Staffing was identified as the No. 1 concern of nursing home operators heading into 2021 in the latest McKnight’s Long-Term Care Flash Survey. 

Offering bonuses to staff for referrals (54%), as well as sign-on bonuses (41%) and bonus pay at the six-month employment mark (18%) turned up as three of the top strategies for improving recruitment and retention, according to survey respondents this month..

The survey also found that far and away the No. 1 tactic for trying to help staff members weather the pandemic has been providing small gifts (such as pizza parties and cookies at nursing stations). Slightly more than three-fourths of respondents (75.1%) said that has been effective, with the next popular choice being the offer of Employee Assistance Program (EAP) services (49%).

For the question, “How do you rate your job satisfaction right now?” respondents averaged 6.8 overall on a scale of 1 to 10, with 10 meaning the highest possible satisfaction.

Meanwhile, increased assistance of video and audio calls with family (88%) was the No. 1 practice for trying to reduce pandemic-related depression among residents, followed by creating safer methods for visitors as the No. 2 at 79%.

The “McKnight’s LTC News 2021 Outlook” survey was conducted Dec. 7-12 and reflects responses from 313 nursing home owners, administrators and top nurse managers who answered an email solicitation to take part. Other results from the survey were highlighted in stories last week.

All response groups included. More than one answer allowed.

Findings revealed a determined workforce that nonetheless is starting to show cracks in resilience and job satisfaction levels 10 months into the biggest public health emergency in a century.

“Some of these folks literally haven’t had a day off since April,” noted Bill McGinley, the president and CEO of the American College of Health Care Administrators. “They might have knocked off early for a summer weekend, but they’re still watching various websites for test results, having to report test results, and are dealing with staff and family issues.”

He said it was a pleasant surprise to see Employee Assistance Programs rise in prominence. “I think it’s great that employees are making use of them. Typically, they’re very unused or not in people’s healthcare programs. I’m glad to see them pushing up a bit.”

The next most popular approaches nursing home operators have been using to recruit and retain staff? Offering flexible scheduling (38%) and creating part-time positions (33%) to allow workers more family time.

All response groups included. More than one answer allowed.

Similarly, the second-tier of popular strategies to help staff weather the COVID-19 storm featured increased use of flex scheduling (37%) and in-service training on stress management (33%).

More not always better

Amy Stewart, the top clinical officer for the American Association of Directors of Nursing Services, said she was not surprised at the enticements offered staff members to help fend off mental challenges of the pandemic. But, she added, they should not necessarily be taken as the best approaches.

Pizza parties and other food enticements are not necessarily as effective as many believe, she noted, based on her involvement in the COVID-19 Impact on Nurses Study (COINS) overseen by University of Kansas Nursing School researchers.

“They (food gifts) didn’t make the staff feel safe,” Stewart told McKnight’s. “In our own survey [by AADNS], we found that this was not what staff needed. They needed more practical things. We found the No. 1 issue for nurses was the guilt of potentially bringing COVID home to their families.”

Stewart said positive examples she’s come across include one organization offering on-site laundry services so potentially infected clothing wouldn’t reach a home environment. Some providers have offered ride-share coupons for employees who worked long hours but didn’t want to drive home. Other initiatives have included bags of essential groceries so employees could go straight home.

“I love seeing all of these wondering things that staff have come up with for residents or even leadership done for staff. It shows that this sector can get through anything,” Stewart said.

The owners and top executives subgroup was more open than the other two (administrators, nurse managers) about offering bonuses of some sort to recruit or retain workers. 

“I don’t think a day goes by that we don’t hear about a member or somebody we know in the long-term care industry telling us about staff that just aren’t showing up, because their family is worried about them getting it,” Stewart said. “I do like the idea of flexible scheduling. It sure should help retain staff.”

Points of optimism

She added that the job satisfaction averages (6.8 overall and 6.9 for nurse managers) were similar to what the COINS survey discovered. The owners and C-suite category averaged the lowest (6.3).

“We thought more people would have the intent to leave, and the survey showed they didn’t,” Stewlart said. “It’s probably one of the more shocking parts of the COINS survey.”

She said this was especially so because that survey was conducted in June, when there were more shortages of personal protective equipment, hand sanitizer and other safety equipment, which could have shaken workers’ confidence more.

“Long-term care nurses are unique in that they really choose to remain in this setting because they love what they do,” Stewart said. “It’s really all about the love of the residents.”

Long-term care psychology expert Eleanor Feldman Barbera, Ph.D., was encouraged that providers have dived into offering more video and audio calls “because that’s the No. 1 thing that helps people feel better.” She added, however, that because recreation services are not billable, they sometimes “don’t get as much respect as they should.”

All response groups included. More than one answer allowed.

Barbera said the heavier focus and use of EAP programs (49% response rate) is laudable, “but 100% should be offering this, and encouraging EAP and stress management techniques. The reality is, it’s a stressful job all the time.” In addition, employers should be emphasizing the privacy of EAP services.

Greater use of psychological services” garnered responses from 36%, a number that should be higher, Barbera said. In the “other” category (7%), respondents listed things such as increased clergy visits, pen pal programs and customized internal TV offerings.

Keys to surviving a tough winter

Barbera, the author of McKnight’s “The World According to Dr. El” blog, said her main recommendation for psychologically surviving a potentially bleak stretch is to “stay as much as possible ‘in the day.’”

“Everything is still very much in flux,” she explained. “We really don’t know how the vaccine is going to affect treatment. We don’t know if people who get the vaccine can still pass [the virus] on to someone else. 

There’s a lot of uncertainty, so it pays to moderate approaches, she added.

“Go with the flow. It doesn’t have to be all or nothing. There’s middle ground to things that you can do,” she observed. “If you can’t have a big Christmas gathering, maybe schedule going for a walk or meeting for hot cocoa in the backyard.”

The key is to participate in self-care, and that includes being flexible.

“If things aren’t working so great, it doesn’t take much to shift things,” she explained. “You don’t have to do every single self-care thing there is. But you could do a few minutes of one thing a day, like going for a walk or bringing on one healthier item, or calling one person you’ve lost touch with.”