In this presentation we discuss how to: -Identify major workforce issues impacting the industry -Discuss predictive staffing strategies to improve cost and care -Provide modern practices to attract and retain staff -Show how to avoid common payroll-based journal reporting pitfalls

1. 10 15 WIN-WIN STAFFING STRATEGIES
Presenter:
Shelly Szarek-Skodny
President/CEO
Diversified Health Partners, LLC
Moderator: James M. Berklan
Editor
McKnight’s Long-Term Care News
& McKnight’s Assisted Living
Presenter:
Peter Corless
EVP of Enterprise Development
OnShift
Tuesday, August 16, 2016
1:00 PM ET
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3. Today’s Agenda
• Identify Major Workforce
Issues Impacting The
Industry
• Discuss Predictive Staffing
Strategies To Improve Cost
& Care
• Provide Modern Practices
To Attract & Retain Staff
• Show How To Avoid
Common Payroll-Based
Journal Reporting Pitfalls

4. Staffing Challenges
Growing
Workforce
Shortage
Continual
High Turnover
Rates
Rising Cost
Pressures
Additional
Staffing Level
Scrutiny

5. Population Growth – 80-84 Years
Source: American Health Care Association

6. More People To Need Post-Acute Services
Source: SNF Volume from Avalere projection model; Medicare enrollment from 2015 Trustees’ Report

7. Registered Nurse Shortage
• Predict 260,000 RNs short by 2025
• Nursing schools do not have faculty,
clinical placement sites or funding
to match demand
• In 2013, more than 50,000 qualified
applicants could not find schools to
enroll in
• Looming workforce shortage
– 2.5 million additional workers
needed to meet demand according
to study by UCSF

8. Tip #1: Identify The Staff You Need
• Set a labor budget
– By position, per shift
– Consider Five Star Quality Rating
• Analyze key metrics to determine
gaps
– Open shifts, call-offs, overtime,
census/occupancy fluctuation
• Pay attention to staff utilization to
potentially fill holes
– Hours worked vs. desired hours
• Start hiring while considering part-
time and PRN mix to add flexibility

9. Attracting Talent To Fill Staffing Holes

10. The Millennials Are Here
Source: U.S Census Bureau

11. Has Your Organization Adapted For Millennials?
78%
Of new hires in
senior care are
millennials
35%
Of providers have
changed their tactics to
attract and engage
millennials
Source: McKnight Senior Living News and OnShift Senior Care Workforce Survey

12. Tip #2: Brand Your Organization
• Be up front and clear
about what your
company stands for
• Promote the benefits
of working for your
company
• Pay attention to your
Glassdoor ratings
• Promote your great
work and fun!
Source: OnShift, 5 Things Senior Care Executives Must Know About Attracting and Retaining Millennials

13. Tip #3: Get Staff Involved In Recruiting
• Create a referral program
• Quicker and cheaper to hire
than a traditional candidate
• Referred hires stay at their
job longer than other hires
• Identify top talent and ask
them to be brand ambassadors
• Consider incentives for
referrals
Top 4 Ways
Millennials Hear
About Companies:
1.Friends
2.Job Board
3.On Campus
4.Social Media
Source: CollegeFeed

14. Tip #4: Go Mobile & Social To Maximize
Applicant Pool
• Keep job applications brief
– 60% of candidates have quit an
online application mid-process due
to its length and complexity
– 1-2 minutes to complete and should
be mobile friendly
• 9/10 job seekers say they’re likely to
use a mobile device
• Post jobs where millennials are—social
media
– Expand reach by encouraging
employees to post open jobs on their
personal social feeds

15. Keeping Talent Engaged

16. Turnover At Crisis Levels In Senior Care
24% | 44%Turnover in Assisted Living and Skilled Nursing
Source: : American Health Care Association & National Center for Assisted Living’s Vacancy, Retention, and Turnover Survey

