Cara Silletto

We used to throw around the term “workforce crisis” in senior care before the pandemic. Times were tough, but we had no idea how bad it could, and would, actually get.

Many senior care organizations are experiencing more than 80% turnover (or worse) during this workforce shortage crisis. As a workforce expert who has focused solely on retention for the last decade, I’d like to offer five potential steps to help slow the revolving door. Is it appropriate now to acknowledge that at least 40% of that workforce turnover is not expected to go away … ever?

We know our profession has its challenges with the difficulty in raising rates to raise wages and the need for people with a “caregiver’s heart,” to name a few. To top it off, many of our positions are lower-paid, lower-skilled roles that new hires could learn in a short period, just like other industries such as retail, foodservice and manufacturing.

At the recent LeadingAge national conference in Georgia, I spoke about creating a place where people want to work. The biggest takeaway among a few who spoke with me after the session was the enlightenment of our true competition at this time. The untethered (or gig) jobs now allow people to work when they want, where they want. Now, leading retailer Target is joining companies like Uber and DoorDash with Target On-Demand.

If the competitive market has changed this drastically and the participating labor force has shrunk, we will continue to struggle to find enough candidates to fill open roles. It’s time to operationalize our turnover. 

Moving forward, let’s begin planning for 40% annual turnover (forever), budget to that, and figure out a new business model that is sustainable. 

1. Stop asking department heads to be “hiring managers.”
It is not sustainable to ask these leaders to continue that hiring responsibility and still meet their departmental regulatory and task-driven requirements. It’s time to boost your recruiting capacity with a part-time or full-time recruiting manager at each location and let the managers be managers again. 

If you are worried about where the funds for this role would come from, consider the dollars being spent on excessive turnover in overtime, temp agency use and replacement of burned-out key leaders. Consider being more proactive with sustainable solutions such as changes in staffing, not more overtime for those who are near their limits.

2. Assign a true owner of retention initiatives.
When retention is everyone’s responsibility, no one actually owns the tasks and metrics associated with reducing turnover. Organizations are finding success when they identify and promote from within, or hire, a part-time or full-time retention specialist (which can be combined with a part-time recruiting role, if needed).

A sample downloadable job description is available at

3. Create reusable onboarding checklists.

Be sure you have detailed onboarding checklists at the organizational level, departmental level and role level that cover what a new hire needs to know by the end of 1) day one, 2) week one, 3) month one and 4) quarter one. True onboarding isn’t complete within a week or two. Make the checklist available to the managers and the new hire so they can communicate effectively about where they are and where they need to be. 

4. Foolproof your new hires.
Consider how McDonald’s used to wait for new hires to memorize the menu before putting them at the cash register, but now, they foolproofed the cash register to walk each new hire through the ordering process to get it right. When a customer orders nuggets, for example, the worker cannot move forward with the order until they ask the customer which sauce they would like. What processes could you foolproof? Where do you need to laminate and post step-by-step instructions for new hires to easily access?

5. Automate what you can.

The fear that “robots will take our jobs” is impractical at this point. We need robots and automation to help our shrinking labor force do its job today. Now the question is, which automation has the greatest ROI, as it is costly to implement new systems and there is little reimbursement currently available. I encourage you to follow technology companies in the healthcare field. I am finding the organizations that have a chief technology officer (not just an IT leader) are winning on this one, as it takes time to properly vet new products, crunch the numbers and, finally, implement the chosen innovations.

So, what’s your plan? Are you going to keep doing it the way it’s always been done? How many more staff and department heads must leave before we make major changes in our approach to retaining the talent we cannot afford to lose?

Workforce thought leader Cara Silletto, MBA, CSP, works with organizations of all sizes to reduce unnecessary employee turnover by bridging generational gaps and making managers more effective in their roles. She is the author of the book, Staying Power: Why Your Employees Leave & How to Keep Them Longer.

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.