Navigating the New Norm in Post-Acute and Senior Care

COVID-19 is creating a new norm in skilled nursing and senior living that requires facilities be even more flexible with employee schedules.

When COVID-19 reached the United States, the senior care industry was already struggling to compensate for “1.2 million unfilled positions every month,” according to Argentum 2020 Workforce Trends report.

Despite the enormous demand COVID-19 is putting on an overburdened workforce, many post-acute and senior living employees are rising to the challenge, serving as unsung heroes who fight for the most vulnerable.

Employee scheduling, attendance tracking, and other workforce management practices are changing quickly, as operators attempt to halt the spread of the virus in their facilities.

The demand on their workforce management infrastructure rapidly intensified when multiple governors required skilled nursing facilities accept COVID-19 patients from hospitals. Operators had little chance to adapt. And, unfortunately, many facilities lacked the  personal protective equipment (PPE) needed to protect employees as well as the workforce management resources needed to manage the crisis.

“Many patients with COVID-19 will need post-acute care to recuperate from their infection. However, post-acute care facilities currently lack the capacity and capability to safely treat patients with COVID-19 as they transition from the hospital to other care settings or to their homes,” said David C. Grabowski, PhD, Department of Health Care Policy, Harvard Medical School.

Knowing this, operators should seize the moment now and adjust their entire staffing process, starting with the time clocks that grant employee access and track attendance to employee scheduling and compliance tracking. Doing so will help them better navigate pandemics and  institutionalize safer practices as well as support resident and employee needs.

Staffing challenges in the Pandemic

Before the COVID-19 invaded senior care facilities, operators struggled to create proactive employee schedules and fully staff their facilities. Unscheduled absences and tardiness caused gaps in employee schedules and sent administrators scrambling to find qualified workers to fill them. They often turned to agency workers to close scheduling gaps. Then COVID-19 changed everything.

The staffing shortages that plagued skilled nursing and senior living operators escalated. Before COVID-19 hit, senior living turnover rates rose consistently for the past seven years to exceed 33%, according to Bureau of Labor Statistics and reported in Argentum’s 2019 Workforce Trends Report.  

Long-term and post-acute facilities report even great staffing shortages with many estimating turnover rates at more than 50% with the highest rates among caregivers. 

Responding to COVID-19

As the virus wreaks havoc across the country, facilities are breaking new ground trying to contain it and protect the most vulnerable members of society. Touchless time clocks and appropriate employee scheduling are critical for providing quality care and stemming the spread of COVID-19.

When multiple state officials demanded post-acute care facilities take in COVID-19 patients from hospitals, they forced these facilities to adjust their employee scheduling practices to try to contain the virus. This task proved monumental for most operators that lacked the right technology and resources.

Facilities attempted to lock down COVID-19 wards and isolate the nurses and employees supporting these wards. However, the staffing shortage combined with inadequate attendance management and employee scheduling made segmenting caretakers increasingly difficult. In addition, a lot of operators stopped using agency workers to fill unexpected employee scheduling gaps to prevent them from spreading germs they inadvertently picked up while working in other facilities.

“…It has been difficult to keep [COVID-19] from spreading in a number of settings, including hospitals, cruise ships, and nursing homes — in Massachusetts alone, some 102 nursing homes had reported 551 cases by Sunday [4/5/2020] afternoon, according to the Massachusetts Department of Public Health.  Even with current restrictions on visitors… employees regularly moving in and out of the facilities means it’s likely that additional cases will occur.” Source: Al Powell, Staff Writer, Harvard Gazette.

Administrators are quickly adjusting nurse schedules to support new guidelines. Many are manually manipulating spreadsheets. Others are attempting to buckle down their workforce management system and create new employee schedules and attendance management policies to enforce social distancing and support COVID-19 patients. Some are even using workforce management software to create nurse schedules and maintenance practices that attempt to contain the virus to the COVID-19 ward. 

With the extraordinary demands the pandemic is placing on senior care staffs, it’s no wonder senior living and post-acute care facilities ranked staffing as a top concern in a recent Senior Housing News survey. Senior care facilities cited staffing as one of their biggest challenges in the pandemic, second only to lack of personal protective equipment (PPE).

As staffing challenges intensify, so has creative problem solving and operator determination  to meet them.

Stopping the virus at the door

Staff responsibilities are evolving quickly as senior care facilities strive to protect residents from COVID-19. As a result, how employees care for and interact with residents continues changing. Some long-term and post-acute care facilities are limiting staff interactions with residents and are even asking staff to monitor residents and provide care from several feet away. Others are using technology, like telemedicine, to interact with residents and assess their needs. In addition, staff are learning new ways of doing routine tasks, from handling food and medications to interacting with employees, residents, and family members.

Employees must also enforce new visitation and social distancing policies. Instead of welcoming visits from loved ones, employees are often required to stop family members from visiting a resident or usher them to visitation rooms with plexiglass barriers separating residents and visitors.  

Implementing new processes 

During the height of the pandemic, most facilities instituted strict procedures to prevent the spread of COVID-19, such as:

• Restricting visitors and non-essential service providers, such as hair stylists
• Monitoring entrances with employees and cameras to enforce new rules
• Closing all, and leaving just one entrance to control traffic
• Requiring residents stay in their rooms
• Prohibiting residents from interacting with each other
• Canceling communal dining and social activities
• Following new employee schedules that often call for longer shifts

Many operators, especially those with few or no COVID-19 infections, relaxed some procedures after a few months. But the second wave of infections is causing some operators to reinstitute these strict practices. Others developed new ways to foster interaction between residents, vendors, and visitors while also limiting personal contact. 

Full PPE equipment has become the new norm for staff, many of whom sport face shields over N-95 face masks throughout their shift. Operators also stepped up their cleaning rituals, requiring staff continually disinfect surfaces. 

Most residents are required to wear face masks when they leave their rooms as are all vendors and visitors. 

By early spring 2020, the government released guidelines to help operators stop the spread of the virus. Post-acute care and senior living operators have widely adopted these guidelines although their application varies. Some facilities manually are manually implementing the new processes while others are using technology to automate screening methods and ensure confidentiality. 

Screening employees

How staff are being treated has also changed. Employees are no longer viewed only as caretakers but also as potential transmitters of a dangerous virus. Consequently, they must undergo health screenings every day before starting work.

The federal Department of Health recommends all employers screen employees and visitors for COVID-19 before they enter the building by checking for temperatures, flu or cold-like symptoms and exposure to COVID-19. Long-term and post-acute care facilities deploy various methods to screen employee health, such as assigning staff to take temperatures and question incoming employees. Some use technology to automate screening efforts and compliance. 

In many facilities, workforce management systems play an integral part in screening employees. Systems with integrated employee scheduling and attendance tracking are streamlining screening efforts and enforcing privacy guidelines.

For example, an intelligent time clock can require employees answer the following CDC-approved questions before allowing them to clock in. In addition, the automated attendance management system helps operators follow American for Disability Act (ADA) for keeping employee health information confidential by limiting access to questions and answers to appropriate personnel.

Have you washed your hands or used alcohol-based hand rub before entering?

• Do you have any of the following symptoms?
  • Fever
  • Sore throat
  • Cough
  • New shortness of breath
• In the last 14 days, have you had contact with someone with a recognized case of COVID-19?
• In the last 14 days, have you worked at a facility or location with a recognized case of COVID-19?

Touchless time clocks add additional protections

Some workforce management providers developed new technology to combat the virus at post-acute care and senior care facilities.