Questions I frequently receive are “How’s staffing?” and “Are we able to fill open positions? These are right and good questions and, appropriately, considered as part of our strategic plan, Portrait of the Future, and our initiative to be an employer of choice in the Charlottesville area.
Let’s take a look at some of the macro-trends impacting the workforce and review some of the measures WCBR is taking to address those challenges.
Demographics and Trends
The U.S. population is aging.
In 2030, the U.S. will reach a demographic turning point — all baby boomers will be above 65 years of age, making one in every five Americans of retirement age. Furthermore, the U.S. Census Bureau has projected that by 2034, people aged 65 years and older will outnumber those aged 18 and younger for the first time in U.S. history. As growth of the population age 65 or older outpaces growth of younger age groups, the population is projected to continue to become older.
The U.S. population growth is slowing.
U.S. Census Bureau Vintage 2021 population estimates reflect that the country’s population grew only 0.1% in 2021, the slowest rate since the founding of the nation, exacerbated by the COVID-19 pandemic.
The Congressional Budget Office projects that population growth will slow from historical rates between 2023 and 2053, averaging only .3% per year during that period. As birth rates remain below the replacement rate, population growth is increasingly driven by immigration.
Generally, life expectancy in the United States improved in the 20th century, however, recent data shows some reversal due to the pandemic and other increases in mortality due to suicide, homicide, drug overdoses, and lifestyle habits that tend to correlate with an increase in diabetes and heart disease.
The U.S. population is racially and ethnically more diverse.
Not surprisingly, this trend is related to immigration being the primary driver of population growth in the U.S. According to the U.S. Labor Department, foreign‑born workers account for the majority of growth in the U.S. workforce. Immigrants are more likely to be in the workforce, either as employees or active job seekers, than native‑born Americans (6% vs. 1%, respectively). Charlottesville is home to one of 28 International Rescue Committee offices in the U.S. The Daily Progress recently reported that the Charlottesville office has welcomed some 150-250 refugees annually to the region over the past 10 years.
Nurses are leaving the profession faster than they are being replaced.
A recent report from CliftonLarsonAllen LLP (CLA), an audit and consulting firm with a senior living practice, estimates that skilled nursing homes will need an additional 102,154 full-time equivalent nurse hires to accommodate the staffing requirements recently proposed by the Biden administration.
Significantly, from the start of the COVID-19 pandemic to December 2022, nursing facilities lost a total of 210,000 jobs. As of September 2023, only 90,400 jobs have been gained back. In January 2023, the American Health Care Association (AHCA) published their State of the Nursing Home Industry report. 77% of survey participants reported moderate to high levels of staffing shortages. 24% further reported closing a unit, wing, or floor due to the labor shortage.
This fall, the Virginia Health Care Association, the state affiliate of AHCA, conducted a similar survey of 170-member nursing homes and found that 44% had put admissions on hold at least once since June 1, 2023, due to staffing challenges; 31% indicated that they received few or no applications for open job postings; and over 90% have asked employees to work overtime or extra shifts.
Virginia has also passed new minimum staffing requirements which will be effective in 2025. While the federal requirements focus on RN coverage, the Virginia minimum staffing requirements consider the daily average hours of RN, LPN, and CNA coverage per resident. Details are to be worked out in the regulatory process. WCBR staffing far exceeds the proposed daily average of nursing time per resident.
The Centers for Medicare & Medicaid Services (CMS) data already shows that the number of nursing homes has dipped below 15,000. While occupancy has increased since the pandemic, some properties have been forced to keep census down in order to be able to provide staff for the rising number of higher acuity patients. Many are concerned that areas with fewer available nursing staff will find it impossible to fulfill mandated staffing levels and be forced to close their doors for good.
For those that can staff their nursing facilities to meet the new federal mandate levels, significant financial hurdles will remain. CMS estimated that it will cost the industry $4B to meet the new standards. CLA, using more current cost reporting information, estimates that the cost will be closer to $6.8B. As inflationary pressures and wage increases mount, ever tighter operating margins are causing concern among industry operators.
Other workforce issues, such as the lack of nursing faculty and supervisors for clinical placements, have resulted in a record number of qualified applicants being denied admission to nursing schools across the country. According to a survey of 909 nursing schools released in October 2022 by the American Association of Colleges of Nursing, a total of 2,166 full-time faculty vacancies were identified in schools offering baccalaureate and/or graduate programs. In another report, the association indicates that 66,261 qualified applicants were denied acceptance to baccalaureate programs in 2022 due to faculty shortages.
Then, following graduation, some may face longer than normal processing times to receive their license due to workforce shortages within state licensing departments. This, coupled with the number of nurses retiring or planning to leave the industry altogether, has made it difficult to keep nursing facilities fully staffed even before the proposed mandate.
