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Delivering Trauma Informed Care is Vital in Long Term Care<p><span class="rollup-image"></span>Trauma Informed Care (TIC) is an approach to care that requires specific staff competency and a system of care delivery that provides the necessary support to care for nursing facility and assisted living residents who may suffer from trauma.</p><div aria-labelledby="ctl00_PlaceHolderMain_ctl01_label" style="display&#58;inline;"><div>TIC also is a regulatory requirement for skilled nursing facilities. At least eight CMS F-tags cover various aspects of TIC making compliance with this critical form of care vital to nursing facility survey success and quality care.&#160;</div></div><span class="rollup-image"></span><p></p><div aria-labelledby="ctl00_PlaceHolderMain_ctl02_label" style="display&#58;inline;"><div>The recently released <a href="https&#58;//educate.ahcancal.org/products/trauma-informed-care-training#tab-product_tab_overview" data-feathr-click-track="true" target="_blank" style="text-decoration&#58;underline;">Trauma Informed Care Training</a> contains simple foundational steps and practical recommendations for implementing a TIC program that can help improve resident outcomes. Individuals will learn how to screen and assess for trauma and incorporate TIC into the discharge process. There also is a focus on building awareness of TIC among staff to help them deliver appropriate care and deliver meaningful activities and other services from a TIC perspective.</div><div><br></div><div>This nine-module online course was developed through a joint collaboration between AHCA/NCAL and the American Association of Post-Acute Care Nursing (AAPACN).&#160; The training is designed to educate long term care providers and nurses about how to implement TIC in their facilities with staff who are appropriately trained and competent to care for residents who are at risk for re-traumatization.&#160;</div><div><br></div><div>TIC is an important aspect of care given that 62 percent of adults have had at least one traumatic event and 25 percent have had three or more traumatic events.&#160;&#160;&#160;</div><div><br></div><div>The cost of the program is $350 for AHCA/NCAL members and $650 for non-members. The program is approved for 5.75 NAB CEs for administrators and 5.10 AANC continuing education hours for nurses.<br></div><div><br></div><div>Members will need to login to <em>ahcancalED </em>with their AHCA/NCAL usernames and passwords to <a href="https&#58;//educate.ahcancal.org/products/trauma-informed-care-training#tab-product_tab_overview" data-feathr-click-track="true" target="_blank" style="text-decoration&#58;underline;">register for the course</a><span style="font-size&#58;11pt;">.</span><span style="font-size&#58;11pt;">&#160;</span><span style="font-size&#58;11pt;">For assistance obtaining usernames and passwords, members should e-mail <a href="mailto&#58;educate@ahca.org" data-feathr-click-track="true" target="_blank" style="text-decoration&#58;underline;">educate@ahca.org</a> with their name and facility contact information.&#160; <br></span></div></div>2022-01-12T05:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/senior_hands_cane.jpg" style="BORDER&#58;0px solid;" />Caregiving;WorkforceTrauma Informed Care (TIC) is an approach to care that requires specific staff competency and a system of care delivery that provides the necessary support to care for nursing facility and assisted living residents who may suffer from trauma.
