Navigating the New Norm in Post-Acute and Senior Care

July 8, 2020 Lynne Jackson

COVID-19 is creating a new norm in skilled nursing and senior living that requires facilities be even more flexible with employee schedules.

When COVID-19 reached the United States, the senior care industry was struggling to compensate for the “1.2 million unfilled positions every month”, according to Argentum 2020 Workforce Trends report.

Despite the enormous demand COVID-19 is putting on an overburdened workforce, many post-acute and senior living employees are rising to the challenge as unsung heroes in the war fighting the most vulnerable in the war against the virus. Employee scheduling, attendance tracking and other workforce management processes are changing quickly as operators attempt to halt the spread of the virus in their facilities.

However, when multiple skilled nursing facilities were required to accept COVID-19 patients from hospitals, the demand on their workforce management infrastructure intensified immediately. Operators had little chance to adapt. And, unfortunately, many facilities lacked the  personal protective equipment (PPE) needed to protect employees caring for COVID-19 patients and the workforce management resources needed to manage the crisis.

“Many patients with COVID-19 will need post-acute care to recuperate from their infection. However, post-acute care facilities currently lack the capacity and capability to safely treat patients with COVID-19 as they transition from the hospital to other care settings or to their homes,” said David C. Grabowski, PhD, Department of Health Care Policy, Harvard Medical School.

Knowing this, operators should seize the moment now and adjust the entire staffing process, from employee scheduling to compliance and attendance tracking, to navigate a pandemic, adopt safer practice and always assure the residents’ needs are met.

Staffing challenges in the Pandemic

Before the COVID-19 invaded senior care facilities, operators struggled to keep their employee schedules properly populated. Unscheduled absences and tardiness caused gaps in employee schedules and sent administrators scrambling to find qualified workers to fill them.  They often turned to agency workers to close scheduling gaps until COVID-19 changed everything.

Staffing shortages plagued skilled nursing and senior living for several years and continue to escalate. In senior living, turnover rates have risen every year for the past seven years and now exceed 33%, according to Bureau of Labor Statistics and reported in Argentum’s 2019 Workforce Trends Report.  

Long-term and post-acute facilities face even great staffing shortages with many reporting annual turnover rates exceeding 50% and some claiming nearly 100% turnover rates among care giving staff — every year.

Responding to COVID-19

As this contagious virus wreaks havoc in facilities across the country, facilities are breaking new ground trying to contain and protect the most vulnerable members of our society.  Appropriate employee scheduling is critical to providing quality care and stemming the spread of COVID-19.

When multiple state officials demanded post-acute care facilities take in COVID-19 patients from hospitals, they forced these facilities to adjust their employee scheduling practices to try to stop a highly contagious virus from spreading.  This task is proving monumental for most operators.

Most facilities are trying to lock down COVID-19 wards and isolate the nurses and employees supporting these wards. However, the staffing shortage and inadequate attendance management and employee scheduling capabilities makes segmenting caretakers increasingly difficult. In addition, a lot of operators stopped using agency workers to fill unexpected employee scheduling gaps in order to prevent these contract workers from spreading germs they may have inadvertently picked up while working in other facilities.

“…It has been difficult to keep [COVID-19] from spreading in a number of settings, including hospitals, cruise ships, and nursing homes — in Massachusetts alone, some 102 nursing homes had reported 551 cases by Sunday [4/5/2020] afternoon, according to the Massachusetts Department of Public Health.  Even with current restrictions on visitors… employees regularly moving in and out of the facilities means it’s likely that additional cases will occur.” Source: Al Powell, Staff Writer, Harvard Gazette.

Administrators are quickly adjusting nurse schedules to support new guidelines. Many are doing so manually on spreadsheets. Others are attempting to buckle down their workforce management systems and create new employee schedules and attendance management policies that support segregated COVID-19 wards. Some are even using workforce management software to also support new maintenance procedures aimed at isolating the virus to the COVID-19 ward. 

