While staffing issues have moderated slightly from the doldrums of three years ago, senior living operators are still working to solve turnover rates among their ranks using initiatives to improve retention.
In a new environment in which wage rates are seemingly permanently elevated compared to just a few years ago – with workers worthy of more flexible scheduling and personalized benefits – operators must get creative to solve one of the most complex aspects within the industry’s debate on staffing.
Operators of all sizes are confronting the post-Covid staffing challenge by spending more time listening to employees, creating leadership and career development avenues and offering support to new hires in order to close the so-called “back door” of the proverbial staffing funnel.
Throughout the year, operators have reported anecdotal success in various aspects of staffing, from ability to hire to the fruits of recruitment paying off in local markets to attract talent from competitors or from outside the industry.
Frontline executives from Sinceri Senior Living, Ecumen, Health Dimensions Group and Westminster Communities of Florida managing this complex issue on turnover within their rosters towards a future in senior living staffing that’s comparatively much brighter than in recent years, albeit fraught with challenges ahead.
Emphasis on first 90-days of employment, engagement is key
Turnover is not a new challenge for the senior living industry, but it is one that intensified during the Covid-19 pandemic. The National Investment Center for Seniors Housing and Care (NIC) published data in May of 2022 that showed that the annual turnover across primary markets the organization tracks was about 85%.
Since then, the staffing pressures have eased across the industry, and the landscape involving turnover has changed, with operators seeing improvements in the last 10 to 12 months.
Operators including Ecumen, Health Dimensions Group, Sinceri and Westminster Communities of Florida shared with SHN that within their organizations, a 90-day window for new hires is the most critical time to impact an employee’s decision to stay or leave an organization.
Between 2021 and 2022, Sinceri Senior Living reported a decline in its rate of turnover, with the company’s vice president of human resources, Michelle Shelton, noting that this year’s turnover rate being “somewhat level” in the range of 20% to 40% depending on the position.
The company deployed regional recruiters last year to bring in new talent and focused on what Shelton called “proactive engagement” with applicants, candidates and newly-hired employees. That engagement includes check-in meetings with employees at 30, 60 and 90-days of employment. The Vancouver, Washington-based provider also rolled out a service recognition program that offers cash rewards for length of service anniversaries.
“It’s critical for engagement to touch base with your employees within that window,” Shelton said. “It’s about anything that we can do to help engage our employees at the community level.”
Even flexible scheduling can become difficult when employees leave quickly, Shelton said, which is what prompted in-part the company’s emphasis on engagement. While it varies by community, each Sinceri property has a “buddy system” that serves as a support network for new employees to help new hires feel welcome.
Sinceri Senior Living operates over 73 communities in 19 states.
Shoreview, Minnesota-based Ecumen has spent the last four years addressing turnover issues within its portfolio of 44 senior living communities, according to Melanie Sullivan, the organization’s chief people officer and a senior vice president. The company calculates turnover on a rolling 12-month average to reduce seasonal variations, and currently the company’s turnover percentage is “relatively flat,” Sullivan told SHN.
That includes participating in a bi-annual Gallup engagement tool, and each community leader is responsible for completing an action plan to improve engagement with teams on the ground. With quarterly connection meetings,
Ecumen leadership at the community level can connect routinely about future goals and challenges within their respective roles.
Sullivan highlighted a program started just prior to the pandemic that created a financial wellbeing program for team members to reduce debt and manage financial stresses through coaching and support.
“Each position has its own unique recruiting challenges, but Ecumen is making headway with some communities not having any open positions,” Sullivan said. “That is a win.”
In the highly competitive Sun Belt market, Westminster Communities of Florida saw volatility last year with folks exiting the industry following the pandemic and was the peak for turnover and fluctuating wage rates, said Westminster Communities of Florida Chief HR Officer Mary Klein. Across its 23 communities, turnover this year is approximately 30%, she told SHN.
“We’ve seen a marked slowdown in both wage movement as well as turnover and greater availability of candidates for our positions this year,” Klein said. “It seems like things are settling back into a more normal rhythm.”
With a checklist for managers to fall back on when meeting with new hires, Westminster is able to reduce turnover. All communities have recruitment and retention committees of all levels of staff to identify where turnover is occuring.
On a case-by-case basis, to improve retention, Westminster management have worked with individual shift leaders to hone management skills to prevent a phenomenon Klein called “eating their young,” in which a new employee isn’t necessarily welcomed into the normal rhythm of a shift. In those instances, staff will work with leaders to offer more training and handle any issues prior to a new hire deciding to leave. That effort to elevate training has shown success after being implemented, she added.
With electronic exit interviews and pulse surveys to new employees, it helps Westminster leadership “keep our finger on the pulse” of the organization, Klein said. That is also coupled with allocating $40 per month towards team member engagement, per employee. Then community-level management has the discretion to use those funds for covering additional training, food truck outings or gift cards.
The company has additionally invested in predictive analytics on hiring, while also applying those predictive indices to better understand management team dynamics and foster stronger bonds between staff.
Health Dimensions Group (HDG) saw success in reducing turnover this year with a 10% reduction this year compared to 2022, with leadership turnover stabilizing for executive director positions in the last 12 months, according to HDG Amber Rogotzke, president and principal of HDG.
“It starts with really digging into and focusing on delivering an exceptional new hire experience by ensuring our new team members feel a sense of belonging and appreciation during their onboarding process and throughout their career,” Rogotzke said.
Through mentorship, training and education, HDG works to reduce turnover by showing employees opportunities for development and career advancement. Going forward, Rogotzke said she believes the industry needs to “improve their flexibility” to accommodate staff by identifying needs at the community level.
“This can be a challenge, but it is certainly doable and we need to continue to improve at this as an industry,” Rogotzke said.
HDG operates a portfolio of 25 senior living communities across eight states, along with also having a major contingent of skilled nursing properties.
Challenges remain, but outlook improving
Care positions have been a tough problem to solve for operators in recent years, and organizations have been stepping up to meet that challenge.
Shelton said positions in care and nursing have remained the toughest position for Sinceri to fill due to competitive salary ranges and availability of positions across the health care continuum. On the flip side, entry level positions also can be tougher to fill than expected with prospects able to work outside of the industry for more pay.
“We need to make sure that we are competitive salary-wise,” Shelton said. “We are, and we look at that salary data regularly but we’re always finding salary creep and competition in the industry.”
For Westminster, the trouble on staffing still lies in retaining licensed health center staff, while also having trouble filling frontline dining positions. But one bright spot has been the company’s recent success in hiring and retaining nursing assistants through programming to recruit registered nurses from the Philippines and Kenya.
“The market seems to have finally caught up to us,” Klein said.
Going forward, Klein said she believes the industry needs to adopt long-term policy strategies to alter immigration standards, a common call in recent years by senior living operators.
But the RN position continues to be the toughest challenge to solve for HDG, with the industry competing with health systems and clinics that offer higher wages compared to senior living.
“Although the available workforce will not grow significantly larger for some time, I have, more than ever, seen a renewed focus on team engagement and retention in our profession,” Rogotzke said.
While Ecumen is also struggling to hire care staff, another area that continues to be a thorn in a community executive director’s side is the company’s environmental services team, Sullivan said.
“We are facing a demographic challenge of more people needing the services we provide, yet there are fewer people available to do the work,” Sullivan said. “That’s why attracting talented candidates, and creating a work environment where they want to stay is key to our success.”