Increased Hiring Challenges, Staff Burnout Could Hamper Senior Living Providers in 2021

Covid-19 exacerbated an already tough hiring environment for senior living providers over the past year.

Now, as the industry nears a post-pandemic environment, it is uncertain if providers will be able to recruit available workers — a challenge that may become harder if hospitality and other industries hard hit by Covid-19 experience quick rebounds.

While hiring may be the toughest near-term workforce challenge, turnover has historically been the biggest labor issue for senior living providers, and increasing retention remains a top priority. But higher levels of burnout could make that goal harder than ever to achieve.

Providers such as LCS are looking at ways to improve recruitment in the post-coronavirus era, Executive Vice President and COO Chris Bird told Senior Housing News. Some of the ways the Des Moines, Iowa-based company is exploring include tweaks to its employee referral program, and using testimonials from residents at its communities as part of the recruitment process.

Bird has had conversations throughout the pandemic with other industry leaders, and all agree that the issues they faced before Covid-19 disrupted operations — notably a push for higher wages and recruitment — will still be around.

“It’s going to become more challenging to balance having a quality workforce with being able to run a healthy business, to meet the needs of all of our seniors,” he said.

Hiring is harder

Before Covid-19, the top two workforce challenges for providers were, respectively, turnover and hiring. The pandemic flipped that.

According to the most recent “Workforce 360” report from OnShift, which polled over 2,100 industry professionals, 67% of respondents indicated that recruiting and hiring qualified candidates is their top challenge, while 57% suggested that employee turnover was their top challenge.

Recruitment has become tougher for myriad reasons. First, early reports on Covid-19 outbreaks made no distinction of long-term care settings between nursing homes and senior housing, OnShift CEO Mark Woodka told SHN.

Second, enhanced unemployment benefits at the federal and state levels helped workers laid off from their jobs make up for a significant portion of their lost wages, allowing them to stay and home and still pay bills.

LCS recognized this in the volume of job applications it received during the pandemic. Where, before Covid-19, the provider would receive 10 applications for a job opening, during the pandemic that same opening would generate half as much interest.

“[Recruiting] has been a little bit harder,” Bird said.

For Solera Senior Living, the recruitment issue was more market specific, President Jamie Ranzan told SHN. States such as Florida were tougher to recruit in because, in some markets, enhanced unemployment benefits amounted to more than what some workers were making, pre-pandemic.

In Denver, meanwhile, Solera has been able to recruit new employees via a partnership the company has with the University of Denver’s hospitality program. These were workers Ranzan expected to enter the hotel industry, one of several sectors adversely impacted by Covid-19, giving Solera a chance to build workforce depth in the market.

“We were able to kind of get that flow of great talent into Solera with that,” she said.

Hiring struggles have not been isolated to unskilled and entry-level positions, either. Covid-19’s first wave placed a premium on hiring caregivers, particularly licensed nurses, Activated Insights CEO Jacquelyn Kung told SHN. The company is the senior care division of Great Place to Work, the organization that puts together the annual Great Place to Work in Aging Services list.

“It was so difficult to hire [nurses] because hospitals were ramping up for their hiring,” she said.

Going forward, senior living providers not only will be competing with other health care providers for caregivers, but will again be locked in competition with restaurants, retail and other employers that are starting to ramp up business again as the economy reopens.

Senior Housing News elicited responses from 13 provider respondents in a recent Pulse survey, including eight respondents with organizations operating more than 50 buildings. The vast majority — 10 out of 13 people, or 77% — said they expect hiring to get harder over the course of 2021.

Turnover up, some providers make progress

Retention remains a challenge for the industry, as well. Employee turnover increased an annualized 15% last year, compared to pre-pandemic levels, according to data from Activated Insights. Turnover rates in senior living average over 40%, industry association Argentum reported in 2018.

Contributing to turnover during Covid-19: There was no uniform approach among providers toward providing workers with enhanced benefits and flexible schedules, so that frontline workers could balance their workplace responsibilities with challenges at home. In many instances, providers offered their staffs only blanket appreciation for their service, leading many workers to simply quit and focus on their home challenges.

“The way providers showed their appreciation and gratitude was very inconsistent,” Kung said.

Over half of respondents to SHN’s pulse survey indicated that turnover increased during Covid-19: 33.33% saw turnover increase by more than 10%, and 25% reported a 1% to 5% increase.

LCS considers itself an outlier in the retention battle. Total workforce turnover decreased by 10% over the past year, while retention among executive directors is around 90%.

While those numbers are impressive, LCS is not the only large provider to improve retention during the pandemic. At Chicago-based Enlivant, turnover was down 8.4% and retention of long-term employees was up 6% year-over-year, then-CEO Jack Callison told SHN in October 2020.

