By Jack Cumming
As something of a senior housing industry junkie, I was watching the recent interview of Watermark’s Paul Boethal by Senior Housing News’s Tim Regan [Click here]. While the whole interview was interesting, Tim brought up staffing near the end. “What does staffing look like at Watermark? And generally, what are you seeing in terms of staffing conditions for senior living right now?”
Listening Beyond “Knowing”
Paul Boethal adroitly responded in very human terms, suggesting that it’s important to listen to employees, prospective employees, and leaving employees. His people sensitivity may have come from his time in military service. The military can be very people-intensive. In answer to the question, he quickly came up with something new. At least it was new to me, not as an idea, but as an idea that provided benefits that Boethal saw and I had missed.
His idea was that if you hired people who wanted to work less than the customary 40 hours a week, you might wind up with more people working fewer hours, but when there was a sudden, unexpected need, they could quickly jump up to the 40-hour mark to respond to the crisis. Responding to a sudden crisis can be time-urgent, requiring all hands on deck. Being able to pivot to answer the need is golden.
The Value of Time Management
In our emerging world of two-earner families and higher wages for workers, there are many people who are happy to work a shift for less than 40 hours a week. For the moment, we can set aside the fixed cost burdens of healthcare and other employee benefits. There are ways of managing that for those with the creativity to think beyond the norm. Minimizing those employment fixed costs allows us to consider the attractiveness of individualized shifts.
Going beyond what Boethal shared in his interview with Tim Regan, imagine that, instead of dividing the day into eight-hour shifts, we divided it instead into two-hour increments. Employees could bid on the shifts, and more difficult-to-fill shifts might come with premium compensation or other benefits to attract takers. That would bring the employment staffing model more into line with the independent contractor gig economy model.
Needs Responsive Compensation
Paul Boethal’s concept — of having more employees working shorter hours to better prepare for those times when a crisis requires existing employees to work longer — triggered Tim Regan to think of a similarly imaginative workforce idea. Tim said, “Frontier Senior Living CEO Greg Roderick talked [recently] about a community where, instead of paying higher wages, the operator switched to paying staff mileage reimbursement and solved some staffing issues.”
It turned out that the employing facility is in an area with high living costs, requiring most workers to commute a long distance to their jobs. Just increasing wages wasn’t working, and employees were leaving for jobs nearer to their homes. One employee suggested the mileage allowance, and that’s what did the trick. The takeaway: Sometimes just empathizing with employees’ challenges and responding in kind can be the medicine that cures the workforce malaise.
If meeting a mileage challenge can be that straightforward, how might the industry help young working families with childcare? For now, regulations may make that prohibitive, but regulations should serve the citizens, not inhibit the meeting of citizen needs. Effective advocacy organizations should be able to help create well-reasoned regulations instead of reactive regulations dreamt up by special interests or a defensive bureaucracy.
Just Thinking
This led me to consider a challenge that recently crossed my awareness. Responding to some resident needs requires around-the-clock presence of an RN (registered nurse). It can not only be costly to hire a nurse for the NOC (“nocturnal,” often 11 PM to 7 AM) shift, but it can also be difficult despite paying a shift bonus. For a small skilled nursing facility, such as one embedded in a life plan community (CCRC), that added cost can be prohibitive. What if, though, a NOC RN was offered a living unit on-site? No commute. That might be more attractive than merely trying to offer money.
Combine that with a more sensible approach to regulations. Proactive advocacy might allow that having an RN living on-site to oversee an experienced and well-trained LPN (Licensed Practical Nurse) to allow more residents to remain in their home, CCRC’s skilled nursing facility. If industry advocates were able to gain recognition that an on-call NOC RN was enough, then having an RN living onsite would be better.
Care Suites are an emerging alternative to skilled nursing for many common age-related conditions, but there can be reimbursement entanglements with Medicare. Also, moving a CCRC from an on-site skilled nursing unit to a care suite concept requires skillful, open interaction with residents from early in the consideration process. Too often, resident engagement is neglected, which can lead to unnecessary lawsuits.
Senior Living’s Challenge
What Paul Boethal and Tim Regan brought to light in this fascinating interview was the role that more imagination can play in improving the care delivered in senior living settings. One has to wonder why this reach for the creative solution isn’t the norm everywhere. What would it take to turn the industry from convention and follow-the-leader innovation toward the embrace of the American spirit of creative innovation? Let’s start now.
