How Workforce Management Technology Enables Quality Care & Cost Efficiency for Skilled Nursing Facilities

April 18, 2022 Yancy Oshita

It’s Official: Skilled Nursing Operators Must ‘Adapt or Die’

According to the 34th SNF Cost Comparison and Industry Trends Report, SNF operators face  unprecedented financial distress with 2019 marking the first time median operating margins dropped below zero.

As reported in Skilled Nursing News, executives consider the following three trends, the biggest factors affecting SNF operators:

  1. Regulatory nuances between states
  2. Rising importance of care quality as measured by CMS Five-Star Ratings
  3. Escalating workforce cost, particularly for front-line caregivers

I believe mounting pressure to improve resident outcomes while containing staffing costs are dramatically changing workforce management. Since the first round of Value-Based Purchasing penalties and the rapid rollout of the Patient-Driven Payment Model (PDPM), many senior executives struggle as they strive to adapt to a new world of lower reimbursements, higher resident expectations, and increasing compliance pressures. Nowhere is this trend more evident than in CMS’ Five-Star Ratings, which has an increasingly high correlation to a facility’s financial health.

Operators can’t control Medicaid/Medicare and regulatory differences between states. However, they can (through modern workforce management technology) reverse this trend and put their facilities on a path to long-term sustainability in care quality and cost-efficiency.

What is the SNF Operator’s Workforce Management Problem?

Direct caregivers, which represent a facility’s highest expense, are critical contributors to resident well-being. Nursing aides, LPNs and RNs handle every caregiver activity from:

  • Taking vitals to serving meals
  • Cleaning resident areas to assisting residents into beds
  • Administering medications to determining treatment plans
  • Assigning employees, to monitoring overall facility care and more.

But with escalating costs of direct care, how can you improve care quality while controlling and/or reducing workforce staffing costs?  

Operators are on the hook for value-based care and operational efficiency. Most are painfully hindered by an archaic workforce management system. One that often involves users stitch together data pertaining to resident needs and employee schedules with actual staffing data. Then users determine how all this data fits into regulatory demands before they can get an accurate view of staffing needs. When schedules, resident needs and regulations remain constant, users can cobble static data into a spreadsheet for an accurate look at their status. But resident needs and schedules change daily, making this manual process inaccurate and error prone. 

In addition, larger providers (100+ staffed beds, multiple facilities), face even greater challenges as they must handle mounting changes to staff coverage, compliance needs, and care hours and quality. Managing this complexity can be overwhelming. Creating “optimized” employee schedules may look good on paper. But how do you really know your true staffing situation, planned and unplanned staffing gaps?

Inflaming the agony that siloed workforce management yields is its inability to provide granular staffing insight (not schedules) and practices to support CMS and ACA-requirements. By providing stale, inaccurate staffing information, these disparate systems prompt erroneous conclusions about what’s working and what’s not in the drive for quality and compliance.

For the demands of modern skilled nursing and long-term care operations, siloed workforce management tools are woefully inadequate. They:

Distort your true staffing picture, giving “optimized” employee schedules, but lacking the ability to connect schedules in real time to staff attendance, causing overstaffing as well as excessive overtime and agency use. 

Force you to manually prepare PBJ reports, cobbling together and classifying statutory data like overnight shifts or contractor hours, consuming time & resources and risking errors and penalties.

Keep you in “staffing anarchy,” causing you to triage data from multiple sources, such as scheduling, time & attendance, and spreadsheets to stay on top of staffing & compliance demands in real time.



Negative Consequences:  Using a fragmented workforce management tools negatively impacts operating cost and compliance risk.

Modernize your workforce management system to adapt and prosper in today's grim operating environment

To maximize care quality and operational efficiency, SNF CEOs and administrators must lead the charge to changing their approach to workforce management. They must deal with the rigors of today’s skilled nursing environment. This means unifying workforce operations data under a single source of workforce truth. This should automatically adapts in real time to reflect the end-to-end staff management process. This includes workforce scheduling to time & attendance tracking to compliance reporting over a dynamic and regulatory-driven resident journey.

