Equity and Inclusion
Recruitment and Retention
Fear of Pandemic Spread and Refusal to Come to Work
Resources to Support Discussions about Vaccine Hesitancy in Nursing Homes
Providing Personal Assistance to Staff
Potential New Staff Policies
Your employees are the foundation of your success as a community during an ongoing crisis. All on-site staff are at risk for contracting an infectious disease, not only in their care and service settings, but also in their own homes and communities. As a result, attention to your staff is critical on a number of fronts.
While a pandemic is an unprecedented crisis, developing thoughtful plans for before, during, and after a crisis can help communities be as well-prepared as possible. With clear policies and staff supports in place, your community will be prepared to address issues in a calm and organized fashion. Below are some of the essential issues to anticipate and address, many of which are referred to in more detail below:
- Training on enhanced infection control in your care setting for all staff members.
- Securing sufficient PPE to protect staff.
- Ensuring frequent communication with staff using a variety of platforms, e.g., a printed newsletter, an app, automatic phone messages, postings in break rooms, posts on social media platforms, and in-person meetings.
- Considering redesigning jobs, and a physical redesign of your community to ensure success in a crisis.
- Conducting an assessment of policies regarding staff vacation, sick leave, and other benefits that may need to be modified. See CDC guidelines and examples under Vacation and Leave Requests below.
- Assessing the use of staffing agencies and private-duty caregivers.
- Giving special attention to frontline staff who are the most vulnerable, e.g., by offering wraparound services that include childcare, financial assistance, food and transportation assistance, and temporary accommodations if social isolation is necessary.
- Identifying staff who need close monitoring, e.g., those who have second jobs, especially in other facilities, and those who may live in underserved areas, thus having limited access to health care or testing.
- Developing strategies to stretch current staff in the event of a shortage, e.g., 12-hour vs. 8-hour shifts.
- Reallocating staff to where they are most needed, e.g., housekeepers also serving as hospitality aides in the SNF, or maintenance and landscaping staff assisting in meal delivery.
- Ensuring management coverage 7 days a week.
- Developing incentive and recognition programs to address staff morale, e.g., hero/hazard pay, special meals, raffles.
- Developing tools to address psychological health issues for short-and long-term stress, trauma, bereavement, etc. Evaluate programs you have currently, and what can be enhanced. (Note: This issue is addressed in greater detail in the Wellness Section of this Playbook.)
- Handling staff turnover and backup strategies.
- Considering partnerships with local organizations to supplement your organization’s needs.
LeadingAge LTSS Center @UMass Boston research reports:
- Workers at Risk: The Lessons of COVID-19 (commentary from LTSS Center Co-Director Robyn Stone)
- The Invisible COVID Workforce: Direct Care Workers
- Risk of COVID-19 Infection Among Direct Care Workers
- Ziegler Survey Gauges Employee Benefits During Pandemic
- Fighting the Coronavirus Requires a Strong Direct Care Workforce
- How to Stand Behind Frontline Workers
- COVID-19 in Nursing Homes: Who is Leaving the Job?
Equity and Inclusion
- Audio interview: May 19, 2020: Robert Espinoza of PHI on Disparities in Communities of Color and Why We Must Better Support Low-Income Workers
- Audio interview: June 5, 2020: Karyne Jones of The National Caucus and Center on Black Aged on Overcoming Fear of Discussing Race in Aging Services
- Audio Interview: July 14, 2020: Dan Stewart of Human Rights Campaign and LEI on LGBTQ Elders, COVID-19, and How Aging Services Can Become More Inclusive
- Audio interview: Sept. 2, 2020: Danny Williams of Eliza Bryant Village on Serving African American Residents, Health Disparities, and Building Trust
- Audio interview: Sept. 2, 2020: Danny Williams on Serving African American Residents, Health Disparities, and Building Trust
- Creating a Culture of Diversity and Inclusion during a Pandemic (CARF International resource page)
- Nurse LEAD Training (LeadingAge Learning Hub)
- National COVID-Ready Caregiver Certification (Nextstep)
General Training (including Infection Control)
- Relias, a trusted business partner, launched a new Virtual Classroom for online trainings. The company also created a free COVID-19 digital toolkit with unrestricted access to online courses such as infection control and telehealth, as well as peer reviewed publications, a webinar series, and more.
