The graying of America is in full force, and the long term care facility workforce is not exempt. Instead of seeking a fountain of youth for staff, facilities are finding innovative ways to employ the experience and knowledge of older staff while keeping them safe and healthy, and they are encouraging intergenerational relationships that enhance quality care and teamwork. And in the process, they are finding that caring is ageless.
As the country ages, it isn’t surprising that the health care workforce is getting older as well. A study published in a 2000 issue of the Journal of the American Medical Association projected that between 2010 and 2020, over 40 percent of the registered nurse (RN) workforce alone will be over age 50, according to researchers P. Buerhaus, D. Staiger, and D. Auerbach. Between 1994 and 2001, RNs 50 years old and over grew at an annual rate of 4.7 percent, said the same researchers in a study published in Health Affairs in 2004. Between 2002 and 2003, the rate shot up to 15.8 percent, the researchers said.
At the same time, the number of RNs under age 35 is going down as part of a 20-year trend, they said.

Ageism A Factor?

While the workforce in general is aging, it hasn’t stopped the influx of ageism in the workplace. According to one study published in the Journal of Gerontology: Psychological Sciences in 2011, there is evidence of bias against older workers. Older workers were thought to be “moderately less apt” in areas such as interpersonal skills and suitability to be selected for any given job, although they were rated higher in reliability, said authors A. Bal, A. Reiss, C. Rudolph, and B. Baltes.
Nonetheless, in long term care, a profession that centers around aging, most facility leaders value older staff and work to keep them healthy and happy. As J. Kenneth Brubaker, MD, CMD, a medical director in central Pennsylvania, says, “I have never seen an instance of ageism in long term care staffing. I’ve worked with some nurses who have been at their facility for 40 years.” He adds, “If you perform well, age isn’t an issue. I suspect that the lower the turnover, the higher the average age of staff.”

Anne Marie Barnett, RN, president of Maryland NADONA/LTC, agrees that ageism isn’t an issue in a profession many workers have entered because “they had an older relative who inspired them to pursue this career. They have a passion for it.”

A greater challenge for Barnett is blending cultures. “A large percentage of my nursing and caregiving staff are from different countries. Language barriers and other issues can impact their relationships with residents and other staff. We have to deal with that,” she says. However, she stresses, “It’s all about leadership and creating good staff relationships. You need to be fair across the board and treat all staff with respect.”

Susan Persch, MBA, senior director of business systems at Brookdale Senior Living in Milwaukee, Wis., adds that “there is no ageism because there is so much important work to be done. We are always looking for good people who share our passion, and we are welcoming to all who share our mission and compassion for caring.”

A Generation Gap?

It is important for facilities to address the needs and concerns of both younger and veteran staff members.
To do this effectively, they need to understand their common concerns and different needs. “Most of the literature says that there are generational differences in the way people approach and value work, and there are generational differences between older and younger nurses,” says Linda Norman, DSN, RN, FAAN, senior associate dean for academics, Vanderbilt University School of Nursing in Nashville, Tenn.
It is crucial to acknowledge and address these differences, says Henri Carlton, RN, BSN, director of nursing for Charlestown retirement community in Catonsville, Md.

Brookdale walkers for Alzheimer’s Association“As we are working alongside younger folks, it becomes difficult to relate sometimes. It can be hard to find common ground, but when we don’t, it can lead to conflict on the floor,” Carlton says. “We have nursing assistants who have been here for 20-plus years, and when a new nurse comes in, they tend to see things differently.”

To understand the generational differences between nursing staff, it is useful to look at history. In the 1960s and 1970s, women had fewer career choices, and nursing was a popular traditional option.

However, as career opportunities for women opened up, Norman says, “We went through a period where it was considered ‘old school’ to be a nurse or teacher—as if you were settling for less if you went into these professions.” In recent years, she adds, there has been a resurgence of interest in nursing as a career choice. Part of this may be because of the nursing shortage and the perception that nursing offers job security, decent pay, and job flexibility.

