This article is sponsored by ShiftKey. This article is based on a Skilled Nursing News virtual discussion with Brandon Tappan, Executive Vice President at ShiftKey. 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: Today I am joined by Brandon Tappan, he has been a licensed nursing facility administrator for 15-plus years and currently serves on the workforce committee for AHCA/NCAL. He’s spent 12 years leading large multi-facility/multi-state operations across the post-acute health care space, and he’s held executive leadership roles at Senior Care Centers, Kindred, and StoneGate Senior Living. With that, I will pass off to Brandon to get us going on today’s presentation.
Brandon Tappan: For today’s agenda, we’re going to start with assessing your staffing workforce situation, and then we’ll move into some strategies for optimizing your workforce. Lastly, we’ll end on some ways to successfully leverage contingent workers as part of your workforce solutions. In the next several slides, I’m going to just highlight some of the national demographic and economic factors that are influencing the challenges that are facing us today, but just a few of these statistics I’ll read to you.
Over the pandemic, the long-term care sector lost 406,000 jobs. I know we’re feeling that now. The American Healthcare Association has reported that 71% of long-term care facilities said the lack of interested or qualified candidates is their top hiring obstacle and 87% of nursing homes are currently facing moderate to high staffing shortages. If you’re listening to this, I know that you’re probably struggling to some degree with your workforce and there’s no reason that you should feel like you’re alone in that, certainly.
This is some data on U.S. population growth. You can see here, this is back to about as early as we were keeping records up until the decade we just completed. We’re at our lowest population growth rate ever. By 2034, older adults will outnumber children for the first time in U.S. history. What that’s telling us really is that the bottom line is not enough people, frankly, are being born to support the jobs that we have in this country. I want to leave you with these issues that are not unique to the COVID pandemic. These are economic factors that are underlying these challenges, and they’re not going to then recover either after COVID to a great degree.
Flexible independent work is growing as people strive for more flexibility in their work life. That’s certainly something that the pandemic was a bit of a catalyst for, more rapid change too, as well as more and more health care professionals that are leaving the workforce. Our greatest workforce segment are those over 55, so those boomers, they are retiring. While recent inflation has some of them returning to the workforce, it’s really not as many as we really need.
During the pandemic as well, consulates were closed and immigration really came to a bit of a halt over those two years. We lost about two million workers that normally would have immigrated to this country during that time frame.With that being said, one in five nurses and one in four nurse aids are foreign-born. That’s not a group that we’re able to get back and are now missing from the workforce. We know that nursing schools are challenged too, not just during the pandemic, before. Now as we enter into something like a post-COVID environment, there’s not enough schools and opportunities even for the folks who are interested in getting into our line of work.
Our nurses are on average in their 50s at this point. The median age for retirement for an RN is 58. Again, just more frankly, a bit of challenging news. I promise there’s going to be some optimism here. I want to leave you again with these, you’re not in this alone and there are large undercurrents here that have to do with things that are out of your control, making this difficult. Coupled with that, especially in our industry and long-term care, we’ve got increasing demand. We know that the baby boomers are continuing to age, chronic illnesses are increasing and the population of seniors is requiring more and more health services.
You can see that chart to the right there, is a bit dated, from the Census Bureau, but you can see what happens to the age groups. As we progress through the next 20 years or so these folks are going to enter into our facility as well. You may have occupancy rates that are still below where you were before the pandemic started. Those occupancy rates are steadily improving, and we absolutely should expect to reach higher than pre-pandemic occupancy rates in the near future.
There’s some regulatory risks on the horizon as well. I’m sure many of you are aware that CMS and the current administration is considering some changes to staffing ratios in their requirements and instituting a federal mandate on what that ratio looks like. That’s estimated to be around a $10 billion cost. It says yet unfunded, at least planned for. That’s going to make things that much more challenging, not just the challenge of the cost to provide that level of staffing, but as we’ve talked already, there’s just not enough workers for us all to succeed and achieve that in a short period of time.
Now, there are a lot of things that are outside of your control. There are a number of things that are still yet in your control and things that we can address. Being a realist about the state of the labor situation doesn’t mean that we can’t be optimistic. We just have to change our strategy. This industry has certainly always excelled at being creative, changing their strategy, finding ways to win.