Unfunded Nursing Home Mandates in 'Build Back Better Act' Will Worsen Historic Staffing Crisis<p>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) said that two provisions in the <a href="https&#58;//rules.house.gov/sites/democrats.rules.house.gov/files/Section_by_Section_BBB_RCP117-18_.pdf">Build Back Better Act</a> (HR 5376) will have a devastating impact on nursing homes and could force thousands more facilities to further limit admissions or possibly close their doors.</p><p>The provisions, one that would require nursing homes to have a registered nurse (RN) on-staff 24 hours a day and another that would require the U.S. Department of Health and Human Services (HHS) to conduct a study on minimum staffing ratios and implement the regulations within one year, are unfunded mandates that, conservatively, would cost the nursing homes industry billions of dollars a year and require hiring more than 150,000 new caregivers.</p><p>“We strongly support having an RN on staff in nursing homes 24 hours a day, as we originally proposed in our <a href="https&#58;//www.ahcancal.org/Advocacy/Documents/24-Hour-RN.pdf">reform agenda </a>earlier this year. However, <a href="https&#58;//www.ahcancal.org/Advocacy/Documents/24-Hour-RN.pdf">current data</a> show that nursing homes are facing the worst job loss among all health care providers. We’ve lost 221,000 jobs since the beginning of the pandemic, and recovery is a long way away,” said AHCA/NCAL President and Chief Executive Officer (CEO) Mark Parkinson.</p><p>“Nursing home providers are doing all they can to attract and retain new workers, but the applicants simply aren’t there. The provisions in this bill do nothing to help us strengthen our workforce and will only force thousands of nursing homes to further limit the number of residents they can serve,” he said.</p><p>AHCA/NCAL estimates that if the HHS study found that nursing homes need to increase clinical and direct care staff by 25 percent, it would require hiring more than 150,000 RNs, licensed practical nurses (LPNs), and certified nurse assistants (CNAs), costing $10.7 billion per year.</p><p>Current requirements mandate that nursing homes have an RN on staff eight hours a day. Under the proposed mandate in the legislation, AHCA/NCAL estimates it would require hiring 21,000 more nurses, costing $2.5 billion a year.</p><p>Phil Fogg, president and CEO of Marquis Companies, who operates more than 20 long term care facilities in California, Nevada, and Oregon, said if Congress enacts these provisions without the necessary resources and recruitment programs, it could have a devastating impact on nursing homes and the residents they serve across the country.</p><p>“The workforce and economic crisis long term care providers are already experiencing is unprecedented. Lack of qualified workers is forcing providers to limit their admissions and, in some cases, close their doors permanently. Providers simply cannot attract more caregivers to our profession and meet the requirements of these mandates without financial support from Congress,” said Fogg, who is also the chair of the AHCA Board of Governors.</p><p>&quot;We all share a common goal, and that is to strengthen our workforce and provide the best possible care for our residents,” said Len Russ, operator and administrator of Bayberry Care Center in New Rochelle, N.Y. “But these unfunded mandates could further exacerbate the challenges we face and ultimately limit access to care for millions. </p><p>“We are eager to work hand-in-hand with lawmakers to find meaningful solutions that will ensure seniors continue to receive the highest quality care and caregivers have access to good-paying, rewarding jobs.&quot;<br></p>2021-11-17T05:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/capitol_blue_skies_flag.jpg" style="BORDER&#58;0px solid;" />Policy;WorkforceJoanne EricksonBill could force thousands of struggling nursing homes to further limit access to care to millions of seniors.
Time for a Staff Empowerment Check<p>​The pandemic hit staff hard. Personal protective equipment scarcity, staff shortages, required COVID-19 testing, working overtime, vaccine mandates—and the list goes on. Simply put, many staff feel disempowered. This feeling, if not addressed, can lead to further turnover.​</p><h2>​​Value is Power&#160;<br></h2><p>Staff empowerment, on the other hand, allows staff to make independent decisions and act on them. Empowered staff are valued and listened to. They stay with their current employers and encourage others to join the team. They have greater job satisfaction. They are happy and want to come to work.</p><p>These individuals are employees nursing homes want and need, especially now when staff retention efforts are so important.</p><p>Several facilities report that they are limiting admissions because of a lack of staff. Some organizations are unable to find qualified staff. To add to the frustration, multiple facilities are vying for the same small pool of candidates; one organization’s new hire is often another facility’s recent departure. In today’s market, an organization that values and treats staff well is the place employees will go.