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
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
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
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
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
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
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
Research from University of California San Francisco found that at least 2.5 million more workers will be needed to provide long-term care to older adults in the United States between now and 2030.
A CareerBuilder study reveals that organizations with a strong employer brand attract at least 3.5 times more applicants per job
Job candidates are researching your company before they accept a job
According to a 2014 Glassdoor survey
https://www.glassdoor.com/blog/9-10-job-seekers-search-jobs-mobile-glassdoor-state-mobile-job-search-survey/
Intelligence Group studies of millennials have found that:
· 64% of them say it’s a priority for them to make the world a better place.
· 72% would like to be their own boss. But if they do have to work for a boss, 79% of them would want that boss to serve more as a coach or mentor.
· 88% prefer a collaborative work-culture rather than a competitive one.
· 74% want flexible work schedules.
· And 88% want “work-life integration,” which isn’t the same as work-life balance, since work and life now blend together inextricably.
Millennials are, in essence, “venture consumers,” Gutfreund says. They’re not looking to fill a slot in a faceless company, any more than a good venture capitalist is looking to toss money at a faceless startup. They’re looking strategically at opportunities to invest in a place where they can make a difference, preferably a place that itself makes a difference.
A CareerBuilder study reveals that organizations with a strong employer brand attract at least 3.5 times more applicants per job
Job candidates are researching your company before they accept a job
Across the country, there is legislative momentum to raise minimum wages. Just this year, 17 states and Washington, D.C. will have increased their minimum wage. This trend will continue, as 11 states have already committed to additional minimum wage increases in upcoming years. For example, both New York and California recently approved measures to gradually increase the minimum wage to $15 per hour (See Figure 1). This public backing for higher wages has also led to most certified nursing assistants (CNAs) in Pennsylvania to secure a new collective bargaining agreement, forging a pathway to a $15- per-hour wage. In addition, over 30 cities and localities have increased their minimum wage above and beyond the state mandated wage minimum.
Employers will spend $592.7 million to comply with the new rule, the DOL estimated, saying that each of the 7.4 million affected establishments will need one hour to get up to speed on the changes. The department calculated that it will cost $254.5 million for businesses to become familiar with the regulation; $160.1 million to make necessary adjustments; and $178.1 million in managerial costs.
While many of the financial challenges that healthcare organizations face today are out of their direct control, leaders can take simple steps to exert control over one of the most significant cost centers: labor. Those that implement a data-driven action plan and acquire the right tools to do the job understand that working smarter not harder puts them in the best position to increase workforce capacity and productivity, assure both patient and employee satisfaction, and deliver cost-effective, high-value care.
OnShift survey with McKnight’s asked:
Average Overtime Within Your Organization (responses limited to skilled nursing)
0-2% - 14.35%
3-5% - 36.71%
6% or more – 48.94% (specifically 6-8% - 26.35%, 9-10% - 12.71%, 11%+ - 9.88%)
A CareerBuilder study reveals that organizations with a strong employer brand attract at least 3.5 times more applicants per job
Job candidates are researching your company before they accept a job