Navigating the Storm: The Guide to Mastering Staffing and Scheduling in Long-Term Care Facilities

Navigating the complex landscape of healthcare regulations and persistent staffing shortages while ensuring quality patient care is a formidable challenge for senior care nursing facility managers and leaders in 2024. Balancing budget constraints with staffing needs for optimal facility performance is more critical than ever. This guide dives into the importance of effective leadership and technology usage in staffing and scheduling, highlighting the role they play as a cornerstone for maintaining staff morale, and productivity, and, ultimately, improving patient outcomes.

In addition, the new proposed CMS staffing mandate presents an even greater challenge for long-term care facilities by establishing minimum staffing standards for registered nurses (RNs) and nurse aides (NAs). While the proposal aims to improve resident care, it could cause additional financial and administrative burden and create even more staffing shortages within the long-term care industry.

Top Challenges Facing Long-Term Care Leaders

While there will be many challenges that long-term care leaders will have to weather in 2024, here are some of the top.

1. Persistent Staffing Shortages:

Nursing homes have experienced the worst job loss of any healthcare sector. While most industries have rebounded to pre-pandemic job levels, long-term care is still struggling.*
The healthcare workforce is already stretched thin, and the aging population continues to grow, increasing the demand for qualified healthcare professionals.

• Competition for talent will be fierce, leading to higher recruitment and retention costs.
• Difficulty ensuring adequate staffing levels could compromise patient care and staff well-being.
• The introduction of a new proposed CMS staffing mandate this year has further complicated the situation. A staggering 94% of nursing homes will need to increase staffing to meet these requirements, which has sparked debate among operators.

2. Financial Pressures:

• Rising healthcare costs and stagnant reimbursement rates will continue to squeeze facility budgets.
• Long-term care facilities continue to have to use more expensive contingent workers to fill the gaps of missing staff causing financial burdens
• Managers and leaders will need to navigate cost-cutting measures while maintaining quality care and complying with regulations.
• Finding a balance between financial viability and optimal staffing levels will be crucial.

3. Regulatory and Compliance Complexity:

• Ever-evolving regulations and compliance  requirements add to the administrative burden for managers and leaders.
• Staying up-to-date with changing regulations and ensuring adherence can be time-consuming and resource-intensive.
• Non-compliance can lead to penalties and reputational damage.

4. Changing Patient Needs and Technological Advancements:

• The patient population is aging and becoming more diverse, with increasingly complex needs.
• Managers and leaders need to adapt care models and invest in new technologies to meet these evolving needs.
• Embracing telehealth and other innovations can improve care delivery and efficiency but requires investment and training.

5. Burnout and Staff Well-being:

• Staffing shortages and increased workloads can lead to burnout and job dissatisfaction among healthcare workers.
• Managers and leaders must prioritize staff well-being by promoting work-life balance, offering competitive compensation and benefits, and fostering a positive work environment.
• A happy and engaged workforce is essential for providing quality care and retaining talent.

6. Additional Challenges:

• Supply chain disruptions and rising costs of medical supplies.
• Cybersecurity threats and data breaches.
• Climate change and extreme weather events impact facility operations.

While these challenges are formidable, skilled nursing, post-acute, and senior care nursing facility managers and leaders can navigate them by adopting innovative strategies, fostering strong leadership, and prioritizing both patient care and staff well-being.

Remember, it's not just about surviving the storm but thriving in the future.

Leading through the Storm

Imagine navigating a complex healthcare landscape: balancing budgets, fulfilling regulations, and ensuring top-notch patient care, all while facing a persistent staffing shortage. This is the reality for long-term care nursing facility managers and leaders in 2024. Yet, amidst the storm, effective leadership emerges as the anchor, stabilizing operations and driving success.

Cultivating a Positive Workplace Culture

Leadership in nursing facilities goes beyond managing tasks; it's about inspiring and empowering your team. Cultivating a positive workplace culture built on trust, respect, and open communication is paramount. Engaged employees are more likely to stay, leading to greater staff stability and improved patient care.