- HealthcareSource, a trusted business partner, is offering 25-plus complimentary COVID-19 related courses with tracking.
- Training Direct Care Workers in COVID-19 Protocols (LeadingAge LTSS Center)
- 2020 State of Training and Staff Development in Post-Acute Care (Relias webinar): Deep dive into current practices in staff development pre- and post-COVID-19, based on data from more than 5,000 health care organizations.
- Protecting Workers: Guidance on Mitigating and Preventing the Spread of COVID-19 in the Workplace (OSHA): The Occupational Safety and Health Administration has issued stronger worker safety guidance to help employers and workers implement COVID-19 prevention programs and better identify risks that could lead to exposure and contraction.
Cross Training/Maximizing Your Team
- Resident Concierge Representatives (Elim Care hiring non-licensed care assistants or resident concierge representatives to perform temperature screens, make beds, deliver trays, and answer phones)
- Audio interview: April 10, 2020: Roger Myers of Presbyterian Villages of Michigan on COVID-19-positive residents, philosophies driving crisis response, and protecting housing residents
- How to Build—And Lead—Resilient Health Care Teams During COVID-19 (Harvard T.H. Chan School of Public Health)
- Helping staff members find their purpose can help turn ‘rock’ employees into ‘rock stars’ (McKnight’s Senior Living): How can managers cultivate staff to become “rock stars” among residents? It’s all about taking the time to listen to residents and help them find their purpose.
- LeadingAge Member Ideas and Inspiration stories:
- Provider Solves the Multiple-Job Problem Among Staff, Boosts Communication for Residents (reassigning staff to dining services, driving, security, administrative positions, etc.)
- Provider Trains Supplemental Staff, Provides Essentials for Staff and Residents
- Financial Incentives and Flexibility to Support Staff
- A Large Meals Program Ramps Up Dramatically
- Provider Innovates in Face of Multiple Challenges
- PACE Provider Adapts to Lockdowns With “Hopemobiles”
Creative Team Setupsd
- Audio Interview: May 21, 2020, Marvell Adams of The Kendal Corporation on Staff Stress, Scheduling, and Self-Care
- LeadingAge Member Ideas and Inspiration stories:
- Check first with your State Department of Health.
- Consider GoodHire, a trusted business partner, for fast, accurate background checks.
Recruitment and Retention
Hiring Displaced Workers
- Fact sheet on displaced workers (LeadingAge)
- Post your jobs on the LeadingAge Aging Services Career Center, which has hundreds of different types of jobs.
- Use pre-written templates to reach out to state and local establishments (hospitality, restaurants, retail, etc.) to let them know you are hiring.
- Member Ideas and Inspiration: Recruiting Displaced Workers
- Member Ideas and Inspiration: Provider Hiring Displaced Workers
- Eden Alternative Live: Emerging Issues in the COVID Era (free thought-leader interviews from The Eden Alternative)
Use the Recruitment Center at the Center for Workforce Solutions
- Learn how to reach non-traditional populations.
- Find resources to showcase the variety of jobs in our field.
- Recruitment Tools
- LeadingAge COVID-19 Workforce Partnerships (LeadingAge partnering with national organizations to connect members with individuals seeking employment)
Promising Practices Shared by Member Communities
LeadingAge also has a number of trusted business partners who can help with recruitment
- Health Carousel’s PassportUSA program places international health care professions in American jobs. It has a deep pipeline of nurses requesting placement in skilled nursing or long-term care.
- MyCNAjobs.com is the largest network of caregivers, nursing assistants, and certified home health aides in the nation.
- HealthcareSource has developed a scaled-back version of its applicant tracking and onboarding solution to help small providers hire staff as quickly as possible.
- RCM Health Care Services is a staffing agency.
- BookJane Inc. offers health care facilities and staffing agencies the ability to use its platform to help relieve staffing shortages and labor inefficiencies.
