Pinnacle Awards roundtable
Daniel Reingold, CEO and President of RiverSpring Living, left, and Carl Tabor, president of Avamere, take part in the 2023 McKnight’s Pinnacle Awards roundtable. Credit: Tori Soper.

More than ever before, providers must personalize scheduling and build programs that speak to individual employees to attract the next generation of workers, skilled nursing and senior living leaders emphasized during an expert panel discussion.

In addition, showcasing the sector’s possibilities earlier and doing so with a broader audience will also be key. Otherwise, demographic shifts threaten to leave nursing homes and other settings short on staff just as demand from baby boomers increases.

“We’ve got to develop more workforce strategy programs. Not every kid has to go to college. Kids need to come into this pathway. This is a phenomenal pathway for a solid middle class existence,” said Dan Reingold, CEO and president of RiverSpring Living in the Bronx, NY, at an early McKnight’s Pinnacle Awards gathering last week. 

“We’ve got to get to sophomores in high school and show them there’s a career path here and get them in a mentoring program. This is what we’re doing on our campus, but we think it has to go nationwide.”

​Reingold was one of six speakers invited to take part in the special roundtable last week. He was joined by  Chris Belford, CEO of Sinceri Senior Living; Lynne Katzmann, CEO and founder of Juniper Communities; Gary Nipper, director of business development for HealthDirect Pharmacy Services; Carl Tabor, president of Avamere; and Ben Unkle, CEO and president of Westminster-Canterbury on Chesapeake Bay. McKnight’s Long-Term Care News Executive Editor James M. Berklan moderated.

Power to the worker

Almost all of the speakers said they were giving employees more say in setting their own schedules. Katzmann said that approach was a natural extension of providing person-centered care, only shifting the focus to caring for employees (whom she calls “associates”) and their lives beyond work.

“They need to be seen as people. It’s not just about a certificate program for moving up. It’s understanding what they want as a human being, as an individual, as a professional,’ Katzmann said, noting Juniper’s recent efforts to roll out “individualized development programs” for more workers as part of a broader human capital program. 

She said her organization and others have leaned into a sales-based approach to recruitment, something they first dabbled with during the early days of COVID-19.

Sinceri Senior Living has also shifted to a marketing approach, hiring recruiters for a number of its 81 buildings, with most of the cost going to corporate. The facilities benefit from more staffing lead generation.

Belford also said Sinceri, which focuses on assisted living and memory care, reduced its agency use by 70% between 2021 and 2022. Much of that was due to a new outlook on scheduling.

“It’s just going to the employees as if they were residents and asking them, ‘What is your need?’ Some employees like four-hour shifts, some like six-hour shifts and some can only work Tuesday, Thursday and Friday because they have daycare then or they have another job,” Belford said. “So we opened up the gamut so they can kind of pick the hours they want to work and we fill the holes as we need to.”

He added that the thinking reflects that of Forbes 100 companies that are starting to entertain four-day day work weeks. He sees no additional costs, and said flex scheduling can reduce overtime and call-outs for illness or other reasons.

Unkle, whose continuing care retirement community has never used agency throughout the pandemic, said others should embrace the idea of marketing jobs in a better light. Like Reingold, he says it’s important to get an early foothold in a market’s talent pool.

“The high school and vo-tech schools are really critical, the tracks that are not college-based,” he said, adding that finding people includes using recently developed technology for targeting ads. “And if you’re geofencing for selling apartments, why aren’t you geofencing for selling your jobs? You’ve got to get off the fence a little bit.”

Among the staffing initiatives the speakers have employed are:

  • Scheduling 4- and 6-hour shifts, and allowing workers to come in fewer days a week.
  • Creating partnerships with community colleges on specific programs that can help make career ladders more realistic
  • Using better technology to improve efficiency and reduce frustration among frontline workers
  • Paying former employees who are in nursing school to complete their clinical rotations in their former facilities

Tabor, whose Avamere Living facilities specialize in post-acute, high-needs care, has more clinical demands than many of the other speakers. Keeping CNAs and nurses has remained a challenge for nursing homes across the US.

A former CNA himself, Tabor said his company has made an effort to elevate the role of CNA for those who want to remain in that position. 

“It’s great to move people along, but when you look at it statistically, maybe 10% of those individuals want to go on in nursing,” he said. “We implemented a recruitment and retention program through a vendor technology and we drove our turnover rate in six months from 70 to 50 [percent]. But more importantly, our 90-day turnover rate was less than 8%. Putting effort into retention and engagement programs is the solution.”

Immigration also needed

Several participants also beseeched the government to do more to address demographic demands that cannot be met by a US population that has too few working-aged people to care for its aging population.

“The immigration issue is something we really need to focus on,” said Reingold, noting that New York City sees some 40,000 new people arrive every three months.

“Give these people work permits while we figure it out. They’d help us tremendously. They’re not going anywhere. Let’s embrace them.”

“Long-term it’s the only solution with the demographics,” Unkle said.

Katzmann cited a recently published study by Harvard’s David Graboswki and others that found increases in the immigrant population result in improved nursing home direct care staffing levels, particularly among full-time staff, with little impact on industry wages or the skill mix. 

“They looked at whether the individuals taking these jobs essentially created a problem for other people who might want those jobs,” Katzmann said. “The answer was no, the quality was high and it solved a lot of problems.”