Hiring and retaining employees in the extended care and rehabilitation facilities in the Chippewa Valley is challenging in many ways. Pay can be suppressed in nursing homes by the fact that Medicaid doesn’t fully reimburse extended care costs. Plus, promotional opportunities abound in extended care, meaning entry-level slots are always reopening. And as Baby Boomers age, more jobs are created. The Bureau of Labor Statistics projects that health care support occupation openings will grow at 23.6 percent over the next eight years. Health care practitioners and technical occupations are expected to swell by 15.3 percent, making these two occupational groups among the fastest growing and they’ll contribute about one-fifth of all new jobs by 2026.
For many who work this sector, one of the biggest perks is the importance of the work. Unlike hospitals, where patients ideally come and go, some staying for only a day, in extended care and rehab, one comes to know their patients. Trust and relationships are established. In short, it’s labor of love.
Dove Healthcare runs three extended care facilities in Eau Claire, two in Chippewa Falls, and four others in the Chippewa Valley area. Kendall L. Rosemeyer, NHA, the Aadministrator at Dove Healthcare-West Eau Claire. Rosemeyer observes that the lights are always on in extended care, which can be problematic when it comes to recruiting.
“The primary goal and challenge for our regional employment marketing coordinator is to find individuals that choose to dedicate their life to caring for people with clinically complex needs in a fast pace, ever changing environment that is highly regulated. Healthcare never closes, we are open 24/7, and this isn’t always attractive to a generation seeking a no weekend, no holiday schedule.”
So, how does Dove Healthcare recruit and retain employees, given the inherent demands of extended care?
“Dove Healthcare-West Eau Claire is attached to the assisted living residence Dove Healthcare-Orchard Hills, and between these two locations we employ a variety of positions that provide a career ladder for advancement, as well as making lateral moves between departments.”
Dove Healthcare-West Eau Claire employees aren’t limited to slots in just these two sites.
“There are eight other Dove Healthcare locations in northwestern Wisconsin, and this affords a variety of growth opportunities as well.”
Further education is sometimes required to qualify employees for promotions or a horizontal shift, and Dove has its employees’ backs, offering scholarships.
“Dove Healthcare-West Eau Claire supports employees’ ongoing education, whether a post-secondary degree, certification, or ongoing credentialing.”
The benefits package can read a little like Google’s, with perks ranging from bereavement pay to an on-site employee gym to a company match in 401Ks to reimbursement for a health club membership and child care, as well as the health, dental, vision, supplemental and life insurance options. The scholarships and work environment have improved recruitment and retention rates.
“By supporting our student employees with scholarship opportunities, a positive learning and working environment, and flexible scheduling, we’ve continually improved recruitment and retention outcomes over the years. We’ve even experienced the reward of having past employees return to us after trying out other healthcare settings.”
Still, recruiting and retention challenges remain.
For Dove Healthcare, recruiting and retaining Certified Nursing Assistants (CNA) and licensed nurses are the most challenging slots to fill. Whereas Dove Healthcare recruits from UW-Eau Claire and CVTC, as well as local high schools, those hired CNAs and RNs don’t always stay.
“Eau Claire has two large nursing programs that benefit us while our employees are in school. However, upon graduating from nursing school or another program, we often see these students moving back home (often to Minnesota) or into employment at the local hospitals where the average starting wage is $5-6 higher than a Dove Healthcare skilled nursing facility.”
Dove Healthcare also competes for the finite CNAs and RNs with other extended care entities.
“The Chippewa Valley is home to numerous health care entities that continuously compete for the same type of employees.”
And many CNAs use that role as a springboard.
“The CNA position is often a stepping stone versus a career choice.”
This is why CNAs who stay in that role are gold.
“We are so thankful for our employees that have committed to being a CNA or nurse in post-acute and long-term care as they provide a consistent presence for our residents and they are wonderful mentors and influencers. However, we’ve definitely experienced a decline in these numbers over the past decade.”
Still, Dove serves an essential role in training health care personnel, wherever they ultimately work.
“We hire a large number of students from UWEC, CVTC, and the local high schools. We have additional exposure from these schools because we are a clinical and practicum site for nursing, therapy, and social work students.”
And some of those students return the favor.
“Most significant is the engagement of our own employees in recruitment! We thank, reward, and incentivize the continuation of employee referrals via a generous bonus program. In addition, we often hear ‘word of mouth in the community’ as a referral source for employment.
Proactive Recruitment of the Problematic Positions
Dove doesn’t just sigh over the forces in play that lure CNAs away. Rather it’s proactive in producing more CNAs.
“We are participating in the newly announced WisCaregiver Career Program, which allows individuals to take the Certified Nursing Assistant (CNA) class and the state competency exam at no cost to them through a state-funded grant. Normally, our class participants pay $625 for the class and almost $119 for the test. Those enrolled in the WisCargiver program will have these fees paid for by the state-funded grant, with the only requirement to work six months after completing and passing the test.”
This also another cash incentive down the road.
“After six months of employment the CNA will receive a $500 retention bonus from the skilled nursing facility. This program just launched March 1st and we’ve seen a substantial increase in the number of enrolments to our CNA classes. We are so thankful to be a partner in the WisCaregiver program and are very optimistic about its influence on our hiring needs, and potential increase in career CNAs and/or future Nurses.”
Dove Healthcare is proactive with its Medication Aides too, which frees its RNs to do other essential tasks.
“We are also a partner in a Wisconsin Fast Forward grant to train Certified Nursing Assistants as Medication Aides. The goal of this grant is to train at a minimum of 32 new Medication Aides by June 2019. We anticipate this will help assist with the licensed nurse shortage as Medication Aides are able to do several of the tasks licensed nurses complete.”
