It’s not every day that an event comes along and upends the traditional supply and demand forces in long-term care. But the pandemic, which descended on the country — and long-term care — in March, has managed to do just that. COVID-19 has inflicted unforeseen pressures among leadership positions, from nursing managers to the C-suite.
The result has been heightened turnover and a demand for compensation levels that the industry has not recently experienced.
“While we’re not sure how much salaries and compensation will continue to increase, we predict they won’t decrease after the pandemic is over,” said Julie Rupenski, owner/principal of MedBest Recruiting, a major executive recruiting firm for long-term care. “We’ve known and expected salaries to increase for years now due to the number of baby boomers entering retirement age, which is a major contributing factor to the talent shortage. The pandemic has simply sped up the increases in salary and compensation.”
As Rupenski suggested, executive salaries and compensation had been on the rise prior to the healthcare crisis. The 2020–2021 “Nursing Home Salary and Benefits Report” from the Hospital & Healthcare Compensation Service, corroborated this trend. The survey, whose data was effective March 1, gathered input from 1,588 nursing homes, representing more than 141,500 employees.
Among all participating facilities in the annual survey this year, administrators’ national average wages rose by 1.03% to $113,000 in 2020. Directors of nursing, meanwhile, saw an even smaller salary gain (0.81%), to $97,500 from $96,720 in 2019.
Still, a clearer picture of wage growth prior to the pandemic may be seen among facilities that participated in the survey in the two most recent years. By this measure, wages for both administrator and DON positions increased by a healthy amount. Administrators’ salaries expanded by 3.36% — the highest increase among salaried positions analyzed — to an average of $115,742 in 2020, up from $111,979 in 2019. Similarly, salaries for DONs rose by 2.6% to $101,465. Another position that experienced notable growth was that of the executive director, whose salary increased by 3.35% to $229,252 in 2020.
COVID-19 curveball?
The pandemic may have thrown this wage information for a loop, experts say. For example, the stress placed on caregivers has created a lot of open leadership positions. As demand has increased, so have salaries.
“We are seeing a hazard pay bump,” noted Ryan McPherson, vice president of Medical Recruitment Specialists LLC, of Stoughton, MA. “They have to pay. There is not a lot of youth in this industry, so to keep these people around, they are seeing a nice little bump in pay.”
Rosanne Zabka, director of reports for the Hospital & Healthcare Compensation Service, anticipates that these temporary bumps will translate to more permanent increases heading into 2021. “We’ll see salary increases for top-level executives who received temporary increases of 4–6% during [the start of the pandemic],” she said, noting that overtime pay increases will also continue into 2021.
Helping to boost salaries is immediate need. McPherson’s firm is filling a lot of interim positions, including administrators and DONs, which helps people command their desired salaries.
Retirements are creating vacancies at the upper levels, he pointed out.
“The DON is the most challenging position to recruit for right now,” said McPherson, whose firm serves clients primarily in the Northeast. “Right now, the DON [position] has become incredibly challenging, the reason being everything falls on their license, and many of the frontline staff have gotten sick themselves so they may have taken time off.”
With “everything clinically getting dumped in their lap,” McPherson pointed out, DONs “were not in the fight to stick it out” and many are calling it quits.
Rupenski agreed that the pandemic has driven up executive compensation.“Successful executives are able to command higher salaries and bonus packages due to the increased demands brought on by the pandemic,” she said. “Their jobs are simply more demanding and, therefore, they have less work/life balance.”
As with salary increases, the pandemic is accelerating a turnover situation that was already high, Rupenski said. According to the annual salary survey, average turnover of top-level executives was 20.46% nationwide this past year.
“I wouldn’t hesitate to say it’s probably even higher with the current situation. We have had the most C-suite, regional and specialty positions in the past few months than ever before,” she said. “I feel that C-suites and boards are finding it crucial to have leaders in place who are at the top of their game. I believe that the pandemic has really highlighted the shining stars of the industry.”
And candidates are closely eyeing the best companies to work for, she said. “Some of the main reasons candidates tell us they are looking for a new role is stability and growth,” Rupenski said. “If the candidates do not feel that their companies are offering these two critical aspects, they will easily find a competitor.”
The hottest jobs
For obvious reasons, clinical leaders have become coveted talent in the long-term care space. “Directors of nursing and resident care directors are extremely in demand,” Rupenski said.
Likewise, because of state and federal governments’ renewed scrutiny on infection control, infection preventionist (IP) has become the new “it” job in long-term care, according to experts.
“We are seeing [IP] as the biggest increased demand position at the moment,” McPherson said.
But the position is not as easy to fill as it may sound. Typically an IP encompasses multiple roles, such as an assistant DON and possibly a staff development coordinator.
“People are hesitant to take on the position because it’s two or three jobs,” McPherson said.
Room to grow
Because of the new staffing and wage demands, long-term organizations need to step up their recruitment and retention game, experts say. And it’s not all about the money.
“I don’t think that increasing salaries and bonuses are the only ways to attract top talent at this time,” MedBest Recruiting’s Rupenski said. “Additionally, I know that many companies are dealing with tough economic situations. My advice to them is to offer the stability and growth opportunities that candidates are desperately seeking. Most people typically don’t leave jobs because of salary, but leave because of how they are valued. Be creative and reward these executives in other ways such as additional paid time off, increased coverage in the way of insurance and bonuses for performance.”
The same approach holds true for lower-level employees, such as certified nursing aides and housekeeping staff. Health Dimensions Group (HDG), which offers expertise in consulting and management services to post-acute, long-term care and senior living providers, created a “Heroes Program” that consists of three different elements: 1) Providing one family-sized meal per week for each employee to feed their family; 2) A Heroes Pledge, which centers on personal protective equipment training and usage; and 3) An attendance incentive program for team members.
HDG also recommends employing tactics that improve and facilitate communication. Shift huddles are one such tactic.
“On each shift, make sure that all team members are in the loop regarding what is expected with PPE, any COVID-19 status changes, and how the team will work together on the shift,” advised Ericka Heid, VP of Human Resources, HDG.
Employee listening sessions are also valuable, she said.
“Set up listening sessions and just be curious about what is going on with how the team is feeling and how you can help,” she said.
During this period, it’s important to take the time to get to know your team members.
“Communities that have the strongest relationships with their teams have proven to weather COVID outbreaks much better than others,” Heid noted.
Employee engagement
Whether you’re talking CNAs or CFOs, it’s all about employee engagement, agreed Mark Heston, founding principal of Mark Heston and Associates Consulting, Des Moines, IA.
“You’d better be spending time with your people and providing them with any kind of recognition and support you can,” Heston said. “You think it was difficult before; it will be more difficult going forward [to keep and attract talent].”
The need to invest in people has created a demand for chief people officers, Rupenski said.
“A way for organizations to better manage retention and recruitment is to find someone who can help stimulate and ultimately affect culture versus a compliance-driven individual for human resources,” she said. “Enter the role of a chief people officer. Additionally, utilizing employee behavioral and talent assessments can also be a valuable tool as part of the recruitment and retention process. As opposed to using it as an exclusionary device, it should be incorporated into team- and culture-building programs. It can also be used as a management tool for future employee
From the November 2020 Issue of McKnight's Long-Term Care News
