Building owners and operators try new approaches to find and keep the best workers.
By Jane Adler
In an industry where employee turnover averages between 25 and 40 percent annually, owners and operators of seniors housing and care properties are introducing new programs and strategies to attract and retain top talent.
Companies are investing more time in recruitment and taking a close look at how operations impact employees from hands-on caregivers to top executives.
Successful programs today emphasize employee training and education and promoting from within, which fosters loyalty. Organizations are also experimenting with decentralized decision-making to give workers more control.
At the same time, programs are being rolled out to recruit top business school graduates as the next generation of industry leaders. Even though seniors housing and care has performed well as an investment class, the sector doesn’t get the attention it deserves as a career, industry executives say.
As human resource management grows in importance, building managers still face a number of challenges. Competition for good workers is fierce, according to operators, and some positions are difficult to fill.
After all, every building owner wants an executive director who’s an expert both in marketing and customer service. A skilled nursing facility administrator not only has to manage a staff, but also comply with numerous regulations and produce quality outcomes.
“A lot of new operators don’t know what it takes to attract good people,” says Nancy Schwalm, chief business development officer of Vivage Quality Health Partners, a skilled nursing and assisted living company based in Denver. “But you’re only as good as your staff, and that includes the nightshift CNA (certified nursing assistant).”
Salaries are rising for top-level positions, says Scott Elsass, managing partner at MedBest, a Tampa-based executive search firm for healthcare and seniors housing facilities. Executive directors at continuing care retirement communities (CCRCs) who are hired directly by the community’s board of directors command annual salaries ranging from approximately $300,000 to $600,000.
Executive directors who work for CCRC management companies with slim profit margins earn less — about $150,000 to $200,000 a year.
Executive directors at high-end assisted living properties earn about $100,000 a year. “Those salaries have really sparked,” says Elsass. The ones who have demonstrated the ability to fill a building and keep it full can also expect to earn bonuses based on occupancy levels. Demand for executive directors who “get it” has increased, says Elsass.
Wages for frontline workers often depend on the market and the local unemployment rate. Areas with high employment are seeing a rise in hourly wages, operators say, though few believe workers quit to earn 20 cents more per hour elsewhere.
Workers mostly leave because of the working conditions or conflicts with a direct supervisor. Many companies offer a standard array of benefits, including 401(k) plans and health insurance. Some feature wellness programs and bonuses based on performance.
Compensation packages don’t tend to vary much in particular markets. So the key to recruiting and retaining top talent is to have a strategy, says Lisa Welshhons, division president at Merit Senior Living, a Des Moines, Iowa-based company that provides human resources services to the senior living industry. “Just like you have a strategy to fill a building, you need a strategy to get the best workers.”
A successful recruitment strat-egy requires three steps, says Welshhons:
1 Define the ideal candidate.
2 Outline the message to that candidate. “You want to sell them an experience, not a job,” she says.
3 Figure out how to find that person.
The second step is important, notes Welshhons. The executive doing the hiring should be able to paint a picture of what it’s like to work in a building and why the work is meaningful. “You need to share your vision with them,” she explains.
Putting extra effort into the process can yield dividends. “The more time you take during the hiring process, the more you minimize turnover,” emphasizes Welshhons. She recommends using behavioral interviewing techniques with questions based on real-life situations.
Instead of asking someone if he or she is a team player (everyone answers “yes”), ask how the person handled and resolved a specific situation that involved a group of workers at a previous job.
At Mainstreet Property Group, a developer and owner of post-acute care facilities, sizing up the candidate’s fit with the organization’s culture is an important part of the interview process. The Carmel, Ind.-based company recently partnered with Health Care REIT to acquire 17 properties for $369 million and another 45 properties in its development pipeline.
Mainstreet expects to develop 48 new projects valued at $1 billion next year. The company doubled its workforce in the last year and plans to double it again to 100 employees by this time next year.
Mainstreet has an on-staff recruiter whose sole job is to find quality workers. Candidates with the right skills and experience are also screened for their strengths and temperament.
