Six Key Drivers Shaping the Future of Senior Living: Key Driver #2

The Endemic Staffing Crisis

NIC Co-Founder and Strategic Advisor Robert Kramer has identified “Six Key
Drivers” that will shape the senior living industry over the next 10 years. Kramer
is also Founder & Fellow at Nexus Insights, a think tank to advance the well-being of older adults through innovative models of housing, community, and healthcare. NIC Notes is publishing a bi-weekly series detailing each key driver. View the first two installments. What follows is an analysis of the second key driver: the workforce.

While senior living providers struggled with labor shortages prior to the pandemic, the crisis not only exacerbated the problem but brought into bold relief the enormous staffing challenge the senior living industry will continue to face over the next 10 years. Just as the pandemic has become endemic—a situation we must adjust to and live with—so too the staffing crisis will be an ongoing issue that requires radical new approaches.

Our industry has historically struggled with workforce issues that were often viewed as correlated with the economy. Low unemployment rates have always been a challenge for the industry.

The crisis today, however, is clearly not just a question of a tight labor market. It is rather a recognition that senior care providers are not just competing to be the employer of choice among other senior care and aging services providers but also with the broad scope of employers in retail, hospitality and healthcare.

It is critical that we compete for the best workers. Staff shortages are a detriment to our residents and our business. The quality of care suffers when too few workers are trying their best to take care of residents. Overworked employees can get stressed, leading to absenteeism and turnover. Providers that face a staffing shortage often have to limit new admissions.

The old approaches alone won’t work. New, innovative ideas are essential to meet this ongoing endemic labor challenge. Here are five short- and long-term strategies to consider:

1. Recast our relationships with frontline and other hourly employees.

   We need to rethink how we view and interact with our hourly employees. Prior to the COVID-19 outbreak, many operators and providers were focused on their hourly staff only from the time they clocked in for a shift to the time they clocked out. What happened outside that shift was not really relevant to us. That approach became totally inadequate during the pandemic. Workers with young children at home needed to care for them when the schools were closed. Workers were worried about feeding their kids who received free, nutritious meals at school which were no longer available. Our hourly workers weren’t just worried about providing dinner but having to provide three meals a day. Added to that, family members, and the workers themselves, got sick and needed help. Scheduling disruptions were common.
   
   I believe that a significant shift in our approach is needed for our providers to be successful employers of choice in the future. We need to move from a transactional relationship with hourly employees to one of empathy and understanding.
   
   We can’t solve their problems, but we can help to address the issues these hourly workers bring with them to work. What does that mean? This is often a population in poverty or struggling to stay out of poverty. They are often juggling multiple jobs as well as multiple assistance programs that they hope to qualify for or continue to qualify for. They are overwhelmingly female, and a significant number are people of color. About a quarter are immigrants. Many are single mothers with children. Understanding these issues means addressing everything from daycare and housing to that last mile of transportation to get to work and even domestic and spousal abuse.
   
   In her book, Workforce Stability, author Ruth K. Weirich, shows that increased worker stability boosts productivity, retention, and morale, leading to greater profitability. The question is how to create an environment that supports workforce stability.
   
   Weirich points to the huge gap that exists between management and employees. Management is often so far removed from the world of the hourly worker that it’s hard to have any understanding, let alone empathy for the daily world of survival that these employees and their families face. We have to start there. Without understanding and empathy we cannot do what’s necessary to boost morale and retain good workers.
   
   Let me emphasize that we are not going to solve all their problems. But we can demonstrate our empathy and be willing to partner with them to be part of the solution.
   
   For example, maybe that means providing day care on site, or partnering with a childcare program. Maybe it means aligning with a domestic abuse center so employees can get free access to confidential services. Perhaps the human resources team needs to be trained on how to navigate various housing and government assistance programs. That’s not what you normally think of as a duty for your HR/benefits team. But if your employees are struggling to get support from these programs, you either need to contract with someone to provide that assistance or you have to offer that expertise in house.
   
   The more employees realize that they’re getting help with these tangible issues that they struggle with outside of work, the more you will become the employer of choice. In turn, they are going to pass that word along to their family and friends.
   
   

2. Highlight our purpose-driven work.

   As the acuity level among residents continues to rise, the industry already has a reputation of paying low wages for demanding work. But we also have a good story to tell. Senior living provides the satisfaction of a job with purpose. Not every employer can say that. We can promote personal connections and how we make a difference in people’s lives which can be enormously attractive to potential workers.
   
   Millennials and members of Gen-Z, in particular, are looking for purpose driven work. These young people want to feel they are making a difference in what they do, not just “holding a job.” Older workers are often looking for purpose in a second career. We offer what these groups are seeking. The added benefit is that we will expand our pool of potential workers to groups that the industry has largely ignored (see point #3 below).
   
   Sometimes residents and employees can even find purpose together.
   
