‘Proof is There’: Successful Skilled Nursing Staffing Initiatives By the Numbers

In 2022, skilled nursing providers faced crushing workforce challenges, and responded with a wide array of initiatives.

Through apprenticeship programs, sign-on bonuses and other incentives and programs, operators did notch wins, as reflected in numbers such as participation rates, program completion rates and retention figures. 

Trilogy Health Services, Dwyer Workforce Development (DWD), Principle LTC and Mission Health Communities are a few of the organizations with staffing success stories to share as the calendar is about to flip to 2023.

Trilogy surpasses 5,000 participants

Louisville, Kentucky-based Trilogy completed a successful apprenticeship program in 2022, with 5,529 employees enrolled, according to Jeanette Jones, director of training at Trilogy. That number jumped up in a matter of months, with enrollees sitting at 1,261 earlier this year.

Broken down further, the majority of apprentices are on the nurse aide track, at 3,323. Other tracks include culinary, hospitality and life enrichment, with 655, 894 and 657 respectively enrolled.

As an apprentice completes various levels in their tracks, Jones said, their wage increases incrementally, up to 25 cents to $1 per hour more. Upon completion, journeypersons have the ability to earn $2,000 to $5,000 more annually.

Trilogy set aside $3 million to account for these wage increases.

“We’ve done a heavy push through Registered Apprenticeship Week to really get the word out for our program,” added Jones. “We have done some targeted marketing within our campuses over the last couple of months.”

Of the 5,529 enrollees, 237 have graduated to journeyperson status, Jones told Skilled Nursing News. Since the inception of the program in 2018, Trilogy has graduated 1,561 employees to journeyperson.

That translates to 947 home-grown nurse aides, 141 culinary aides, 297 in hospitality and 176 in life enrichment. While Trilogy doesn’t offer registered apprenticeship programs for licensed practical nurses (LPNs) or registered nurses (RNs), the operator continues to put forward scholarships and tuition reimbursement.

Full staff support

Principle LTC, meanwhile, has focused on an interdisciplinary approach to staffing initiatives with its “Principle Beginnings” onboarding and orientation program, according to John Dailey, vice president of employee experience at Principle.

The program is all about support for new employees, he said. The North Carolina-based operator offers early wage access, as well, if staff members need funds prior to payday.

The team remains cautiously optimistic as new hires increased by 15% compared to 2021, and terminations decreased by 11%.

Another heavy-hitter, Maryland-based Dwyer Workforce Development (DWD) has big plans for the next couple years. Its staffing initiatives involve ambitious “wraparound services” for a cohort of “Dwyer Scholars,” covering everything from housing, transportation and child care to mental health counseling and social work services for employees. Scholars refer to non-licensed employees in its CNA training program.

DWD has been buying facilities to support the growth of its workforce initiatives, most recently acquiring 50 facilities in Texas operated by Regency Integrated Health Services.

“If something else comes along that complements what we’re doing and fits geographically with what we’re doing, then we’ll take advantage of that,” said Jack Dwyer, founder of DWD and also founder, owner and president of Capital Funding Group (CFG).

DWD CEO Barb Clapp expects the number of Scholars to reach about 700 next year; after its first year as a startup not-for-profit organization, about 287 students are expected to graduate from its CNA scholar program.

“We thought, okay, we’ll pioneer this concept. We thought there’d be other people that would follow, and maybe they will, but I haven’t seen anything yet,” added Dwyer.

Return on retention

DWD, along with representatives from operators Brickyard Healthcare and Mission Health Communities, recently shared staffing initiative updates at SNN’s Staffing Summit. A common thread among the operators was a change in approach to be more proactive and flexible, to build the pipeline and keep people interested.

“While recruiting is extremely important, retention is equally as vital,” said Dailey. “We must continually provide ways for people to be at their best. Flexible scheduling, affordable and meaningful benefits, fair pay, work-life balance, and great supervisors are essential in creating a culture where people want to come to work.”

Similar to Trilogy’s apprenticeship program, mentorship preceptor programs at Mission Health have yielded an 85%-plus retention rate among participants, according to Cheri Kauset, VP of customer experience and communications for the Florida-based operator.

Trilogy was able to retain 90% of its apprenticeship graduates, Jones said, only losing a “handful” who completed the program. To put this data point into context, Trilogy is currently seeing 52% retention for employees in the same kind of qualifying job roles.

“That’s quite a story there … those that are engaged in the program and graduating are staying at a much higher rate,” said Jones. “The overall program paints a similar picture.”

Trilogy has retained 71% of the 1,561 journeypeople since 2018, compared to just 25% of the operator’s overall population of employees.

“The proof is there. Developing and investing in your people, they want to stay with you and they want to grow with you,” said Jones.

The biggest pandemic-related change to Trilogy’s apprenticeship program was with the CNA track – the team had to make room for the temporary nurse aide (TNA) waiver put in place with the public health emergency (PHE).

Jones and her staff had to be “agile” and maneuver to better pull that lever. At one point, Trilogy had 588 TNAs on the roster; that number dropped to 27 by the time the waiver expired, all in Indiana.

‘Create our own supply’

Coupled with its apprenticeship program, Trilogy is in the middle of bringing a CNA certification and training program in-house. The program will offer paid training on the job, with pay increases built in upon completion.

“It marries well with our registered apprenticeship program,” said Jones. “While you work, we’ll pay you to become a certified nursing assistant … that is a main strategy to attract non-licensed workers to Trilogy. Pay them to train them, get them certified, get them into our campuses and let them fall in love with our campuses and our residents.”

It’s still a new concept for Trilogy, Jones added. The team has hired CNA instructors and hopes to start classes next year.

“It’s on the immediate horizon,” noted Jones. “We’re hiring for growth, not just to manage through a pandemic.”

Certified CNA instructors are “hitting the ground running,” getting classes scheduled and non-licensed future employees in the door.

Jones hopes home-grown initiatives like the CNA certification and training program, as well as the apprenticeship program, will reduce competition among operators for staff, and reduce turnover as well.

“We’re to the point where we have to create our own supply,” said Jones. “We can’t rely on people to be dissatisfied with their current employers, we need to go get new applicants into the industry. We believe that providing them on the job paid training and certification will help us do just that.”

In terms of state and federal advocacy around staffing initiatives, Dailey believes more needs to be done to align reimbursement with the “reality of where we are.” Increased costs of care, widespread staffing shortages and rising acuity among nursing home residents posing the latest challenges.

“As an industry, with more jobs currently open than people to fill them, we must learn to better value and respect each staff member, in the same way we do our residents,” said Dailey.