MDS Alert

Hint: Finding, recruiting, and retaining quality staff will become more important — and more difficult.

Direct-care workers provide the vast majority of hands-on care within a facility, and the need for competent and trustworthy staff will only increase as our population ages.

If you haven’t already begun tapping into the national conversation about hiring trends of direct care workers, start soon.

“Arriving at a successful recruitment and retention strategy takes time and commitment,” says Kezia Scales, PhD, director of policy research at PHI, in New York.

And if you’re struggling to recruit and retain enough staff, you’re not alone. Scales and her colleagues at PHI suggest that the issue is more related to the culture and realities of the long-term care industry rather than your particular facility.

“The quality of direct care jobs must also be transformed to become an attractive and viable career option for millions of workers now and in the future,” Scales says.

Recruit the Best-Suited Staff

In its program publication Growing A Strong Direct Care Workforce: A Recruitment And Retention Guide For Employers, PHI points to recruiting the right staff from the onset.

Look to your current direct-care staff, especially employees that have excelled in their roles at your facility. Can you identify what qualities or experiences have set them up for success, in comparison to other colleagues who may be struggling or unreliable?

PHI suggests making these successful employees part of your recruitment and hiring team. Talk to them and see what they identify as their strengths, as well as what sets them apart and sets them up for success. Plus, incorporating staff who are excelling into your recruitment and hiring efforts can help boost their self-confidence as well as their trust and commitment.

“By seeking input from staff, you will strengthen your recruitment approach while acknowledging their value to your organization,” PHI says.

Build Relationships to Target Outreach

Between social media, community colleges, and community events, you have a potential plethora of suitable candidates to bring on.

“Build partnerships with schools, colleges, workforce development organizations, and other agencies that serve unemployed or low-income workers, immigrants, younger or older workers, and others,” PHI says.

Focus on individuals — and again, look toward your established staff first. Do they know anyone they believe would be suitable to join your workforce? “Consider offering a bonus for successful referrals, but make it clear that there will be no penalty for referrals that don’t work out,” PHI suggests.

Take your recruitment game to where the people are — social media. Ask multiple successful employees whether they’ll give a testimony to the work that they do and what it’s like to work at your facility. Consider making a separate page within the jobs or careers section of your website to post these testimonies, and make sure that they’re visible and available to new applicants. Post available jobs on social media. Consider asking your social media manager to introduce a “Current Jobs” post feature, along with the job descriptions for any roles you need filled, and real photos of content and happy current employees.

Focus on Character

Direct care necessarily constitutes on-the-job situations where residents feel extremely vulnerable, where employees may feel unsafe or awkward, and where stress and turnover may be high. For these reasons and others, keep in mind PHI’s recommendation to take a chance on hiring someone who has the character that you were hoping for and an ease of chemistry with staff or patients before you hire someone who has experience but jumps around between facilities or whom you cannot reliably trust.

Acknowledge the unique difficulties and joys of choosing caregiving as a job or career.

“One of the most important questions to ask in a direct care interview is: ‘Tell me about a meaningful relationship you’ve had with an older person or a person with a disability, and how that relationship has impacted you.’ Caregiving skills can be taught, but a caring nature is essential,” PHI says.

Train the Skills Your Facility Prioritizes

When training new colleagues, emphasize your facility’s commitment to person-centered care— and revamp your new employee training so it’s employee-centered learning.

“With limited time and resources, direct care instructors often fall back on traditional teaching methods such as lectures, videos, reading assignments, and tests,” PHI says.

Instead, build your new employee training around employees receiving more comprehensive and dynamic training. Keep in mind any difficulties they may have learning or communicating. For example, someone who speaks English passably well may not absorb everything your trainer teaches in a lecture-style seminar, but this same person may be the best active listener, have the gentlest hands, and be the hardest worker.

Focus on providing a training foundation of core competencies, such as “client rights, ethics, and confidentiality; assistance with activities of daily living; clinical skills and infection control practices; safety and emergency protocols; and self-care,” PHI says. From these building blocks, your new employee will naturally have a grasp on resident rights and safety, compliance, and delivering high-quality, comprehensive care.

Top tip: Start a peer mentorship program, where your highest-performing staff are assigned to mentor your new employees. Nurturing trust and confidence between staff can boost performance all around.

Empower and Support Workers

Create a culture based around high-quality communication and empowering staff to reach out when things go well and when something goes wrong. Be aware — and compassionate — about what your staff might be dealing with once they exit your facility’s doors.

“Despite their commitment, direct care workers may face significant obstacles to remaining in their jobs, such as challenges with childcare, transportation, housing, immigration, or health care. Employers can bolster retention rates by supporting workers in managing these issues,” PHI says.

That doesn’t mean you need to start a daycare within your facility (though at least one facility has had astounding success and boosted residents’ happiness and quality of life by incorporating a preschool). But you can adjust your policies so workers aren’t penalized for having emergencies that prevent them from making their shift, like a sick child or a car breakdown.

Don’t Assume Management Can’t Grow

Management, including direct supervision, can play a major role in retaining employees and boosting work place satisfaction. But neither supervisors nor management are necessarily naturally prepared to oversee employees. Training can go a long way in helping supervisors navigate sticky situations with their direct reports, boosting confidence and keeping employees motivated to stay in their jobs at your facility.

“By learning to implement a person-centered ‘coaching’ style of supervision, supervisors can significantly reduce disciplinary actions, boost worker satisfaction, and reduce turnover,” PHI says.

One way to think of the difference a ‘coaching’ relationship can make versus a more traditional supervisory role is to think about how the relationship can change. Check out the chart, below, with PHI’s delineated differences in interactions.

The coaching style of supervision provides employees with the confidence, trust, and tools they need to feel respected and the parameters in which they can excel. Think of coaching as the person-centered “care model” of supervision, championing individual relationships over one-size-fits-all interpretation of the rules and the consequences.