​Employing and retaining staff at long term care (LTC) facilities continues to be a challenge with nursing shortages, leading to potentially lower staff morale from more challenging workload and insufficient nurse-to-resident ratios.

Many LTC companies are at their wit’s end over the situation while others are thinking creatively to help develop more certified nursing assistants.

‘Never Seen Anything Like It’

Frank Romano is owner of Massachusetts-based Elder Services, and he said that in his 45 years in this industry he’s “never seen anything like it. Our centers are about 80 percent occupied so we have empty beds—not because there aren’t patients, but because we don’t have enough staff.”

Christopher Schmidt, president and CEO, Schmidt Wallace Healthcare, based in Alabama, said, “lately, we lost some workers who we never thought we’d lose as they pursued other professional opportunities. These were workers who we thought would spend their entire careers with us, but things are different now. You have situations where if one person contracts COVID-19 then 20 walk out the door.”

Other Industries Are ‘Stealing Our Workers’

Matthew Yarnell, president of SEIU Healthcare Pennsylvania, which negotiated the recent contract with several nursing-home operators, recently told The Wall Street Journal (WSJ) that 30 percent of the industry’s workforce nationwide exited during the COVID-19 pandemic.

For example, in 2019 in Pennsylvania, 7,000 people applied for CNA certification. That dropped to 2,000 a year in 2020 and 2021. The overall rigors of the job can be measured through CNA-to-patient ratios. In a 7.5-hour day shift, Yarnell said a CNA could expect to serve 20—and perhaps as many as 50—residents.

“People cannot take care of 20 individuals on a day shift and feel good about their work,” he said. The new contract raises hourly pay by an average of 20 to 25 percent and incorporates new state rules limiting a CNA to just 12 residents per day shift, later dropping to 10, WSJ reported.

Romano said raising wages can help to make a difference.

“Other industries are stealing our workers,” he said. “In Milford, Amazon was offering $22 per hour with full benefits and was supporting their employees’ college tuitions. Bank tellers are making $22 per hour. It’s hard for us to pay that. I believe wages for CNAs will be $30 by next year. And, making it tougher, Medicare and Medicaid haven’t been keeping up with the wage hikes.”

Romano added that long term care employment agencies “are stealing our full-time workers because they can offer them the opportunity to work four days per week (not five) and have a three-day weekend. Who wouldn’t want that? Our industry needs to do a better job at creating a career ladder. There are nursing schools, but enrollment is limited because there aren’t enough certified instructors.”

Romano said nursing schools are receiving 4,000 applicants, but have only 120 slots because of faculty shortages.

“Class sizes probably won’t be getting bigger any time soon because nurses typically aren’t the type that pursue secondary education in order to teach,” he said.

Hiring an Entire Team of Recruiters

Tom Grape is founder, chairman, and CEO of Benchmark Senior Living, a Waltham, Mass.-based provider of senior living in the Northeast with 64 communities. He said that at Benchmark, the company is building an entire team of recruiters within an entirely new structure, headed by a new leader of the talent and acquisition teams. It is also hiring a recruiter for each region; someone who is well-versed in the needs and issues particular to their regions.

“Having an entire team dedicated to recruitment will also lead to more robust brainstorming and innovation,” Grape said.

Benchmark also continues to expand its partnerships with vocational schools, high schools, and colleges, helping students who are interested in long term care to begin working with the company, in appropriate roles, even before they are certified or have graduated.

“Once they’ve achieved certification or a degree, they can move into essential care roles with a full understanding of our communities, the residents, and the work we do,” Grape said. He said his company’s longevity is indicative of their satisfaction. It has more than 100 employees who have been with Benchmark for at least 20 years.

“The company has been successful by living our values and creating a supportive and inclusive culture—an attribute that our employees consistently cite as the reason they choose to work here,” Grape said.

“We’re retooling our marketing to depict this culture and highlight our accomplishments in ways that will capture the attention of young people launching their careers. One way is to do a better job bringing this information forward at job fairs and onto popular social media channels,” Grape said.

“Our investment in these workforce recruitment efforts, as well as our retention programs, demonstrates the vital importance of attracting talented caregivers, and giving them the ongoing support that they need to develop and grow in their careers,” he added.

Company-Wide Zoom Calls Identify Hiring Needs

Schmidt Wallace Healthcare is a family-run business with five facilities and 780 patients. It employs 1,110 and does not use a hiring agency.

“We’ve put in new systems to help recruit, retain, and develop a stronger culture,” Schmidt said.

Every Friday, it has a Zoom call with its centers and checks in to see how many and what type of job openings they have. Team members then share ideas on how to fill them, Schmidt said. These meetings also are a chance for Schmidt to get his facility leaders’ minds “organized” because their jobs are tough with so many things are going on all the time.

Schmidt recruits aggressively when pursuing candidates, reaching out via call, text, and email.

“We determine where our population of workers is hanging out and go there to recruit,” he said. “We visit grocery stores, soccer fields, churches during their evening classes. We are working to establish better apprenticeship programs at the community colleges.”

From Soccer Fields to Nursing Field

Four years ago, Schmidt established a strong international recruiting program—focused on Kenya.

“We’ve hired employees from Kenya, but more than that, we ask them to reach out to their relatives and try to persuade them to work in the US. We’ve established liaisons to these potential candidates through local taxi drivers, and we’ve traveled to Nairobi the past two summers and set up job fairs that about 300 locals attended.”

He said he’s persuaded about 30 to start working for Schmidt Wallace Healthcare. At his facility in Talladega, Ala., he provides housing for them at an apartment building across the street.

For his existing employees, Schmidt relies on the career-ladder approach, letting those who first join his team know that they can better themselves if they stay with the company. Three of his five nursing directors began at the company as CNAs. To further address the shortage of nurses, Schmidt created four Nursing Assistant Academies that teach students how to become sanctioned through the Alabama Health Department; 450 CNAs graduated from the academies last year.

Improving Culture

Owners also are becoming more focused on improving company culture, in the hopes it prevents staff from walking away. For example, Schmidt makes an effort to have every staff member know every teammate’s and patient's names.

At orientation, he has all new hires fill out a card, listing their favorite animal, candy bar, hobby, and television show. The information is entered into a spreadsheet, which everyone has access so that it helps them get to know each other more easily and build relationships. For fun, on every new person’s first day, they are given their favorite candy bar.

He also has supervisors share their cellphone numbers with their staffs so that each member can reach them at all times if there is a problem.

“Our employees know that at any time if a problem such as a materials shortage or difficult situation arises, they can reach out for help,” he said.

The company also established its “Gold Standard” of service. Comprised of 10 rules, all employees are trained to help each other. One rule is, when walking the halls, no staff member should bypass a call light or spill light if it has been activated. Another is, when passing each other in the hallway, they are to address the other person by name or with a wave.

“All of these little things make a huge difference in improving our culture,” Schmidt said. “We want to make a such a strong connection with each employee that they can truly feel it.”

Paul Bergeron is a freelance writer based in Herndon, VA.