Staying Put via Promotion
One of the strongest incentives to stay with Dove is the possibility of promotion. Julie Schwennsen is an example. She started at Dove Healthcare-West Eau Claire in 1997 as an RN. Then she became a nurse supervisor, a nurse case manager, and is in a regional role today as a Nurse Educator and Dove Healthcare’s expert for providing quality dementia care. Both the state and general community solicit her expertise. Dove feels lucky to have her, but that gratitude runs both ways.
“I am proud that I work for Dove Healthcare and I look forward to coming to work every day; otherwise, I wouldn’t still be here. I look back over the years and see how much I have grown, not just as a nurse, but as a person. Dove Healthcare has given me the opportunity to expand my career in many ways.”
But Schwennsen doesn’t just revel in her string of promotions. Extended care is where she wants to nurse.
“I love what I do. I plan on working here until I retire, which I hope is years away. Some people don’t understand why long-term care is where I want to be, but it’s my passion. I would never trade a day that I’ve worked in long term care.”
It’s similar for Megan Krump, who started as an RA, was promoted to Lead RA, and is now an Assistant Director at a Dove Healthcare assisted living residence.
“The movement that I have experienced within Dove Healthcare has kept fresh challenges in front of me. When I transitioned from an RA to the Lead RA, I learned to leader and how to be a role model for the team. Transitioning from Lead RA to Assistant Director provided new challenges and growth every single day. Being able to advance within the company makes me want to learn and put forth my best effort so I can continue to do so.”
Grace Lutheran Communities
Dove Healthcare’s challenges are not specific to that organization. Grace Lutheran Communities has two assisted living communities in Eau Claire and another in Altoona and independent living in Eau Claire and Chippewa Falls, as well as rehab facilities, adult daycare, and even childcare. Like Dove, it’s challenged in filling the RN and CNA slots, as well resident assistants. Pay is part of the problem
Bryan Bessa, Grace Lutheran Communities’ human resources director, said, “These jobs are labor-intensive and not as high paying as jobs in other sectors. I often get asked, ‘Why not just pay them more?’ It’s a logical question, however, our state Medicaid system continues to be one of the lowest reimbursement systems in the nation. Nearly 70 percent of the people we care for are on Medicaid, and most facilities in Wisconsin can lose $50/day per resident caring for residents on Medicaid.”
Demographics further complicate things.
“You couple this with a health care workforce crisis, an aging workforce, and an aging population and you have a recipe for problems. The demand for services is rising, and the supply of workers to help them is dropping. Medicaid and insurance companies tell you how much they will pay you for providing care, but it is not enough to cover the cost of the care. When you look around the state, you see multiple nursing home closures, including in Durand, Strum, Fall Creek, and now Dallas.”
Then there’s the allure of other industries.
“Our staff members have other options, no doubt. We are competing with entirely different industries outside of healthcare that require less skill and training and that pay more as well.”
So, how has Grace responded to these considerable challenges? For starters, they grease the skids to becoming a CNA and even pad that sled for a cushioned ride.
“We offer paid CNA training. This is a big deal because we pay participants a wage while they train. That perk allows them to earn some money while they are preparing for a healthcare career and they get the training for free. It’s also a great way to get the candidates familiar with our communities and gives them a great glimpse at what it means to work there.”
There are also excellent benefits with a real rarity in this work world: health care that is quick and with no co-pay.
“We have an excellent benefits package, including PTO, 403b with a match, and tuition reimbursement. One of the biggest benefits is our health plan. Our partnership with Marshfield Clinic Health System gives our employees who are on the health plan exclusive access to their near site clinic. This allows employees to receive care more quickly and, in many cases, without a charge for the visit.”
As with Dove, Grace Lutheran’s size means lateral and vertical possibilities for its employees.
“Grace Lutheran Communities has one of the largest long-term care networks in the Chippewa Valley. That means stability, but it also means that we can share staff across our communities. This benefits our employees by allowing them more flexibility and advancement opportunities without losing benefits and longevity.”
The extended care health care career can be long-term for the health care providers too, as it keeps them employed through recessions.
“One thing that sets us apart is that it is a stable career. Even when people leave during a manufacturing boom, we see them come back to health care when those industries experience mass layoffs. We are a cornerstone of the economy and a very stable, predictable career choice.”
A Profoundly Purposeful Career
Beyond the benefits, opportunities for advancement and surety of employment, it’s profound purpose that attracts and keeps the extended care and rehab workers.
“Most of our employees would tell you they stay it is their “family,” but not in the sense you imagine. The family they speak of is the people who they directly care for and the residents’ loved ones as well. It just goes to show that building meaningful and trusting relationships with those residents is at the heart of what we do.”
Those relationships increase the quality of the care.
“Being able to learn about the people we care for on an individual basis really embodies what long-term care is about and allows us to provide amazing care.”
And those relationships even increase the quality of the referrals.
“We find that many of our hires come from referrals from other employees, which really helps. First, it is totally objective information which I think means something special compared to the HR department saying, ‘This is a great place to work.’ The other reason is that employees are protective of their work environment and their residents. Staff almost never recommend someone come work for us if they don’t trust them to do a good job. That makes our job in HR much easier!”
Of course, HR in extended care still plays an essential role.
“If I have learned one thing about recruiting and retention, it is the ‘platinum rule,’ very similar to the golden rule which is, ‘Treat one another the way you want to be treated.’ The platinum rule is to “treat others the way THEY want to be treated.” We can’t assume we know how others want to be treated.”
In a sector with so many challenges, retaining your workers is essential, so you become the employee you want them to be, for kindness begets kindness and kindness is the crux of extended care.
“Your people are your most important asset and we need to treat them that way. I think most people want to be valued and they will go the extra mile if they feel you will do the same.”