Dealing with Staffing Shortages with Lean Principles & Smart Recruiting Practices

Hearing about the shortage of workers in the long-term care industry is like listening to a broken record. We keep hearing it over and over again.

An article in McKnight’s Long-Term Care News quoted a human resources expert who called the LTC worker shortage a “train wreck waiting to happen.” According to industry predictions, it doesn’t look like the staffing shortage will end any time soon.

Paul Osterman, a professor at MIT, offers these sobering statistics: a national shortage of 151,000 paid direct-care workers by 2030, with an estimated gap of 355,000 paid workers by 2040.

For many hourly positions in long-term care, the median income is about $13.48 an hour. This includes employees like nursing assistants, home health aides, housekeepers, medical assistants, and cooks. This level of pay can make it hard to support passionate employees and keep them happy.

It’s a vicious cycle. When facilities are understaffed, their staff is under pressure, quality measures tend to suffer, and resident satisfaction decreases.

Staffing Shortages in Long-Term Care

The staffing situation in long-term care (LTC) has been difficult, especially in the last few years. Between June and September 2021, the workforce situation got worse for 77% of assisted living providers and 86% of nursing homes. Almost all of them had staffing shortages and over half of them had to limit new admissions due to these shortages.

Avoiding the damaging effects of staffing shortages is a primary concern for long-term care facilities to ensure they keep their doors open and serve patients effectively.

How to Prevent LTC Staffing Shortages

Of course, solving these staffing shortages isn't simple. There is no one-size-fits-all solution, but there are a few things that research tells us can help. Below are some strategies you can use to help prevent or mitigate the effects of LTC staffing shortages.

1. Examine Pay

A vital component of attracting and retaining workers is paying good wages. Many employers are quick to blame COVID-related unemployment benefits, but those have stopped and are unlikely to affect the current labor situation. Take some time and be honest with yourself. Are your wages competitive? If not, see if you can raise them to attract more candidates.

2. Lean on Volunteers

We often overlook the difference that good volunteers make. They can play a major role in creating a well-rounded, caring experience for residents. They're a great way to fill the gaps that short staffing can create. Some areas they can help with include:

• Companionship: Social isolation can be a serious problem for older adults, and volunteers can be wonderful resources for social interaction. They might sit and talk with residents or help organize parties and events.
• Transportation: Volunteers can also help patients get out into the community. Whether they have a doctor's appointment or simply want to explore the local mall, volunteers can help them get there safely.
• Skills and services: Volunteers can come from all walks of life and may have skills and services to offer that help add spontaneity and fun to the residents' days. They could give haircuts or massages or teach a painting class.
• New ideas: Since volunteers can be so versatile, they're a great resource for getting new perspectives into the LTC facility. These suggestions might range from different events for residents to training classes on how to use technology.

Use your volunteers and consider improving your volunteer program to get more of them involved.

3. Implement Lean Utilization

In real estate, the mantra is: location, location, location. But in long-term care, in response to the current shortage, the mantra has been: staffing, staffing, staffing.

Mordechai Finkel, director of Human Resources at Greek American Rehabilitation & Care Centre, runs a one-person HR department for a 188-bed, 210-employee skilled nursing facility. His mantra is lean HR utilization. 

What does this mean for managers? It means to invest in your employees, to develop all your employees to their highest level of skill through role enhancement, whether it’s delegation skills, flexibility, or use of technology. Doing so will directly impact quality of care.

4. Enhance Roles

Role enhancement refers to helping workers assume more responsibility by expanding their skills. They may take on innovative or non-traditional roles to help improve care. For nurses, ongoing professional development not only expands their skills, but it ensures that they are providing up-to-date, safe, and expert care.

At Greek American, Finkel says the nursing department identifies nurses who are able to be trained in wound care, EMR, QA auditing, and management of core quality measures. He says that enabling staff to “spread their wings” enhances their career paths at Greek American and beyond. 

In the activities department, staff are also trained in feeding residents as well as managing the facility gift shop. “We try to expand their horizons as much as possible,” he says. The result? Staff are more likely to be invested in their profession.

5. Delegate

A Harvard Business School article outlines nine tips for effective delegation:

1. Know what to delegate.
2. Define the desired outcome.
3. Provide the right resources and level of authority.
4. Play to your employees' strengths and goals.
5. Allow for failure.
6. Establish a clear communication channel.
7. Be patient.
8. Deliver and ask for feedback.
9. Give credit where it's due.

If staff are unable to delegate effectively, this leads to cramming work at the end of the shift, and that starts the overtime spiral. Everyone must understand expectations and responsibility.

6. Improve Flexibility

Finkel notes that the one word he eliminated from all job titles at his facility is the word “specialist.” 

He explains: “I can’t tell you how inefficient things are when a person specializes in one area and can’t move on to another skill or task. At our facility, every CNA is trained in rehab skills, in feeding, and creating a fine dining experience. This is above and beyond their regular job description. All of our housekeepers are trained in advanced floor care and laundry. This way it’s like plug and play. We’re never going to be stuck if one of our ‘specialists’ calls out one day, so all of our employees are trained to do all of the different aspects of the other responsibilities as well.”

7. Consider Technology and Recruitment

While long-term care is by nature a people business, technology is designed to help in numerous areas. In recruiting, for example, the use of technology is widespread.

With the current staffing shortage, there is fierce competition among LTC facilities, especially in areas where there are multiple facilities, to find top-notch candidates and entice them to come on board. Finkel says that finding quality candidates is his biggest challenge, and that staffing tends to be rougher seasonally as well. That’s why it’s important to cast a broad net. 

To attract as many candidates as possible, Finkel says job postings should appear on as many social media sites and websites as possible. “You want to get it in front of people as fast as you can.”

That’s where an applicant tracking system (ATS) comes in. An ATS simplifies the process, allowing an employer to post to multiple job sites at once.

It’s also important to make the best use of your interview process. At this stage, you can weed out your best candidates. You can use an ATS to conduct phone and video interviews, run background checks, and more.

Plus, an ATS gives you a pool of qualified candidates for future reference. You may have had several decent candidates for a position that you filled. If you need to hire for that position again, you should be able to view candidate history. That means you might be able to set up interviews without even re-posting the position.

Finkel says it’s important to streamline the entire process. This is especially crucial for millennial candidates. If an application takes too long, many of them will move to the next posting. That’s why you must make the process as smooth as possible.

The same can be said for onboarding. First impressions count, especially in the workplace. A strong onboarding experience can create a solid foundation for employees so they feel knowledgeable in their role and connected to the company. It can also help with retention and work performance.

Look for an ATS that streamlines the entire recruiting process, from job posting through onboarding. Your goal should be to provide a seamless experience to new hires. If they can complete required paperwork before Day 1 on the job, they can jump right in and feel a valued part of the team from the get-go.

How SmartLinx Can Help

SmartLinx is a workforce management tool filled with tools for managing and preventing staffing shortages. Improve employee satisfaction and implement lean utilization practices to maximize the capabilities of your existing team. The ATS can also help your hiring and onboarding processes so you get started on the right foot.

Learn more about SmartLinx Solutions’ ATS and our integrated suite of workforce management solutions, or or reach out to schedule a demo today!

About the Author

Frank Estevez joined SmartLinx Solutions as Development Manager in 2012 and transitioned into a Product Manager role in 2015. He provides release program management of the various SmartLinx products. He has 20 years’ experience in providing software solutions across numerous industries.