With the extraordinary demands the pandemic is placing on senior care staffs, it’s no wonder senior living and post-acute care facilities rank staffing as a top concern in a recent survey by Senior Housing News. Senior care facilities cite staffing as one of their biggest challenges in the pandemic, second only to lack of personal protective equipment (PPE).

As the challenges hindering proper staffing rises, so has the creative measures and the determination of operators to meet them.

Stopping the virus at the door

Staff responsibilities are evolving quickly as senior care facilities strive to protect residents from COVID-19 as well as continually provide quality care. How staffs care for and interact with residents continues changing. Some long-term and post-acute care facilities are limiting staff interactions with residents, requiring they monitor and provide care from several feet away. Others are using technology, like telemedicine, to interact with residents and assess their needs. Staff must learn new ways of doing routine tasks, from handling food and medications to interacting with employees, residents, and family members.

In addition, employees are tasked with enforcing these new policies. Instead of welcoming visits from loved ones, employees are turning away residents’ family members seeking to visit a resident.  

New policies staff are implementing

  • Restricting visitors and non-essential service providers, such as hair stylists
  • Monitoring entrances with employees and cameras to enforce new rules
  • Closing all, and leaving just one entrance to control traffic
  • Requiring residents stay in their rooms
  • Prohibiting residents from interacting with each other
  • Canceling communal dining and social activities
  • Following new employee schedules that often call for longer shifts

Most facilities are requiring staff don extra PPE equipment and clean and disinfect every surface they encounter. Most follow the government guidelines to stop the spread of the virus, although their application varies. Some facilities are using technology to automate screening and ensure confidentiality. Others are resorting to manual exams and pen and paper reporting

Screening employees

How staff are being treated has also changed. Employees are no longer viewed as caretakers alone but also as potential transmitters of a dangerous coronavirus. Consequently, they must undergo health screenings every day before starting work.

Long-term and post-acute care facilities deploy various methods to screen employee health, such as assigning staff to take temperatures and question incoming employees. Some are using technology to automate screening efforts and abide by government guidelines. The federal Department of Health recommends all employers screen employees and visitors for COVID-19 before they enter the building. Most check for temperatures, flu or cold-like symptoms and exposure to COVID-19.

In many facilities, workforce management systems are playing an integral part in screening employees. Systems with integrated employee scheduling and attendance tracking are streamlining screening efforts and enforcing privacy guidelines.

For example, an intelligent time clock can require employees answer the following CDC-approved questions before allowing them to clock in. In addition, the automated attendance management system helps operators follow American for Disability Act (ADA) for keeping employee health information confidential by limiting access to questions and answers to appropriate personnel.

Have you washed your hands or used alcohol-based hand rub before entering?

  • Do you have any of the following symptoms?
    • Fever
    • Sore throat
    • Cough
    • New shortness of breath
  • In the last 14 days, have you had contact with someone with a recognized case of COVID-19?
  • In the last 14 days, have you worked at a facility or location with a recognized case of COVID-19?

While many of these new requirements seem to be focused on controlling the spread of COVID, many of these new ways of operating and staffing will be with us permanently. And rightfully so. Being adaptable and amenable to your staff’s changing needs, being flexible with these changes, and most of all, protecting your staff and your residents are things that will make our entire business thrive and, in the end, even more profitable.

Legal considerations

Understandably, operators are tempted to deploy extensive screening measures to protect residents. It’s important to set limitations. Employees, vendors, and visitors have rights that must be considered. Keep medical information confidential, even what may seem insignificant like a normal temperature reading or a sneeze is protected medical information. That does not mean this information shouldn’t be documented and reported but rather reporting should be limited reporting to designated officials.

Please note: This information is not intended to be viewed as legal advice.  Please consult legal professionals to understand these regulations and how they affect you.


Additional Resources

Senior Living Facilities: Staffing for Success in the Pandemic

How SmartLinx Supports Senior Care Facilities Fighting COVID-19

McKnight’s Online Forum: Staffing a Crisis—How Senior Care Facilities are Successfully Dealing with COVID-19

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