17. Millennials & What They Value
Personal
Development
Collaborative
Work Culture
Real-Time
Feedback
Flexible Work
Schedules
Work-Life
Balance
Making the
World a Better
Place
Companies with engaged employees outperform those
without by 202%
Source: Dale Carnegies, Engaging Millennials in the Workplace

18. Tip #5: Offer Training & Career Growth
Opportunities
• 65% of millennials said personal development
was the most influential factor in their
current job
• Training & onboarding should be offered to
meet various learning styles
– Offer online learning
– Engage them with quick hit content
– Use shorter sessions
• Design career tracks for each position
– Show employees that they have the potential
to move up
– Identify & track measurable goals

19. Accept Technology At Work
• Millennials LOVE their phones
–96% of millennials said their
phone is the most important
product in their lives
–Phones were more important
than their toothbrush (93%)
and deodorant (90%)
Source: Bank of America Survey, 2014

20. Tip #6: Give Feedback Often
• Employee evaluations once a year
not nearly enough for millennials
• Regularly track and incentivize the
behavior you want to see
– Behavior tends to improve when it
is tracked
– Offer perks for those that perform
above certain levels
• Call-out good work as part of your
team huddle

21. Tip #7: Provide Employees A Voice
• Ask millennial employees to help make
your work place millennial-friendly
• Conduct regular surveys
– Quick daily surveys using smart phones
– Identify problem shifts
– Predict and prevent turnover
– Trend happiness
• Follow up
– Let employees know you got their
suggestions
– Communicate a plan to improve issues

22. Tip #8: Give Staff More Control
• When employees feel they have
some control over their schedule,
they’ll be more engaged
• Utilize mobile technology
– Scheduling
– Managing call-offs
– Shift changes
– Employee communication
• Allow employees to request their
preferred schedule
• Take requests into consideration
when building schedule
“It’s so convenient to
have my schedule on my
phone. It’s great!”
Senior Living Communities

23. Offset Wage Pressures

24. Minimum Wage Is Rising Across The U.S.
Highest State Minimum Wages Effective 1/1/2017
Washington D.C. ($11.50)
Massachusetts ($11.50)
California ($10.50)
Connecticut ($10.10)
Vermont ($10.00)
Source: Economic Policy Institute, “Minimum Wage Tracker.”
National Conference of State Legislatures, “State Minimum Wages: 2016 Minimum Wages by State.

25. Minimum Wage Increases Affecting Senior Care
• 30+ cities and localities have
increased their minimum wage
above and beyond the state
mandated wage minimum
• Private companies vie for talent
by preemptively raising their
starting pay.
“As the minimum wage
increase goes into effect in
Chicago, 56% of our
workforce at our Senior
Suites Communities will
average a 24% wage
increase.”
- Jon DeLuca, CEO,
Senior Lifestyle Corporation
Source: OnShift, The Staffing Advantage: Strategies to Reduce Labor Costs

26. New Overtime Rule Became Final
OLD RULE NEW RULE
$23,660
Previously, full-time, salaried workers
who earned up to this amount
annually ($455 a week) were not
eligible for FLSA overtime protection.
$47,476
The DOL more than doubled the salary
threshold, requiring employers to pay
workers who make up to this annual
amount ($913 a week) overtime pay.
Source: Society for Human Resource Management

27. Strategy #9: Get Predictive To Balance Staffing Levels
• Develop a staffing ladder to hit
daily targets
• Look ahead to identify census
fluctuations and plan
accordingly
• Be flexible by making staffing
changes as census fluctuates
• Keep tabs on “clock-riders”
• Staffing at the right levels
results in cost savings

28. Average Overtime
(% of Labor Budget)
Tip #10: Focus On Overtime & Agency
• Most overtime and agency use can be
prevented
• Set overtime goals—monitor them
daily
• Predict OT to prevent it before it
occurs
– Compute hours worked compared to
remaining hours scheduled
• Put a plan into action today!
– Set guidelines for acceptable use
– Maximize utilization of current
employees
– Consider creating an internal pool of
per diem and on-call employees
Source: McKnight Senior Living News and OnShift Senior Care Workforce Survey

