AGE-u-cate Training Institute Blog

The workforce crisis in long-term care lingers as organizations desperately try to climb out from under the effects of the pandemic. The problem is so complex it feels too overwhelming to tackle, yet the current situation is not sustainable. The stress on administrators and the leadership team is taking a toll. Ensuring quality of care is simply impossible without a full complement of staff.

Human Resources professionals are working furiously to get people in and are gaining no ground due to turnover. The process of recruitment, hiring, and onboarding needs to be dramatically re-tooled to include intentional retention strategies.

A Path Toward Retention

The first hurdle is to create a new story about why someone should want to work in the aging services industry, and secondly, why long-term care?

The hard facts are important such as wages and benefits, work schedule, number of paid days off, etc. But there must be more to the picture. This industry has so much to offer that it should not be such a struggle to entice people to work for us.

Why Work in Aging Services

• The opportunity for a legitimate career. Create a narrative about the job security afforded to people working in the industry and the plentiful growth opportunities. This must be the reality for all positions. Housekeepers can become infection prevention specialists and a dishwasher can become sanitation certified. Nursing assistants can become a team leader or scheduler, and a receptionist can become the concierge. We must begin to think about the growth path for all positions.
• The work is meaningful and soul-filling. We need to talk more about the purpose and mission of our work. We help elders live their best lives toward the end of their lives.
• The ability to make a difference. Show up with a smile, hugs, understanding, and empathy, and you will get so much back in return, one person at a time. 
• The gift of working where people live. Being in relationship with elders means we can hear their stories and benefit from their wisdom.

Why Work in Long-Term Care

• The ability to serve the under-served. Talk about being part of a team that cares for people who have often lost their family and friends and depend upon the care and kindness of others.
• Be an agent of change. Acknowledge that there is room for improving how we care for frail elders and need people who can help transform the way things are done.
• Specialization. Discuss opportunities to dig into specialty areas such as hospice, rehabilitation, dementia care, culture change. Build into your retention system the education and training needed to guide people in their areas of strength.

Why Work for Your Community

Find ways to differentiate your community and make it easier for a recruit to say yes.

• Competitive wages must be a component in this market, but not the only strategy.
• Beginning day one, communicate your willingness to invest in each employee by inquiring about interests, goals, and ambitions.
• Create robust career ladders for all positions. High-quality, relevant, engaging training and education is a critical component of any growth strategy. 

Gather insight from your leadership team and a sample of employees with this recruitment and retention temperature tool.  An effective strategy can begin with first understanding your organization's strengths and areas for improvement.

About the author:

Julie joined the AGE-u-cate team in 2020 after working 31 years in nursing home operations. Starting in social services and admissions, she moved into management and executive positions in 1990 after obtaining an Illinois nursing home administrator license. Her passion for dementia capable care came early in her career when she had the good fortune to work with and learn from culture change pioneers. Julie is also an adjunct instructor in Gerontology and Aging Services at Northern Illinois University in DeKalb, IL. She lives in the Northwest Chicago Suburb of Schaumburg, Ill.

It is time to get serious about changing the onboarding process for new hires, and there is no time to lose.  Maggie Keen, Vice President of Corporate Development at MissionCare Collective delivered this impactful message for AGE-u-cate's February Virtual Road Trip entitled, "Building Culture:  Rethinking recruitment, onboarding, and retention to drive better care and a better workplace."  

Part of my responsibility as the VP of Grant Initiatives is to track the progress of Compassionate Touch® and Dementia Live® online coach training for the nursing homes that are participating in our Civil Monetary Penalty Grant (CMP) projects.  We have amassed an impressive list of nursing home staff in Ohio , Minnesota, North Carolina and Tennessee who have completed online training to become Compassionate Touch® and/or Dementia Live® coaches.

After months of reviewing training reports, this week I noticed something other than the number of new coaches, and that is the number of coaches since 2019 who are still with their facility.  

I need to preface by saying that this information has not been confirmed by participating facilities, but each time an email bounces back to me- the name is scratched off my list.  In Ohio, 99/124 Compassionate Touch® and 76/106 Dementia Live® coaches appear to be reachable with the same email address used to enroll in coach training, indicating retention of 79% and 71% respectively.

