Dr. El

As the editors of the June 2021 volume of The Gerontologist put it, “Workforce issues are the most significant challenges facing the long-term care industry.” 

This special edition of the journal focuses on the long-term care workforce, examining factors that increase staff retention and mining the circumstances of the pandemic for clues to stabilizing the workforce into the future.

Some highlights from the publication, which was edited by Suzanne Meeks, Ph.D., FGSA, and Howard B. Degenholtz, Ph.D., FGSA, are included here.

Researchers Kennedy et. al. found that nursing home administrator turnover was associated with higher turnover in direct care workers; efforts to support administrators in their roles would therefore reap rewards beyond the retention of one individual. Nicholas Castle, Ph.D., a long-time investigator of nursing home staffing, found “support for the idea that retention is associated with better quality” and proposed looking at three- and five-year retention rates rather than shorter time frames to better assess benefits. 

Anecdotally, I’ve observed that the development of team relationships can take well over a year, and it’s often three years before the aides treat me (and I’m assuming others) like I’m really one of them. This point about direct care staff is particularly relevant given issues to be addressed later in this column.

Most fascinating to me was the discussion by Kezia Scales, Ph.D., my latest researcher crush, in “It Is Time to Resolve the Direct Care Workforce Crisis in Long-Term Care” (interesting reading and not behind a paywall). 

Scales states that “although high unemployment rates may stabilize the direct care workforce in the short term — and potentially improve LTC quality, as seen in previous recessions (Huang & Bowblis, 2019) — these gains will be temporary unless matched by sustained improvements in direct care job quality.”

The job quality improvements she refers to include not only making permanent the hazard pay of the pandemic, but also addressing other retention factors such as “supportive supervision, flexible scheduling, the intrinsic rewards of caregiving, career development opportunities and more.” She also suggests continuing successful recruitment efforts implemented during the pandemic, such as “new recruitment sites, streamlined hiring and onboarding protocols, and technology-based training approaches.”

In addition, Scales emphasizes the importance of “upskilling” the direct care workforce — including improving their ability to recognize changes in residents so that problems can be addressed early rather than after they become more expensive to treat. I’ve addressed the prevention aspect of care before, most notably in “If toileting were a billable service…

Key to this discussion is the issue of payment models. Scales sees the potential of managed care organizations and value-based payment arrangements to promote the upskilling and retention of direct care staff in order to realize cost savings from preventing unnecessary medical expenditures. 

After 20-plus years in the field, there isn’t a doubt in my mind that there are savings to be had from investing in the training and retention of direct care workers. At the very least, even if it were a break-even proposition, we would create sustainable business environments that nurture employees, residents and families, becoming part of the solution rather than part of the problem of aging.

In a relatively disheartening time in the industry, I find it heartening that there are researchers devoted to studying the challenges encountered in long-term care and to proposing a myriad of ways in which to resolve them.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition and a Gold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements and/or content writing, visit her at EleanorFeldmanBarbera.com.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.