   For example, at two Goodwin House properties in Virginia, the staff included a large number of immigrants, many of whom for years had been seeking U.S. citizenship. So, the communities started a program to help. Residents raised money to pay the fees for filing for citizenship and tutored employees on civics. A front-page story about the program appeared in the Washington Post and the community’s recruitment efforts soared.
   
   At another community during COVID, a resident asked a frontline caregiver how she kept going because it was so tough. The frontline caregiver said she was concerned about her three children—ages four, six and eight—who were not learning at home. The resident was an educator and knew many of the other residents had college and graduate degrees. So, they started an online tutoring program for the staff’s children.
   
   Bottom line: If we want our employees to treat residents like family, we have to treat our employees like family too. We must demonstrate that we care about the details of their lives and their daily challenges, just as we want them to care for the details and daily challenges in the lives of our residents.
   
   

3. Expand our pool of workers.

   With low birth rates, competition for workers will become more intense. Though the senior living industry has typically targeted workers in the 35-55 age group, we need to expand our workforce to recruit those who are younger and those who are older.
   
   In the wake of the pandemic, Millennials and Gen Z now understand the effects of social isolation and loneliness and have increased empathy for older people. As I mentioned in the previous point, these younger generations don’t want just a job. They want to know their work has meaning and purpose. We need to highlight that our jobs make a real difference in people’s lives. This is enormously attractive to younger people.
   
   Older workers can help fill the gaps too. In Japan, for example, people aged 60-80 provide care and companionship for those age 80-110.
   
   Retirees here are exploring “encore careers.” These second careers combine continued income, personal meaning and social impact. The key is that these older workers, like their younger counterparts, want to help others. Take, for example, someone who has retired from decades of government service or clerical work. An “encore career” in senior living offers the spirit of service and a paycheck.
   
   Another interesting idea is to engage residents as volunteers. This model could be especially useful for middle market properties. The nonprofit 2Life Communities, in their new Opus middle market community, will require residents to volunteer 10 hours of their time every month to help out. Residents can help at the front desk, work in the library, coordinate activities, or perform other duties. An unexpected benefit is that new residents are attracted to the community because of its focus on volunteerism.
   
   Immigration initiatives are going to be key to address workforce shortage now and in the future. Immigration is critical to attract workers who both value service and esteem older adults. We must pursue opportunities to advance immigration at the state, federal and company level.
   
   

4. Emphasize training and career paths.

   Workers often leave their jobs because of an issue with their direct manager. The manager may be unaware of the worker’s situation or may not be providing the necessary support for the worker to be successful. Are our managers trained to develop a relationship with the worker? Do the managers listen? Are they engaged with the worker during those critical first 90 days on the job? The same holds true for frontline workers. Are they being properly trained? Do they understand their job and the company’s values? How are you investing in them to make them feel supported?
   
   Establish a career path for workers. Show them how they can advance and help them do it. A structured program can help caregivers become certified as CNAs and CNAs become LPNs. Line cooks can be trained to become chefs. Housekeepers can become supervisors. Consider a scholarship program for those seeking the credentials needed to advance. Or offer scholarships in return for a set number of years of service. Another idea is to develop relationships with community colleges and nursing schools to provide internship opportunities and a recruitment pipeline.
   
   

5. Leverage technology.

   Senior living providers are adopting innovative strategies to screen potential employees. Machine learning is being used to find applicants who want to serve others. Finding the right employees by asking the right questions can boost retention efforts.
   
   Technology will also free workers from some rote tasks. The goal of technology is not efficiency, which is simply the byproduct, but to enable the staff to have more real interactions with residents. The employee has the time to chat with residents and ask how they’re feeling that day, instead of rushing to quickly perform a task and move on or being bogged down with paperwork.
   

   For example, the Japanese market has pioneered the use of “smart” diapers. Equipped with sensors, these diapers not only alert the staff when a resident is wet or soiled but also perform an instant urinalysis. This tells the staff whether the resident is dehydrated and at risk for developing a urinary tract infection. The technology eliminates the need for the staff to perform the routine and invasive checks that can lead to confusion and sometimes anger on the part of the resident. The worker in that situation doesn’t feel good either. The technology frees up staff time so they can engage with residents in ways that improve their quality of life.

The pandemic made a difficult staffing situation much worse and just as the pandemic looks to be endemic so too the staffing challenge is going to be endemic and require new, creative solutions. If we are only competing on wages, we are going to keep losing and will continue to have high turnover. Paying fair and competitive wages is essential, but the challenge is much deeper. We must engage workers beyond the hours of their shift and demonstrate empathy and willingness to come alongside them in their challenges. We must rethink our role and deploy a range of short- and long-term strategies to win the competition for talent.

Next Up—Key Driver #3: A New Customer Arrives with a Different Take on Longevity. Our new customers want their lifespan to match their healthspan or wellspan. We need an engagement view of aging and retirement shaped by growth and opportunity, not by deficits and decline.

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