Implications and Opportunities
The demand for employees has outstripped supply since the beginning of the pandemic and does not appear to be letting up any time soon. In fact, demographic trends combined with increased regulatory requirements all but ensure that the staffing challenge will become more difficult, not easier. There are, however, a number of factors that can positively influence retention, recruitment, and career choices.
Work culture and environment
Perhaps the most significant influence on retention is that of ‘company culture.’ A 2019 study by Glassdoor found that nearly two-thirds of employees cited a good company culture as one of the main reasons they stay with an organization.
As part of its goal to be an employer of choice, WCBR committed to measuring workplace culture by partnering with Great Place To Work® (GPTW) in 2022. GPTW is considered a leader in measuring workplace culture. WCBR conducted surveys in 2022 and 2023 and will conduct the survey again next spring. To be certified a Great Place to Work®, organizations must achieve an average score of 65% or better on all survey statements. WCBR nearly achieved this certification with a 63% average score in 2023, an 8% increase from its initial score of 55% in 2022. WCBR utilizes the survey to identify areas for improvement, as well as areas of strength, and develops action plans for continuous improvement.
Creating a sense belonging is an important contributor to a healthy culture. Important work has been done and will continue in the area of diversity, equity, and inclusion (DEI) for associates and residents. The strategic plan includes a DEI initiative that has resulted in the development of an Inclusive Excellence Plan that recognizes, values, and supports a WCBR community that is welcoming to all. In fact, a Diversity, Equity, Inclusion, Accessibility, and Belonging (DEIAB) Steering Committee will be proposing a revision to WCBR’s Values that will include belonging as an organizational value. (More on WCBR’s values will appear in a future edition of Happenings).
Training and development
Investing in associates’ development supports retention, career path growth and general enhancement of skills, sense of pride, and accomplishment. WCBR and the WCBR Foundation support development in many ways.
The WCBR Foundation continues to support WCBR’s associates through The Newton and Wilma Thomas Education and Workforce Development Fund. Programs include scholarships to attend accredited schools; student loan repayment assistance; financial support for conferences, workshops, and licensing or certification beyond minimum employment requirements; and individual or group training programs to grow knowledge and skills.
Also, with WCBR Foundation support, leadership development workshops were provided to managers and senior leaders. More training is being planned for supervisors this year. LeadingAge Virginia, the state association representing not-for-profit senior living communities, offers a ‘mid-manager’ training series and WCBR had several supervisors complete the program. Skills and leadership of supervisors are critical to frontline associates’ satisfaction with work.
An important component of meeting ‘demand’ is increasing ‘supply’. WCBR offers a number of formal and informal training and mentoring opportunities. In recent years, WCBR staff have mentored students in clinical pastoral education, dietetics, human resources, long-term care administration, medical records, nursing, recreational therapy, and social work. These mentoring opportunities keep our knowledge and skill sets high by engaging with students and providing recruitment opportunities and career ladders for internal growth.
We continue to pursue partnerships and initiatives with local vocational and educational institutions to provide a clinical site, internships, and other workforce development opportunities. We are pleased to team up with Piedmont Virginia Community College (PVCC) to provide third semester LPN students and first semester RN students with placements at WCBR.
Exposing high school students to the benefits of working with older adults is vital. This year, we were pleased to re-engage with Fluvanna High School’s CNA program and plan to receive students in spring 2024. For jobs that do not require degrees but do require specialized skills, WCBR is taking a close look at professional development courses that can be offered to train or upskill team members, e.g., HVAC technicians.
While not employees of WCBR, we also invest in the future of the profession by hosting medical trainees from the University of Virginia (UVA), from summer scholars in their premedical years to Internal Medicine residents and Geriatric fellows. These third- and fourth-year students work closely with geriatrician and WCBR Medical Director, Dr. Brad Murray, to provide care in WCBR’s clinic and care areas. UVA’s Geriatric Medicine Division is one of the major participants in the PACLAC (Preventative, Acute, Chronic and Longitudinal Ambulatory Care) rotation in the third year, which is the first year UVA medical students practice clinical medicine. Prior to that, most learning is done in a classroom or simulated environment. WCBR is the perfect place for curious students to meet older adults who have had a lifetime of interactions with the healthcare system. WCBR hosts two students at a time for approximately six weeks, so that they can observe residents and community-admitted patients in various states of health. WCBR offers a rich learning environment, and residents are very generous with their time and advice for these early career physicians. This rotation through WCBR is consistently ranked among students’ favorites. Many return for a two-week elective rotation in their fourth year, when they can expand their knowledge in geriatric principles of medicine.
Training and development not only enhance current skills but helps to support a pipeline for future careers in the field.
Wages and benefits
Wages and benefits comprise approximately two-thirds of WCBR’s budget. This is not surprising given that WCBR budgets for approximately 270 full-time equivalents, which represent over 300 full- and part-time associates. Having a compensation structure and competitive wages and benefits are an important part of recruitment and retention efforts.
