Agency Staffing Survey Reveals Acute Labor Shortage

MITC recently conducted a staffing survey in which 137 agencies employing nearly 40,000 staff from across the USA participated. The majority of agencies have reviewed hiring, retention, and scheduling to try and manage the situation better.

Across the board, from smaller agencies with less than 50 staff to the largest providers with over 2,800 employees, agencies reported an excessive number of open positions, primarily for direct support professionals. The average agency employed 320 staff when fully staffed and had 25 open positions, or nearly 8% of all positions open. The total number of open positions was over 3,000.

Struggling to deliver vital services to a vulnerable population, agencies have responded by authorizing, or at least paying, more overtime. Of the agencies who participated in the survey, 65% reported overtime was higher than they wanted.

Turnover rates varied quite a bit, indicating that some agencies may be doing a better job with retention practices than others. Some agencies in South Carolina, North Carolina, Indiana, and Illinois reported turnover rates for direct support professionals as high as 80%. Turnover carries both direct and indirect costs. Turnover costs include:

  • Additional overtime for other staff to cover vacant positions
  • Lost billing if services cannot be delivered
  • Management and HR time to interview, hire, and on-board replacements
  • Training time and costs

Direct costs related to HR issues, such as off-boarding administration, recruitment and replacement hire activities, and fill-in staffing. Less obvious, but no less costly, are the negative impacts to staff morale, productivity, and performance, which can lead to the potential for adverse client outcomes and diminished quality of client care.

On the other hand, agencies in Maryland, New York, and Pennsylvania reported turnover rates under 10%. Not surprisingly, the agencies with the lower turnover rates were in states where paying around 20% higher pay rates for direct support professionals is feasible, but pay is probably not the only difference between agencies.

Ways to Improve Retention and Hiring Rates

Almost all agencies participating in the survey have taken steps to improve retention and hiring. Steps taken included:

  • Better applicant screening to concentrate resources on those most likely to stay
  • Emphasizing total compensation value, rather than hourly rate
  • Improved, more organized on-board training
  • Referral hiring bonuses
  • New hire bonus on completion of training
  • Mentoring programs
  • Buddy programs
  • Annual review of retention and on-boarding process
  • Awards, award trips
  • Employee appreciation days and events
  • Contests
  • Gift cards
  • Monthly staff newsletter
  • Graduated pay scales with incremental increases
  • Shift differentials
  • Early access to benefits
  • Creating new positions to focus on hiring direct support staff
  • Working with local colleges, such as nursing schools
  • Developing career ladders and career paths
  • Profit sharing

Using small bonuses to thank employees is common. For example, one agency with a large number of group homes has a monthly attendance competition. The group home with the best attendance record gets a pizza party at their location.

Providing adequate training makes sense. Inadequately trained staff members are more likely to leave. We recommend agencies provide opportunities for people to improve their skills via training sessions, presentations, and team assignments. Employees like to share what they know; the act of teaching others ensures the employees own learning.

Apart from pay, agencies reported problems with the quality of applicants among those who are available. Common problems were:

  • Applicant can’t pass drug and background checks
  • No-shows for interviews and training
  • No relevant skill sets
  • Failure to complete training successfully
  • Poor concepts of attendance responsibilities

How Scheduling Can Help Retention

Of all the agencies participating in the survey, 42% are considering new scheduling systems. This makes sense. With more open positions, agencies are forced to move staff around more. As well as minimizing overtime, improved scheduling practices can also help with retention.

Unfortunately, one of the biggest complaints employees have is lack of advance notification and planning for schedules. Poor scheduling or last minute schedule changes can cause conflicts with employee’s home lives and cause them to seek alternative employment, even at a lower pay rate. Frequent rescheduling leads to a culture of frustration and uncertainty in your workforce, and encourages absenteeism and turnover. A DSP will be much less motivated to show up if they are constantly being rescheduled, especially at short notice, even if they get overtime.

When scheduling employees, it is important to track employee preferences and restrictions to maximize employee satisfaction with their shifts, and to avoid calling employees to fill an open position they can’t take. MITC recommends integrating capturing schedule preferences and restrictions into the new hire procedures. Allowing sufficient time between shifts for employees to go home and rest helps as well. Try to avoid calling employees who have just finished a shift back in.