However, Norman stresses, “Much of the renewed interest in nursing has to do with the younger generation’s desire for altruistic work. These young people want to do something meaningful and see nursing as an opportunity to help people improve their health.”

Meeting Staff Expectations

Norman and her colleagues studied generational differences and found that “the biggest thing was the amount of physical work and hours. Older nurses didn’t like the longer [12-hour] shifts as much as the younger nurses did.” In fact, she says, in facilities where only longer shifts were available, veteran nurses were more likely to retire or look for jobs where they could have 9:00 to 5:00 schedules.

Norman suggests, “If you want to retain nurses, issues related to shift lengths become important to consider. That was borne out in our research.”

Brookdale resident, Innovative Senior Care therapistYounger staff are more likely to have been weaned on culture change and teamwork. As a result, they expect to be a valued and respected part of the health care team. “One reason a facility may have high turnover is that they have staff who don’t feel valued by practitioners,” says Brubaker. “Good interpersonal relationships between physicians and staff are more likely to create a happy work experience for everyone. It affects the quality of care when staff are afraid to talk to the physicians or feel that the doctors don’t listen to their suggestions.”

However, just as younger staff have different learning experiences and expectations, he suggests that younger physicians are being taught teamwork and person-centered care as well.

A Common Denominator

While younger and veteran nurses are different in many ways, they also share many values. For example, Norman says, “Younger and older nurses share an overwhelming desire to help people. They want to be able to feel that they can make a meaningful contribution. Both generations look at nursing as a stable field.” At the same time, younger nurses may come into the profession with a more tangible intention, Norman suggests, because they had many options and chose nursing.

To identify and promote the common ground that nurses of all generations share, “you have to change the question,” Carlton says. She suggests that instead of asking nurses why they went into the field, it is more useful to ask them what nursing means to them.

“When we asked this, we pretty much heard the same thing across the board—they wanted to make a difference in people’s lives. When we don’t get caught up in the holier-than-thou rhetoric, we find that we all are in this profession for the same reasons. The core of what we do and why we do it is the same,” Carlton says. “Once we talked to staff this way, everyone could relate, and you could see the passion coming out all over the place.”

Tossing Out Stereotypes

Disposing of stereotypes about age is important to the success and satisfaction of older staff and good relationships between staff of all ages. For example, while some older workers may not be as adept at using technology as their younger counterparts, techno-phobia and age don’t necessarily go hand in hand.

As 67-year-old Melanie Scalese, coordinator for performance improvement, risk management, safety, and infection control at Charlestown, says, “I do well with computers. Nowadays, most older people are comfortable with technology. Even a lot of our residents use computers easily.” The key is to have strong training programs for younger and older staff that ensure they are comfortable with all the job skills they need, she says.

Brubaker adds, “For the most part, nurses’ interest in lifelong learning will make them want to work at a new skill.”

Carlton agrees that many older nurses welcome the opportunity to learn something new. “The younger generation challenges us to do better and be more knowledgeable,” she says. “We need to encourage older nurses to take this opportunity to be even better at what they do.” She adds that older nurses need to realize that questioning decisions and seeking multiple opinions is common in the younger generation of nurses.

“You can’t take this personally. This is how they have learned to seek and process information. It’s not an attack on your judgment,” she says.

Persch agrees that such generational differences don’t have to mean a generation gap: The key is to understand younger people’s frame of reference.

“People between the ages of 18 and 25 often are referred to as ‘generation digital.’ They grew up with the computer as a primary language. Rather than have to learn it, they are bilingual. It is a given that they know computers and technology,” she says.

One way to get away from stereotypes is to get away from words and language that promote them. As Carlton says, “Words like ‘old’ become very inflammatory. We stopped using those kinds of words, and we were able to get down to the essence of what we do and find common ground. We have to constantly remind ourselves not to get sucked back into earlier ways of thinking.”

Two-Way Learning

Bringing together younger and veteran nurses and nurse assistants can help make the most of the skills and strengths both bring to the table.

