There’s no question that employee turnover in senior care has been, and continues to be, one of the profession’s most challenging issues. With 50 percent turnover in direct care, as reported in the American Health Care Association (AHCA) “2013 Quality Report,” community leaders are continually looking for ways to dismantle the revolving door and increase long-term retention. 

One area that deserves attention is employee engagement, which can not only reduce turnover but also improve quality and the bottom line. In fact, research from Gallup shows that work units with high engagement have “higher productivity, profitability, and customer ratings; less turnover and absenteeism; and fewer safety incidents” than those with less engaged workers.

Types Of Engagement

Operating with a disengaged workforce can be costly. Gallup estimates that disengagement costs a staggering $450 billion to $550 billion annually in lost productivity.

To improve employee engagement, leaders must first be aware that it is not the same thing as employee satisfaction. Satisfaction refers to how happy employees are, with no regard to their performance. Employee engagement is the “emotional commitment the employee has to the organization and its goals,” the AHCA report says, and can be measured in part by the amount of effort an employee expends on behalf of the organization.

The report lists three types of commitment that come into play when examining employee engagement:
■ Affective commitment: An emotional attachment to the organization, or “I stay because I want to.”
■ Continuance commitment: Fear of loss, or “I might as well stay.”
■ Normative commitment: Obligation to stay, or “I need a job.”

Getting more employees to the level of affective commitment will advance engagement in an organization. Employee engagement should be a key strategy for any senior care employer looking to reduce turnover, lower costs, and improve productivity and the quality of care their residents receive. After all, engaged workers are those who enjoy coming to work. They are productive, feel respected, and go beyond what is expected of them, often without being asked.

While there are many ways to go about driving employee engagement—from interviewing and hiring practices to recognition initiatives and leadership training—the following steps offer practical advice to drive sustainable improvements among the workforce.

1. Getting It Right From The Start

Employee turnover is highest during the first 90 days of employment. This is a critical time to get new workers properly trained and oriented so they start their new job on the right foot. Administrators and executive directors play an important role during this time, although it’s very common for their involvement to be limited during employee onboarding.

A good place to start is during general orientation. Executive directors and administrators should welcome new orients, have coffee with them, and even deliver the resident rights in-service. A community’s open door policy should be explained from day one, inviting new employees to stop in to talk with community leaders whenever they’d like.

Shelly Szarek-Skodny, chief executive offer at Century Oak Care Center in Middleburg Heights, Ohio, reinforces how critical it is for leadership to be present during an employee’s first days. “Administrators need to let new employees know that they care, they’re available, and employees are welcome to talk to them at any time. They need to be present and walk the floors every single day,” she says.

2. Embrace Mentoring

Mentor pairing is another practice that facilitates employee engagement from the outset. Assigning a mentor to a new employee helps to fast-track employees becoming self-sufficient. Mentors should come in to the first day of training to meet their new hires with the goal of making them part of the team, right off the bat.

“The engagement of a peer is much different than management. It’s faster for new hires to become successful taking care of patients and residents because they have someone working right next to them,” says Szarek-Skodny. “Quite often, they become friends, which is a great thing. When friendships form, attendance typically improves because no one wants to call-off and leave their friend hanging.”

Mentors should be involved with their new hires for the first 90 days. Their involvement should be greatest during the first 30 days, beginning with orientation and shadowing and then reaching out every day once initial assignments begin.

Weekly touch-base meetings for the rest of the onboarding period are critical in keeping new hires engaged, offering them a peer support system and encouragement when they need it. Mentor feedback is also critical in helping the employee demonstrate the proper technical skills to ensure patients and residents are receiving quality care.

Once new hires hit their 90-day milestone, it’s party time. “This is a big accomplishment. Celebrate it at a company meeting with a cake and certificate of achievement. These little things can go a long way,” Szarek-Skodny says.

Mentors should also be recognized. Consider a financial bonus or thank-you lunch. This provides additional incentive for the mentor to make each new employee successful and engaged with the organization.

3. Give Employees A Voice

Knowledge, power, and information are important aspects of engagement. Providing transparency into key processes within the organization and giving employees some level of control will go a long way toward facilitating engagement.

A good place to start is with employee schedules. Giving staff a voice in the scheduling process will help them feel better about the results.

Community schedulers and supervisors should ask employees about their shift and work-availability preferences. Which days work best for them? What times do they prefer? When are they unable to work? Do they feel strongly about working in one unit or department over another?

While it can be difficult to balance requests, it’s important to give employees some control over their own schedules. When open shifts arise, be sure to communicate them openly and broadly, so extra shifts can be shared equally among staff.

Consider how the use of technology can help balance requests with the organization’s needs to create best-fit schedules, track shift updates, and offer easy schedule access to employees.

4. Make It A QAPI Thing

Creating an employee task force is another way to increase engagement. When employees have a role in solving an issue, they tend to have greater buy-in. Different people from different roles and departments should make up the group. They should meet monthly for 30 minutes at a time, using information from employee surveys to help identify the specific task or issue to be resolved. 

This approach can also be part of Quality Assurance and Performance Improvement (QAPI) efforts, asking employees for areas of improvement and connecting these back to organizational goals and vision. 

An open forum for communication is foundational to a successful task force to establish trust and promote engagement. Once action plans have been formed and implementation begins, be sure to credit the employees for their hard work.

Consider these practices to increase employee engagement by fostering openness, empowerment, input, and recognition. Incremental improvements in these areas can add up to greater numbers of workers who work for the organization because they genuinely want to stay.

Mark Woodka

Mark Woodka is chief executive officer of OnShift, a provider of Web-based staff scheduling and labor management software for long term care and senior living. He can be reached at