This article is sponsored by Pinnacle Quality Insight. This article is based on a Skilled Nursing News virtual discussion with Chris Magleby, CEO of Pinnacle Quality Insight. The discussion took place virtually on November 29, 2022, during the SNN Staffing Summit. The article below has been edited for length and clarity.

Skilled Nursing News: Our speaker today is Chris Magleby, he is currently the CEO of Pinnacle Quality Insight, a customer and employee insight company whose surveys and software show senior care and senior living providers what to celebrate and where to improve. Pinnacle reduces employee turnover using simple software that surveys employees and guides managers in recognizing accomplishments and addressing issues. Now it is my pleasure to hand things off to Chris.

Chris Magleby: Today I want to talk about five different strategies that we can do to try to keep our employees. Before I get into that we have a lot of really interesting data that I want to share with everybody.

Here at Pinnacle, we measure customer satisfaction levels, we get customer satisfaction feedback, and we also do employee engagement and employee satisfaction surveys, specifically for senior care and for senior living. We exclusively serve the aging services field, and we’ve got some interesting sets of data that comes from this sector that illuminate some things that are happening across the U.S. and specific with health care, and then even more specifically with post-acute and long-term care.

I want to go into some of that, and hopefully, share some interesting stuff. Before I do that, I want to tell you a little story. I was at a concert earlier this summer, Andy Grammar, and as part of his concert he brought up some of the staff. I’m in Salt Lake City, Utah, and there is a children’s hospital here called Primary Children’s Hospital. This is some of the palliative care team at Primary Children’s Hospital that he brought up on stage and sang to them.

He had been visiting with some of the kids the night before he performed. The parents of one of the kids there were talking to him and he said, “You don’t understand how these people are. Every night we have to leave our sick children here in the care of others. This is very difficult for us and these people that care for our children, they’re actual angels.” That phrase got me thinking a little bit, and it got me thinking about the people who choose to be in this profession, who choose to be in healthcare and why they do it, and the roles that they’re filling.

I would challenge every one of you who’s on this webinar today to think about how you think about your staff members to change it a little bit, to understand that to somebody, to your residents, and to their family members, your staff members are actual angels who are taking care of their loved ones when they can’t do it themselves.

If you take a second and you talk to your staff members, try to understand their ‘why’. Why they’ve chosen this profession, why they’ve chosen this career you’re going to find out some interesting stuff.

There’s a calling to this profession. I’ll bet a lot of you that are attending this webinar right now have something similar. There’s a reason that we’re in this line of work—because we care about others and we want to try to take care of others. When we care for others and help others, it is fulfilling to us. That’s very important because it can change our outlook on how we treat our employees, and how we’re taking care of them. If we have this mindset that they are actual angels and taking care of our loved ones when we can’t, that’s one thing.

The other thing that you can do is you can understand that this is not all about money. A lot of things that we are facing with the workforce shortage and with turnover over the last two years, we’ve seen big inflation numbers. We’ve seen wages going up. There’s competition for employment. You have to remember that these people in health care, they might get offered more pay somewhere else, and they might be tempted to take that if they’re not feeling fulfilled in their job.

If you can help them feel fulfilled, if you can help them understand the purpose of caring for others and getting a fulfillment that goes beyond money, that is something that’s going to help you, that’s a resource to you. Maybe resource isn’t the right word, an asset to you is that the people in this field are doing it for a reason beyond just the money.

Money is important. We need money to survive. They’re going to need to get paid.

If they get a big job offer, that’s a lot more money, some of them are going to take it. Most of them are.

If we’re talking a little bit of an increase, but the job’s not going to be as fulfilling—as long as the job that you’re offering and that you’re providing to your employees is fulfilling, that’s going to outweigh sometimes some of these financial factors. As we just keep some of this in mind of the attitude we want to take towards our employees. How the employee continuity and how the employees translate into better care for your residents, and how it translates to higher satisfaction levels for the residents and for the family members.

