Better training, Career Paths Key to Rebuilding Nursing Home Workforce – Skilled Nursing News

Skilled nursing facilities will need solutions to better retain and attract operational staff like New York-based New Jewish Home’s Geriatric Career Development program. Nevertheless experts say that investment in a universal direct care workforce may be needed.

The direct care workforce, which includes certified nursing assistants (CNAs) in nursing homes, typically provide between 60-to-80% of all the hands-on service in the facilities they work in, according to Robyn Stone, senior vice president of research at LeadingAge and director of the LeadingAge LTSS Center at UMass Boston Stone. Direct care workers perform critical tasks such as laundry, medication administration and oversight.

“If we were really paying attention to how this occupation could be used, giving folks more opportunities to work across settings, a universal workforce concept, would have a lot of advantages,” Stone told SNN.

Speaking at Mathematica’s Center’s recent webinar on sustaining, strengthening and scaling up the direct care workforce, Stone pushed for more flexibility in terms of where those employees can work as part of the post-COVID restructure. The long-term care industry lost five percent of its workforce from Feb. to Dec. 2020, equating to nearly 342,000 jobs lost.

The idea is turning a lot of heads.

“I remember how early on in the pandemic there were these emotional news stories of planes of doctors flying into New York City and other cities that were hit hard to help out. I thought that would be completely impossible for the direct care work force given the state-to-state training requirements and other issues, and that’s a problem,” said Robert Espinosa, vice president of policy at New York-based direct care workforce advocate PHI National, at the webinar.

Because CNAs have different training requirements than home care aides, these employees lack opportunities to work across settings, according to Stone.

Attracting a Younger Workforce

Making nursing home operational staffing jobs more attractive starts with giving workers more flexibility and raising wages. Attracting new, younger workers to the industry will also be key. The U.S. Department of Health and Human Services (HHS) estimates that nearly 27 million people will need some kind of long-term care by 2050. The HHS definition of “long term care” includes nursing and personal care facilities, residential care facilities and home health care services.

“The top two challenges for the 15,000 nursing homes throughout the country serving close to 1.5 million of society’s most frail and vulnerable are financial and workforce,” Jeffrey Farber, M.D., president and CEO of The New Jewish Home told Skilled Nursing News. “The financial challenges are due to long-standing and worsening inadequate reimbursements from state Medicaid programs. Our workforce challenge is mainly attributable to our society’s penchant toward ageism, which has led to both chronic underfunding for long-term care and a dearth of workforce to meet their needs.”

Through the Care For Our Seniors Act, the AHCA/NCAL and LeadingAge urge a multi-phase approach that leverages federal, state and academic resources to streamline professional career pathways. The proposal also included student loan forgiveness, tax credits and other incentives for licensed health care professionals who work in long-term care.

Norman Rokeach, founder and president of Marquis Limited in New Jersey, private equity firm Tryko Partners’ health care affiliate, recently proposed allowing for more flexible work hours that fit the staff’s needs.

“Thinking outside the box and being more flexible with employees will be key,” he said at the Synergy Summit earlier this month. “Changing their schedules to be more flexible. A lot of these folks are single moms … so perhaps it’s a six-hour shift versus an eight-hour shift and a 12-hour shift twice a week versus the traditional 40-hour week.”

Though COVID has only worsened the shortage, staffing has been a significant problem for nursing homes for years.

Median turnover at facilities reached 94% between 2017 and 2018, according to a Health Affairs analysis published in March.

Seeing a problem without a solution, the New Jewish Home took a proactive approach, creating a pipeline for at-risk youth to work in their facilities. The New York-based operator established its Geriatric Career Development Program (GCD) in 2006, recruiting students ages 14 to 24 and targeting local under-resourced high schools to work in skilled nursing.

“I absolutely see our program as a national solution to [our workforce challenge], while also having proven to be a powerful high school enrichment program and a pathway out of poverty for underprivileged youth in under-resourced communities,” Farber said.

GCD Yields Strong Results

Located in the city’s Upper West Side, New Jewish Home provides a full range of senior care services, including long-term care, senior housing, short-stay rehabilitation and home care.

GCD’s young adult program offer underprivileged youth in under-resourced communities pre-certified nursing assistant training (CNA), a home health aide course, and internships.

Close to 200 young people have graduated from the program, 76% of whom have gone on to be hired by the New Jewish Home.

Candidates can become certified as CNAs after a course and an internship in a New Jewish Home facility, John Cruz, GCD program director, told SNN.

The initiative has played a crucial role in the nursing home’s ability to handle staffing shortage challenges.

“I think every single long-term care facility is dealing with staffing shortages, and we’re no different,” Cruz added. “Last summer, we were able to hire about 35 young people to work in our facility so that they can complete their clinical training, which provided much-needed support to our organization and to our facility.”

The company also hired an additional 20 to 25 GCD alumni to serve as CNAs, housekeepers, food service workers, clerks and staff for its COVID testing center, according to Cruz.

He described GCD as something of a “staffing agency.” An increasing number of SNFs have had to depend on such agencies to keep staffing at sufficient levels. The company plans to expand the program to New Jewish Home’s Westchester campus, which has a SNF in Mamaroneck, New York.

“We plan to grow both locally and nationally through the addition of training sites for cohorts of students at other nearby nursing homes and through program replication throughout the country after securing a sustainable financial model to cover the costs of running the program so it is not entirely dependent on philanthropy,” Farber said.