CREATIVE RECRUITMENT, RETENTION & DEVELOPMENT
STRATEGIES FOR THE SENIOR SERVICES WORKFORCE
2017 SENIOR LIVING SYMPOSIUM
KATHRYN BROD
President
LeadingAge Ohio
B.C. Ziegler and Company | Member of SIPC & FINRA
PRESENTED BY:
March 16, 2017
• To consider the impact of labor issues in aging services,
now and in the future.
• To hear about creative approaches to staff recruitment
and retention.
• To foster innovative solutions for senior living staff
recruitment and retention.
OBJECTIVES
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AGENDA
3
• THE WORKFORCE LANDSCAPE
TOPIC 1
• BUILDING A WORKFORCE FOR SENIOR LIVING
TOPIC 2
• HEIGHTENING EMPLOYERS’ EXCELLENCE
TOPIC 3
QUESTIONS & ANSWERS
TOPIC 1: THE WORKFORCE LANDSCAPE
2016 MASSACHUSETTS
STATEWIDE DIRECT CARE
NURSING VACANCY RATES
Source: Massachusetts Senior Care Association Annual Employment Survey (2010-2016)
Direct Care Nursing (RN, LPN, CNA) vacancy rates have more than
doubled since 2010 leading to 1 in 7 positions going unfilled
6.4% 6.9%8.3% 8.3%
9.3%10.0%
15.8%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
2010 2011 2012 2013 2014 2015 2016
OHIO WORKFORCE SURVEY
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For Nursing & Assisted Living facilities in the state:
• 75% have fewer STNA’s/Direct Care Workers than planned
• 60% have fewer RN’s than planned
• 54% have fewer LPN’s than planned
For Home Health & Hospice providers in the state:
• 57% have fewer HHA’s than planned
• 33% have fewer RN’s than planned
• 48% have fewer LPN’s than planned
In addition, front line staff workers in areas such as food service, laundry, and
housekeeping are also in short supply.
THE NEED FOR CAREGIVERS:
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• Certain positions have no applicants, a situation reported by:
– More than 20% of nursing and assisted living facilities
– More than 40% of home care and hospice providers
• High turnover of caregiver and front line staff is also common.
Often employees leave because they do not like working in a
long-term care setting or it is simply not a good fit, a situation
reported by:
– Approximately 55% of nursing and assisted living facilities
– Approximately 25% of home care and hospice providers
WHY ARE POSITIONS SO DIFFICULT TO FILL?
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Wage & Benefit Disparity
• Providers reported a median hourly starting wage for
STNA’s/Direct Care Workers of $10.15 and $9.65 for HHA’s
• Better pay draws these critical employees away:
– 7 out of 10 STNA’s/Direct Care Workers who left their jobs,
left for better pay
– 8 out of 10 HHA’s who left their jobs, left for better pay
• Employers note a lack of “fit” with caregiver role
– 5 out of 10 STNA’s/Direct Care Workers and 1 out of 4 HHA’s
who left their jobs did so because the long-term care setting
wasn’t a good fit
WHY IS THERE A CRISIS?
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• Nearly 1 of 5 providers has limited admissions or reduced
services - creating access to care issues for individuals and their
families
• Due to these shortages, a large number of providers are currently
using overtime, double shifts, and other financial strategies to
cover the holes/gaps in their staffing schedules. This overuse of
current staff can lead to quality of care issues due to
fatigue/burn-out of care staff and increase the overall cost of
care.
HOW PROVIDERS ARE TRYING TO COPE
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TOPIC 2: BUILDING A WORKFORCE FOR SENIOR
LIVING
Education
• Working to replicate the C.L.L.E program (Cincinnati
LeadingAge Ohio member ERS has developed this
program);
– Introduce children to positive aging
– Provide opportunity for engagement by elders with children
• Working on a high school ‘alternative pathway’ approach
for at-risk students
– Working to replicate program implemented by DD community
• Ongoing work with community colleges to build LTC
pathways from STNA to Nursing
BUILDING A WORKFORCE
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Frontline care giver initiatives underway in the state:
• Frontline Supervisor Training (partner: OSU)
• Elder Certification Pilot underway (funded through OSU
grant)
Career Pathways work underway:
• Exploring non-LTC models for building workforce pathways
• Exploring potential partners for building workforce
pathways
BUILDING A WORKFORCE
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Professional/Career Initiatives/thinking:
• Retired Nurses
– attending nursing association conferences to highlight nursing
needs in aging services; perhaps of interest to some retired
nurses?
• Attracting Geriatricians
– Identified University of Cincinnati professor (Kautz Chair of
Geriatric Medical Education) interested in growing number of
geriatric physicians
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BUILDING A WORKFORCE (CONT’D)
TOPIC 3: HEIGHTENING EMPLOYERS’ EXCELLENCE
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“Becoming an employer of choice isn’t easy. It means taking
an honest look at your current workforce and what you want
it to become. It means acknowledging some difficult truths
and making internal changes.” Jody Ordioni, 2013.
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• Minimum requirements
– One year of 80% or greater occupancy
– If an organization has less than the appropriate benchmark
median number of Days Cash on Hand (or Current Ratio),
additional supporting materials will be requested in order to
validate financial viability.
– if a nursing facility or home health organization, the facility
must be a 3-Star or above (as of the most recent published
rating).
• Not applicable to a multi-site
– Exceptions to multi-site organizations that centralize their
human resource functions.