This is something that I want to show you. Like I said, we measure customer satisfaction in this sector as well as employee satisfaction and engagement. There’s some interesting things that we can learn. This is satisfaction rates from 2018 up until 2022 Q2 of this year 2022 across this segment of healthcare. The top line is independent living. Then the blue line is assisted living. Then we have short-term SNF at the bottom then long-term SNF is the green bar there in the middle.

If you look at long-term SNF, assisted living and independent living, you can see that they mimic each other. They seem to move at about the same pace throughout the last four years even throughout this point. This is Q2 of 2020. In Q2 of 2020, I’m sure you all remember that’s the onset of the pandemic. A real interesting thing happened with resident and family satisfaction rates during that time. You can see they all peaked.

As difficult as that time was for all of our residents and their family members, this is the highest satisfaction level that we’d seen in about the last 10 years for long-term care SNF, for assisted living, for independent living. There’s a big peak in resident satisfaction and a lot of that was because they really appreciated the response of the industry to the COVID pandemic. The elderly were the most at risk for COVID-19, as you know.

One thing I like to point out to everyone who attends these webinars is that they go back to their staff members and they thank them because they really did a lot to respond to the pandemic and to take care of our frail population and our seniors. We really want to make sure that everyone that’s involved knows how thankful we are as a community to them for everything that they did.

Then as the pandemic weighed on you, you started to see some satisfaction rates dip a little bit. Up until this point, assisted living, independent living, and long-term SNF mirrored each other. There were some ups and downs. You can see long-term SNF had a bigger dip in Q4 of 2020 than the other sectors did. They moved together up until this point.

Then you see a separation of independent living from assisted living and from skilled nursing. In independent living, they have completely recovered from the pandemic and their satisfaction rates are actually higher than they were pre-pandemic. Independent living is doing really well, but the satisfaction rates in assisted living have started to dip, and so has long-term SNF since Q2 in 2021.

The reason for that is Q2 of 2021, when we really started to fill the workforce shortage. The residents in independent living didn’t have as much interaction with staff. They weren’t relying on the staff for their activities of daily life. They didn’t need a lot of interaction with the staff. They really just needed a place to stay and then they had a little bit of interaction with the staff. In assisted living and SNFs, there are a lot of interactions with the staff, and the staffing shortage started to really pay a huge effect at that time. Much so that you can see that here towards the end of the graph, these satisfaction numbers are actually lower than at any time during the pandemic. At first, we had a spike in resident satisfaction levels, but as the pandemic waned on, the levels started to dip as the visitor restrictions kept going on, there was some difficulty.

There was a lot of difficulty through the pandemic with PPE. The data is showing us that residents and family members are having a harder time with the workforce shortage than they even had with the pandemic. That’s something that we want you to understand, is that they’re having a hard time, and the second thing is they don’t completely understand the workforce shortage. They understood the pandemic. They knew what was going on, everyone was talking about it. The workforce shortage, that’s a foreign concept to some people, especially the older generation. All they’ve known is the opposite of a workforce shortage.

What they’ve always known is a job shortage and more workers. There’s always been more workers than there were jobs and for the first time in a lot of these people’s lives, they’re experiencing more job openings than there are people. That doesn’t make sense to them. One of our survey respondents in 2021 kept telling me they’re short on staff. It doesn’t make sense to them. It should be pretty easy to solve this problem. Well, just go hire more people.

We have to explain to them, there aren’t more people to hire. Things could change as the economy starts to slow a little bit. It’s taking a little bit of pressure off of the workforce shortage, which will be welcome. Some of the recession is not welcome, but some of the workforce shortage problems easing will definitely be welcome. One thing that we recommend to everybody is to explain to your new admissions what’s going on.

Tell them that there is a workforce shortage and that you’re working very hard to get more staff, but please be patient with us and understand what’s going on. Try to set expectations, because a lot of them don’t understand this. Let them know you’re looking for people. If they have anyone that they want to refer to you. Do you have any employee referral bonuses, anything that you could offer them? Setting expectations is really important.