Using text/email reminders to notify employees of their next shift with instructions of what they are meant to do can also reduce absenteeism and helps motivate employees. Using task scheduling to assign employees specific duties creates a check list for them to tick off. People like to know what they are meant to do.

Planning for holidays well in advance can minimize overtime and avoid disruption. Even though DSP’s get extra pay for working on a holiday, few want to work on a holiday. Planning holiday schedules well in advance will lead to greater satisfaction and better attendance.

Using scheduling and time & attendance to monitor frequent offenders helps identify employees who regularly show up late, leave early, or call in sick, and set a bad example to other employees. This in turn, causes lower productivity and overtime.

As well as working on the hiring and retention process, agencies reported that they had changed some of their scheduling practices by:

  • Investing in new scheduling software
  • Allowing different sites greater flexibility in how they schedule staff
  • Introducing rotating weekend shifts (one on, one off)
  • Creating more full-time positions
  • Increasing the number of part-time staff
  • Creating dedicated scheduler position(s)
  • Monitoring hours to ensure employees get a break to avoid burn out
  • Implementing longer shifts on fewer days
  • Using salaried staff to cover open shifts

Empower Employees Through Self-Service

Improved employee self-service can also help with retention and improve productivity.

Try publishing schedules on the internet. Allow employees see their schedule for the week and who they are working with, open positions, check their timesheets, view PTO balances, and more. This saves time for you and your staff. Empower employees to request PTO online. This avoids employees getting frustrated if they end up playing telephone or email tag with their manager and saves everyone time. Once employees are used to looking at your website, use the website to make organization-wide announcements and engage your employees in your projects.

Use automated text or email alerts to remind employees about license expirations, upcoming training, reviews, and more. Sending automated happy birthday and anniversary greetings all help. An HR email blast can keep different groups of employees updated about changes that affect them. Simple emails of praise at the completion of a project, monthly memos outlining achievements of a team to the wider division, and peer-recognition programs are all ways to inject positive feedback into a workforce. Also, consider reporting accomplishments up the chain. A thank you note to the employee is good, but copying higher-ups makes that note even more effective.

Employee Recognition Can Make All the Difference

Make sure your agency is on top of review dates and provide career paths for DSP’s. Employees want to know where they could be headed and how they can get there. Annual reviews or mid-year check-ins are one obvious venue for these discussions, but also encourage workers to come to HR with career questions and wishes throughout the year. Employees like to feel like their hard work is being rewarded. Part of making sure your employees feel this way is giving DSP’s the opportunity to achieve the non-tangible benefits of recognition and advancement. Reward exceptionally smart, resourceful, and hard-working DSP’s by gradually increasing their responsibilities and giving them more important titles. A DSP who’s advanced from an entry-level position to a manager role is much more likely to be loyal than one who’s done the same job for years.

It’s not enough to simply offer the potential for advancement — it’s also important to make sure that DSP’s understand how they can advance in your agency. Provide DSP’s with written guidelines on what factors will help them advance, such as good attendance records.

Try to promote from within your agency workforce, rather than recruiting outsiders. While this may sometimes be unavoidable, hiring an outsider to fill a vacancy when there are qualified employees with years of experience who could conceivably do the job can give the impression that you don’t care about your employees’ accomplishments.

Lastly, conduct exit interviews. If they don’t yield enough information to help solve a retention problem, consider asking longer-tenured employees why they stay. Ask questions such as: Why did you come to work here? Why have you stayed? What would make you leave? And what are your nonnegotiable issues? What about your managers? What would you change or improve?

While there are no quick fixes for turnover, making a few key changes can increase caregiver retention and help alleviate the challenges agencies face by caregiver shortages.

Agencies Speak Out on Scheduling

With restricted funding, labor shortages, and state and federal mandates continuing to pressure providers, human service agencies need to use their limited human and financial resources as efficiently as possible.

Ineffective employee scheduling directly impacts labor costs, productivity, and an agency’s ability to operate within budget. Effective scheduling solutions improve manager productivity and enable managers to make more informed scheduling solutions, while eliminating the inefficiencies inherent to a paper scheduling system.

In this article, agencies across the United States share their experiences using an automated time & attendance solution, how they implement optimal scheduling practices, and the benefits of effective scheduling.

