LPC Advisory Group: Workforce Discussion

Workforce | October 28, 2021 | by Dee Pekruhn

On Thursday, October 21 2021, the LPC Advisory Group focused on the pervasive issue of workforce recruitment and retention. Natasha Bryant, LeadingAge LTSS Center, Andrea Price-Carter, LeadingAge, and Jon Golm, WeCare Connect, each presented on workforce challenges and solutions from a research, policy, and operational perspective, respectively. Below, the meeting is summarized in a notes format; here also are the slides and recording offered during that session.

The presentation began with Natasha Bryant, Senior Director of Workforce Research and Development at the LeadingAge LTSS Center. The LTSS Center has been working on research and strategies for professionalizing the direct care workforce. This workforce tends not to be valued by our society or the healthcare system, many caregivers are earning low wages without benefits, and working conditions can be poor. These factors lead to lower quality of care, lower satisfaction by residents and families, and unmet needs among care recipients.

The LTSS Center wrote a paper that outlined strategies providers can follow to professionalize their direct care workforce and create career pathways. The six strategies Natasha reviewed in detail were: 1) expand the caregiver pipeline, 2) competency-based training and education, 3) facilitate career advancement, 4) increase compensation, 5) prepare universal workers, and 6) reform the LTSS financing system. Natasha highlighted the New Jewish Home’s geriatric career development program, which aims to expose young people to the aging services field and train students to work in nursing home. Similarly, New Jewish Home has a program for adults aged 18-42 who are unemployed, preparing them for available jobs through training and education. She encouraged our field to think about out to increase opportunities for foreign born workers to come to the United States and be trained to work in our field; she referenced the IMAGINE act. Natasha spoke at length on the importance of quality training materials, including training in a real-world environment, with intentional and targeted in-service training. LTSS Center has developed the competencies that are required for this workforce, including both the technical and interpersonal skills sets that are needed. Creating career pathways help ensure caregivers become intentionally a part of the healthcare team and contributes to retention of high performing employees.

Natasha also emphasized the need for an enhanced living wage, and she referenced the study of LTSS Center and U. Mass Boston, entitled “Making Care Work Pay.” The study found it would benefit more than 75% of the direct care workforce, and would help relieve staffing shortages, adding the equivalent of 330,000 direct care workers to the current field. Natasha mentioned that some states are exploring the idea of ‘social insurance’ as a way to finance LTSS. Finally, she gave a walk-through of the website for the Center for Workforce Solutions, and she gave examples such as “Careers that Love You Back” and training materials that can help members reach high school students and non-traditional workers.

Next, Andrea Price-Carter led the policy discussion on workforce initiatives, and she spoke at length on current LeadingAge advocacy efforts on federal funding opportunities. First, she gave highlights from our recent staffing “pulse” survey with members, conducted at the end of September. Seventy-five percent reported that staff were leaving to find better opportunities elsewhere; 52% said that CNAs were the most difficult to recruit and 42% said workforce challenges were so great that they were unable to admit new residents. She pointed out that these results were similar to the recent National Investment Center’s “Wave 33” Survey.

Andrea then went through the American Rescue Plan Act of 2021, which is part of the Biden Administration’s pandemic response plan. This included a 10% FMAP for Medicaid HCBS, $360 billion for aid to state and local governments, and $7.7 billion to HHS to expand a public health workforce. All these funds in various ways may be applied to training, recruiting, and retaining healthcare workers. What is currently being debated in the Infrastructure Bill, and the one LeadingAge is most engaged in, is the Build Back Better Act. This Act must move through the entire reconciliation process to be ratified. It is a historic opportunity to professionalize the LTSS workforce nationwide. Andrea spoke in detail on the Direct Care Workforce Recruitment and Retention Grants, Medicaid HCBS Expansion, Nursing Home Worker Training Grants, the Health Professions Opportunity Grant (HPOG) Program, and Older Americans Act (OAA) funding. She concluded by explaining that there is pressure to bring down the $3.5 trillion price tag, and to do that, there will be major revisions to the bill’s language. The House should be voting on both bills, she thought, by the end of October.