“We want people who are good to work with,” says Mainstreet CEO Zeke Turner, who meets with every candidate. “We create teams that play to someone’s strengths.”
At the property level, Turner believes Mainstreet’s new buildings — called Next Generation communities — attract good frontline workers. The facilities feature a mix of 70 post-acute beds and 30 assisted living beds, high-end common areas and amenities, private rooms and baths, and large rehabilitation therapy space.
The buildings feature plenty of natural lighting and HVAC systems that reduce odors. Efficient floor plans maximize the time staffers spend with residents.
A building renovation can also present an opportunity to recruit top talent. The healthcare center at St. Andrew’s Village, a CCRC in Indiana, Pa., is undergoing a $10 million renovation.
The 31-year-old, 131-bed facility is being reconfigured to create four small, distinct households or neighborhoods. St. Andrews Village has 250 employees and is owned by Presbyterian Senior Living based in Dillsburg, Pa.
“We are redesigning ourselves,” says Brian Parks, executive director at St. Andrews. The redesign includes a culture change that emphasizes resident-centered care. Instead of relying on top-down management, staffers run their own neighborhoods. Residents and families are also part of the decision-making process.
The first redone section of the building opened in September with 22 beds for seniors needing memory care. The second new section opens in November. Parks is already getting good feedback. “The employees love it. They figure out how to solve problems. We already see a difference,” he says.
Turnover also seems to have slowed, though Parks says it’s too soon to declare complete success. Staff turnover was 77 percent in 2014, but so far this year is running at 47 percent.
Other changes were made to reduce turnover. A schedule coordinator was hired to establish set work hours so employees know when they’ll work. More full-time workers were added since they’re less likely to quit. “Turnover among part-timers was killing us,” says Parks.
Win worker loyalty
Operators emphasize the importance of training and education to reduce turnover. Companies need a rigorous “on-boarding” program for new employees, says Merit’s Welshhons. The program should include in-depth job training as well as information about the company’s culture.
If the majority of employee turnover is in the first 90 days, then there’s a problem with the hiring and training practices. “Turnover needs to be analyzed in order to identify trends,” says Welshhons.
Though some operators see training as a big expense, the turnover cost of one employee is about $3,500, Welshhons notes. This includes the cost of replacing the employee, the payment of unemployment insurance in some cases, and other expenses associated with an employee who leaves.
Vivage has 2,100 employees in 26 buildings, a combination of skilled nursing and assisted living facilities. Vivage owns about one-third of the properties; investors own the rest.
“We promote from within and create career ladders,” says Schwalm of Vivage. The company has internal training programs for each key function, such as a director of nurses training program, and a business office manager training program. “We make people feel they have a future.”
Vivage also conducts ongoing medical skills training — an important program element because of the rising acuity or frailty of residents and the increased expectations of hospitals seeking high-quality nursing care partners. Training includes the psycho-social needs of residents as well. “We feel we can build loyalty through training,” says Schwalm.
The company‘s employee satisfaction surveys every month tell managers what performance areas need improvement.
Recognizing that the industry needs more and better workers, Vivage employees also teach continuing education classes for the local healthcare association and at junior colleges.
Though no one enjoys the unpleasant task of dealing with poor employee performance, companies are easing the strain by taking a straightforward approach. At St. Andrews, executives engage in what’s called “fierce conversations,” a movement to be direct with co-workers and hold each other accountable. “We don’t let difficult issues go unaddressed,” says Parks, who emphasizes that the conversations are done with kindness, care and compassion.
Employees at Mainstreet can take as much or as little time off as they want, but conversations around the topic create a system of continual performance review. Does the employee have his or her work done? What has the employee done to prepare for an absence? An employee who takes a lot of time off indicates a deeper problem. “We try to figure out what’s going on,” says Turner.
Employee problems should be addressed quickly, says Merit’s Welshhons. The longer a bad situation is allowed to fester, the worse it becomes and the more costly and disruptive it is to the community and the residents.
Employees should be given the opportunity to respond to complaints and be offered coaching. But the key is to confront the situation head on, says Welshhons. “Too many times we put our heads in the sand and hope it will go away.