Finding the right candidates – Staffing S.O.S. #4: Solutions to the Workforce Crisis in Long-Term Care Recruitment

This is the 4th of a series of 6 articles about recruitment, retention and culture in long term care. Each of these issues – retention, recruitment & culture – has a direct bearing on the staffing crisis in the sector. There are no easy fixes, and only careful, disciplined approaches will have long-term, beneficial effects. These articles address leadership and systems, and are based on the best available organizational, behavioral and psychological research.

To address your staffing crisis, contact Stackpole & Associates: istackpole@stackpoleassociates.com or call +1-617-719-9530

“Fish where the fishes are”
Recruiting workers

Recruiting staff in long-term care is hard, in part because turnover is so high. In a workforce crisis, the first order of business is to stop the losses. The second urgent need is to attract more good job candidates.

There are two practical ways to look at recruitment:

1. How to attract new employees (“Getting them through the door”)

2. Where to find new employees (“Fish where the fish are”)

This article is about where to find new employees for long term care – “Fish where the fish are.”

Who are they – and where are they?

In the prior article on recruitment, Why frontline caregivers take their jobs, we described the general features of the nursing assistant (NA) workforce in long-term care: [1] [2]

• Women (90%)
• White, (62%), Hispanic (14%), Black (10%), & immigrant
• ~20% hold more than one job
• 60% are juggling childcare and adult care roles
• 18% of NAs live below the Federal Poverty Level (twice the national average)
• 63% of NAs have less than $25,000.00 in assets; 61% have no discretionary income
• 36% rely on some form of public assistance.
• 55% are single; 42% are married.
• Rely on public transportation to commute to work; ride-sharing is common.

How would they hear about, or look for jobs?

Given these characteristics (above), how would these employee prospects learn about open jobs at your nursing home or home care agency? This is a simple question without a simple answer! There aren’t simple answers, because there are different profiles among employee prospects. There are multiple personality profiles (personae) that describe the workforce.

Consider where and how these different people would come to know about openings in your
long-term care operation. For example:

This is not exhaustive, but intended to show that Career Caregivers are not going to hear about your job opening on TikTok, and Young and On the Move are not listening to the AM radio station that Empty Nesters are. And most importantly, and regardless of what the sales representatives say, there is no” one size fits all” job posting channel that will capture the variety of your audiences. And there is certainly no one-best message.

Current Employees

Referrals from existing employees are an excellent channel for finding and recruiting new staff. Many organizations use an employee incentive program to encourage these referrals. Unfortunately, while the research on how these programs should be structured is very clear, most long-term care organizations, once they have established a “referral bonus” for example, little
more is done to change or find tune this process. This is an error. If your organization has a referral incentive in place, and you are dissatisfied with the number or type of referrals being made, the steps to remedy the situation are:

• Eliminate the program and tell all the employees that you are doing away with the referral incentive program because it is not working (change should be “public”)
• Recruit 3 to 5 staff members to sit down and talk about what would constitute good incentives for the referral program. This discussion should not be limited – let the employees speculate, but make it clear that because they think of it, it may not necessarily be implemented!
• Take one of the ideas that is economically feasible, and implement it in a very public way. (Is not your idea after all!)
• Allow this incentive to function for 2 to 3 months, and then implement another one.
• Rinse, and repeat.

What the research shows is that varying incentives is much more effective than having a single, established plan that goes on without change. The second principle is to make the program very public (all the staff should know about it, and that the ideas came from them).

Segment to Succeed

To succeed at recruitment a segmented approach is necessary, by which we mean different audiences need different messages and often different images, as well.

From the last article: How to get prospects in the door, remember why frontline caregivers take their jobs:

• Empathy
• Altruism
• Location
• Flexibility
• Need to be needed
• Purpose

And what’s NOT on the list

• Prestige
• Pay

Competition for job candidates – especially nursing assistants (NAs) – is extremely high in most marketplace areas, so your recruitment channel selection and messages need to be smarter and more efficient than Amazon, Walmart, or McDonald’s.

Motivation falls into two categories: 1. Extrinsic (e.g., pay, benefits, flexible schedule, or location), and 2. Intrinsic (e.g., empathy, altruism, or friendships).

Extrinsic motivations – especially pay and benefits for nursing assistants – are less compelling than other jobs in the same marketplace area. So, among extrinsic motivators, flexible schedule, benefits and location are more emphasized.

Matching the motivation and the message

Since the extrinsic motivators of pay and prestige , for example, cannot be promoted effectively for most of these jobs, it’s important to focus on the altruistic or purpose-based motivations, and match your messages, and pictures to these human emotions.

[1] J Am Geriatr Soc 68:1657-1660, 2020.  https://doi.org/10.1111/jgs.16509

[2] Kurtyka, B. & Dombi, B. The State of The Direct Care Workforce 2022-2023. National Association for Home
Care & Hospice. See: https://bit.ly/3LNDurW