An effective automated scheduling solution can improve efficiency and organization at an agency. Community Living Connections is a non-profit agency founded in 2004. With 300 staff providing community supported living services to approximately 200 individuals in Wisconsin, CLC supports individuals to live in their own homes and participate in community life, providing in-home staff to help with planning, personal cares, medical support, finances, relationship building, and more.

The Senior Scheduling Manager at Community Living Connections, Stephanie Stringer, has seen improvements since automating scheduling practices, “It is liberating to have schedules accessible, accurate, and up-to-date. Employees can check schedules from anywhere, which makes it easy.”

The benefits have been numerous, “I know how important it is for our systems to run well and be up-to-date. CLC can really have flawless transitions between shifts. This helps the employee be less anxious. Employees have said it’s a huge relief to know that they aren’t going to have to work late. Those comments usually come from people who previously worked at another agency or remember how it used to be here prior to MITC with unreliable schedules. Even my boss thinks what MITC and centralized scheduling have provided has given so much consistency and reliability to the function of the agency.”

Developmental Services of Dickinson County supports over three hundred adults and children in a variety of home and community-based service settings in central Tennessee. The agency employs over 280 staff working in eight counties with an annual operating budget in excess of $9.0 million. The agency manages 3 day programs, 30 smaller group homes with 2 beds, and a home and community-based service program.

Barbara Brandon, Team Manager, and Amber Donegan, Payroll & Benefits Coordinator, have improved scheduling practices at Developmental Services. Prior to using MITC, “Managers maintained schedules in excel. Whoever was on call had to flip through pages and pages of schedules and employee information that may or may not have been updated to find people to cover shifts. MITC gives managers more opportunity to see what’s actually going on. We have a weekend supervisor who covers on call shifts. Working with accurate schedules saves a lot of time. We have cut down on wasting time with phone calls and avoid calling people to cover a shift who are already working.”

Some agencies perform scheduling in a centralized manner, with a dedicated individual or department put in charge of all scheduling concerns. Community Living Connections has a scheduling department overseen by Stephanie Stringer. “In our scheduling department, we have 3 people. I supervise and direct a Scheduling Manager and a Scheduler under me. We roll out schedules 2 months in advance for all employees. Supervisors are each in charge of a certain number of locations, and are ultimately responsible for shifts that aren’t filled at their locations. We meet twice a week with the three teams of supervisors to discuss scheduling and open shifts. I talk with teams monthly at their individual team meetings as well.”

“Overall, centralized scheduling is really a relief and tool that frees people up to do other aspects of their job. We ask employees and other staff not to do certain functions in MITC to allow the scheduling department to be responsible for most updates. This works better for us because too many hands being involved increases the chances of mistakes. I find our department needs to micromanage to a certain extent just to make sure no one makes a mistake that we are unable to track. Some might see it as obstructionist, but it prevents mistakes that would be even more cumbersome to correct,” according to Stephanie with Community Living Connections.

Gateway Services started in 1970 in an abandoned schoolhouse in Malden, Illinois, staffed by a crew of three, one program, and $34,000. Today, Gateway has grown to support 10 programs, 2 main locations with day programs, 6 group homes, home-based supports, and acts as the administrator of BPART (a transportation program). During its long history, Gateway Services has had to implement many changes. One of the latest was to implement a new workforce management, payroll, and financial system.

“Our accounting assistant maintains the staff schedules. The schedules are used to ensure everyone has only 40 hours scheduled. This allows us to produce the early overtime warning report. This report gives us the opportunity to minimize overtime. The benefit of putting in the schedules is we can cut staff hours to reduce overtime where we can,” according to Mandi Johnson, CFO with Gateway Services.

Mandi believes Gateway is still working toward the ideal scheduling system, “We didn’t force management to do things. In my opinion, schedules should be set up 4-6 weeks in advance with adjustments made as needed. We have one program that won’t do that. They start from scratch every 2 weeks. If we’d have said, “you’re going to do it this way and that’s it” things would have been smoother.”