Adaptive Leadership for Changing Tides

Healthcare is constantly evolving, demanding flexible leadership styles. It is vital that long-term care and skilled nursing leaders develop key leadership skills like:

• Situational Leadership: Adapting your approach based on the specific needs of your team and the situation at hand.
• Delegation and Empowerment: Trusting your team members to take ownership and make decisions, fosters a sense of responsibility and growth.
• Effective Communication: Keeping your team informed and engaged through clear, consistent communication channels.

"The human element is paramount in long-term care. Leadership means forging genuine connections with residents and staff, recognizing them as individuals with unique needs and aspirations." - Mark Parkinson, CEO of LeadingAge, in a 2023 interview with McKnight's Long-Term Care News.

"Challenges are inevitable in long-term care, but they also present opportunities to grow and learn. Strong leaders see challenges as catalysts for change, and use them to build resilience and strengthen the communities they serve." - Mr. David Garcia, Executive Director of the Center for Aging Services. (Source: Panel discussion at the American Geriatrics Society Annual Meeting, May 2023) https://meeting.americangeriatrics.org/2023-meeting-programs

Avoiding the Common Reefs: Staffing and Scheduling Pitfalls

Identifying and understanding the three most common pitfalls in staffing and scheduling is crucial. These include underestimating the importance of proper staff-to-patient ratios, the impact of poor communication on scheduling accuracy, and employee satisfaction. This section offers insights on how to avoid each pitfall through strategies like implementing data-driven staffing models and utilizing efficient communication platforms.

Identifying and navigating common pitfalls is crucial for success. Here are the top three to watch out for:

1. Underestimating Staff-to-Patient Ratios: Ensuring adequate staffing levels is vital for quality care and staff well-being. This section explores data-driven methods for determining optimal staffing ratios based on resident needs and acuity levels. Healthcare facilities must meet various compliance demands, from staffing minimums to reduced hospital readmission rates and reporting requirements. Without clear tools for meeting these requirements or proving compliance, you might face significant fines or a reduced rating that can affect your ability to attract and serve residents.A facility's reputation depends in large part on the nurse-to-resident ratio and overall resident safety. Not following federal and state regulations can mean that your facility doesn't get reimbursed by Medicare or state programs.In addition, organizing team members across multiple facilities, diverse census demands, and worker availability can be time-consuming and pull administrators away from more valuable tasks. It’s vital to make sure you have a proper nurse-to-resident ratio. Here are some data-driven approaches to ensure you have enough staff for quality care.

• • Census and Acuity-Based Scheduling: Using a scheduling software that pulls in your census and acuity PPD data in real-time and creates schedules automatically. This helps you make sure you have enough staff for proper staff-to-resident ratios and to meet compliance requirements.
  • Flexible and Responsive Scheduling: Employ scheduling software that allows staff input, self-scheduling, and real-time adjustments to address fluctuations in resident needs.
  • Staff Skill Mix: Ensure adequate representation of nurses, aides, and other staff categories based on residents' care needs and skill requirements.
  • Staff Turnover: Account for anticipated turnover rates when calculating staffing needs to avoid understaffing during transition periods.
  • Resident Satisfaction: Incorporate resident and family feedback on staffing levels and care quality into decision-making processes.
  • Benchmarking: Compare your staffing ratios and outcomes to national benchmarks or similar facilities to identify areas for improvement.

