10 15 WIN-WIN STAFFING STRATEGIES

Presenter: Shelly Szarek-Skodny

President/CEODiversified Health Partners, LLC

Moderator: James M. BerklanEditor

McKnight’s Long-Term Care News & McKnight’s Assisted Living

Presenter: Peter Corless

EVP of Enterprise DevelopmentOnShift

Tuesday, August 16, 20161:00 PM ET

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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

Staffing Challenges

Growing Workforce Shortage

Continual High Turnover

Rates

Rising Cost Pressures

Additional Staffing Level

Scrutiny

Population Growth – 80-84 Years

Source: American Health Care Association

More People To Need Post-Acute Services

Source: SNF Volume from Avalere projection model; Medicare enrollment from 2015 Trustees’ Report

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

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

Attracting Talent To Fill Staffing Holes

The Millennials Are Here

Source: U.S Census Bureau

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

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

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.Friends2.Job Board3.On Campus4.Social Media

Source: CollegeFeed

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

Keeping Talent Engaged

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

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

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

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

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

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

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

Offset Wage Pressures

Minimum Wage Is Rising Across The U.S.

Highest State Minimum Wages Effective 1/1/2017Washington 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.

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

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.

$47,476The 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

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

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

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

Last

Minute Call-Offs

Employees P

unching In

Early/O

ut Late

Not Havin

g Enough Qualifi

ed Staff Ava

ilable

79%

41%

74%

Source: McKnight Senior Living News and OnShift Senior Care Workforce Survey

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

Strategies For PBJ Success

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.

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

Additional PBJ Implications

• Tenure & Turnover

• Information on Nursing Home Compare

• Five Star Quality Ratings

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

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).

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

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

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

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

Staffing Strategies Where Everyone Wins!

Higher Quality Care & Service

Improved Cost Control

Better Performance & Efficiency

Increase Employee Retention

Five-Star Rating

Greater Customer

Satisfaction

Shelly Szarek-SkodnyPresident/CEO

Diversified Health Partners, LLC

QUESTION & ANSWER

Peter CorlessEVP of Enterprise Development

OnShift