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February 1, 2021 | Human Resources | Posted by Ascentis Thought Leadership

Biggest Workforce Challenges for HR Pros in Long Term Care

Long-term care has always been a particularly challenging field of employment, both for the workers on the frontlines and for the HR professionals behind the scenes. Working in nursing homes, senior care centers, and other long-term care facilities can be difficult physically, mentally, and emotionally, and the financial rewards are lower than in many comparable fields. All of those factors have only been exacerbated during the COVID-19 pandemic. That adds up to a uniquely demanding situation for the human resources teams tasked with keeping those facilities fully staffed and functioning smoothly. Let’s look at a few of the most crucial areas of focus for HR pros working in the long-term care industry. 

Reducing turnover 

The healthcare industry in general has long struggled with high rates of employee turnover. In some states, the turnover rate for healthcare workers overall is double the national average for other jobs. In long-term care facilities those numbers are even higher, ranging from 45% to 66% even before the added stresses of the pandemic. As many as 25% of nursing assistants say they are actively looking for new work at any given time. Those high rates are due to a combination of factors including high stress, long hours, low pay, and emotional trauma — a veritable perfect storm of workplace challenges.  

Low employee retention is especially worrisome in long-term care because it can have a direct impact on the quality of care a facility is able to provide. High turnover makes it difficult for an employer to establish and maintain a consistent company culture that makes new hires feel welcome. A facility that is left understaffed when workers leave their roles may have to resort to overscheduling remaining staff to avoid gaps in service to their residents. Those factors in turn contribute to a vicious cycle of quicker burnout and still more turnover.  

While the nature of long-term care means that there will probably always be a higher-than-average rate of turnover, facilities can help reduce those numbers by focusing on improving communication, providing tools that give employees more control over their own schedules, and offering more opportunities for on-the-job training and advancement. 

Managing schedules 

Scheduling for an industry that requires round-the-clock care from certified providers is an ongoing challenge, especially when you factor in the previously mentioned difficulties with retention and cost-cutting measures. It’s yet another double-edged sword of managing HR in the healthcare industry: high turnover rates lead to staffing shortages, which lead to many overtime hours, which leads to payroll cost overruns, which leaves less money to invest in recruiting and hiring quality replacements for departing staff.  

Long-term care scheduling is made all the more complicated because there are many positions that require specific certification or training in certain healthcare equipment or techniques. Leaving shifts unstaffed or scheduling underqualified workers could potentially put residents at risk. Since most healthcare facilities do not follow a traditional “nine to five” work schedule, making sure that all shifts are staffed by qualified and certified employees at all hours – especially while minimizing overtime payouts – can be an enormously complicated task for an HR administrator. 

Staying compliant 

Long-term care facility administrators report a 17% higher rate of concern about compliance issues than admins in comparable industries. That should come as no surprise, considering how high the stakes of compliance can be in the healthcare field, and how much a chronic worker shortage increases the risk of noncompliance. With regulations surrounding quality of care, data reporting, and data privacy added on top of FLSA requirements around minimum wage and overtime, long-term care facilities face a multi-pronged challenge for mitigating risk. A few key compliance concerns that are especially important to long-term care employers include: 


FLSA requirements 

The Fair Labor Standards Act (FLSA) includes specific directives on overtime pay and minimum wages for direct care workers. As long-term care facilities frequently employ minimum wage workers in entry level positions and deal with overtime pay for hourly employees due to staff shortages and 24-hour scheduling, administrators need to be especially mindful of these regulations.  

Payroll-based journaling 

Section 6106 of the Affordable Care Act (ACA) requires long-term care providers to submit staffing and payroll information for all direct care employees. This data is audited by the government to create reports on staffing levels, turnover and retention, and overall quality of care. The U.S. Centers for Medicare and Medicaid Services (CMS) offers a free system for facilities to record their payroll-based journaling (PBJ) efforts. This reporting factors heavily into the five-star rating system issued by the CMS, which is a vital consideration for both patient and employee acquisitions.  

HCSS Certification 

Depending on the location of your facility, Health Care Staffing Services (HCSS) certification may be a requirement. This evaluation program is designed to establish a set of training and performance standards for staffing services that provide temporary clinical staff to care facilities. Even if your state or locality does not require HCSS certification for staffing firms, it may be worth looking into, as certification may factor into insurance rates and other certification programs. 

Pay rules  

In an industry that requires as diverse a range of schedules and skills as long-term care, establishing and abiding by consistent pay rules can be a challenge, but it is a necessity. From complying with federal guidelines for classifying full-time and contingent workers to abiding by union-mandated pay rates to following the aforementioned FLSA overtime and minimum wage rules, keeping compliant requires a robust payroll system and highly adaptable HR processes. 

Keeping costs down 

Long-term care is an expensive industry to maintain at every level, and HR and payroll costs are no exception. Recruiting and hiring new employees costs a considerable amount — about $2,200 per nursing assistant by some industry estimates. Attracting new hires can be all the more difficult because of the long-term care industry’s notoriously low rates of pay. Wages for direct care workers stand at about half those of workers in comparable industries, and as many as 30% of nursing roles are staffed by contingent workers who generally do not receive benefits. While spending less on wages and benefits might look like a cost-saving measure on the surface, those savings can be quickly eaten up if your business is constantly spending money on hiring and recruiting due to low retention rates.  

Managing your long-term care workforce 

Any way you look at it, long-term care is a challenging industry in which to work. High turnover, heavy regulation, complex scheduling and payroll requirements, and other factors make this a particularly difficult area for HR professionals. Lasting success for HR administrators in care facilities depends on adaptability, strong attention to detail, and exceptional communication skills. Fortunately, there are also a number of technological solutions that can aid in those efforts. 

An active long-term care environment requires a workforce management software that offers communications tools, employee self-service options for scheduling and timekeeping, and a robust learning management system for on-the-job training and certifications. Automating as many of those processes as possible can help create a more welcoming, nurturing work environment that will ease the burden on HR staff, keep quality employees more engaged for longer and maintain a safe and nurturing environment for residents.  

By opening channels of communication, empowering your existing staff, improving employee retention, and avoiding the financial penalties that come with noncompliance, your facility can protect the bottom line and enable a better care experience for staff and residents alike. 

Find out more about the many ways Ascentis workforce management solutions are tailored to help your organization meet the biggest challenges facing long-term care facilities today.

With more than 35 years of experience in providing Software as a Service (SaaS) solutions, Ascentis thought leaders have become a respected source for insights, tips, and innovations in the Human Capital Management (HCM) space.