Care home leaders expect non-clinical staff shortages to have a crippling long-term impact on the talent pool and career interest in the space – both at the clinical and supervisory level – as many young people choose to enter the labor market via other industries .
Infection control protocol and more broadly the stringent regulatory requirements the industry is known for are currently seen as barriers to recruitment and retention of non-clinical staff, especially as industries outside of healthcare relax personal protective equipment (PPE) and sanitation requirements.
Dietary aides, housekeepers, kitchen staff and recreation services all fall under the non-clinical banner.
“We had these shortages before Covid and they only got worse after Covid…those areas haven’t come back either,” said Jay Moskowitz, CEO of Vivage Senior Living.
Around 90% of non-clinical employees are internal to Vivage – the operator has a few facilities that use national contracts for such positions.
For the first time ever, executives brought in agency staff, Moskowitz said, primarily for food and housekeeping.
Vivage operates 31 facilities in Colorado, one in Missouri and one in Nevada.
Non-clinical vacancies have more than doubled from pre-pandemic numbers, according to Scott Laakso, director of human resources for Massachusetts-based SALMON Health and Retirement. Open positions have increased from less than 10% to 20-25% at this stage of the pandemic.
“Staff members have so many other opportunities outside of health care right now,” Laakso added. Such opportunities don’t involve as much regulatory compliance and infection control, he said.
Nate Schema, CEO of the Evangelical Lutheran Good Samaritan Society, said about 300 of 1,400 nonclinical positions are currently open at its 150 locations in 22 states. In other words, one position in five is to be filled.
“It’s so critical. These non-clinical positions are part of your pipeline, it’s where you identify talent that is often your future leader or your nurses, your future clinical leaders in your communities,” Schema said.
The Good Samaritan has seen this type of career path time and time again, Schema said, with lawnmowers moving into executive directors and dietary aides moving into administrator roles.
“This affects the future of our organization in far more ways than what is happening on a day-to-day basis right now,” Schema noted. “Overview, this is a serious issue that we are working to address along with any clinical openings we know of.”
Non-clinical agency staff
Sky-high agency prices aren’t just a clinical staffing problem for the industry, executives told Skilled Nursing News. Operators are seeing a 35% to 40% markup on fares in some cases, as well as charges for Uber fees and other transportation costs to get to work.
“Before the pandemic, I never used temp agencies for these positions, ever,” Moskowitz said. “The administrators are in the kitchens, in a particular community. The cleaners help wash the laundry because we have to.
SALMON Health has had difficulty filling the recreation staff and dietary aide positions. Similar to Vivage, Laakso said the past year marked the first time in company history that they had to use agency staff for meals.
Although the operator has recently been able to maintain its staff, there have been times over the past 12 months where it has found staff to work, take extra shifts or work overtime.
Schema said bloat rates have normalized in recent months for agency staff, dropping from 1.5 to three times the normal agency rate to 1 to 1.4 times that rate. Non-clinical agency staff make up less than 5% of total agency usage at Good Samaritan, though the operator has “a long way to go” from what Schema would describe as a sustainable situation .
SALMON generally hires directly for catering and contracts with a third party for its housekeeping and laundry.
In order to compete with agencies and other industries, operators raised base salaries across the board for non-clinical staff.
Vivage increased non-clinical salaries in February for its establishments between 12% and 20% depending on the position. The move coincides with Colorado adjusting its living wage, which was raised to $12.56 an hour in January.
SALMON raised the hourly pay for chef positions from $17 to $18 an hour before the pandemic — Laakso said it’s closer to $23 to $24 an hour now for that particular position.
While non-clinical salaries vary widely for the Good Samaritan given its large footprint, Schema said the operator has increased salaries by 20% to 30% since the pandemic began.
Recruit and retain non-clinical staff
Many operators are offering first-time retention and referral bonuses for non-clinical positions — Vivage bonuses range from $500 to $1,500 depending on the community, according to Moskowitz.
Vivage also works with the state Department of Labor to post job openings and host job fairs at shelters for non-clinical positions.
“We are out of the agency because we have a lot of high school kids working for us,” Laakso added. “We offered a pretty lucrative referral bonus up to $1,000.”
Local high schools and technical college culinary programs have helped fill the void, especially this summer, he said.
There are simply too many pandemic hurdles to jump through, while other industries like hospitality and retail do not have to comply with the regulatory requirements imposed on the entire healthcare sector.
“We’re struggling to get employees who are tired of wearing face masks 24/7 in their jobs,” Moskowitz added. “Most industries now, most professions don’t require you to wear a mask… even though Covid is still here as we know.”
Schema says PPE requirements present a “unique disadvantage” for operators trying to find non-clinical staff.
“We have people applying for laundry, housekeeping, dietetics roles and one of their first questions at the interview is ‘well do I have to wear a mask? If you go to McDonald’s or Burger King, we all know the answer,” Schema said.
Outside of Covid, the long-term care environment requires non-clinical staff to be trained in dementia training, resident rights and other regulatory controls before they can hit the ground running, Laakso said.
This is another “inherent competitive disadvantage” compared to other industries, Schema added. Many potential non-clinical employees can’t afford to wait two to three weeks to get started, they can’t wait to pass multiple rounds of background checks.
“Restaurants and vendors here in the upper Midwest, they’re literally paying people to come in for an interview. They give them a gift card or entice them to show up for an interview,” Schema explained. “It’s a very dynamic time.”
The care home working environment has placed the non-clinical staff member under more scrutiny than ever before because of Covid, Laakso said.
Still, industry leaders hope high school and college students starting out as a non-clinical worker for a nursing home might consider a clinical pathway or a non-clinical supervisor position to stay in the industry. from an early age.
“You just have to be able to show people that within our profession there is a career ladder that people can move up,” Moskowitz added.
Laakso said SALMON has had some success that way, bringing in non-clinical staff at a young age, and then they see what clinical staff do in a facility and decide to pursue that career.
“We’re uncovering all the rocks and doing everything we can to get people into the building and get them interested,” Laakso said. “There are so many different paths you can take in health care and post-acute care…you can go into the kitchen, but you can end up becoming a nurse one day.”