WCBR is also committed to regularly evaluating compensation and uses consultants and other resources to help manage this important component of its budget. In 2021, WCBR began planning to meet then Virginia Governor Northam’s proposed minimum wage increase of $15/hour by 2026. Though implementation of the bill was delayed, and the minimum wage currently stands at $12/hour in Virginia, WCBR implemented the $15/hour minimum in 2022. The wage adjustments for associates at or near $15/hour also included compression adjustments. Wage increases are considered annually during the budget development process and presently begin at $15.45/hour for a new hire with no experience in select positions. Most new hires begin above the minimum, however, based on work-related experience and other credentials. These wages are competitive with other large employers in our market.
WCBR provides a generous benefits package for full-time associates. These include health, vision, and dental insurance; paid time off; 403(b) retirement plan; life; and long- and short-term disability plans. Additionally, associates (including part-time associates who work 1,000 hours annually) may choose to participate in Flexible Spending Accounts for dependent childcare expenses and medical expenses not coverage by insurance. And as previously noted, WCBR is able to offer educational scholarships, student loan assistance, emergency assistance, and other support through the WCBR Foundation. Recognition events, service awards, use of the fitness center, discounted meals, free parking, and the annual resident holiday gift fund are also ‘benefits’ of working at WCBR. An area that WCBR will need to further evaluate is the extent of benefits offered to part-time associates.
Technology is affecting the future of workplaces and the workforce. For some, technology is a welcome enhancement for reducing repetitive tasks and improving quality; for others it may stimulate a career change, or even retirement.
WCBR continues to adopt and enhance its use of technology to support care and services. Most recently, a Technology Strategic Plan was developed and presented to the WCBR Board of Trustees. The Plan includes the formation of two administrative workgroups: a Data Analytics Committee and an Innovation Technology Committee. The latter will evaluate the selection and adoption of various technology projects.
Examples of recent technology enhancements include upgrades to the electronic medical record (EMR) in the Health Center; replacement of the nurse call/emergency call system across the campus; installation and implementation of a two-way (resident-associate) communication system in the Health Center; the use of Bluetooth-enabled blood pressure devices and scales in the Health Center which populate results directly into the individual’s EMR; and implementation of Touchtown® for associates which allows associates to access payroll and benefits information, general announcements, the Associate Handbook, and other information.
Some future technology enhancements include full deployment of the EMR in Catered Living and Vista and selection of an EMR for the Clinic; replacement preventative maintenance software; and further evaluation of software to support dining services operations.
The use of technology will require training and support to ensure successful implementation.
Making it easier to work
The CDC reports that in 1970, the average age an American woman had her first child was 21.4 years. In 2000, the average increased to 25 years of age. The most recent census data indicates the average age is now 30. This trend in delayed childbirth is resulting in a significant number of employees (primarily women who more often serve in caregiving roles than men) who are becoming members of the “sandwich generation” in which they find themselves caring for both children and parents.
A recent Harvard Business School study, The Caring Company, indicates that caregiving roles are growing among U.S. workers, with 73% having caregiving responsibility for a child, older parent, or family member living with a disability. Similarly, results of the AARP Understanding a Changing Older Workforce survey indicates that 53% of employees between the ages of 40-49 reported being a caregiver for another adult—spouse, parent, or other adult relative. Survey participants reported having to work remotely, change work hours, reduce hours, use paid leave, or quit working to provide care. Being creative with job duties and work schedules may help cover necessary work by offering part-time hours to those who are caregivers or have other responsibilities, such as a single parent taking a child to school.
Among the lessons learned from the pandemic is that some jobs can be performed remotely (at least part of the time) and that work hours can be more flexible. Finding ways to support associates who are caregivers will become increasingly important.
So, how’s staffing?
The Charlottesville market has been experiencing labor challenges for a number of years. During portions of the pandemic, there were as many as three job openings for every one person applying. Unemployment rates in our region are at historic lows. On September 30, the Bureau of Labor Statics reported a Charlottesville unemployment rate of 2.7%.
Yet, WCBR has managed to maintain a low position vacancy rate (approximately 10%) and reduced turnover year-over-year (27% in FY23, 33% in FY22), and is well below the industry average (44% at CCRCs). This is not to say that we are satisfied. Factors involving the above cited ‘opportunities’ have certainly contributed to this success. WCBR also restructured the Human Resources office by replacing a generalist position with a full-time recruiter. This has resulted in a positive impact on ‘speed to hire’ by reducing the time an application is received to initial response, scheduling of interviews, reference checks, hire offer, and background checks (drug and criminal).
A continuous focus on work culture and environment, training and development, wages and benefits, technology, and work/life balance are the building blocks upon which we will succeed in the face of ongoing recruitment and retention challenges. Doing these things is not only nice, but necessary. To achieve our goal of becoming an employer of choice, WCBR will need to leverage the competitive advantages we enjoy today while developing others that will distinguish WCBR as a great place to work. Doing so will be essential to fulfilling our mission and strategic goals.