Developmental Services of Dickson County gained time to focus on other tasks after implementing a scheduling solution, “Using scheduling with MITC makes your life a whole lot easier, especially when you have a lot of employees on the payroll side. I’ve been able to do a lot more accounting work that I didn’t get to do before. I can’t imagine the headache without MITC. MITC is a huge timesaver overall to everyone in administration.”

According to Stephanie Stringer, “When I first joined CLC, 50-60% of calls to the eCell manager were scheduling questions from employees! We found that our paper copies of schedules posted in the houses were inaccurate or not up-to-date. Once we started training and getting staff used to looking online for themselves, calls to the on-call phone were greatly reduced. Keeping schedules accurate and verifying assigned shifts has been much easier. The number of calls pertaining to scheduling are rarely an issue. On-call scheduling questions are seldom brought up as a problem in our bi-weekly meetings.”

“Developmental Services has definitely saved time on the approving of payroll. We have better control of what employees are actually doing as compared to schedules.”

MITC scheduling offers additional features to improve agencies’ operations.

“We use MITC availability selection criteria to help fill open positions. MITC allows CLC to screen or filter for available employees. All of our managers have access. We use MITC scheduling daily,” says Stephanie Stringer.

Agencies have the option to give employees access to schedules. Stephanie Stringer shared that, “Community Living Connections allows employees to view their timesheets and make edit requests. Employees can view and request PTO through their calendar. Employees cannot edit their own information or restrictions.”

Most employees are able to benefit from self-service. “There are a handful of folks who struggle with self-service. It is largely because they are in a certain age range or lacking tech savvy. A good 90% of staff understands how to use MITC and use self-service,” according to Stephanie Stringer with Community Living Connections.

Developmental Services also gives employees access to self-service. “Employees use self-service, and the employees that I’ve talked to like having the access to it. Since we’ve started doing scheduling on the web as well, they can see schedules. We have an issue with PTO on our midnight shift, because it’s hard to know which day they really want off. We haven’t enabled PTO requests online for this reason. We have 10 people we support who work for us and they use client timesheets.”

Gateway Services has experienced reductions in overtime since implementing a time & attendance and scheduling solution from MITC. Mandi Johnson, CFO shared that, “Three years ago, overall overtime was 23%. Now it’s down to 5.77%. In the CILA program it is now 11.23%, down from 36% due to using scheduling and early overtime reports. At first, I ran reports and would give mangers notes about which employees were in danger of going over. They would look at schedules and adjust them as necessary to prevent overtime. Now, managers are on the web checking daily reports themselves.”

Scheduling can assist in reducing overtime, however the nationwide staffing shortage has made many agencies reconsider their ability to focus on overtime reductions.

According to Stephanie Stringer, “In certain households, when there is a good pool of staff, CLC would be able to control the flow of overtime. It’s a great idea, but with our staffing shortage, reducing overtime isn’t a priority. We are happy to contain it! We’ve weighed whether it’s ok to go with the overtime, decided it is, and we build a percent into the budget to pay for it.”

Barbara and Amber with Developmental Services agree, “We haven’t seen reductions in overtime because we’re short staffed right now. We’re down 30 people currently. Overtime might have been higher than what it is today without scheduling. It is helpful to see at a glance how many hours employees are scheduled for to make sure the agency isn’t giving any one employee more overtime than anyone else.”

There are benefits of an MITC Solution that Stephanie at Community Living Connections had not experienced previously. “I was in a similar role at a different agency doing the same type of work prior to coming to CLC. In that job, all schedules were Excel spreadsheets. I was responsible for having 25 schedules up-to-date and ensuring they were understood. After starting this job at CLC, I thought “if I’d have had MITC, I never would have left the other job, and it would have been so much better. I have worked with other scheduling systems. We get some mixed reviews from managers. Scheduling can be the scapegoat, and be blamed as the reason people are frustrated.”

She continues, “I prefer just a few people working with schedules as opposed to every single manager. Their real function as a manager is the advocacy and care of clients and the supervision of staff. Managers take these jobs because they want to work with people, certainly not to spend their time on scheduling.”

Staff Shortage Gets Worse

Acute shortages of home care workers are occurring all over the country, threatening care for people with disabilities and older adults. Many agencies are struggling with retention and scheduling as a smaller pool of workers are increasingly moved around to cover open positions.

