Why The Caregiver Definition Must Be Expanded For Nursing Homes to Overcome Labor Crunch

As the Centers for Medicare & Medicaid Services (CMS) works to establish federal minimum staffing levels, industry leaders are calling on the government agency to broaden the caregiver definition.

The current federal requirement does not provide a specific daily minimum standard, rather, it states that nursing homes must provide “…sufficient nursing staff to attain or maintain the highest practicable … well-being” of every resident.

However, some state standards and what CMS has previously recommended in past reports to Congress, largely only factor in certified nursing assistants (CNA), licensed practical nurses (LPN) and registered nurses (RN) when breaking down the minimum amount of time a staff member should be directly caring for a resident.

Advertisement

That way of thinking needs to change for nursing homes to meet such future federal standards, according to Massachusetts Senior Care Association President Tara Gregorio.

“It’s critically important that we recognize that our caregiving team is not just CNAs, LPNs and RNs … Each of our facilities are very different in makeup and population,” she said during a panel discussion at the annual Zimmet Healthcare Services Group conference in Connecticut.

For example, Massachusetts has a number of facilities that treat substance abuse disorder (SUD) which can require a different kind of staff makeup compared to a long-term, custodial type care facility.

Advertisement

It is also one of the states with nursing home staffing standards — 3.58 staffing hours per patient day for the calendar quarter. Resident care assistants (RCA), often also referred to as temporary nursing assistants (TNA), do count toward that minimum.

“We just have to make sure that whatever we see on a state and federal level has that flexibility to really reflect the uniqueness of a nursing facility,” Gregorio added.

But it’s not just the federal government that needs to be flexible. Providers should remain open-minded when coming up with unique and different ways to cultivate a new nursing home workforce.

Making a ‘Majestic Difference’

Staffing challenges providers face are the “root cause” of so many other issues, according to Majestic Care CEO Bernie McGuinness, and it’s forced leaders like himself to think more creatively now than ever to not only recruit but retain care team members.

Most recently staff at five Majestic Care facilities participated in a pilot program back in June with Archangels, a caregiver advocacy platform founded in Boston.

Part of the Archangels program is a survey called the caregiver intensity index that provides each caregiver not only with a score, but then provides those who take the quiz access to state and local resources and other forms of assistance.

McGuinness said during the panel that the goal was to have 150 team members fill out the survey, and that was doubled in the first 60 days.

The survey results showed that while Majestic Care employees were stressed and sometimes overwhelmed at work, still at numbers lower than the national average, they also felt that they had someone in their corner, he said.

McGuinness also saw the use of the free telehealth app-based program, rolled out earlier this year, increase during this time.

Overall, Majestic Care’s work with Archangels gave him an idea of where they were compared to national averages, but how the company can offer different benefits to attract and retain staff as they continue to grow.

The Indiana-based operator also recently launched the Majestic Difference, an employee focused benefits program that features incentives such as perfect attendance bonuses, cell phone plans and, in some locations, subsidized housing.

The biggest “home run” for the staff so far has been Majestic Care’s mobile program, according to McGuinness, which provides a smartphone with unlimited talk, text and data through T-Mobile so long as the employee works for the company.

The perfect attendance bonus, another favorite among the staff, has also deterred call-ins — especially those on the weekends when staffing can already be limited.

While the costs are not insignificant, McGuinness said the impact all of the different initiatives and programs being offered are having is evident.

“It’s way cheaper than paying agency rates. It’s way cheaper than constant turnover in these buildings and it’s not just about the financial impact that staff is having on the bottom line. It has driven down our regulatory results, it has hurt five star ratings, it stops us from occupancy growth,” he added.

Climbing the career ladder

Massachusetts nursing home providers have also looked into ways to break down barriers to transportation, housing and food — some going so far as to purchase row homes to enable staff to live locally and provide free groceries.

Despite those ongoing initiatives, “real robust career ladders” are a central focus to growing back the workforce.

The state association has been working with the MIT Sloan School of Management to help operationalize the RCA to CNA training program as the Covid-19 related waivers have expired and certification deadlines are quickly approaching.

Mass Senior Care is also working on a CNA to LPN career path with the help of MIT professor John Gruber and national impact finance and advisory nonprofit Social Finance.

One of the biggest barriers for CNAs to further their education and move up the career ladder is the price to do so, Gregorio said.

Through this program, someone who wants to be an LPN can have their schooling initially paid for Social Finance. That money then turns into a debt package that may be paid for in part or in total by the nursing home where they are employed — as long as they stay there.

If the employee decides to leave that nursing home, however, the debt follows them, she added.

Looking at the toolbox in a different way

Changing the mindset on nursing home scheduling, and getting away from strict 12 or eight-hour shifts is one way to invite different kinds of workers into a building, Gregorio said.

More broadly, it’s about looking at the industry’s “tool chest” in a different way.

Gregorio has often thought about family members who for years come visit their loved ones, and the facility becomes their community — or young retirees who would be willing to work four hours a day — and how they can get involved in the long-term care workforce.

It comes down to thinking innovatively about where nursing homes can find the next generation of caregivers because “the people are not there,” she added.

“If you’re doing CNA training in your building, why couldn’t we welcome people from the community to come in and sit on whatever module they want to be a part of and learn a skill,” panel moderator and Zimmet Healthcare Chief Innovation Officer Steven Littlehale said.

McGuinness echoed those sentiments, adding that many people who either visit their loved ones in a nursing home or are unpaid caregivers themselves “have that heart” to work in a facility.

“We’re not Google, we don’t put a slide through the middle of the lobby, we’re not the sexiest job ever, you can’t do it from home in your pajamas over Zoom,” he said. “But most of the time we take care of more people than the county hospital takes care of everyday. We might be the No. 1 or No. 2 employer in our county, we need to be loud and proud about the things we do.”

Companies featured in this article:

, , , ,