- OnShift offers a Senior Care Recruitment Toolkit to help reach displaced workers.
- Attract, Engage, Retain, Grow: An Effective Hiring Process (CLA): Recruitment is more than filling jobs, it is about finding long-term employees who want to be there, provide value, and contribute to growth.
- Senior Care Survey Report: Workforce 360 (OnShift): Hiring, turnover, burnout, safety among top workforce challenges. Across all demographics, finding and hiring qualified job candidates (67%) is the top workforce challenge in long-term care and health care, followed by employee turnover (57%).
Ideas and Trends
- Making Care Work Pay: How Paying at Least a Living Wage to Direct Care Workers Could Benefit Care Recipients, Workers, and Communities (LeadingAge LTSS Center @UMass Boston): Our analysis found that raising the pay of direct care workers to the living wage in their respective states of residence would translate into meaningful wage gains for the lowest-paid aides, improve productivity, and have a significant effect on the overall economy.
- Making Care Work Pay: How A Living Wage For LTSS Workers Benefits All (Health Affairs): Article focusing on the publication.
- The pace of Boomer retirements has accelerated in the past year (Pew Research Center): Job losses associated with the COVID-19 recession may contribute to more retirements among baby boomers.
- Nursing and residential care facilities lost 8,600 jobs in October 2020 (Altarum): Employment in nursing homes, which has been flat or slightly declining for several years, has fallen in each of the past eight months and is down 8.4%, or 133,000 jobs, since February, according to an analysis.
- Tracking the Impact of the COVID-19 Crisis on Nonprofit Employment (Johns Hopkins Center for Civil Society Studies): The Johns Hopkins’ Center for Civil Society Studies analyzed data from the latest BLS Employment Situation Report to estimate nonprofit job losses through October 2020. They then looked at month-over-month trends to see how the overall recovery of early nonprofit job losses is proceeding.
- Law creates permanent pathway to employment for temporary nurse aides (McKnight’s Senior Living): In Pennsylvania, Senate Bill 1268 allows temporary nurse aides hired during the pandemic to be placed on the state’s Certified Nurse Aide Registry and become eligible for permanent employment in long-term care facilities, including AL communities.
- Growing & Developing The Healthcare Workforce (PharMerica webinar): This webinar provides practical and replicable approaches for growing and developing a sustainable, senior living health care workforce. Apprenticeship models will be explored as a strategy to retain workers while providing a powerful return on investment. Implications of Covid-19 are addressed.
- Direct caregiver crisis in nursing homes: The COVID crisis has exacerbated the impact of the chronic shortage of certified nursing assistants in nursing homes. Link goes to document, “An Initiative of the Live Oak Project and the National Assn. of Health Care Assistants (NAHCA) to Address the Workforce Crisis Among Certified Nursing Assistants in Nursing Homes.”
- How Did COVID-19 Impact Direct Care Workers? (LeadingAge LTSS Center @UMass Boston): A new research brief from the LeadingAge LTSS Center @UMass Boston documents the impact of COVID-19 on direct care workers.
- COVID-19: Experiences of Direct Care Workers in Aging Services (LeadingAge LTSS Center @UMass Boston): Concerns over understaffing, family needs likely turnover culprits during pandemic. A substantial percentage of direct care workers have experienced a series of external and work-related challenges during the COVID-19 pandemic, leading many to leave their jobs within long-term care, according to a new research brief from the LeadingAge LTSS Center.
- Supporting frontline workers key to resolving senior living’s ‘burnout crisis’ (McKnight’s Senior Living): After battling COVID-19 on the front lines for almost a year, senior living employees are at a breaking point—even more so than workers in home health agencies, hospitals or retail settings.
- Nonprofit sector lost over 7% of its workforce in the first year of the pandemic (Center for Civil Society Studies, Johns Hopkins): In an effort to track the ongoing impact of the coronavirus pandemic on nonprofit employment, this report documents our estimates of COVID-induced nonprofit job losses through February 2021.
- To know us is to love us? New effort could boost interest in long-term care careers (McKnight’s Senior Living): The beginning of an effort to encourage medical school graduates to not only enter geriatrics, but consider practice in LTSS settings.
