Short-staffed nursing homes change recruitment, retention practices – Waterloo Cedar Falls Courier

Nursing homes are short-staffed in the Cedar Valley and across the United States.

In fact, the American Health Care Association reports that half of all U.S. nursing homes aren’t accepting new patients due to inadequate staffing. It is estimated that nearly 400,000 people have left the nursing home industry since the pandemic began.

But nursing homes have been under staffing pressures long before COVID began taking its toll.

Kris Hansen doesn’t pull his punches.

“Professional pay has lagged behind,” said Hansen, CEO of Western Homes Communities in Cedar Falls. “This work has always been tough, but the work got exponentially tougher with COVID and all the PPE, the risk that goes with it.”

When COVID hit, “nursing homes were suddenly the firefighters holding the tinderbox with fire all around us. All of a sudden, we needed the highest amount of talent with the proper certification and licensure almost overnight – without the appropriate foundation to even begin from. We’ve been playing catch-up ever since,” he explained.

Western Home has lost about 300 employees since February 2020 for myriad reasons. Only 1% left due to COVID vaccine mandates, said Amanda McCormack, human resources director.


Throughout the Cedar Valley, nursing home staff is exhausted and stretched thin. Some employees were forced make child care decisions when schools closed and shifted to remote learning at the height of the pandemic and chose not to return to work. Others have changed jobs for more pay. Baby boomers are ready to retire and may have opted out early.

“We’ve seen burnout in nurses and CNAs (certified nursing assistants) who have been in the COVID fight for so long they’re starting to question whether they even want to be in health care,” said Lisa Gates, CEO at Friendship Village in Waterloo.

“It’s hard to see light at the end of the tunnel. On the flip side, it’s hard to attract people into the business if they’re considering becoming a nurse or CNA. COVID has made people say ‘Do I really want to do this as a career?’”

Millisa Tierney, CEO at NewAldaya Lifescapes in Cedar Falls, describes COVID as a “game-changer” that has created a “different reality in how we are trying to function. We are open to a paradigm shift.”

Staffing, recruiting and retaining workforce requires “accepting the reality of these shifts, as well as operational shifts, and moving forward from a strategic position for our staff family and our resident family,” Tierney said.

There are staffing shortages in every department “across the board, not just nurses and nursing aides. We’re short on dietary aids, cooks and all other services,” said Shelleen Hatch, NewAldaya’s director of human resources.

“In the Cedar Valley, the talent pool of nurses and CNAs is small with the number of nursing homes, retirement centers, hospitals and clinics. We can’t fill all the openings. We have people who apply and set up interviews, and then don’t show up for the interviews,” said Sherry Turner, Friendship Village executive vice president of health services.

“Working in long-term care isn’t sexy. We’re struggling with people leaving the industry for less emotionally stressful jobs,” Gates said.

Better pay

Nursing homes have boosted base pay rates. At Western Home Communities, there have been wage increases for front-line caregivers — nurses, medical and nursing assistants — and hourly positions. There is an additional hourly wage for employees who prefer pay in lieu of benefits such as insurance and personal time off.

Friendship Village’s Gates said nursing homes can find themselves in a bidding war. “Someone raises their average salary by $5, then $6 and you end up in with salaries that are quickly unsustainable.”

Traditional hiring practices are proving ineffective at reaching today’s potential workforce, so nursing homes are stepping up their game in recruiting and retention.

“Anything that has been a ‘best practice’ in the HR world has been done for years, and it doesn’t work anymore. Attitudes and how people look for jobs have changed,” said NewAldaya’s Hatch.

At Western Home, “we’ve been having walk-in interviews. In the past year, we’ve had Zoom interviews. We talk to people about what the schedule looks like, about opportunities for growth,” said Amanda McCormack, system human resources officer.

New tools

Nursing homes are using job websites like Indeed, as well as Facebook postings, LinkedIn, Grow Cedar Valley, All Iowa Community College job boards, Handshake (University of Northern Iowa, University of Iowa, Northwestern, Upper Iowa University, Wartburg College), Iowa Health Care Association, LeadingAge Iowa, IowaWorks, Waterloo Community Schools’ Waterloo Career Center and Cedar Falls High School’s Center for Advanced Professional Studies.

Recruiters regularly participate in high school and college career fairs and work to build partnerships with area high schools, colleges and universities through various programs and apprenticeships. Hiring campaigns are created for media, including TV and radio.

NewAldaya’s HR team has spent time honing in on what motivates the current workforce and how individuals are making employment decisions, as well as ways to attract them to apply and interview for jobs, Hatch said.

Eight-hour shift work is being replaced by more flexible scheduling at Friendship Village, Gates said. “Now it’s ‘do you want to work from 10 a.m. to 10 p.m., do a 12-hour shift, pick up a 6 p.m. shift.’ We have to be flexible and sometimes we have to fill holes. We also have our day care center with employee discounts.”

The nursing home also awards four scholarships annually to provide students with LPN training and has participated in a CNA apprenticeship program. “We hope to renew that in the spring and see if we can get anybody interested,” Turner said.

A range of incentives are being offered, including signing bonuses, retention bonuses, COVID hazard pay at the height of the pandemic, and matching contributions for 401(k) plans.

In 2021, Western Home returned more than $50,000 to employees through their referral program, COVID vaccine bonuses, wellness reimbursements, tuition and student long reimbursement and Payactiv benefit which allows employees to be paid for their worked time the next day rather than waiting two weeks for a paycheck.

“That gives us an opportunity to get people in our door and expose them to who we are, what we are, what we do,” Hansen explained.

Wonderful field

Training and leadership development, wellness programs, employee recognition and building culture and engagement through activities for employees such as food days, spirit weeks are important, as well.

“We need to pay enough to be worthy of their hire,” said Gates. Friendship Village is seeking “people who strive and desire to give of themselves and serve others. It can be a very rewarding and fulfilling career. It’s not just all about the money.”

At NewAldaya, Tierney said “I hope people will take a look a retirement services and nursing homes. It’s still a wonderful field and wonderful career path. It’s been challenging in the last few years, but still some of the best experiences in my career.”

Hatch noted, “We have so many employees who have been with us for 30, 35 and 40 years and they’re still going. That kind of commitment keeps us all going.”

Western Home Communities’ Hansen said, “I’ve seen the love that our folks have for our residents. I couldn’t be prouder of people who stuck with us or who joined us. It’s a Rosie the Riveter moment. We have to be flexible to what is happening with employment in the industry. We can’t organically grow the amount of talent we need going forward.”

Subscribe to our Daily Headlines newsletter.