To start your workforce management transformation, SNF operators need to modernize your current approach around a central source of workforce operations truth with must-have capabilities that enable them to:

  1. Automatically generate optimal employee schedules in real time based on resident acuity, nursing hours per patient day (NHPPD), and service changes across multiple facilities, and adapt to ever-changing resident and regulatory demands.
  2. Instantly find and recommend best qualified employees to fill open shifts based on skill, overtime status and company policies, and provide equal opportunity & flexibility for qualified staff to fill shifts.
  3. Automatically identify true staffing gaps or overstaffing in real time including planned & unplanned changes.
  4. Instantly communicate with care workers in real time via any mobile device so they can:
    1. Notify employees of scheduling changes and available open shifts.
    2. Enable employees to sign up for open shifts and request time off.
    3. Enable employees to swap shifts with each other.
  5. Continuously organize all CMS and ACA-required staffing information in real time to comply with the latest federal and state regulations and deliver audit-ready reports on demand, including overnight shifts and contractor hours.
  6. Automatically analyze hourly staffing data and CMS calculations in real time that could negatively impact CMS Five-Star Ratings and proactively recommend steps to correct staffing issues to protect and improve your rating for each facility.

How centralized workforce management software can optimize nurse staffing and Five-Star Ratings?

According to Centers for Medicare & Medicaid Services, “there is considerable evidence of a relationship between nursing home staffing levels and resident outcomes. The CMS Staffing Study, among other research, found a clear association between nurse staffing ratios and nursing home quality of care.”

The number of nursing care hours residents receive per day (HPPD) plays a key role in a facility’s CMS Five-Star Quality Rating System. CMS uses the system to judge the experience a skilled nursing facility provides Medicare recipients and publishes the ratings. This helps consumers compare providers and promote higher overall quality of care.

Star ratings can make or break your reputation as a long-term care provider.

However, research by Harvard and Vanderbilt universities showed an interesting stat. “75% of skilled facilities were almost never in compliance with what CMS expected their staffing level to be based on residents’ acuity.” Given this staffing dilemma and the mounting pressure to deliver quality care at lower costs, how can SNF operators provide the right staffing level (per CMS Five-Star Ratings) while reigning in staff and overtime costs?

Complying with CMS’ strict staffing requirements can be daunting when navigating fluctuating PPD census values and sudden scheduling changes. Operators can no longer rely on standard employee scheduling procedures. They must track multiple scheduling variables, close gaps and share data between Payroll-Based Journal, scheduling, attendance, payroll, and employee communication systems—in real time.  Using modern workforce management technology can optimize and preempt staffing gaps by enabling operators to:

  • Create optimal nurse schedules based on resident acuity and nurse overtime status.
  • Notify qualified nurse staff of open shifts and enable them to sign up, anywhere, anytime.
  • Allow nurse staff to access schedules, swap shifts, and adjust time off
  • Analyze staffing data and latest CMS criteria to predict a Five-Star Rating for any facility, anytime.
  • Proactively alert operators of impending staffing issues that will damage Five-Star Ratings. 

How a modern workforce management system can improve caregiver engagement

According to HR Solutions, “85 percent of engaged employees displayed a genuinely caring attitude toward patients, compared to only 38 percent of disengaged employees while 91 percent of engaged employees recognize their workplace as dedicated to patient care, compared to only 42 percent of disengaged employees.”

Research continues to confirm the link between engagement and productivity and loyalty. “Engaged employees make it a point to show up to work and do more work -- highly engaged business units realize a 41% reduction in absenteeism and a 17% increase in productivity. Engaged workers also are more likely to stay with their employers,” according to Gallup.

In skilled nursing facilities, employee engagement directly impacts the level of care employees give residents.

A modern workforce management system engages employees through mobile technology that lets employees:

  • Take control of their schedules. When employees can quickly find and respond to new schedules well in advance, they can more easily balance work and family responsibilities, which fosters better feelings about their employer.
  • Adjust easily to their life demands. If they can’t work a scheduled shift, employees can use their mobile device to notify the right people, swap shifts among each other, and even request time off.
  • Understand their finances. With their hours and pay varying from week to week, employees want to quickly access timecards, paystubs and detailed pay history with the ability to fix any punch errors without contacting HR.
  • Work at remote locations. As more direct caregivers and other staff work in remote locations, such as home health-aids, they can easily punch in at authorized remote sites while communicating with management.

Workforce management has been re-thought for the modern, skilled nursing and long-term care organization. Find out how you can solve the pain of workforce staffing and compliance and become a workforce management champion, giving you and your team the vision and data to deliver quality care lower cost. Stop juggling or delaying your workforce management problems.

Take the first step of taking control of your workforce management: See The SNF Operator's Playbook to Deliver Quality Care at Lower Cost.


Additional Resources

[Blog] The Growing Influence of Five-Star Quality Ratings in LTPAC

[Blog] How to Use a Mobile App to Enhance Employee Productivity 

[Blog] Maximize Quality and Minimize Cost with Workforce Management Software

[Webinar] 7 Secrets to PBJ Success

[Case study] Trilogy Health Services Advances Quality Care and Reduces Costs

[Case study] Excelerate Healthcare Drives Efficiency and Cuts Costs at 8 Facilities


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