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Dealing with Staffing Shortages with Lean Principles & Smart Recruiting Practices

Hearing about the shortage of workers in the long-term care industry is like listening to a broken record. We keep hearing it over and over again.

An article in McKnight's Long-Term Care News quoted a human resources expert who called the LTC worker shortage a “train wreck waiting to happen.” According to industry predictions, it doesn't look like the staffing shortage will end any time soon.

Paul Osterman, a professor at MIT, offers these sobering statistics: a national shortage of 151,000 paid direct-care workers by 2030, with an estimated gap of 355,000 paid workers by 2040.

For many hourly positions in long-term care, the median income is around $20,000, the equivalent of $9.62 per hour. Mordechai Finkel, director of Human Resources at Greek American Rehabilitation & Care Centre, laments this fact: “I'm sorry, that's not going to get you employees who put their heart and soul into the profession.” He notes that Greek American pays its housekeeping staff more than the median salary. Even for certified nursing assistants (CNAs) in long-term care, the median salary as of January 2018 was only $27,940.

It's a vicious cycle. When facilities are understaffed, their staff is under pressure, quality measures tend to suffer, and resident satisfaction decreases.

Lean utilization

In real estate, the mantra is: location, location, location. But in long-term care, in response to the current shortage, the mantra has been: staffing, staffing, staffing.

For Finkel, however, who runs a one-person HR department for a 188-bed, 210-employee skilled nursing facility, his mantra is lean HR utilization. What does this mean for managers? It means to invest in your employees, to develop all your employees to their highest level of skill through role enhancement, whether it's delegation skills, flexibility, or use of technology. Doing so will directly impact quality of care.

Role enhancement

According to the National Institutes of Health, role enhancement involves expanding workers' skills so they can assume a wider and higher range of responsibilities through innovative and non-traditional roles. For nurses, ongoing professional development not only expands their skills, but it ensures that they are providing up-to-date, safe, and expert care.

At Greek American, Finkel says the nursing department identifies nurses who are able to be trained in wound care, EMR, QA auditing, and management of core quality measures. He says that enabling staff to “spread their wings” enhances their career paths at Greek American and beyond. In the activities department, staff are also trained in feeding residents as well as managing the facility gift shop. “We try to expand their horizons as much as possible,” he says. The result? Staff are more likely to be invested in their profession.


In a Fast Company article, an executive coach outlines six steps to better delegation:

  1. Prepare
  2. Assign
  3. Confirm understanding
  4. Confirm commitment
  5. Avoid “reverse delegating”
  6. Ensure accountability

If staff are unable to delegate effectively, this leads to cramming work at the end of the shift, and that starts the overtime spiral. Everyone must understand expectations and responsibility.


An article in a scholarly journal details how skill flexibility contributes to both cost efficiencies and superior performance. Finkel notes that the one word he eliminated from all job titles at his facility is the word “specialist.” He explains: “I can't tell you how inefficient things are when a person specializes in one area and can't move on to another skill or task. At our facility, every CNA is trained in rehab skills, in feeding, and creating a fine dining experience. This is above and beyond their regular job description All of our housekeepers are trained in advanced floor care and laundry. This way it's like plug and play. We're never going to be stuck if one of our 'specialists' calls out one day, so all of our employees are trained to do all of the different aspects of the other responsibilities as well.”

Technology & recruitment

While long-term care is by nature a people business, technology is designed to help in numerous areas. In recruiting, for example, the use of technology is widespread.

With the current staffing shortage, there is fierce competition among LTC facilities, especially in areas where there are multiple facilities, to find top-notch candidates and entice them to come on board. Finkel says that finding quality candidates is his biggest challenge, and that staffing tends to be rougher seasonally as well. That's why it's important to cast a broad net. To attract as many candidates as possible, Finkel says job postings should appear on as many social media sites and websites as possible. “You want to get it in front of people as fast as you can.”

That's where an applicant tracking system (ATS) comes in. An ATS simplifies the process, allowing an employer to post to multiple job sites at once.

It's also important to make the best use of your interview process. At this stage you can weed out your best candidates. You can use an ATS to conduct phone and video interviews, run background checks, and more.

Plus, an ATS gives you a pool of qualified candidates for future reference. You may have had several decent candidates for a position that you filled. If you need to hire for that position again, you should be able to view candidate history. That means you might be able to set up interviews without even re-posting the position.

Finkel says it's important to streamline the entire process. This is especially crucial for millennial candidates. Industry insiders say that if millennials can't apply for a job within 45 seconds, they're on to the next one. That's why you must make the process as smooth as possible.

The same can be said for onboarding. First impressions count, especially in the workplace. According to the  Employee Job Satisfaction and Engagement: A Research Report by the Society for Human Relations Management (SHRM), a strategic onboarding and assimilation program can help new hires become embedded in the company and thus more likely to stay.

Look for an ATS that streamlines the entire recruiting process, from job posting through onboarding. Your goal should be to provide a seamless experience to new hires. If they can complete required paperwork before Day 1 on the job, they can jump right in and feel a valued part of the team from the get-go.

Learn more about SmartLinx Solutions' ATS and our integrated suite of workforce management solutions.


About the Author

Frank Estevez joined SmartLinx Solutions as Development Manager in 2012 and transitioned into a Product Manager role in 2015. He provides release program management of the various SmartLinx products. He has 20 years' experience in providing software solutions across numerous industries.

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