2. Communication Gaps in Scheduling: Inaccurate or unclear scheduling can lead to staff shortages, frustration, and ultimately, compromised patient care. This section highlights communication tools and strategies to ensure clear, efficient scheduling processes.Implementing efficient scheduling and communication solutions can solve nearly every obstacle you currently face. Tackling scheduling issues, communicating schedules with staff in real-time, identifying open shifts, organizing time off, and covering absences can be a breeze when all information remains in a unified scheduling platform.Here are some key tools and strategies to improve nurse scheduling:

• Real-time scheduling software:
  • Allows self-scheduling, shift swaps, and open shift access from mobile devices.
  • Get real-time data on staff availability, overtime, and scheduling conflicts.
  • Communicates automatically updates for changes and call-outs.
• Team communication platforms:
  • Ensure you are using real-time communication through messaging, group chats, and announcements.
  • Facilitate document sharing and task management for better collaboration.
  • Offer video conferencing for virtual meetings and staff training.
• Mobile apps:
  • Find a mobile app that caters to your specific employee communication needs and give your staff instant access to schedules, updates, and communication channels.
  • Allow push notifications for reminders and important information.
  • Promote flexibility and accessibility even outside the workplace.
• Automated Notifications and Reminders:
  • Send automatic alerts for schedule changes, open shifts, and upcoming deadlines.
  • Leverage SMS or push notifications for immediate and accessible communication.
  • Ensure notifications are received through preferred channels (email, app, etc.)

3. 3. Neglecting Employee Satisfaction: Dissatisfied staff are more likely to leave, exacerbating staffing issues. This section explores strategies for boosting employee morale through recognition programs, professional development opportunities, and work-life balance initiatives.

Ways to Improve Employee Satisfaction

Avoid Employee Burnout:

3. 3. • Combat chronic workplace stress with technology, adequate staffing, and flexible scheduling.
      • Prioritize genuine care for employee well-being and HR engagement.
      • Streamline operations with a workforce management platform to reduce manual work and boost morale.

Increase Employee Engagement:

3. 3. • Provide regular staff appreciation and recognition (lunches, events, surveys).
      • Implement a workforce management platform to eliminate pain points and connect teams.
      • Celebrate staff achievements and milestones.

Recognize & Celebrate Staff:

3. 3. • Offer personal positive feedback, longevity bonuses, employee of the month awards.
      • Acknowledge personal and professional milestones to keep staff motivated.
      • Remember, they chose healthcare to make a difference - celebrate their contributions!

Provide Thoughtful Benefits & Perks:

3. • Go beyond base compensation with paid time off, quality health insurance, and additional perks.
   • Consider stipends, relocation assistance, tuition reimbursement, and referral/sign-on bonuses.
   • Give nurses the autonomy they deserve by letting them choose shifts.

Time and Attendance: Charting a Clear Course

Accurate time and attendance tracking is vital for ensuring compliance with labor laws and minimizing legal risk. This section discusses the correlation between precise time tracking and effective payroll management, alongside strategies for efficient tracking in nursing facilities and ensuring compliance requirements are met.

Accurate time and attendance tracking is not just about payroll; it's about compliance and risk mitigation. The benefits of precise time tracking, are the following:

• Simplified Payroll Management: Let’s face it, payroll is one of your biggest priorities, and you need it processed quickly and accurately every time. Long-term care facilities can significantly improve the accuracy and ease of their payroll processes with the right combination of technology, process optimization, and communication for a facility's needs and resources.
  • Invest in reliable payroll software: Automate payroll calculations, deductions, and tax payments, minimizing errors and saving time. Choose software specifically designed for the healthcare industry to handle specialized pay structures and overtime rules.
  • Integrate with time and attendance systems: Utilize time tracking systems that seamlessly feed data into payroll system, eliminating manual data entry and reducing errors, and allowing you to monitor your employees’ time and enforce pay policies.
  • Leverage mobile employee app tools: Offer staff mobile access to paystubs, PTO balances, and schedule updates, promoting transparency and self-service convenience.
  • Clearly communicate payroll policies: Clearly communicate policies regarding overtime, shift differentials, and paid time off to avoid confusion and potential disputes.
  • Improved Budgeting and Forecasting: Data-driven insights into staff hours inform better budgeting and resource allocation decisions.

Smart data-driven decisions drive success. The right data across your entire organization can inform decisions, improve budgeting, predict overtime, eliminate staffing shortages, and ensure compliance. Here are some of the key ways that data-driven insights can help your business perform better.

