Speaking of National Emergencies…

Planted outside a nursing facility not far from my neighborhood is a sign that reads “Now Hiring:  RN’s, LPN’s, and CNA’s”. Right around the corner from that nursing home are two buildings with home health and personal care agencies. They also had “Now Hiring” signs out front. Other nursing facilities and agencies in my town are advertising for help – signs, newspapers, online, billboards. All of these Now Hiring signs are adding up to the appearance that this town is in critical need of long term caregivers. And this town isn’t the only one.  

The problems may only get worse. An astonishing new report from PHI, the Paraprofessional Healthcare Institute, states that between 2016 and 2026, the U.S will need to fill 7.8 million direct care jobs, and that by 2026, the direct care workforce will be larger than any other single occupation. (This doesn’t count nurses.) Direct care workers are the home health aides, certified nurse aides, personal care aides who provide the majority of the hands-on assistance with activities of daily living for persons who have disabilities associated with aging, or other conditions.  

The factors driving this explosive job growth include the increasing use of home and community based services versus nursing facility care, increasing life expectancy, and the aging of the baby boomer generation. There’s no surprise here – it’s been talked about for years.

What is different in this figure is the use of newly available occupational separation data from the Bureau of Labor Statistics that allows PHI to project the number of people who are leaving the direct care workforce. Of the 7.8 million job openings, 6.4 million are the result of people either leaving the workforce entirely (3.6 million) or leave direct care for other industries (2.8 million).  Rising demand only accounts for 1.4 million new positions. These numbers don’t account for people who move from employer to employer within direct care. 

This is a challenge that is calling out for both macro-level and micro-level solutions. I could go on and on about the macro level solutions required at the state and federal levels, but for now let me stay at the micro level. What can HCBS providers do, if anything, to attract people to and keep people in direct care?  

A few years ago, I was the Director of Human Resources for a company that owned and operated long term care facilities, both nursing and assisted living, around the state.  Even then, recruiting and retaining direct care staff was a significant challenge. Unfortunately, there was a sense that high turnover and recruiting challenges are just the cost of doing business. It’s true – turnover and running short-handed are costly. Using available data I calculated that the cost of each separation and new hire cost the company, on average, about $2700. This didn’t even take into consideration the costs that are more difficult to quantify, but there is evidence that high levels of turnover are also associated with higher workers’ compensation costs and reduced outcomes for individuals served.  

Of course, pay is one of the factors that leads to high turnover and difficulty in recruiting. Pay is closely tied to levels of reimbursement which may be out of the hands of many providers, particularly in the HCBS world with Medicaid’s prominent role. But pay is only one of many factors that employees value in their jobs. The opportunity to develop meaningful relationships with the individuals they care for and supervisors, and the ability to contribute to the quality of life for people who depend upon them are also highly valued by direct care workers. I have heard numerous stories of people who left direct care for what they thought would be easier, comparably paid work in retail or other areas, and then came back to direct care because they missed “their” residents or clients. 

There’s an opportunity here for employers to differentiate themselves by investing in management practices that promote that different value proposition, and this investment may make good business sense. These practices could include training managers how to coach and empower direct care workers to participate as full members of the care team, investing in training or education to increase skills or develop career paths for direct care workers. They can be as simple as scheduling and pay practices that incentivize desired behaviors and outcomes. Employers can more effectively recruit and select for the “soft” skills that are central to good caregivers:  compassion and empathy, alongside dependability, reliability, and trainability, and that may contribute to longer service as an employee. These are not necessarily expensive investments to make, dollar-wise, but they can pay off in a more loyal, engaged workforce that is committed to the well-being of the people that they are serving.  

Many employers say how much they value their workers but are not always aware of the extent to which their practices don’t reflect that value.  They aren’t doing anything wrong – but they may be missing an opportunity to stand out in this highly competitive labor market.  Sage Squirrel would love to connect with HCBS providers (personal care agencies, home health agencies, and assisted living communities) who are interested in how they might do this. 

#BeyondCompliance, #LTSSTransformation, #OperationalEffectiveness, #SageSquirrel

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