There are some brutal facts to face, for sure, but let’s get into some things that we can do to address these issues in your centers. The first thing I suggest is that we look at your workforce specific to your community and develop a tool to evaluate your community’s strengths and weaknesses around a workforce strategy. I’ve listed just a number of the categories affecting a workforce strategy. These are not all of them. There certainly isn’t a tool that is the best out there. Something that you should build in your community though to assess where we are great, and where we have the biggest challenges in our center.
Take all the knowledge that your communities are very well versed in quality improvement, in multidisciplinary strategic problem solving that you all do very well, that you’re mandated, frankly, to do for emergency preparation, for infection prevention, for quality measures, etc.,, and just apply those skills to your workforce solution for something that’s tailored to your community and that’s a long-term strategy for success.
I’m going to suggest that we ask ourselves some tough questions. If in your assessment of your community’s needs, you feel like we need to focus more on our orientation process or our training process, or the ways in which we retain people, and you find that the vast majority of your time and resources are dedicated to recruiting, I think we should ask ourselves is that resource timed well and is that resource allocated to the right place at that right time? Follow your plan and make sure that the resources that you’ve built, the executive, sponsorship and support that you’ve got for the plan that you’ve written, allocate those resources to the right places at the right time.
I see a number of communities that, for example, really incentivize hiring new staff over investing in the retained staff. I wonder if many of our communities really have the technology that they need to make some of the decisions around their workforce in today’s really dynamic situations. I wonder, are we balancing the capacity of the clinical leadership team that’s tasked largely with executing on this strategy? Are we prioritizing hiring volume over hiring for quality and hiring for fit? These are just some of the questions. Again, I suggest that we ask ourselves and put against the strategies and assessments that we make on our specific communities.
This slide really discusses some of the journey you may experience as you progress through improving the workforce situation and workforce strategy. If you’re in a crisis mode, you’re likely prioritizing first and foremost patient safety. You’re trying to limit your expenses, reduce the turnover so this problem doesn’t get worse. You’re recruiting management roles, you have likely been in that period of instability for an extended period of time, and you very well may be using a significant amount of contingent staffing if not dependent upon them for that patient safety.
Now, progressing out of that crisis through your work plan to a point where you’re really gaining some more consistency might look like a shift to limiting the overtime and the burnout that your existing staff are experiencing, investing more in your clinical management and really committing to them being in a management role, enhancing your orientation and your training programs, rebuilding your occupancy and starting to really ramp your hiring now, then consolidating those PRN partnerships, the partnerships in which you build a contingent workforce, finding true partners for you, that work for you and meet your needs the best. Then reducing that dependency overall on contingent workers.
Lastly, where you feel like you’re really optimizing your workforce may feel a bit more like this, where you’re now maximizing your occupancy and looking for new revenue opportunities. You’re doing some advanced workforce planning, meaning succession planning. I’ve got this great nurse, am I talking to that person about what their goals are? What are their motivations? What do they want to get out of their time in this community?
Making plans and vision painting for them what it looks like to move into a nurse management role, and how am I going to plan for that to occur? Making sure that time off is well planned for and everyone gets to use some of their time off so they have a good work-life balance. If we’ve got some turnover, again, we’re using our contingent workers in a really strategic way to limit burnout, to limit the overtime usage to cover for time off and make sure we don’t derail our long-term workforce strategy plans.
I’ve seen some really interesting programs around mentorship. Your direct care workers partnering with leadership around newly hired nurses and nurse aids so that they feel mentored and they have a vested interest in their success in the culture. They’re also, frankly, our best referral sources for new team members. Do you have programs that reward referrals and mentorship? Are we really culture-building in the facility? Do we have opportunities for advancement at really every role? Are there ways to be engaged? Are we measuring that engagement? Are we communicating with our team where we’re going, how we’re going to get there and what their role along the way is?
Painting a grand vision. Being more creative with our scheduling, interjecting as much choice and flexibility as we possibly can. We know that that is something that today’s workforce is longing for. Are there ways to use shorter shifts and consider our peak demand differently than just, I need this many at this typical scheduling time frame of 7:00 to 3:00, 3:00 to 11:00, 11:00 to 7:00? Optimizing your total cost of labor. Then, again, being really strategic with your use of contingent staff.
This excerpt has been edited for length and clarity. To watch the full discussion on video, please visit:
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