• Enterprise-Wide Decision Making: Getting a workforce software solution that shows you real-time workforce data across your facilities can help to make better business decisions, whether that is hiring new staff, optimizing current resources or controlling labor costs.
• Predictive Scheduling: Scheduling software integrated with real-time census and acuity needs helps to forecast future staffing needs based on anticipated changes in resident acuity and other factors.
• Predictive Budgeting: Analyze historical data on staff hours, resident needs, and seasonal fluctuations to forecast future staffing requirements and associated costs. This allows for more accurate budget planning and avoids unexpected expenses.
• Cost Optimization: Identify peak and off-peak hours based on staff utilization data. Allocate resources to periods with higher demand and consider cost-saving measures like reduced staffing during times of lower resident needs.
• Labor Cost Control: Analyze overtime patterns and identify areas where overtime can be minimized through scheduling adjustments or skill-based staffing strategies. This helps contain labor costs and improve staff well-being.
• Continuous Improvement: Regularly monitor and analyze staff hour data to identify areas for further improvement in budgeting and resource allocation, enabling a continuous cycle of optimization.
• Enhanced Compliance: Reliable timekeeping helps you comply with labor laws and regulations, reducing legal risks.

Compliance shouldn’t keep you up at night. From time tracking to reporting, having the right timekeeping and compliance reporting systems can help to minimize risk, avoid penalties, and spend your energies on the bigger picture.

• Accurate Pay: Having a proper time and attendance tracking software system ensures accurate calculation of regular and overtime pay, protecting you from underpayment claims, removing errors and wage theft issues. This aligns with the Fair Labor Standards Act (FLSA), which mandates accurate recordkeeping and minimum wage compliance.
• Overtime Regulations: Precise timekeeping helps adhere to overtime regulations, limiting potential liabilities associated with exceeding allowed overtime hours. This reduces the risk of lawsuits and fines related to overtime violations.
• Tracking Break and Meal Periods: Automated timekeeping systems that track real-time workforce data helps confirm that employees receive mandated breaks and meal periods as required by law, preventing claims of missed breaks and potential lawsuits.
• Accurate and Easy Regulatory Reporting: An integrated time-keeping and compliance system that comes with out-of-the-box regulatory reports, such as Affordable Care Act (ACA) and PBJ reports, can save time and ensure reporting accuracy and make sure you are audit-ready.
• PBJ Reporting: Having an automated PBJ (Payroll-Based Journal) reporting solution that automatically connects actual hours worked with payroll data, helps to save staff manual work creating the reports, minimizes errors, and protects the facility and its employees from financial losses and fraudulent claims.
• Protecting Against Fines and Penalties: Accurate timekeeping and PBJ reporting prevent violations that could lead to fines and penalties from government agencies like the Department of Labor. This avoids financial burdens and maintains the facility's good standing.

Smartlinx: Your Lighthouse in the Storm

Smartlinx, an integrated workforce management solution, addresses specific challenges in long-term, senior, and post-acute nursing facility staffing. Its features include optimized scheduling, real-time workforce time tracking and visibility, compliance management, communication tools, and HR management suite. This section explores how Smartlinx can streamline staffing and scheduling processes, supplemented by real-world success stories and testimonials from healthcare managers and leaders.

"When we talk about workforce development, we need progressive strategies for recruitment and retention,” said Marina Aslanyan, chief executive officer of Smartlinx. “A proactive model is key to organizational success and that’s really impossible without technology.”