- One year into pandemic, nursing home workforce has declined by 11.5 percent (McKnight’s Senior Living): Nursing homes lost 11,600 jobs in February, contributing to the 11.5% reduction in the nursing home workforce seen since February 2020, a drop of 182,000 jobs.
- Staff burnout, disengagement are most disruptive forces facing skilled nursing (2021 Healthcare Trends Survey Report, AMN Healthcare): Provider burnout, disengagement and the resulting shortages that follow are the most disruptive forces facing health care providers, including those in long-term care, over the next three years.
- COVID-19 pandemic has resulted in an estimated 4M workers prematurely retiring (Alliance for Lifetime Income): The COVID-19 pandemic has resulted in an estimated 4 million workers prematurely retiring, according to an economic report released Tuesday.
Fear of Pandemic Spread and Refusal to Come to Work
- Hot Topic: How to Incentivize Staff to Work During a Pandemic? (PDF)
- Hot Topic: Crisis Workforce Management (PDF)
- Audio interview: April 8, 2020: Elizabeth Weingast of The New Jewish Home on coping with a large number of COVID-19-positive residents
- Audio Interview: June 3, 2020: Lori McLaughlin of WestShore LLC on Overcoming Staff Fears and Poor Service from Public Health Services
- “We Are in a War”: Mitigating Burnout in COVID-19 (Center to Advance Palliative Care)
- Many health care employers not reporting COVID-19 worker deaths (Kaiser Health News): Some health care employers—including a number of long-term care facilities—have been choosing not to report health care worker deaths to occupational safety officials amid the pandemic.
Prevention: Support Your Current Staff
- Show direct appreciation by providing groceries, gift cards, etc. See examples here.
- Open and transparent communication with staff is critical; communicate regularly with staff via video or in writing.
- Introduction to: The Art of the Supportive Check In (LeadingAge): Dr. William Mansbach of Mansbach Health Tools, Allison Ciborowski of LeadingAge Maryland, and Dee Pekruhn of LeadingAge discuss how to have critical conversations with employees who are experiencing anger, stress, anxiety, or other psychological challenges in the workplace.
- The Art of the Supportive Check In (1-page flyer): This is a companion handout to reinforce key takeaways from “The Art of the Check In Call” training videos.
- Getting to work may be an issue if public transportation options impact their hours:
- Provide free PPE for those staff using public transportation, and consider subsidizing their transportation, or paying for backup options, e.g., Uber or Lyft.
- Financial issues are affecting nearly everyone. Consider bonuses, appreciation pay, or try OnShift’s Wallet powered by PayActiv, which allows staff to receive their wages as they earn them.
- 10 Practices That Could Land You in Hot Water During COVID-19 (ADP)
- Flyer re special thank-you meals for staff (Hebrew Home at Riverdale)
- States use varying approaches to address staffing shortages in senior living during pandemic (McKnight’s Senior Living)
- Direct care workers experience pandemic challenges, but rate employer preparation, communication high: study (McKnight’s Senior Living): Direct care workers say their employers have prepared them and communicated well about COVID-19, according to a recent study.
- Companies Offer Creative Solutions to Worker Burnout During the Pandemic (Wall Street Journal): From surprise days off to 30-hour workweeks, managers are devising ways to help employees; ‘How are you really, really doing?’
Audio interviews on staff support practices:
- May 14, 2020: Rob Lahammer of Presbyterian Homes & Services on Tough Media Environment, Staff Engagement, and Opening Up
- July 1, 2020: Deke Cateau of A.G. Rhodes on Morale, Testing, and Reopening
- July 21, 2020: Manny Ocasio of Asbury Communities on a “just culture”
- July 29, 2020: Colleen Frankenfield of Lutheran Social Ministries of NJ on Early Problems, Motivating and Supporting Staff and Residents
- July 31, 2020: Terri Cunliffe of Covenant Living Communities & Services on a multi-state rapid hiring process
- August 5, 2020: Derrick DeWitt of Maryland Baptist Aged Home on supporting staff in a small nursing home with very limited resources
- Nov. 2, 2020: Anne Levesque of Wake Robin on Innovative Ways to Support Staff
- Jan. 4, 2021: US Surgeon General Dr. Jerome Adams on COVID-19 Vaccines, Plus CVS Program Updates
Resources to Support Discussions about Vaccine Hesitancy in Nursing Homes:
- The Institute for Healthcare Improvement (IHI) has developed 2 documents to help support conversations about vaccine hesitancy with nursing home staff: COVID-19 Vaccine Education: A Guide for Conversations with Nursing Home Team Members (includes a script outline and ideas for preparing and having conversations about vaccine hesitancy) and accompanying slides.