Jon Golm concluded the panel presentation with a discussion of his organization’s work, WeCare Connect. WeCare Connect was created by Wellspring Lutheran Services and is currently working with over 1,200 LeadingAge member locations nationwide. There is an important shift that has happened in retention: employees want a voice on a regular, ongoing, non-anonymous basis. He said that our field has a “serious 90 day turn over problem,” and many organizations are not getting feedback from those attritions. Jon explained that employees now expect non-anonymous feedback and without fear of retaliation. The current job market makes it very easy for employees to change jobs quickly as needed. He discussed an Ink Magazine article that came out explaining the crux of the issue: “Feedback that goes unheard.” He explained that we must show employees that we hear them; survey feedback should be followed up on, with direct actions that offer response on an individual level. Jon discussed statistics around the negative effects of not effectively following up on survey feedback. He compared and contrasted the anonymous and non-anonymous survey, and said that benchmarking really has very little value to employees and their direct supervisors. Employees want to know what changes are being made that are in response to their individual feedback. WeCare Connect offers an interactive dashboard for managers to follow up on feedback at every level of the organization and can be tracked in real time as subsequent surveys are rendered.

Next, we explored a few follow up questions with the panel. Dee asked members on the call what positions are the hardest to fill, and why, and what would make recruiting staff to their organizations easier. Members responded that LPNs, CNAs, cooks, nurses, housekeeping, dining services, and all entry level positions are the hardest to fill. Flexibility in hours, job sharing, a thoughtful plan for retention and not having employees “stolen” by for-profit employers would make recruitment easier, according to members on this call.

First Question: For all three panelists. In short, why do you think we have the workforce challenges we have in aging services?

· NB: Our industry doesn’t have a good reputation, and people are not attracted to the jobs. Wages are lower than at hospital and other healthcare sector jobs. How do we make these better jobs that attract and retain people? LTSS is looking at, how do we make people aware of all the opportunities in aging services including HR, management, etc.? How do we raise awareness and make these direct care jobs places where people want to stay? A recent study on displaced workers found that these workers, during the pandemic, that very few went into our sector because of the low wages and physically demanding work.

· APC: The pandemic has affected the settings and people that direct care workers are caring for. The glaring gap of a career ladder, which is much needed. How do we invest in training?

· JG: A focus on “potential wrong hires” has been helpful to clients. It’s hard to retain people if you are hiring the wrong people to begin with. Promote honesty in describing the job, the organization, and the environment so employees know exactly what job and organization they are joining. The interview description and reality should be the same, but often times we ‘oversell’ and then the new hire is disappointed.

Second Question: This question is for Natasha. What tool on the LTSS website do you wish members would use more to help in their workforce challenges?

· NB: There’s a lot of turnover in the first 30-60-90 days. The peer mentoring programs can offer an advanced role for a CNA and a higher wage. Our recent study interviewed CNAs where they are on their own, and they feel a big lack of support from peers and their supervisor. Really listen to the aides and the information they can provide. And – how else can we reach out to non-traditional workforce populations? When aides are well placed, they really enjoy the work that they do. (LTSS Center also has programs that help with education in elementary schools, high schools, colleges, summer enrichment programs, etc.)

· APC: Funding certainly would help with increasing wages, making training and education programs more widely available. This would help with recruitment.

Third Question: This question is for Andrea. How can we as members help move the dial and get involved in pushing these bills over the finish line, and if they are passed, which one or ones will have the greatest impact on LPCs?

· APC: The one that has the greatest impact would be the Nursing Home Training Grants. Those are available to every state and open to all healthcare / long term care organizations. Those funds are mandated to include training and covering the increase in wages. Members can get involved in LeadingAge Action Alerts and tell their congressmen and senators that these are bills they should support. Funding under LTSS system, any opportunity we have to increase financing through Medicaid HCBS will be beneficial to LPCs.

Fourth Question: This question is for Jon. I noticed that in your presentation that the positions that are hardest to recruit are also the most difficult to retain in your dashboards. What can an organization do if they want to track the implementation and efficacy of those changes they make on an individual level? What have you seen that works?

· JG: A feedback loop with real-time notifications is key and builds the tracking mechanism. Were they resolved, how quickly and was it successful? Having that ability to look at whether we are hearing people and really solving their problems makes a difference. A CEO [who Jon works with] has a requirement now that no vacant position gets filled again until it is fully understood why the person left, and what could have been done to salvage the relationship.

Dee thanked all the panelists for their participation, wisdom, and learning shared. Then, she reminded everyone about the upcoming November LPC Advisory Group sessions and opportunities to network at the National Annual Meeting. The meeting adjourned at 3:00 p.m. EST.