ELIGIBILITY
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• Employee Engagement
• 5-Star
• Resident Satisfaction
• Financial Strength
• Employee Benefits
• Turnover/Retention
• Agency Use
• Evaluations
• Innovation/Culture
• Community Engagement
• Leadership Continuity19
• For each category:
– Tool for measurement
identified
– Measurement provided
– Best practice suggested
CATEGORIES
• All member types
• Instrument not prescribed
– MyInnerView, Quantum,
or self
• The results must reflect
that the organization’s
overall employee
satisfaction is 75% or
greater; i.e. overall score
for employee satisfaction
is in the upper quartile.
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ENGAGEMENT
Does not meet: < 75%
Meets: ≥ 75% and ≤ 85%
Exceeds: > 85%
Trust!
• Nursing Homes & Home
Health only
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STAR RATING
Does not meet: < 4 Stars
Meets: 4 Stars
Exceeds: 5 Stars
• Scripps Gerontology Center measures resident satisfaction
in the state of Ohio with a bi-annual Long-Term Care
Ombudsmen Survey (each alternating year a survey
occurs; residents then family members). The state of Ohio’s
average resident satisfaction establishes the benchmark for
this measure.
• For hospice (CAHPS)
RESIDENT/CLIENT SATISFACTION
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Does not meet: < State Average
Meets: At least State Average
Exceeds: Exceeds State Average by at least 5 percent
• All member types
• Range of member types requires flexibility in how financial
stability measured:
– Days Cash on Hand
– Current Ratio
• Must show ability to sustain employees!
FINANCIAL STRENGTH
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• All member types
• An Employer of Choice organization must provide all of
these benefits:
– Health Insurance (Medical & Rx)
– Retirement Plan
– Employee Assistance Program
– Educational Assistance
– Paid Time Off
– Bereavement Pay
– Jury Duty Pay +
at least four of the benefits from the Additional
Benefits category (dental, life, vision, etc.)
EMPLOYEE BENEFITS
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• All member types
• Retention (stability/consistence, satisfaction) vs. turnover
(disruption, management/mismatch/etc.)
• To calculate employee turnover rates, divide the number
of employees staying 90 days or less for the past 12 months
by the average number of active employees at the worksite
during the same period.
– a weighted approach or an overall approach.
TURNOVER & RETENTION
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Does not meet: ≥ 30%
Meets: ≥20% and ≤30%
Exceeds: ≤20%
• All member types
• Calculated by looking back one year from the E.O.C.
application date to determine the number of open
resident-facing (or direct care) positions
– Litmus test: not needing to provide coverage (e.g.
housekeeping, maintenance, etc.)
• Exceptions apply:
– Temp to perm agencies
– Holiday parties
AGENCY USE
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• All member types
• Evaluations for ALL employees
• By policy described in the employee handbook
– If 30-day evaluations are required, then 90% of all applicable
evaluations have occurred by the 30-day anniversary of all
employees
– If annual reviews must be completed by the end of the
month, then 90% of all evaluations should have occurred
within the end of the applicable month
• To meet: 90% timely
EVALUATIONS
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• Creative/Innovative Practices/Culture
– How does the organization heighten employee satisfaction or
engagement and/or customer satisfaction?
– Demonstrate!
• Community Engagement
– How does employee participation contribute to the positive
impact the organization has on its surrounding community
– “A not-for-profit notable area, for sure!”
• Leadership Continuity
– How does organization demonstrate business/continuity
planning
– To meet: All leadership team positions should have plan in
place; To exceed: all supervisory team positions
ESSAY CATEGORIES
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• GOLD All met with three (3) exceeds
• SILVER All met
• BRONZE Eight (8) of eleven (11) met
• Signature of Executive Director verifying veracity of
information
EMPLOYER OF CHOICE
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QUESTIONS & ANSWERS
B.C. Ziegler and Company is registered with the National Association of State Boards of Accountancy (NASBA)
as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of
accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints
regarding registered sponsors may be addressed to the National Registry of CPE Sponsors, 150 Fourth Avenue
North, Suite 700, Nashville, TN, 37219-2417. Web site: www.nasba.org. Attendees are eligible to receive
credits for attendance at the 2017 LeadingAge Massachusetts & Ziegler Senior Living Symposium. No
prerequisites are required for this group-live educational conference. Program level is basic.
For more information regarding administrative policies such as complaint and refund, please contact our
offices at 312-705-7262. Fees for this workshop are detailed on the registration form.
©2017 B.C. Ziegler and Company | Member SIPC and FINRA
• Ziegler is a privately-held investment bank, capital markets, wealth management and alternative
investments firm
• A registered broker dealer with SIPC & FINRA
• Ziegler provides its clients with capital raising, strategic advisory services, equity & fixed-income
trading, wealth management and research
• Founded in 1902, Ziegler specializes in the healthcare, senior living, educational and religious
sectors as well as general municipal finance
ABOUT ZIEGLER
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DISCLAIMERInvestment banking services offered through B.C. Ziegler and Company. FHA mortgage banking services are provided through Ziegler
Financing Corporation which is not a registered broker/dealer. Ziegler Financing Corporation and B.C. Ziegler and Company are
affiliated and referral fees may be paid by either entity for services provided.
This presentation was prepared based upon information provided to Ziegler Investment Banking (ZIB) and contains certain financial
information, including audited and unaudited information, certain statistical information and explanations of such information in
narrative form (the “Information”). ZIB believes this information to be correct as of the date or dates contained herein. However,
the financial affairs change constantly, and such changes may be material. Today’s discussion may contain forward-looking
statements, which may or may not come to fruition depending on certain circumstances, including those outside the control of
management. Please be advised that ZIB has not undertaken, assumed no duty and are not obligated to update the Information. In
addition, please be advised that past financial results do not predict future financial performance. The material in this presentation
is designed to present potential financing structures and options for discussion, however it does not represent a commitment to
underwrite bonds, place debt or provide financing and thus should not be relied upon as a promise of financing or underwriting
commitment.