In Minnesota and Wisconsin, nursing homes have denied admission to thousands of patients over the past year because they lack essential staff, according to local long-term care associations. In New York, patients living in rural areas have been injured, soiled themselves, and gone without meals because paid caregivers aren’t available, according to testimony provided to the state Assembly’s health committee in February. In Illinois, the independence of people with severe developmental disabilities is being compromised, as agencies experience staff shortages of up to 30 percent, according to a court monitor overseeing a federal consent decree.

The emerging crisis is driven by low wages, mostly funded by state Medicaid programs, and a shrinking pool of workers willing to perform physically and emotionally demanding work. It portends even worse difficulties to come. America’s senior citizen population will swell to 88 million people in 2050, up from 48 million currently, and requires more assistance with chronic health conditions and disabilities, experts warn.

“If we don’t turn this around, things are only going to get worse,” said Dr. David Gifford, Senior Vice President of quality and regulatory affairs for the American Health Care Association, which represents nursing homes across the U.S.

Rising Demand, Stagnant Wages

For years, experts have predicted that demand for services from a rapidly aging population will outstrip the capacity of the direct care workforce.

The U.S. Bureau of Labor Statistics estimates an additional 1.1 million workers of this kind will be needed by 2024 — a 26 percent increase over 2014. Yet, the population of potential workers who tend to fill these jobs, overwhelmingly women ages 25 to 64, will increase at a much slower rate. Falling immigration and refugee rates may make the situation worse.

After the recession of 2008-’09, positions in Medicaid-funded agencies were relatively easy to fill. Now, however, the improving economy has led these workers to pursue other higher-paying alternatives. Turnover rates have soared.

At the same time, wages for nursing assistants, home health aides, and personal care aides have stagnated, making recruitment difficult. The average hourly rate nationally is $10.11 — a few cents lower than a decade ago, according to PHI, an organization that studies the direct-care workforce. There is a push on now in a handful of states to raise the minimum to $15 an hour.

Hardest to cover are people with disabilities or older adults who live at some distance from a city center and need only one to two hours of help a day. Workers prefer longer shifts and less time traveling between clients, so they gravitate to other opportunities.

Hard Times in Wisconsin

Some of the best data available comes from Wisconsin, where long-term care facilities and agencies serving seniors and people with disabilities have surveyed their members over the past year.

One of seven caregiving positions in Wisconsin nursing homes and group homes remain unfilled, one survey discovered; 70 percent of administrators reported a lack of qualified job applicants. As a result, 18 percent of long-term facilities in Wisconsin have had to limit resident admissions, declining care for more than 5,300 vulnerable residents.

“The words ‘unprecedented’ and ‘desperate’ come to mind,” said John Sauer, president and chief executive of LeadingAge Wisconsin, which represents not-for-profit long-term care institutions. “In my 28 years in the business, this is the most challenging workforce situation I’ve seen.”

Sauer and others blame inadequate payments from Medicaid — which funds about two-thirds of nursing homes’ business — for the bind. In rural areas, especially, operators are at the breaking point.

“We are very seriously considering closing our nursing facility so it doesn’t drive the whole corporation out of business,” said Greg Loeser, chief executive of Iola Living Assistance, which offers skilled nursing, assisted living, and independent living services in a rural area about 70 miles west of Green Bay.

Like other short-staffed operators, he’s had to ask employees to work overtime and use agency staff, increasing labor costs substantially. A nearby state veterans home, the largest in Wisconsin, pays higher wages, making it hard for him to find employees. Last year, Iola’s losses on Medicaid-funded residents skyrocketed to $631,000 — an “unsustainable amount,” Loeser said.

Wisconsin Gov. Scott Walker has proposed a 2 percent Medicaid increase for long-term care facilities and personal care agencies for each of the next two years, but that won’t be enough to make a substantial difference, Loeser and other experts say.

The situation is equally grim for Wisconsin agencies that send personal care workers into people’s homes. According to a separate survey in 2016, 85 percent of agencies said they didn’t have enough staff to cover all shifts, and 43 percent reported not filling shifts at least seven times a month.

These staff shortages are making it more important that agencies have the right workforce management tools to help with employee retention and manage the changing schedules of a shrinking workforce. To learn more about how workforce management can help your agencies minimize turnover and improve retention rates, contact MITC.