29. Tip #11: Develop A Plan For Filling Open Shifts
• Be proactive and plan ahead for
holidays, summer vacations, etc.
• Provide visibility to staff members
– Give all qualified employees have
a chance to volunteer
• Fill call-offs equitably
– Identify and offer the shift to all
staff that are available & qualified
– Select the replacement by
considering overtime risk
Top Drivers of Overtime
79%
41%
74%
Last Minute Call-
Offs
Employees
Punching In
Early/Out Late
Not Having
Enough Qualified
Staff Available
Source: McKnight Senior Living News and OnShift Senior Care Workforce Survey

30. Driving Significant Cost Savings
Overscheduling Reduction
Annual Savings, Single
Facility (100 beds)
.1 PPD $75,600
.2 PPD $151,200
Overtime Rate Reduction %
Annual Savings, Single
Facility (100 beds)
1% $24,000 – $60,000
5% $120,000 - $300,000

31. Strategies For PBJ Success

32. What Is Payroll-Based Journal?
Payroll-Based Journal (PBJ) is a new system used by CMS to
electronically collect:
• Employee tenure information
• Census data
• Direct care hours worked – including agency & contractor
Failure to submit or reporting inaccurate data can be costly,
potentially leading to citation and civil money penalties.

33. Accuracy Is Critical
• Inaccurate reporting could have
several side effects
• Enforcement action down the
road
– Potential to use inaccurate
data in civil liability cases
– Inaccurate data used to justify
regulatory action
– Potential use within fraud and
abuse situations - from false
claims to anti-kickback

34. Additional PBJ Implications
• Tenure & Turnover
• Information on Nursing
Home Compare
• Five Star Quality Ratings

35. Collection Has Begun
Fiscal
Quarter
Date Range for Staffing
Data
Submission
Deadline
1
October 1 – December
31
February 14
2
January 1 –
March 31
May 15
3
April 1 –
June 30
August 14
4
July 1 –
September 30
November 14

36. Defining Direct Care
CMS defines direct care staff as those individuals who,
through interpersonal contact with residents or
resident care management, provide care and services
to allow residents to attain or maintain the highest
practicable physical, mental, and psychosocial well-
being.
Direct care does not include individuals whose primary
duty is maintaining the physical environment of the
long-term care facility (for example, housekeeping).

37. Tip #12: Collecting Contractor Hours
What providers are doing
• Contact agency & contractors to
provide this data for upload
• Manually collect and enter into
CMS
• Utilize systems to allow these
caregivers to easily check-in and
check-out

38. Tip #13: Reporting Boomerang Staff
Issue with reporting rehires
• CMS only allows for one hire
and one termination field
per submission
• This creates errors or lost
data if those staff are part of
the same submission
What providers are doing
• Submit separate files for
rehired staff
• Submit PBJ reports more
frequently to reduce odds of
rehires overriding

39. Tip #14: Addressing The Day Divide
Issue reporting shifts spanning 2 days
• Communities must report hours to
the actual days worked.
• Most systems are not set-up to
automatically report in accordance
to these requirements
What providers are doing
• Change shifts to start at midnight
• Manually adjust and enter to meet
regulations
• Contract with vendors that can
automatically allocate these hours

40. Tip #15: Trash Manual Schedules & Adopt
Technology
• Predict and prevent
overtime
• Automate scheduling &
labor management
• Staff to resident need,
service levels
• Gain visibility into staffing
across properties
• Fill open shifts fast
• Get Payroll-Based Journal
Reporting right

41. Staffing Strategies Where Everyone Wins!
Higher Quality
Care & Service
Improved Cost
Control
Better
Performance
& Efficiency
Increase
Employee
Retention
Five-Star
Rating
Greater
Customer
Satisfaction

42. Shelly Szarek-Skodny
President/CEO
Diversified Health Partners, LLC
QUESTION & ANSWER
Peter Corless
EVP of Enterprise Development
OnShift