David Wilkins

Let’s face it: 2020 has turned everything upside down, and that’s putting it mildly.

Just as many organizations were developing and executing long-term talent strategies, COVID struck and all of healthcare was put into crisis mode, reacting to the challenges presented by a virus that is hitting senior living and senior care especially hard. Any strategic planning that was underway to address persistent, systemic challenges in talent supply and demand was upended by the virus and it’s attack on the most vulnerable — our seniors.  

Thus far, everything about COVID has been about negative disruption and immediate needs. But as we examine crucial business and talent responses to the disease, a slightly more nuanced picture emerges, one that reveals the possibility of tackling long-standing talent challenges in senior living and senior care, first as a reaction to COVID, but also as the set-up for long-term change.

While COVID is by no means in the rear-view mirror, we have learned that when it comes to talent, you don’t have to choose between a short-term reaction and a long-term strategy to address the systemic supply and demand challenges. A well-designed strategy can address both challenges, while also improving staffing levels and reducing premium labor spend.  

Better staffing, better results

For decades, research has consistently found that higher staffing levels, longer tenure and less turnover lead to improved resident outcomes. Some studies have found connections between turnover and mortality rates, where more of the former leads to more of the latter. Other studies have found that a higher staffing level is one of the best predictors of survey deficiencies and improved quality measures.

Staffing has been found to be a better predictor of rehospitalization rates than MDS quality measures, a finding echoing decades of research on hospitalization readmission risk. There have also been several studies linking turnover and lower staffing levels to adverse quality of care outcomes such as increased use of restraints and psychotropic drugs, an increased risk of pressure ulcers and contractures, and more residents reporting moderate to severe pain. 

Staffing levels are just as important when it comes to COVID. Over the last six months, there have been numerous studies linking staffing levels to COVID infection and mortality rates. The most recent found that while a facility’s initial infection risk was subject to multiple factors, the likelihood of an outbreak and resulting deaths stemming from that initial infection point were both directly correlated to staffing levels.

For those of us that work in this industry, this is just confirmation of common sense. With less staff, it’s harder to follow infection control protocols, and it’s more likely that staff are caring for more residents per staff member, increasing the number of contacts and potential exposure points.

Invest up front

Senior care organizations now face the daunting challenge of needing to reduce expenses, especially premium labor costs, while simultaneously increasing staffing levels. Senior care leaders don’t have the option of doing one or the other. 

Consider that the average direct, hard dollar replacement cost for a registered nurse is around $13,000, while nurse assistant replacement costs are around $3,000. It doesn’t take many retention “saves” to add up to a pretty significant dollar savings, and every RN, LPN or NA who doesn’t leave the organization contributes to a net increase in staffing. 

On the hiring side, the average shift differential for every RN filled via agency or overtime versus a direct hire is around $240. For a CNA, it is more than $50-$65, depending on region. Given these differentials, reducing your time-to-fill by 5-to-10 days on average across even a relatively small number of openings can dramatically reduce your backfill costs and result in higher staffing levels.

These turnover reduction and hiring speed strategies don’t need to be pursued in isolation. If providers can combine time-to-fill reductions with turnover reductions, the resulting premium labor savings will typically be in the high six-to-seven figure savings for even small to mid-sized organizations. 

Senior care organizations are at an inflection point. Long-standing issues in hiring and retention are no longer just talent challenges but are fundamental ​to the health and safety of residents. Don’t choose between the health of residents and the health of the business. Instead, view  talent management with a business mindset, one that takes into consideration proven strategies and investments to transform ​your staffing practices and delivers a higher quality of care to residents. 

David Wilkins is chief strategy officer for HealthcareSource.