Nursing homes provide crucial services in our society. While caring for our vulnerable family members and friends, nursing homes (or “NHs”) themselves have become some of the most vulnerable businesses in this country, due in large part to pandemic-related challenges leading to declining occupancy rates and severe staffing shortages. Not surprisingly, difficulties related to employee morale and retention are among their greatest challenges. And while still facing costs and precautions associated with COVID-19 mitigation, nursing homes now also face new public postings of staffing data by CMS that could exacerbate their challenge. As the industry adjusts and organizations retool, it has become more important than ever for nimble NHs to identify opportunities to reverse recent trends, keep valued employees, post improved staffing ratios and – hopefully – attract more residents as a result. This Insight takes a deeper look at the current situation and provides a five-step roadmap to help your organization through these troubled times.

The Unique Role and Posture of Nursing Homes

NH residents are among the most vulnerable people served by the nation’s healthcare system. Residents cannot care for themselves at home or in an assisted living centers, but do not qualify for admission to a hospital or long-term acute care setting. In the space between services provided by assisted living centers and hospitals, NHs fill an important gap. But for various reasons, they face some of most severe staffing shortages in a healthcare industry whose limits have been brutally tested during the past two years. The staffing shortage affects not only a Home’s daily operations, but understaffing can have ripple effects. Fewer beds for NH residents can create backups in the entire continuum of patient care. Specifically, when a patient is ready for discharge from acute care but unable to go home and no NH beds are available, it is left up to the hospital to ensure that a solution is identified.

Since the March 2020 explosion of COVID-19 in this country, NHs have consistently been under a microscope. NH residents and staff had some of the highest infection rates of COVID-19. Compounding that problem, long-term facilities are suffering from one of the most severe staffing challenges in the health care sector. NH employment levels dropped by 14% or 221,000 jobs since the beginning of the pandemic. Yet, they also face shortages of critical staffing specialties.

An Even Brighter Spotlight to Shine on Staffing Issues

As if current staffing challenges were not already enough, the Centers for Medicare & Medicaid Services (CMS) announced on January 7 that it will begin posting data on weekend staffing and staff turnover levels at Homes, highlighting key staffing issues that these facilities face. Specifically, CMS noted that it will post data on total staffing levels (specifically, nurses working on weekends and the percent of nursing turnover over a 12-month period).

According to its announcement, “CMS will begin posting data on the level of weekend RN and total nurse (e.g., RN, licensed practical nurse (LPN), certified nurse aide (CNA)) staffing for all NHs on the Care Compare website in January 2022. This will be reported in terms of the average number of RN and total nurse hours worked per resident per day on weekends. Further, to encourage facilities to increase nurse staffing on weekends, CMS will also add total nurse staffing on weekends to its staffing rating domain of the Nursing Home Five Star Quality Rating System in July 2022.”

Reporting staffing data is nothing new for CMS facilities, as the January 2022 announcement indicates, “CMS has a long-standing commitment to transparency” and providing data is a key means to help consumers choose a facility as well as help NH’s improve staffing and enhance the health and safety of nursing home residents. The agency considers staffing as one of the most important factors in assessing the quality of care at a facility. It correlates staffing rates with the outcomes of resident experiences. CMS has historically viewed lower staffing ratios during nights and weekends, coupled with high turnover rates, as indicators of poor performing facilities. However, this is the first time CMS will be publishing employee-level staffing of this level. The CMS announcement effectively directs more attention toward this issue as Homes continue working to attract and retain enough staff to meet their needs.   

5 Steps NHs Can Take to Respond to These Challenges

Hospitals, nursing homes, and home health agencies are all competing for the same nurses and aides. Staffing agencies are also recruiting nurses and other professionals to supplement (at premium cost) these providers’ needs. Success can obviously improve the NH’s financial position and provide more resources and stability moving forward. Below are five considerations and recommendations to consider:

1. Meaningfully engage your staff. Leaders should conduct night shift and weekend meetings with staff and listen to their ideas and concerns. Listening to, respecting, and responding to staff concerns will help identify opportunities to implement meaningful changes that are responsive to employee needs. Following through on these opportunities will help retain valued staff and attract productive new employees.
2. Ask current employees to help. Happy employees are among your best recruiters, so ask for their help and reward those who bring successful new employees into the fold. Various types of recognition, rewards or bonuses can be very effective.
3. Use technology, flexibility and creativity to compete for staff. Examine and consider how expensive third-party staffing companies are using technology to attract staff. Look for opportunities to develop your own tech-driven systems to make hard-to-fill shifts more rewarding and easier to access. Consider enhanced premiums and rewards for those who step up to take on weekend and night shifts.
4. Remember that there is “no place like home.” While agency or traveling nurse gig work may be attractive to some, remember the advantages many workers will recognize in working close-to-home, having more scheduling flexibility, and possibly working part-time shifts. Examine and emphasize your company’s flexibility, responsiveness to employee needs and mutual pride and visibility in your community.
5. Money talks. Recognize that although will it may cost more to fill certain shifts, those costs may not necessarily be as high as using a supplemental staffing company if you are able to retain employees, improve patient satisfaction, and create a more satisfying work environment for your employees. Emphasize flexibility and creativity in finding ways to cover those hardest-to-fill spots on your schedule.

Conclusion

Even in the face of tremendous staffing challenges, organizations that listen and respond to their employees, and are not afraid to try creative new approaches to staffing, may gain competitive advantages, in terms of both recruiting and also in publicizing their successes – and hopefully improving their overall business results.