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The Solution to the Staffing Crisis in LTC May Be with the Millennial Generation [Full Title Below]
The Solution to the Staffing Crisis in LTC May Be with the Millennial Generation: Hiring and Retaining Them Will Not Be Easy!
The Staffing Crisis: Present and Future
The emerging staffing crisis in the long-term care (LTC) community is not new. Scholars have been predicting the crisis for the last two decades. The staffing crisis is related to both the availability and competency of staff. A host of strategies for training, retaining, and recruiting qualified staff has been offered, but many of them thus far have proven to be ineffective on several levels. LTC organizations located in rural and less desirable urban areas are feeling the preponderance of the staffing crisis. The staffing levels of registered nurses in certified LTC facilities declined 25% between 1999 and 2003.1 LTC leaders are at a crossroads in their efforts to recruit and retain competent staff.
There is very little debate on what needs to be done, and in most cases, LTC leaders are willing to go the extra mile to improve care. LTC scholars blame the staffing crises on Medicaid and Medicare reimbursement, which prevents them from being able to compete with the salaries offered by hospitals, outpatient practices, and managed care companies.2 An independent analysis performed by the accounting firms BDO Seidman/Eljay, LLC, identified that the actual cost of providing older persons critical nursing home care was underfunded in many states by at least $4.4 billion annually, and the LTC industry operates at a 2.5% negative margin when factoring both Medicare and Medicaid funding into the overall LTC financing equation.3 According to the 2000 U.S. Census, 19% of home healthcare aides and 16% of nursing home aides did not make enough from their caregiving jobs to rise above the poverty line.4
Many LTC leaders argue that the current regulatory environment provides very little room for LTC organizations to be selective or even creative with their hiring practices. In fact, most LTC facilities are content to simply identify candidates who can pass a drug and background check. The staffing crisis is predicted to worsen in the years to come, as a fraction of employees from the Baby Boomer Generation slowly exits the workforce. Today’s LTC workforce is more diverse than ever because it consists of employees from four generations and various cultures.5,6 The solution in the midst of a broken economy and an unprecedented nursing shortage may be with employees from the Millennial Generation.
The Challenges of Hiring Millennial Generation Workers
The Millennial Generation is also referred to as Generation Y or the Net Generation. So far, there are 80 million people in the United States in this category, with ages 16-29 in the current workforce. Employees from the Millennial Generation are exposed to more technological advances than past generations, and many of them grew up in single-family households.7 In some states, the outlook for Millennial Generation employees is bleak, which makes recruiting and retaining qualified staff even more difficult for some LTC facilities. According to a report co-released by the Keystone Research Center in Harrisburg, PA, and the Center for Economic Policy and Research (CEPR) in Washington, DC, workers between the ages of 18 and 29 have seen their wages stagnate and the quality of their jobs deteriorate since 1979 in one state that has more than 700 nursing homes.8
Tyler9 suggests that employees from the Millennial Generation lack skills in crucial areas such as professional behavior, basic writing, confidentiality, critical thinking, and how to give and receive constructive criticism. Coincidently, these are all skill sets that are needed to change the image and raise the level of care in the LTC community. Hence, if LTC organizations want to hire and retain employees from this generation, they need to consider nonmonetary systems that focus on rewarding, teaching, mentoring, trusting, and work-life balance. Similarly, Gallup research revealed that 53% of Generation Y employees placed extreme importance on the amount of creativity that is allowed by employers, which is a luxury that may be stifled by state and federal regulations in the LTC community.10
Taking the recruitment process seriously is the first step in recruiting the right people in the LTC organizations. LTC facilities must forego the urge to hire staff merely to fill an open position. This holds true even at the level of direct care staff. Additionally, LTC leaders must use informal recruitment wisely while working in complete transparency. The ultimate goal is to select employees who will seamlessly fit into the culture of the LTC setting. The administrator and the director of nursing have the biggest departments in the facility; therefore, training should start with them. Over the next decade, LTC leaders will be faced with the task of managing a workforce that is more diverse than ever. The number of workers age 65 years and older is expected to increase nearly seven times as fast as the total labor force.11
Census figures show that in the United States, minority populations are increasing at a much faster pace than is the majority white population. Between 1980 and 2000, the U.S. white population grew by approximately 9%, the African-American population increased by approximately 28%, the Native American population by 55%, the Hispanic population by 122%, and the Asian population by more than 190%.12 In the United States, the LTC workforce is heavily dependent on women from minority racial and ethnic backgrounds, and increasingly on immigrant women, to fill low-paying, direct-care positions.6
Managing Generational Diversity in the LTC Setting
The integration of employees from the Millennial Generation into a diverse workforce presents a new set of challenges for LTC leaders. Patterson13 suggests that LTC leaders must be extremely cognizant of generational diversity and its impact on the organization’s cohesion. However, LTC leaders can learn to manage these challenges while decreasing the facility’s turnover rate if they include the following six pivotal points into their overall workforce planning strategy:
1. Advocate progressive human resource management at all levels.
2. Educate employees on how to make accommodations and listen to one another.
3. Focus on organizational learning.
4. Educate department heads on how to manage generational and cultural conflicts, teamwork, and group cohesion.
5. Become the living embodiment by becoming the change you want to see in your employees.
6. Enforce facility policies that promote equality of opportunities, and advocate diversity to mobilize the diverse labor supply and enhance the level of care and services.1,2,6,8,14,15
Failed Strategy in LTC
The likelihood of finding human resource and management training happening at the facility level is extremely unlikely. Rather, facilities are more inclined to facilitate training on topics that are federally and state mandated. LTC leaders have also battled with their inability to create sustainable programs. Surprisingly, LTC leaders also blame the industry’s ever-changing regulatory climate on the inability to maintain sustainable programs. Sustainable staffing and recruitment initiatives must be directed, monitored, and supported at various levels throughout the LTC system. Such assistance includes soliciting help from the facility’s corporation, owners, and state regulatory agencies; many of the staffing and recruitment issues are simply too difficult to manage at the facility level.
Unrealistic recommendations that are impossible to implement in LTC settings are also attributed to the inability to create sustainable programs. Thus, strategies fail because of the following: (1) the organization's culture is inappropriate to meet the challenge; (2) incentives and rewards are not based on performance or competitive achievement; (3) problems exist with traditional silos in the organization’s structure; and (4) challenges are inherent in managing change as the organization adapts to new competitive conditions.16
Conclusion
If LTC organizations aim to recruit and retain employees from the Millennial Generation, they must be prepared to work for it, because these employees are vastly different from past generations. Successful strategy will require LTC organizations to reassess their organizational culture, develop a realistic workforce plan, and educate and train leaders and employees on generational and cultural diversity.
The author reports no relevant financial relationships.
Mr. Brownlee is President of Brownlee and Associates, LLC, San Pedro, CA.
References
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