March 21, 2022

Staffing Level Mandates

by Patrick Bultema, President & CEO

Lately, the aging services news has been dominated by federal pronouncements promising to “get tough” on nursing home standards and enforcement. It’s understandable given the spotlight COVID has put on the density of cases, deaths, and the experience of living in nursing homes during the pandemic.  However, I must confess to mixed feelings on this one. 

On the one hand, we at The Eden Alternative® have been advocating for a better way for quite some time.  We are grateful and inspired by the senior living operators who have been implementing our approach. These folks deserve our admiration and praise during this unbelievably tough season. They are part of the solution.

On the other hand, it’s clear that many nursing homes truly are falling way short of a perfectly reasonable expectation: that residents should be able to live meaningful and full lives, no matter their age or changing abilities. COVID has made the failing of many nursing homes all the more unbearable. But are more regulations and enforcement – “getting tough” - the best answer? That’s hard to unequivocally agree with.

Let’s take one part of the proposed solution: a mandate for increased staffing at nursing homes. Clearly, staff are essential to empowering Elders and supporting lives well-lived. However, some key elements of the call for increased staffing seem to be getting lost in the conversation.

First, it’s assumed that the staff are available. They are not. The truth is, scores of good operators have struggled tremendously to find and hire quality staff, even with extraordinary efforts. Simply put, there is a clear shortage of CNAs, nurses and other key staff. And the pandemic has made matters far worse. This is, of course, a broader societal issue not specific to nursing homes. It hardly seems fair to put the onus on nursing homes to hire more when as a society as a whole, we clearly need to train more CNAs, nurses, and others. It’s a much broader issue that calls for a broader solution.

Second, there is a clear problem with compensation here. Recently, I was driving home from the airport and stopped at a convenience store for gas. On the pumps, doors and pretty much everywhere were “Urgent, Help Needed” signs. The message: “Hiring urgently for all shifts. $17/hr starting, paid vacation, full benefits, matching funded 401k.” It’s a real issue when a person can earn more working a convenience store shift than serving our Elders. I hear the constant refrain coming from many in the industry: we need higher government reimbursement rates. Maybe that’s true. But what is indisputably true is that you can make more working at a convenience store than pouring your life into supporting Elders. Nursing homes alone cannot own this problem. Society must.

And that leads me to my third point: the quality of the work and the quality of the care environment MATTER. A nursing home dominated by an institutional, medical model that treats care as something done to Elders instead of with them is not a place people want to work. Let’s call it what it is: depressing. For decades, Eden fought against the resulting life-threatening plagues of loneliness, helplessness, and boredom we find in these settings.  What’s more, we have been advocating for a common-sense approach of partnering with Elders, empowering them to live the lives they desire, and transforming caregivers and family members to partners in lives well-lived.

If you want to work with and support Elders, how can you feel good about being a part of an operation that makes them feel lonely, helpless, or bored?  You might as well go work at a convenience store where at least the pay is better. From where I sit, one of the big issues of staffing is having a place where staff want to work, let alone a place where Elders want to live, and their families want to visit.

That’s what The Eden Alternative has been about from the beginning. And the numbers prove it out.  One of our exemplary partners is Signature HealthCARE.  A few years back, they published a study in the Journal of Aging Science where they compared staff retention across operations before and after implementing the Eden model. Implementing the Eden approach resulted in a 24% reduction in staff turnover. This is the case in many of our partner organizations. Recently, I was visiting the C-Suite of another residential senior living operator. They told me that in their “Eden” communities, they had half the staff turnover rate that they had in their non-Eden communities, and that they had a waiting list of staff who wanted to transfer to the Eden communities. These are places staff want to work.

It's easy to see it working. On a recent visit to an Eden-affiliated community in Mississippi – SentryCare – I had a chat with a young man who was working as a CNA. SentryCare has been an Eden practitioner since the late 90s and CEO Chris Cheek is Chairman of the Eden Alternative Board. As I learned this young man’s story, it was obvious where his joy came from. He was raised by his grandmother and had so much appreciation and respect for her as a wise Elder. And so it was a joy for him to earn a living building relationships and partnering with other Elders to help them to live the lives they desired. Honestly, I was so inspired. His passion was predicated on doing right by the Elders he was partnering with in an environment that invests in it. At SentryCare, the character, values, and quality of the environment matters not just to the Elders and their family, but to their staff as well.

Mandating increased staffing at nursing homes may seem like a no-brainer. But it’s clear to me we must get smarter about what that means when there are no people to hire because they can earn a better living elsewhere. And those that are working hard day in and out may be doing so in an environment that fosters suffering. If you’re asking hard questions about how you ‘fix” your staffing problems, why not give Eden a call?

We’d be happy to help.