For example, as Norman says, “You need to look at what contribution older staff can make in mentoring new staff. That is where decision-making experience and clinical expertise can really come into play.”
She urges managers not to be short-sighted in their quest to lure younger nurses with a few years of experience versus new graduates. “It often is harder to recruit new nurses to come into long term care, and sometimes facilities are skeptical of nurses with no experience,” she says. “Matching up veterans with novices can help the newer nurses learn from the older nurses and really begin to appreciate the value of long term care.”

This can help facilities attract and keep good young nurses, Norman says. As she explains, “Those who are interested in the field may get turned off when they are told that they need more experience. If they go into acute care to gain that experience, chances are that you won’t get them back.”

By partnering newer nurses with more experienced nurses, the pool of practitioners from which to draw grows, and it can help older nurses handle the physical demands of the job. 

Growing Awareness Of LTC

Younger nurses increasingly are seeing long term care as an appealing option, says Norman, partly because of a growing emphasis on geriatrics in the nursing school curriculum.

“There has been a push within health care itself to increase the content and emphasis on geriatrics in professional education,” Norman says. “As a result, nursing students are seeing the attributes of the elderly and value of helping them.

“When I went to school, the attitude was that you couldn’t do much for elders—just keep them comfortable. Now we know that we can do much more. That helps people see geriatrics and long term care as a more viable place for care delivery,” she says.

The growing emphasis on geriatrics in educational curricula presents an opportunity for facilities to attract the best and brightest nursing staff. As Norman says, “Nursing homes can reach out and partner with schools of nursing to identify opportunities such as summer programs where students can come and work in the facility.”

She also applauds the idea of facilities providing scholarships with a catch. “Nothing stimulates someone’s interest in a place like a scholarship with a work requirement,” Norman says.

Safekeeping Treasures

As important as it is to attract young nurses, it is equally valuable to retain veteran nurses. One way to do this is to implement procedures and innovations to keep them physically healthy.

Brookdale staff at fundraising event.“When I went into nursing, I heard seasoned practitioners complain about back pain. They worked through the pain proudly,” recalls Carlton. “When I came to my current facility, there was lots of talk about injuries. They no longer were a badge of honor. In fact, they were unacceptable.”

The facility developed a campaign to encourage safe lifting and implemented the use of mechanical lifts. It purchased high-low beds that enable ergonomic-ally correct care, and they utilize simple solutions such as proper desk height, back-friendly chairs, and good lighting.

Carlton says, “We constantly look at ways to better preserve the bodies of both residents and staff. We have a very comprehensive wellness program that includes prevention as well as reactionary components.”

The results show. As Carlton says, “We have nurses in their 70s who are very effective bedside because we have provided things that assist them.”

Maxine Roby, MS, NHA, administrator of Rowan Community, a senior care community in Denver, says that it is important to make older staff feel empowered about their health. “Someone in their 20s goes to the doctor for a knee problem and gets it fixed. But an older person might think he or she is stuck with the problem. We need to encourage people to get help for illnesses or injuries at any age,” she says.

When older staff members feel good, the positive energy is reflected in their work. As Roby says, “We have a nurse who is in his 70s. He is standing all day long, bending, moving. In some ways, it keeps him young.”

Saying Goodbye

While facilities may decide to implement initiatives to retain older nurses, some aging practitioners simply will be unable or unwilling to handle the challenges of working on the floor in this setting. As Barnett says, “When staff get older, they may tend to slow down and look for less physically demanding challenges.”
Even older nurses who love their jobs and can still perform them effectively may choose another path. For example, Scalese is retiring soon. While she hopes to continue working on an as-needed basis, she is ready for the next phase of her life.
“I’m looking forward to retirement. I have goals for my life after retirement. I wouldn’t be comfortable sitting at home.”

In the meantime, she loves her work. Some of her younger colleagues call her “mom” and are happy to answer call bells so that she doesn’t have to rush up and down the halls. She will miss her familial relationships with residents and staff, but—like many older nurses—she has left a legacy that she hopes will inspire younger practitioners to follow her example.
Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.