Dr. Eleanor Barbera


When I spoke about the challenges of staff turnover at the Louisiana Nursing Home Association convention last week, I asked the group, “If you were able to bring in the same salary you were currently making, would you want to have the job of an aide?”

The response was a ratio that would likely hold at any LTC convention – in an audience of close to two hundred people, only one person said yes.

“You do realize what we’re doing here,” I commented. “Over the next hour or so we’re going to talk about how to get people to take and remain with jobs we wouldn’t want to have ourselves.”

As attendees pointed out, being an aide is physically and emotionally demanding work for low pay, little autonomy and not enough respect. These downsides – once partially offset by longstanding, gratifying relationships with medically stable, cognitively intact residents – have given way to more challenges as facilities take in increasing numbers of shorter-term, higher acuity residents.

To woo workers to the field – and keep them from the lure of relatively stress-free retail positions at the same pay – it might be time to re-envision our role as employers.

They come for the “special sauce” – and they’ll stay for the buffet

The main appeal of jobs in long-term care (our “special sauce,” if you will) is the opportunity to help others. No fast food joint can compete with that. We need to offer more, however, if we want our workers to stick with us.

In addition to traditional benefits, we can enhance our appeal by providing a “buffet” of nontraditional benefits that build on our missions and on employees’ desires to help others.

One of the unique features of LTC is our access to wisdom from elders, which can offer perspective on life and how to live it. If we envision ourselves not just as caregivers for the aged and ailing but also as organizations that can impart life wisdom to those with whom we come into contact, we can strengthen our allure as employers.

In his New York Times article How to Live Wisely, Harvard professor Richard J. Light, Ph.D., writes about a seminar designed to help students make the most of their college experiences and to reflect on what they’d like to get from their lives. With our treasure trove of life knowledge (i.e., residents) we don’t need to be an Ivy League university to do that too.

Imagine if part of joining your team included a class in how to make the most of the job experience and to ponder questions such as the ones asked in the Harvard seminar: “What does it mean to live a good life? What about a productive life? How about a happy life?”

Our seminars could easily follow the university’s model of three 90-minute discussion groups over the course of a year – and the time frame might help new employees through their initial anxiety about working with those at the end of life. (For more on this, see Absenteeism and turnover in LTC? Death anxiety could be the cause.)

Our “professors” could be senior staff members, consulting psychologists and residents. (An added bonus: think of the positive impression this opportunity would make on potential residents and their families.)

Along with our focus on life wisdom, we can make more of an effort to offer healthier life choices to employees, including ways of fitting exercise into a busy schedule (such as an onsite gym or a walking group), meditation classes (consider one open to residents and staff together), onsite childcare, flexible scheduling or a carpooling program. To find the most valuable starting points, ask your workers for their “wish list” for a happy, productive work life.

There are wonderful reasons to start and sustain a career in long-term care, as attested to by the general enthusiasm of the LNHA conventioneers. We would be wise to highlight those elements that keep us energized about our own jobs and to add enough additional encouragers so that we too would be satisfied to work as aides.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.