and so what do we do about that? What we need to do is we need to emphasize the mission and the purpose of our work. We over-index the best in the country in terms of employers as a sector in this space, in mission, and purpose.
The last area, of course, is growing our staff. I used to be an operator. Many of us are just consumed with filling roles. That’s what we should be doing. At the same time, we want to be hiring people and growing them. As a SNF industry on average, 15% of our roles are promoted from within. Now, look at that compared to hospitals who promote from within almost half of their leaders through all the ranks.
Same thing with hotels and retail, where about a third of their roles are promoted from within. By the way, if you’re wondering if you have senior living, that’s about 17%, 18% versus the SNF selectors at 15%. The good news, though, is that the best providers in our space, the best SNFs, fill 40% or more of their roles from within. That translates directly into lower turnover because our carriers, our staff, feel like there’s a future for them within the organization.
The takeaway here is to set a goal. Have this be a CEO-level issue that we want to be promoting from within. All sorts of systems will need to change for this. What we are going to see is a huge drop in employee turnover and a big increase in engagement. In summary, we do have a lot of problems in this space. The workforce trends are very clear in that we are getting fewer applicants in recruiting.
We are lagging in employee engagement. We are not promoting from within as much as other industries. The good news is that there are things we can do about it. We can stand out as employers, we can emphasize purpose and we can promote from within at much higher rates because the best in our industry do, and they are seeing rewards for that. Those are the workforce trends we wanted to share.
Just a special focus because we’re going to talk a lot today about CNAs and personal care aides. What the data shows is that all of us, and definitely our carers, want the supplies and training to do a good job. In particular, it’s interesting that almost half of our carers are born after 1982 and more than half born before 1982. For the older CNAs and care aides, what’s really important is that their management, their leaders, are doing the right thing.
That they see them doing the right thing, especially to do with patient care and treating each other with respect. Then after 1982, our carers here prioritize more fun and comradery. Those are the trends that we’ve seen over the last 12 months, and of course, 5 years before that.
SNN: Thank you very much, Jacquelyn. Charles, this next question would be for you. I’m curious, what other misconceptions about the caregiving workforce exist?
Charles Turner: We have access to a robust pool of, let’s call it a “care force”. We have multiple tens of thousands of people that work on our platform that can help fill open shifts at a moment’s notice. Because we have that platform, we can ask them questions.
We have a rich database to do research and survey work. We’ve set out over the last, well, year, a couple years, to explore and exploit the misconceptions between frontline caregivers and their bosses. You’re either at the community level or at the corporate level, asking a series of questions, almost asking the same questions, and see how they respond.
A lot of the things that we found, there’s a lot of places where we generally agree. Things like people want to come and go at your building because of pay. I don’t think that’s a big secret. I think a big misconception of that is people would leave the industry because of pay. Turns out, the weird thing is that’s really not true.
We know about 15%, call it mid-to-low tens percent, of our caregiving workforce left the industry because of COVID altogether. That all probably happened mostly early COVID. Disagreement on vaccine mandates and things like that. While there’s disagreement on how that should have been handled, we’re not seeing the evidence that it’s forcing people to leave the caregiving workforce, but they want to stay in that workforce.
Yes, we have a labor shortage. We know that. Generally, broad healthcare, they’re probably six points or so below the mean at where they started in terms of filling open positions pre-pandemic. If you take senior care out of that, we’re not doing as well as, say, our hospital brethren. I think some of the things that she alludes to speaks to that.
Other things that I think there are misconceptions on are things like what the energy and emphasis we put around culture as a company is. We think that we’re going to win this battle for the best caregiver, if we have a better culture. Again, I’m an owner-operator developer in my past. My concept of culture was a notion of, I want everybody to have your classic definition of culture, right?
Which is your classic, your common beliefs and processes and rituals. Turns out that’s not actually culture to a frontline caregiver. Culture to a frontline caregiver, it turns out, is much more one-on-one. Like Jacquelyn alluded to management integrity, but it really comes down to, are you respecting me as an individual and what I do, and the quality that I provide and the love and care that I provide for residents? Do I believe in your overall mission statement?
Mission statements are fine. I’m not discounting that, but that’s not going to drive. We’re finding it’s the relationship with people and the people that you report to. Are you respecting me as an individual? As we talk about culture, I think we need to reframe the conversation.
When we say culture, what does that mean? When we talk about respect, people say, well, people leave because of a lack of respect. That is true, but we also have a misconception of what that means. I think as an operator, we’re like, “Oh gosh, Lori’s my caregiver. I need to praise her for doing a good job.” They don’t want to be praised for doing a good job. They want to be respected for their opinions and their knowledge of those residents, the knowledge of the processes.
The hard work that they do and the love they provide the residence. They want to be treated as an equal, not to be condescended to and praised for doing a good job. As we’re looking to build, I think this is a managerial issue, where if we’re spending a lot of time and energy resources at a community level, a company level, I would be on how to get my frontline management to understand the wants and needs of caregivers and respect them as individuals. Know their names, know them as equal contributors to a team, not just a cog in a wheel.
This excerpt has been edited for length and clarity. To watch the full discussion on video, please visit:
With decades of combined experience operating senior care companies, KARE understands the impending threats of the labor crisis and the need to solve it. To learn more visit: https://www.doyoukare.com/.