Senior Living Providers Ease Multi-Site Worker Restrictions As Labor Challenges Grow

When the pandemic hit last year and communities across the country closed their doors to the outside world, one common practice went by the wayside: multi-site staffing.

In the pre-Covid days, it was common for senior living workers to move from one community to another, either within the same company or for different companies, sometimes even working across different care settings. But when Covid-19 case counts began to rise in the spring of 2020, some providers halted that practice to limit the spread of infections, prompting some to wonder whether it would ever make a comeback.

Fast forward to 2021, and many senior living communities have relaxed those restrictions thanks to the rising rate of vaccinations, more advanced infection control practices and a better understanding of Covid-19 and how it spreads.


Communities that “bubbled up” to prevent the spread of Covid-19 at the start of the pandemic — such as Clackamas, Oregon-based Generations, LLC, and Shady Oaks Assisted Living in Bristol, Connecticut — have found ways to safely craft policies that allow workers to move around more freely.

Other providers, such as Portland, Oregon-based Frontier Management, maintained the flow of outside health care workers during the pandemic with added protocols and policies to prevent the spread of Covid-19.

Perhaps the biggest force driving this trend is the longtime industry labor shortage. For many providers, the pandemic has put even more pressure on staffing, according to Charles Turner, CEO of Kare, a staffing app that connects workers with more than 70 long-term care companies in eight states.


“The labor shortage is no secret, it’s always the number one or number two concern of any of the CEOs in our space,” Turner told SHN. “At the end of the day, the only way of solving it is having multi-site workers.”

Multi-site policies evolve

When the pandemic hit last year, senior living providers recognized the infection risks posed by workers moving among different buildings, and they crafted policies intended to minimize these risks. That included Kare, which initially limited workers — “heroes” as they’re called in the app — to picking up shifts in just one building. The company also worked with its customers to make sure they were posting enough shifts for workers to stay dedicated to one community.

But by the summer of 2020, providers using Kare began to ease those restrictions, and that trend continues as providers see advances in Covid-19 testing capabilities and rising vaccination rates among residents and staff.

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“By the early fall, I’d say only about half the communities were enforcing movement restrictions [for workers],” Turner said. “Fast forward to now and I would say of all of the hundreds of buildings that we’re in … I’d be surprised if there are more than five actually enforcing restrictions.”

Certain strategies have allowed providers to continue their multi-site staffing practices throughout the pandemic. For example, Frontier Management allowed essential medical providers into communities, and it did so by sharing vetted, tested workers with other senior living industry and health care companies.

The practice worked because all of the companies shared the same infection control policies and procedures, according to Kandice Alcorn, vice president of clinical services at Frontier.

“Sharing staff within the health care industry is much safer, in my opinion, than sharing staff with a retail store in the local market,” Alcorn told SHN.

The operator also created new centralized staffing positions to provide training and assistance for multiple communities and dedicated staff.

“I do believe we will begin to see more multi-site usage of employees within the industry and within our own organization based on sheer supply and demand,” Alcorn said. “Additionally, the use of agency staff utilization has increased exponentially within the industry.”

At Mt. Laurel, New Jersey-based Brandywine Living, workers can pick up shifts in any Brandywine community near them, but not for other health care providers. The provider enacted a “one job” policy dictating that workers could only work at Brandywine and not for another senior living or health care company.

But that policy, coupled with the operator’s infection control protocols and vaccinations among residents and staff, allow those workers to move among Brandywine’s 32 communities.

Brandywine has its own proprietary staffing system called MyLifeMySchedule — or “MyMy” for short. Using the MyMy system, workers can browse open shifts at local Brandywine communities and pick them up as long as they are qualified.

Expanding the bubble

When the pandemic hit at Shady Oaks in Connecticut, the community sealed itself off from the outside world to prevent the spread of Covid-19. And today, that policy has resulted in a perfect record of no outbreaks among residents, and only a small number of staff cases.

As part of that policy, Shady Oaks Owner Tyson Belanger had to limit employees to working only in the community and nowhere else. By February, Shady Oaks relaxed that policy to allow its employees to work other jobs, including for other senior living providers.

“Our policy now is that it’s okay to work here and other senior homes as long as they’ve been vaccinated,” Belanger told SHN.

Generations, LLC, is another senior living provider that “bubbled up” in a similar fashion to Shady Oaks. When the pandemic hit last year, the company stopped its workers from traveling between care sites at its communities, or to other local Generations communities.

But by the time vaccinations started ramping up in the senior living industry and new case counts began to fall, the company rolled back that policy. Doing so was also a necessity, given the current availability of workers, according to Generations Executive Chairman Chip Gabriel.

“Right now, staffing is probably our biggest challenge that we have in our organization, bar none,” Gabriel told SHN. “It’s just a huge issue to get people to show up to work and fill shifts.”

The bottom line, Turner says, is that necessity is the mother of invention.

“Ultimately, people need workers, and they were going to figure out a way to do better infection control and monitoring and detection early so that they could bring in multi-site workers,” Turner added.

To get over that hurdle, both Shady Oaks and Generations are focused on being the employer of choice for their local market, including by offering competitive wages and benefits. For example, Shady Oaks has raised its starting pay rate to $18 per hour.

“Last week in our hometown — all five nursing homes and us — we were all hiring CNAs at the same time,” Belanger said. “And that suggests to me that it’s a very competitive market for hiring right now.”

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