Some other interesting pieces of data that we have access to. One of the pieces of software we offer is called Retain and it helps retain employees in this sector of healthcare. The way Retain works is it connects into the company’s payroll software or to their HR software. From those two pieces of software, we pull in all this data about their employees and then we start communicating with the employees. Well, because we’re pulling in all this data, we have access to a lot of employment trends across a big segment of the population in senior care.

We have records on over 300,000 employees from senior living and from post-acute care about what’s going on in the sector with employment. As we started looking at some of that data, we found some things that were very interesting. First of all, we went and we looked at the tenure of employees when they separate from employment.

We looked at this data in 100-day segments. If you look at this graph, you can see that the majority of turnover is happening in the first 100 days of employee tenure. Then after they get past that first 100 days, there’s a huge drop. It drops more than half in the next 200 days. Then after that, there’s another huge drop and then it tails off.

We’ve learned from looking at this data that’s specific to senior care and senior living, that there is a big problem with our new hires. We hire somebody and then we’re having a very hard time retaining them through the first 100 days. If we can get them past those first three months, those crucial first 100 days, the chance of their turnover starts to go way, way down. Hopefully, this is resonating with you and you’re seeing this in your operation and realizing yes we do have a problem when we hire new people. Almost 40% of every new hire does not reach day 100.

That’s a big chunk of our workforce that we’re investing in finding new employees and training new employees in onboarding and getting them all set up so that the investment is not even lasting 100 days. We looked at this and we thought, “Is there any way that we could help this?” Just to drive this home a little bit, this is some information from the American Healthcare Association. In skilled nursing, since January 2020, we’ve lost almost 240,000 jobs during this pandemic. There’s a lot of people that have left the workforce and a big chunk of this is coming from our new hires. They’re not sticking around, they’re not making it. This is a problem that is unique to our sector.

I know there’s other sectors that have this problem, but if you look at the U.S. on average it’s actually very different from what we are experiencing. This data on the left was published by Harvard Business Review. This shows when people leave their jobs. You can see that there is a spike in the first three months, but then separations remain high until the first year mark, and then that’s the biggest point of turnover on average in the U.S.. Then turnover starts to go down a little bit and then it spikes again at two years. Then after two years, employee turnover goes way down.

If you contrast that to the graph on the right, that’s the long-term care average. You can see that we have this huge spike in the first three months, but then after that it starts to really go down. You can see there is a little bit of that at the six-month time period, but then it really trickles down, and by the time you get to well before two years, turnover is very low. I have a friend that works in investment banking and his bank has an initiative in place where they are trying to keep their new hires for two years.

They know if we can keep our people for two years, we’re going to have them for a long time. The chance of them leaving after two years is very, very low, and they become lifers there. In our sector, you can see on the left here that after two years this number goes almost down to nothing. We always maintain a little bit of turnover in our sector. We don’t go down to nothing like some of the other industries do. We always have a little bit of turnover because this is a hard job.

You can see that if we can usher people through the first three months, their chance of turnover goes way down. Unlike the investment bank where you need an initiative to keep people through the first two years, your initiatives only need to be about three months long. If you can keep someone there for three months, the chance of their turnover goes way, way down. Then if you can keep them through six months, you’re pretty much set after that point.

This was not a new problem. This problem has always existed in long-term care. In 2019, we were losing about 30% of our new hires before day 100. Then in 2020 and in 2021, the pandemic has really emphasized this problem. It’s gone from 30% up to 39%. We’re losing almost 40% of our new hires before day 100. The good news is, there are some things we can do to fix this. We don’t have to keep people for two years. All we need to do is focus on the first 100 days.

This excerpt has been edited for length and clarity. To watch the full discussion on video, please visit:

Pinnacle Quality Insight leads the way in employee retention and customer satisfaction for senior care and senior living. Through surveys and software, it helps providers understand their customers and retain their employees. To learn more, visit: https://pinnacleqi.com/.