- The American Health Care Association/National Center for Assisted Living has many toolkits and resources to support these discussions on the AHCA #GetVaccinated website.
- Vaccination Communications Tool Kit (ACHA/ NCAL): Encourages long term care staff and residents to get the COVID-19 vaccine. Includes tips for communicating the importance of vaccination and highlighting progress, along with template letters, sample social media, and media prep material.
- Protect Pregnant Women Through Research not From Research (NPR): Doctors who treat pregnant patients are finding themselves in a tough and familiar spot as the COVID-19 vaccines roll out: making decisions about the use of a particular medicine in this group of patients without any clinical evidence to guide them.
- Safe Pregnancy as COVID Surges: What’s Best for Mom and Baby? (NPR)
- Interim recommendations for use of the Moderna mRNA-1273 vaccine against COVID-19 (WHO): This interim guidance has been developed on the basis of the advice issued by the Strategic Advisory Group of Experts on Immunization (SAGE) at its extraordinary meeting on 21 January 2021.
- Interim recommendations for use of the Pfizer–BioNTech COVID-19 vaccine, BNT162b2, under Emergency Use Listing (WHO): This interim guidance has been developed based on the advice issued by the Strategic Advisory Group of Experts on Immunization (SAGE) at its 5 January 2021 extraordinary meeting.
- Addressing Vaccination Myths and Misconceptions (New York Times): We are concerned about how inaccurate, extreme and widespread these theories have become, because getting vaccinated is the best way for women to protect themselves and their families.
- Mother to Infant Transmission of COVID 19 Appears to be Rare (NIH): Pregnant women who experienced severe symptoms of COVID-19 had a higher risk of complications during and after pregnancy, according to preliminary findings from a National Institutes of Health study. Compared to COVID-19 patients without symptoms, those with severe symptoms were at higher risk for cesarean delivery, postpartum hemorrhage, hypertensive disorders of pregnancy and preterm birth.
- COVID Vaccine Efforts: The Push to Reach Wary Medical Workers (New York Times)
- Outline for Vaccine Hesitancy Conversations (Institute for Healthcare Improvement handout): “We developed two short resources (a text document and a slide presentation) to guide nursing home leaders in conversations with staff members and residents. These materials are designed to help each individual think through whether or not they would like to receive the COVID-19 vaccine and to address any questions or concerns.”
- Outline for Vaccine Hesitancy Conversations (Institute for Healthcare Improvement slide deck)
- CCRC operator encouraging employee COVID-19 vaccinations with cash bonuses (McKnight’s Senior Living): AZ-based Sun Health is providing cash bonuses to employees who receive their COVID-19 vaccinations, as well as paid time off should side effects prevent any vaccinated employee from being able to work.
- Tyler Perry on Vaccine Acceptance (YouTube video): The half-hour special provides helpful and factual information for viewers looking to protect themselves and their families from this unprecedented crisis. Tackling issues head-on, Perry asks the hard-hitting questions to help the community gain insight into this new vaccine.
- Ways to boost COVID-19 vaccination uptake—a report by the COVID-19 Vaccination Uptake Behavioral Science Task Force (February 2021). This report “integrates insights and concrete/practical recommendations from a high-level team of behavioral science experts regarding a specific question—how can we increase COVID-19 vaccine uptake among employees of long-term care facilities?” Components include: an initial review of research findings about factors correlated with vaccine uptake, and meta-analysis of predictors of COVID-19 vaccine uptake specifically; and specific suggestions to improve vaccine uptake among long-term care facility staff from each task force member. Listen to a March 2021 LeadingAge interview with Dr. Sigal Barsade, the Task Force Chair.
