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Shaping the Workforce: Emerging Trends for Long Term Care Employers


The quality of long term care service is directly tied to the quality of employees providing that care. To ensure the best possible outcomes for residents, long term care providers must build and maintain an effective, well-managed workforce. This is no easy feat, however, particularly in an historically tight labor market. Three challenges confronting the industry follow, with thoughts on how to address them.

1. Recruiting and Retaining Good Employees

Long term care facilities that hire and retain good employees are best positioned to provide quality care, but the health care industry at large is facing significant shortages. The U.S. Bureau of Labor Statistics projected this year that 1.1 million more nurses are needed to avoid increasing the current shortage. Physicians are also in high demand, with the Association of American Medical Colleges projecting a shortage of between 42,600 and 121,300 physicians by the end of the next decade.

As the national unemployment rate remains below four percent for the last few months, it's generally an employee's market. Employers, therefore, must work harder to attract quality applicants, and some recruiters are using marketing tactics to do so. Forward-thinking employers are coordinating efforts between recruiting and marketing to ensure branding and communications are consistent and attractive not only to potential customers, but also to potential applicants. Employers are also tailoring their approaches to specific demographics. For example, millennials – now the largest generation in the U.S. labor force – typically search online for job postings as opposed to attending job fairs. They also tend to be more interested in benefits and work-life balance than just salary. They want opportunities to learn and grow. If they are not engaged at their current job, they are motivated to leave and find a position better suited to their needs and interests.

To remain competitive, employers must therefore recruit like they market, with targeted and tailored messaging. They must also engage and retain their workforce. The fundamentals of ongoing training, competitive compensation, proactive management, and generous benefits never change. Employers should consider adding new benefits to improve retention, such as flexible scheduling, tuition reimbursement, and generous leave policies. Internal advancement and succession planning are also key to retention. Be mindful of high-performing employees. Often an employee who excels will be promoted into a position for which she has not been trained and in which she has little support. This can result in the employee burning out or disengaging. The employer has, in effect, promoted her right out of its workforce. Developing a plan for training and promotion that incorporates most of your employees, especially the high performers, will pay dividends in this tight labor market.

2. Fostering a Healthy Workforce

Keeping employees healthy (and on the job) is also a key challenge. Many large employers have developed employee wellness programs to foster good health among their workforce. The conventional wisdom is that wellness programs improve productivity while decreasing absences, insurance premiums, and health care costs. However, the truth is that these programs are expensive, can be laden with liability because of the sensitive information that is exchanged, and often have only negligible outcomes on the health of the workforce.

A recent study refuted the efficacy of wellness programs, finding that although organizations spent more than $8 billion in 2016 on these programs, the effects were imperceptible. The joint study was conducted by the University of Chicago and the University of Illinois and involved a large sample size – 12,500 individuals – who were divided into a control group and a treatment group. At the end of the year, there was little difference between the two groups. Damon Jones – one of the professors who conducted the study – explained that no discernible difference was found in health spending, sick leave, salary, job separation or gym visits. The study found that employees who chose to participate in workplace wellness programs were already healthier and had lower health care costs than non-participants. Instead of improving the health of the whole, the programs only rewarded healthy employees for being healthy. Perhaps these employees should be rewarded for being healthy, but their employer likely believed it was realizing a larger benefit. Employers should conduct their own cost/benefit analysis to see if these programs are really worthwhile.

3. Paying Employees Correctly

Employee compensation is another challenge. Even if an employer is able to staff its positions with healthy, well-trained employees, it still must pay them correctly. A critical concern in long term care is how to properly compensate employees for meal and rest breaks. Relatively straightforward in theory, this can be difficult in practice because scheduling breaks into the workday sometimes results in employees not being paid for time they worked.

While federal law governing employee compensation – the Fair Labor Standards Act – does not require an employer to provide a meal or a rest break, many states do. In fact, 21 states require an employer to provide a meal break for its employees, and nine states mandate both a meal break and a rest break. (Help with states in our footprint can be found here.) For example, in Tennessee, an employee must get a 30-minute unpaid meal or rest break if he or she is scheduled to work for six consecutive hours, unless the job allows ample opportunity to take such a break.

But can't employers implement a system that automatically schedules breaks into their employees' day and deducts the breaks from their pay? Not necessarily. Automatic deductions made by an employer's timekeeping system are often the cause of class action lawsuits brought by employees. A policy that makes automatic deductions without requiring an employee to edit the entry may make payroll easier and save on wages in the short term, but it is difficult to apply accurately. Workdays do not lend themselves to scheduled breaks, particularly in long term care. Take, for example, a nurse working the floor. She often cannot excuse herself for an uninterrupted 30-minute break, so she works through her break but does not get paid for it. If she does this twice a week for 50 weeks, she is owed 50 hours of back pay for the year. If we assume the facility employs 50 nurses and nursing aides, the problem grows exponentially. In addition, the FLSA allows employees to recover three years' worth of back wages if the employer is found to have willfully violated the law and to recover the employees' attorneys' fees if they show they should have been paid even a minute more than they were.

Employers must therefore ensure that employees take required breaks, and they must do their best not to interrupt those breaks. The reality of the workplace, however, is that breaks will be interrupted. In long term care, a resident's life may require it. Employers must plan for this contingency by having software that allows an employee to input or modify the amount of break time taken and a policy that requires him or her to do so. Employers must also enforce that policy by disciplining employees who do not adjust their break time to reflect actual hours worked, which often results in an employee being paid more. Employers with these mechanisms and policies in place will save more in the long run than those who do not ensure their employees are being paid for the time they actually work.

As profit margins shrink and the labor market tightens, fine tuning the fundamentals of recruiting, hiring and compensation can provide a competitive edge that is tough to find in long term care. In sum, determine where your ideal candidates are and go to them; offer benefits that they value; give your employees opportunities to learn and advance; determine whether your wellness plan actually increases the wellness of a meaningful percentage of your workforce; and protect yourself from litigation by compensating your employees for every minute they are on the job.

For assistance with recruiting, hiring and compensation matters, contact the author, Adam Gates, or any member of Baker Donelson's Labor & Employment Group.

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