Admittedly, there is likely a margin of error in these numbers, but assuming a -10%, these numbers are impressive, considering the massive turnover that has occurred during the pandemic.  

Employee Engagement and Retention

While the recipe for retention is far more involved than just providing staff education, I believe I am justified in believing the human resource investment that these participating facilities made in Compassionate Touch® and Dementia Live® training may have contributed to the retention of these coaches.  Many of these coaches are still in touch with me and share their excitement about starting up training again.  

 National Commission for Quality Long Term Care, 2007

 Public Policy and Aging Report, 2017

 National Institute of Health, 2021

The above studies reveal that the reasons for voluntary separation include many factors, but lack of quality training and education, feeling ill-prepared, and absence of professional growth were consistent factors. 

Compassionate Touch® and Dementia Live® coach training is high quality, relevant and fills knowledge gaps that move the ill-prepared to a place of confidence and competence.  These programs are also utilized as career ladder opportunities in many organizations, and that number is growing.

Everyone should take a moment and think of your accomplishments over this past year- I am sure there are many.  For me,  taking stock that perhaps our work at AGE-u-cate® has helped to in some way to keep employees engaged and retained is very rewarding.

This blog title is credited to a member of the Board of Directors for the National Association of Health Care Assistants (NAHCA).  I was enlightened after attending a symposium entitled, "The New CNA Workforce:  Frontline Lessons from the Pandemic" given by NAHCA. 

Career CNA board members and thought leaders shared their passionate pleas for significant change.  It really was quite moving, and frankly, sad.  Sad in the sense that they felt compelled to give everyone a piece of their mind about how, for decades, they have been treated by their superiors and organizational leadership.  

A stern warning was delivered, "We will not tolerate these conditions much longer", and seriously, who can blame them.

Lori Porter, Co-founder and CEO of NAHCA shared this startling reality- there are 425,000 fewer nursing home workers today than before the pandemic, and if serious change doesn't ensue immediately, this number will grow exponentially.

Why must change be driven through threats?  The answer is because nothing else seems to have worked.  

Don't think that it is only about the pay.  Yes, nursing assistants need, and deserve to make much more than they do, but what they also need is to be a valued and respected member of the team.  

I reeled hearing one CNA board member describe how in the middle of rendering care to one resident, a nurse knocked on the door to say that there are two more call lights going off and could she please hurry up. Seriously?  This unacceptable and disrespectful to the nursing assistant, and the care receiver.  

Wake up to Change

Change in this realm will include everything from a long-term national strategy to reform the long term care system to immediate, organization-specific actions.  But, one CNA board member laid it out, "We need to get back to the basics, and re-set."  My ears perked up, because this exact phrase has been our mantra at AGE-u-cate for months.   

We simply must take care of the caregivers, so that they can give their best to their care receivers.  The basics include respect, dignity, and appreciation for all.  When we get back to the basics, we can begin to rebuild a healthy organizational culture. 

It will be up to leaders to work in tandem with all employees create the path to a healthy culture.  Listen to what your staff have to say- you may be surprised how much thought they are giving to the issues at hand, because they deeply care.  So many ideas were shared, but one that stood out to me is the desire for more education and training that grows skills and leads to advancement.  The lack of a career ladder for CNAs is a detriment to the future of this workforce.

I heard so many great ideas from these passionate CNA thought-leaders and I crave more conversation.  We have to give them what they need, so I am grateful that NAHCA Board Chair Sherry Perry has agreed to meet with me next week to continue the conversation.   Sherry's profile on the NAHCA website includes this statement:

"Being a member of NAHCA has inspired me to be the best CNA I can be.  It’s helped me to realize that my voice can make a difference not only for other CNAs but most importantly the elders we care for.”

Thank you Sherry and to your colleagues for speaking your voice- I hope you know that you were heard by many, and I am honored to have been included.

In a recent article published by McKnight's Senior Living, a survey of caregivers in Texas showed that while pay was an important factor in staying in the senior services field, it wasn't the only driver of satisfaction.  This is contrary to what most managers believe.  The study listed feeling respected, job flexibility and pride in the physical workplace as important to staff connected to their work.  So, how can the industry make small, but impactful shifts to improving retention among caregivers and other roles?  Here are a few simple ideas to get your wheels turning: