Making the Most of What You Have: How to Staff Smarter in Senior Care

The labor shortage in long-term care (LTC) has many providers in dire straits. With the growth of the aging population and projections calling for an additional 2.5 million workers, the outlook is bleak.

I recently spoke with a senior care executive who described how their approach to addressing workforce challenges requires the same priority and attention as other strategic initiatives like improving occupancy and quality. This transformation is a sea change for some, as workforce issues have never been as intense as they are today and as such, have never received as much focus.

Unfortunately, many providers jump the gun in their response to the labor shortage and the day-to-day of “working short.” Often, it’s simply assumed that more employees need to be hired to fill the gaps, but this is not always the case.

Before you spend the money, resources and time associated with hiring additional employees, it’s important to evaluate your organization’s staffing practices. What you may find is that your needs could very well be fulfilled with the resources right in front of you. 

"I see technology as being vital to being able to staff appropriately."
-Irene Fleshner, Principal, Reno Davis & Associates; SVP Strategic Nursing Initiatives, Genesis HealthCare

With such critical workforce issues in post-acute healthcare, gaining deeper visibility into real-time staffing events and metrics is imperative. Here are three steps to take when evaluating your staffing:

Step 1. Use Data to Identify Staffing Gaps

The biggest risk to achieving your labor management goals is not having the staff to fill scheduling gaps. But what are the gaps in your schedule? This sounds like it should be easy to identify, but it is much more complicated given the dynamic scheduling process in senior care. According to Irene Fleshner, Principal, Reno Davis & Associates; SVP Strategic Nursing Initiatives, Genesis Healthcare, "If you have a big giant database that will collect all of the variables that go into the complexity of the staffing, that database can provide you with a staffing schedule. I think that it's absolutely vital to have it today."

Since staffing is so complicated, I recommend that you and your managers concentrate on these metrics to identify true gaps in the schedule.

• Open Shifts: It is important to have staffing requirements set for each shift based on census and resident and patient acuity. As those numbers fluctuate, staffing plans should as well. To get a full understanding of need, it is important to not only examine open shifts in your master schedule, but also those that could be created by fluctuations in census and acuity.
• Overtime & Agency Use: When there is consistency in overtime and agency, there is likely a gap in your schedule. Map the overtime and agency hours to specific shifts and determine if a pattern exists. If so, consider those gaps as shifts that need to be filled.
• Call-offs: Similar to overtime and agency use, providers should document and analyze call-offs by employee and shift to determine if there is a recurring pattern. Trends might develop where an employee tends to call-off the Friday after pay day. If a pattern like this exists, a manager should have a conversation with those employees to determine if they are committed to work those shifts. If they prove not to be, consider those shifts as gaps.

These staffing metrics provide a more holistic view into the true gaps your organization needs to fill. But before HR posts those jobs, you should examine the use of your current staff to see if improvements can be made. Software like OnShift’s staff scheduling, engagement and labor management platform can quickly show you which positions, shifts and status (full, part or per diem) to fill.

Step 2. Make Sure You’re Utilizing Each Employee to Capacity

Understanding how well your organization is utilizing employees isn't as easy as it sounds. To get started, managers must look at the staff you have on hand by reviewing the full roster of current employees. This includes both full-time, part-time and per diem associates. Be sure that HR managers do not jump the gun on hiring before taking a close look at the hours worked for each and every current employee. Consider the following questions as current employee lists are reviewed:

• Are full-time staff working 37.5 or 40 hours a week?
• Are employees working the number of hours they have committed to work?
• Are there part-time employees that would like to work additional shifts?

Based on our experiences working with thousands of post-acute care providers on their staffing strategies, we see many providers determine that they are not fully utilizing employees. Consider how underutilized employees can fill holes in the schedule without resorting to overtime. But how do you determine who is underutilized? Start here:

• Compare Hours Worked to Thresholds: Establishing thresholds allows you to get a better view of employee utilization. Simply divide an employee’s hours worked by their hours-available threshold to determine their utilization. For example, if an employee is supposed to work 24 hours per week but is only working 16 hours per week – they are underutilized (67%).
• Set Hours-Available Thresholds: Take the time to get a picture of exactly when each staff member can work. Many employees have a lot to balance in their daily life – childcare, school, other jobs. In fact, more and more we hear employees in post-acute care are working multiple jobs. These responsibilities may make it impossible for them to work at certain times throughout the week. By understanding staff members’ true availability, managers can gain a clearer view into how well they are being utilized when day-to-day staffing decisions are made. What’s more, understanding their work availability preferences leads to more desirable schedules, a key determinant of staff satisfaction.

Next, look to your part-time and per diem staff. Can you fit them into any of the open shifts? These two groups are on your staff roster to provide you with greater flexibility in your employee scheduling process. Like all underutilized staff, make sure that these employees are working the hours to which they’ve committed.

When filling open shifts, first consider underutilized staff and see if they are willing to work those shifts moving forward. If so, there is no need to hire for those positions.

Step 3. Give Your Staff More Options

If you’ve made it this far (completed steps 1 and 2) and your organization’s schedule still has some gaps, it’s time to increase your options. Look to other staff members within your organization to see if there's interest in working additional shifts. You can do this by:

• Giving Staff Visibility Into Open Shifts: Make sure that open shifts are visible and can be easily requested by all your staff members. When open shifts become available, notify all available and qualified employees instead of going to the same group of employees to pick up the shift. This will increase your chances of getting open shifts filled and eliminate any perception of favoritism by distributing extra shifts more equitably among your staff.
• Expanding Your Pool: If you are part of a multi-facility organization that has other communities in the same geographic area, explore whether you can create a staff pool to be shared across buildings. Scheduling staff among neighboring facilities has become a common practice with post-acute providers given the challenges in the labor market. This is another practice to consider before resorting to the use of agency staff or hiring an employee. For example, Royal Healthcare Group was able to fill 33% of open shifts with a staffing pool.

If you do decide that there is a true need to hire, streamline the process by implementing an employee referral program. Providers we work with often say that referred staff members perform better and remain with the organization longer since there is a vested interest in their success.

Put Staffing Data at Your Fingertips for Faster, More Informed Decisions

As a provider, you need to have predictive and actionable staffing information available at your fingertips that provides insight and analysis into your staffing needs. It’s critical to implement processes that give management the tools to succeed. Employee scheduling technology is key to providing transparency into staff utilization and hiring decisions in senior care. You cannot succeed in today’s market using outdated and inefficient employee scheduling practices. A smart staffing strategy will resonate throughout your organization in the form of staff satisfaction and lower turnover to better care and financial outcomes.