As staffing remains one of the leading areas of trouble for nursing homes, operators have turned to technology tools that have improved both retention and recruitment of workers in the last year.
But while operators, advocates and even insurance providers associated with the skilled nursing sector applaud the implementation of staffing-related technology, doing so is easier said than done.
Tight margins, thinly stretched staff and sometimes a lower-than-expected rate of return (ROI) on technology investments all present challenges.
Scott Code, vice president for LeadingAge’s Center for Aging Services Technologies (CAST), has been observing a range of different technology types that have helped with staffing or to make workers’ lives easier. Software that assists with staffing includes applications for flexible scheduling, early access to earned wages, and tools for employee retention such as pulse surveys, Code said.
Operators agree that technology has helped with flexibility and diminished the uncertainty in staffing, and allowed them to step away from use of more expensive labor pools such as travel nurses. However, these tech initiatives come with a high price tag of their own.
“We’re definitely increasing technology. We’re definitely benefiting from it,” said Tina Johannessen, national director of human resources at Covenant Living Communities and Services. Covenant Living is one of the largest not-for-profit senior housing and care providers in the United States, with 22 communities in 10 states. But despite those investments and benefits, Covenant has encountered challenges, with tech for hiring temporary non-clinical employees proving to be too expensive.
Shifts in investment priorities
Compared to 2020 — when providers were in the thick of the Covid-19 pandemic and investing heavily in video conferencing and infection control tech — more organizations invested in staffing-related technology in 2022, according to a recently released survey from specialty investment bank Ziegler.
Workforce/staffing scheduling systems cracked the top five areas of tech investment last year, with 47% of respondents saying they had targeted these solutions.
However, less than 25% of respondents said they plan to invest in this type of tech in 2023, the survey showed.
The Ziegler CFO Hotline survey gathered feedback on technology spending from 150 senior living organizations in December 2022 and was produced with input from LeadingAge CAST.
Staffing scheduling solutions will still take up a bigger portion of the tech budget for senior care providers compared to areas like telehealth, with only 14% of organizations planning to allocate funds towards telehealth.
And beyond scheduling software, investment in technology for staffing covers a wide range of uses and tools to ease the burdens, said Lisa McCracken, director of senior living research at Ziegler. It encompasses investments in everything from smart hiring and recruitment tools to Artificial Intelligence (AI) and use of automation via robotics.
“The financial investment is similar all across the board, from point solutions to larger enterprise-level platforms like OnShift,” she said.
Nursing homes have also used technology to improve such tasks as note taking – an area linked to burnout among clinical staff.
Code from LeadingAge CAST noted that other innovations that can alleviate problems from a depleted labor pool included robotic solutions, such as physical robots in dining services that move food and dishes back and forth from the dining area to the kitchen, for example. Or, robots that help with delivery, dispensing medication, physical therapy, and even cleaning services and starting video chats for residents.
“Whether it’s technologies that help support staffing practices … or technologies that help make staff be more efficient and/or reduce the need for staff, providers are looking at both,” Code said.
Covenant officials cited use of handheld notepads for nurses for electronic management records (EMRs). Covenant officials said that these handhelds reduced nursing documentation time by 30%.
Even though Covenant doesn’t plan to use workforce management and on-demand staffing platforms for employing clinical staff, the company continues to use job listing sites such as Indeed for successful outreach as well as monitoring employee reviews for improvements in recruitment, Johannessen said. Covenant Living has successfully used scheduling tools such as OnShift in conjunction with Payroll Based Journal (PBJ) data for maintaining a consistent pool of caregivers, she added.
Johannessen said her organization is trying to move away from an agency-based workforce.
“We are really focusing on hiring our own internal employees and then also retaining those employees and engaging them, of course, to make this a great place to work, and then really driving those agency numbers down.”
Financial, operational considerations
Given the climate of tight margins, technology tools that could help with staffing don’t always offer the ROI that would justify their use.
Covenant Living’s Johannessen said that her organization tried to “dabble” in using technology solutions to hire temporary workers on flexible schedules for dining services positions, dietary aides, nutrition workers as well as housekeeping. But “that price point was pretty high,” she said.
And then there is the resistance from staff in implementing new technology solutions that take time to master and implement.
Zeigler’s McCracken advises that for improving the rate of return on investment (ROI) for technology solutions, sharing a long term goal with staff up front is important to the successful implementation of any new technologies.
“When you adopt these technologies, you need to fully utilize all of the features and solutions that are embedded within that technology. Often, providers might utilize only three-quarters, or may even less, of the elements embedded within the technology.
So the ROI goes both ways. Providers need to invest in the right technologies, but at the same time, adopters need to maximize the benefits that those technologies offer,” McCracken said.
Meanwhile, it pays to be simply thoughtful and patient when introducing a new technology, said Code.
“Be realistic about the amount of time, training and support a new technology initiative may need,” he said. “Focus on how the technology will help staff be more efficient and provide better care for the residents.”
Pulling a new initiative together might require getting help from a cheerleader from the ranks of staff or residents. And sometimes, it may be important too to reckon with the staffing shortfalls and put a pause on a project until staffing is sufficient, he said. f
As for Covenant Living, Johannessen said, the organization hires employees in the Human Resources department who are already familiar with staffing technologies so that there isn’t pushback due to the extra time needed in learning a new technology.
When thinking about ROI, providers also should consider potential insurance-related cost reductions. Insurers are concerned about the risks posed by the current labor crisis and are eager for “soup-to-nuts” details about how nursing homes are addressing the challenges, including through tech use, according to Scott Lieber, managing director at Marsh, an insurance brokerage and risk management firm.
“I think innovation is a must. And there’s a lot of good technology out there that is helping skilled nursing operators perform more efficiently,” he told SNN. “The underwriters definitely like to hear about the different types of technology that operators are looking to implement within their communities and how it’s been working.”
Since technology can be expensive, advocacy groups are seeking to provide more government funding for electronic health records that, while not directly contributing to increasing staff, may at least help with making their work a bit easier. And any financial support for investing in Electronic Health Records (EHRs) might free up dollars for tech more directly related to the workforce.
LeadingAge is working with the Post-Acute Technology Coalition to introduce a bill related to EHR funding, said Andrea Price-Carter, the advocacy group’s director of workforce and technology policy.
The draft bill, currently seeking potential sponsors from a few Congressional offices, would provide financial incentives to five types of Medicare post-acute care and long-term care providers to acquire or upgrade existing health information technology and implement EHRs.
Despite the costs and operational challenges related to workforce technology, providers should keep in mind that labor pressures will persist even as consumer demand increases, said Jenna Kellerman, director of workforce strategy and development with LeadingAge.
“Unfortunately, we know that the workforce crisis is going to continue based on the demographic changes ahead, so waiting to implement until an organization has better staffing is not a realistic expectation,” she said. “If we want the solution in the future, we need to start today.”
Staffing solutions still remain a more popular area for allocation of technology funds by nursing homes, behind wifi- and building infrastructure spending for technology, according to the Ziegler survey.
Across the past year, investment in technology for staffing even rose against other areas, the survey results show, as organizations were relatively less likely to have invested in medication management technologies (15%), care coordination tools (15%), and robotic process automation (3%).
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