- 3 keys to optimal COVID vaccine campaigns for senior living organizations (McKnight’s Senior Living): Organizations that make COVID vaccinations part of their health and wellness programs will put everyone in a better position for what’s ahead.
If You Lose Staff
- Have a ready pool of staff (e.g., those you have cross-trained).
- Never stop your recruitment efforts (see above).
Audio interviews on emergency staffing and recruitment:
- April 29, 2020: Karolee Alexander and Sue LaGrange of Pathway Health on Emergency Staffing
- April 14, 2020: David Hood of RPA on emergency preparedness plans and working with local and state emergency agencies
- June 17, 2020: Tina Sandri of Forest Hills of DC on Coping With COVID-19 Early, Plus Workforce and Testing Difficulties
- Dec. 30, 2020: Laura Hoffman of LeadingAge Washington on Rapid Response Staff Teams
Providing Personal Assistance to Staff
Check first to see if your local community has organized childcare centers for essential workers. LeadingAge member communities have developed creative ways to help staff with childcare:
LeadingAge Member Ideas and Inspiration articles:
- Free, onsite, temporary care approved by the state
- A “Child Care Exchange” Allows Employees to Help Each Other
- Repurposing vacant apartments as childcare centers
- A Relief Fund, Meals, and Support for Staff With Children
- No-Cost Childcare Program Set Up for Staff
Medical Services On-Site/Telehealth
Start thinking now about providing medical services at your community, or facilitate telehealth appointments.
Can you partner with a local hospital, urgent care, or other health care facility?
Can you repurpose vacant areas for staff to live at the community for a period of time?
Can you use nearby hotels that may not be filled to capacity?
Some communities have provided tents (set up indoors), used air mattresses, or housed staff in model homes or guest suites.
- Member Ideas and Inspiration: Dozens of Staff Live on Provider’s Campus to Protect Residents
Potential New Staff Policies
Limiting Staff to One Place of Employment
You may wish to consider limiting staff to work in one community to lessen the spread of the virus (Note: Check your state labor laws). How can you compensate them for making this change? A few considerations:
- Develop your own pool of these workers to allow them to the first to be called for an open slot.
- Use the cross-training ideas listed above.
- Schedule them for 12-hour shifts.
Vacation and Leave Requests
- Staff Vacations and Travel Considerations During COVID-19, including detailed CDC recommendations
In addition, some of our member communities have implemented the following during a crisis or pandemic:
- Requiring staff to inform supervisors of the vacation destination.
- Allowing 2 weeks off, but not consecutively.
- Requiring quarantine after return from specific destinations.
- Allowing only one team member to be on vacation at a time.
- Audio interview: July 7, 2020: Kassie South of Franke at Seaside on Surging Cases in SC, Visitation Concerns, and PPE
- COVID-19 Employment Law Update: Reopening the Workplace (LeadingAge webinar)
- Video podcast for employees of National Church Residences, with one employee’s story of her experience having COVID-19
- Policies to prevent or cope with worker infections: FAQs from AMDA
- CNA staffing, turnover top focus for federal government (McKnight’s): Turnover among certified nursing assistants at long-term care facilities will be a top priority for the Centers for Medicare & Medicaid Services going forward, a top agency official pledged.
- Nonprofit employment recovery slowed significantly in September, still down by nearly 8% (Johns Hopkins Center for Civil Society Studies): As part of our continued effort to track the ongoing impact of the coronavirus pandemic on nonprofit employment, we have analyzed data from the latest BLS Employment Situation Report to estimate nonprofit job losses through September 2020.
- Trilogy’s people-first staffing approach has led to a nearly 50% lower employee turnover rate than the industry average (McKnight’s Senior Living): Louisville, KY-based Trilogy Health Services knows that ensuring a great workplace culture is critical to the firm’s success.
- Audio interview: Oct. 5, 2020: Jeannee Parker Martin and Eric Dowdy of LeadingAge California on the Coronavirus Commission on Nursing Homes