Smartlinx emerges as a comprehensive healthcare workforce platform, guiding you through the complexities of staffing, scheduling, time-keeping, HR, and compliance in skilled nursing facilities. Its features include:

• Optimized Scheduling: Generate ideal and efficient schedules based on staff availability, skills, and resident census and acuity needs.
• Real-Time Attendance Tracking & Workforce Visibility: Gain instant data-driven workforce insights into staff activity and patient care delivery across the organization including all facilities.
• Compliance Management and Reporting: Ensure adherence to CMS PBJ regulations and labor laws with automated workflows, real-time data, integrated systems and instant reporting.
• Mobile Communication Tools: Foster seamless communication between staff and management with an employee communication mobile app. The app enables employees to access real-time schedules, swap shifts, submit PTO requests, and obtain key information 24/7.
• Hiring, HR, Benefits and Payroll: Streamline hiring practices, manage time-off accruals, centralize and manage all master employee records and automate payroll processes and enforce pay policies all from one healthcare workforce platform.
• Integrated Contingent Staff Management: Gain end-to-end independent contractor management, integrated compliance reporting, and fill open shifts quickly from the largest staffing agencies on the market.

See how Smartlinx has helped other long-term care organizations to improve workforce efficiency, control labor costs, streamline and ensure compliance and improve employee engagement.

Oriol Health Care Case Study

Business Challenge: Providers everywhere know the challenges of complying with changing regulations, such as Payroll-Based Journal Reporting (PBJ). These demands intensify in organizations with disparate HR, payroll, and time and attendance systems. Oriol Health Care faced these issues head on when they realized the lack of integration among their legacy systems would prevent them from successfully meeting new regulatory reporting requirements. However, they wanted to do more than comply with regulations, Oriol sought to optimize staffing levels, so they could better support their clients while gaining visibility into their workforce and PPD levels.

Solution: In a few short months, Oriol Health Care achieved impressive business outcomes involving scheduling, overtime costs, and staffing/census visibility:

• Reducing overtime costs 25% in three months, with substantial savings in the first month.
• Successfully transmitting Payroll-Based Journal Reports to CMS, fulfilling key regulatory requirements.
• Experiencing immediate improvements in staff scheduling.

“With labor costs at 85% of operating expense we realized we needed to implement the best workforce management solution on the market.” said Elizabeth Cogavin, CFO, Oriol Health Care.

The user-friendly Smarltinx scheduling system yielded remarkable results. Oriol schedulers gained visibility into the facility’s entire schedule and no longer had to assess individual departmental Excel spreadsheets. They can easily track scheduled and unscheduled absenteeism, see what they scheduled versus budget, and easily make necessary changes. Oriol personnel can access real-time census-related data and adjust accordingly. Employees can view their schedule on multiple platforms.

Parker Jewish Case Study

Business Challenges: Parker Jewish Institute had four disparate systems for scheduling, timekeeping, payroll processing and human resource management. As a result, there was redundancy of entering employee information into the different systems and multiple opportunities for inconsistent employee information. There also wasn’t any way of knowing what overtime was until the payroll was completed and processed.

Solution: After implementing Smartlinx, Parker now has insight into controlling one of its biggest expenses, labor. Being able to monitor overtime has allowed managers to be more aware of the patterns of their supervisors in assigning overtime and in developing policies to utilize other employees in non-overtime status when possible.

• Consolidation of 4 disparate systems into single, fully integrated suite
• Proactively eliminate unnecessary labor expenses
• Deeper insight enables greater monitoring of overtime

“We learned that if a schedule is correct and the employee properly punches in and out, an electronic timecard should not have to be modified.” said Michael N. Rosenblut, President & CEO, Parker Jewish Institute.

About Smartlinx

Smartlinx is a leader in workforce management and human capital management solutions for the healthcare industry. As the only Healthcare Workforce Platform designed specifically for skilled nursing, senior care, and post-acute care, Smartlinx software streamlines operations, closes scheduling gaps, reduces overtime, and ensures PBJ compliance. From scheduling, time and attendance, payroll, compliance, human resources, and business insights, Smartlinx delivers the essential tools to manage your entire workforce across facilities from one seamless platform. Thousands of healthcare facilities rely on Smartlinx every day to plan and adapt quickly in real-time to their workforce needs.

Request a demo or for more information call 877-501-1310.