Bird attributes LCS’ success in part to the company’s professional development program. This identifies emerging young leaders in the space and provides them with a year of training across various facets of operation, at different communities. These emerging leaders also learn about support structures LCS provides its communities.

The program stayed in place during Covid-19, but LCS had to adapt it to virtual settings because of restrictions on non-essential personnel inside communities. With vaccine clinics ending and vaccinations proving effective in the fight against the virus, Bird hopes to ramp up in-person training soon.

“We are building our future executive directors and administrators,” he said.

Solera has not seen significant attrition during the pandemic, which Ranzan credits to the company’s culture-first focus. However, the provider mandated vaccinations for staff and saw some workers leave, as a result. Those departures have not been a huge number, Ranzan indicated, saying that the vast majority of staff understood the safety of residents was paramount in Solera’s decision to mandate vaccines.

“We respect their decisions [to leave] and are working around that,” she said.

Aegis Living saw its staff turnover decrease 10% in the final six months of 2020 — the lowest turnover rate for the Bellevue, Washington-based provider in six years, Chief People Officer Sandra Preayale told SHN.

Aegis implemented a range of approaches to head off turnover. It implemented hero pay bonuses ranging from $250 to $500. It provided meals for staff and their families along with new childcare opportunities and telehealth benefits, and the provider purchased 300 laptops for employees who have school-aged kids participating in at-home schooling.

It set up counseling and support services for team members, including bringing in third-party experts to help employees deal with pandemic-induced stress.

Aegis continued its Potato Soup Foundation, a non-profit that works to benefit employees going through crises or dealing with emergencies. The Potato Soup Foundation has helped almost 300 employees in need to date. Over the past 12 months, 44 employees received contributions with a total amount paid out of $120,000.

And the company launched a new holiday grant assistance program where employees were given the option to apply for a $2,500 grant. Forty employees were selected to receive the money (for a total of $100,000), and another 75 received smaller grants ranging from $500-$1,000.

Additionally, employee engagement scores are the highest in the company’s history, with a recent third-party employee survey data reporting 79% engagement among staff.

Preyale credits this, along with strong leadership, as the driving force in the decrease.

“[Our team has] incredible strength, and our community leaders continue to be strong role models,” she said.

Burnout increases

The combined struggle to recruit new workers and uptick in turnover is resulting in an expected increase in employee burnout.

Activated Insights data reveals that, through January and February of 2021, burnout among senior housing workers increased 12 percentage points over the previous year, to 26% among providers tracked by the firm, Kung told SHN.

By comparison, hospitals and hotels reported only an 8% increase in employee burnout, and grocers reported only a 6% increase.

Solera experienced growing employee burnout at a couple of its communities, which the company addressed with enhanced benefits such as hero pay, referral bonuses for new hires suggested by associates, and improving support at the executive director and central office levels. At one community, Solera brought in agency labor to provide relief.

Ranzan and the rest of Solera’s leadership team conducts weekly check-ins with its executive directors and sales teams to discuss trends inside their buildings, and come up with solutions to make work easier on-the-ground staff.

“A healthy balance is what we’re solving for, and have always solved for,” she said.

Aegis is addressing the burnout issue by encouraging staff to take time off, proactively hiring to fill positions in leadership and among care staff, and looking at more ways to bring people back together safely, in person, Preyale told SHN.

“We did all of these things throughout last year, but we have the opportunity now to bring these events back in-person and help further build that strong camaraderie,” she said.

The most important aspect of its response is clear, consistent and transparent communications between executive leadership and community staff. Aegis is also identifying people at all levels of the organization and inviting them to meet with senior leaders to help inform their career development and goal setting.

“Our communication continues to be paramount in supporting team members,” she said.

LCS Identified two areas where burnout is occurring. First, adapting to virtual meetings added stress among community leadership, compared to face-to-face meetings with regional executives. Bird indicated that as more communities loosen restrictions on visitors, that is beginning to subside.

“We have allowed ourselves to lock up our schedules, with meetings virtually versus traveling in and out of communities,” he said.

The other area where burnout is a concern is on the front lines: nurses and caregivers constantly wearing masks and PPE during shifts; associates sometimes working double shifts. The company offers enhanced benefits including flexible scheduling, hero pay and additional vacation and personal time.

Additionally, LCS’ HR department created engagement and culture calendars for its executive directors to keep workforces excited about coming to work and meeting the needs of residents. The calendar includes activities intended to strengthen teamwork and team building, blended with rewards such as food trucks, games and reward giveaways.

Burnout might be heightened in the pandemic era, but senior living providers should have tools to help alleviate this issue.

“Employee burnout is not a new term in the industry,” Bird said.