&#160;</p><p>Consider Mary&#58; She has been mandated to work overtime and comes to work for the 14th day in a row. When she tries to explain she is too tired to work any additional days, her supervisor criticizes her for not being a team player. The next day, she is told she must receive the COVID-19 vaccination or she will be fired. She wants additional information on the vaccine; though she was given a pamphlet to review, she doesn’t feel that it addressed all of her questions.</p><p>She is frustrated, overwhelmed, and considering leaving her current position as a certified nurse assistant (CNA) and abandoning her dream of becoming a nurse.&#160;</p><h2>​​A Common Scenario<br></h2><p>Mary’s friend Yvonne tells her about her own employer, another nursing home on the other side of town. Yvonne shares that her facility also has several of the same mandates but also explains that her concerns are heard and, when possible, her input is acted upon.</p><p>For example, when the vaccine mandate was implemented, members of the leadership team provided support, shared additional information to address specific concerns, and facilitated a group discussion where staff came together to talk freely about vaccine concerns. Yvonne also reports that when there are call offs, the entire team works together to share the burden of the additional hours.</p><p>To Mary, this sounds like a much better environment for her, so she applies for a position where Yvonne works and leaves her current position.&#160;</p><p>Although the above example highlights a CNA, staff who feel disempowered work in many positions across all departments. Mary left because she felt she wasn’t being heard.</p><p>Employee empowerment is about allowing staff the autonomy to flourish, according to a 2020 article published at www.business.com titled, “Trust the Process&#58; 13 Tips to Empower and Encourage Your Staff.”</p><p>Empowered employees are more likely to&#58;</p><ul><li>Embrace change</li><li>Be more productive&#160;</li><li>Show an interest in improvement</li><li>Have a good attitude toward work</li><li>Provide better care</li><li>Follow best practices.</li></ul><p>Moreover, empowering employees increases employee retention and job satisfaction, improves interaction with residents, and enhances accountability within the team.</p><p>Management practices significantly affect employees’ sense of empowerment. Here are eight strategies nurse leaders can adopt to improve staff empowerment.&#160;<br></p><p><em>1. Encourage communication and information sharing.</em></p><p>Empowering employees requires trust, and trust is built through clear communication and valuing input from others. Encourage information sharing, and emphasize that all ideas are welcome. During the next team meeting, use clear communication and ask for input from staff at all levels. Staff who feel their input is valued are more likely to come to their supervisor with problems and solutions.</p><p>Moreover, when employees contribute input, act on it when possible. Share how staff contributions improve care and outcomes. Remember that actions can speak louder than words and demonstrate to the team that their feedback makes a difference.</p><p><em>2. Recognize employees for hard work.</em></p><p>Recognition and appreciation for hard work increase the likelihood the person will repeat it. Make it a priority to recognize and thank a staff member daily. Be specific about the actions they did that you appreciate. Recognize the efforts of other departments, and convey how their contribution helps improve care for the residents.&#160;<br></p><p><em>3. Provide coaching and mentoring.</em></p><p>Effective coaching and mentoring help staff to understand what they need improvement on and offer solutions they can act on. Don’t delay coaching and mentoring. Instead, address issues as they are identified, and take action.</p><p>Additionally, encourage staff who have demonstrated mastery in their role to mentor others. Cultivating an environment of continuous improvement and mutual reinforcement not only acknowledges the importance of each individual’s contributions, but also builds the skillset of the entire team.<br></p><p><em>4. Learn flexibility.</em></p><p>Look beyond how things have historically been done, and consider instead how they could be done. One example is flexible scheduling, tailored to meet the needs of staff. Staff will feel empowered, are more likely to show up, and are more likely to be productive at work. Ask staff if they have ideas to improve processes.&#160;</p><p><em>5. Foster growth.</em><br></p><p>Provide growth opportunities for all staff. When possible, provide professional development across departments. Create a career ladder so that employees see opportunities for advancement within the organization. Discuss career aims with staff to better understand their goals and wants. Tailor educational offerings based on the requests of staff. One key way to both empower and retain staff is to help them to envision a rewarding future within the organization.</p><p><em>6. Engage with employees one-on-one.</em><br></p><p>Take the time to sit with employees, ask about their day and how things are going. Get to know staff on a personal level. Staff feel empowered when their managers listen to them and show concern about their well-being.&#160;</p><p><em>7. Listen to concerns.</em><br></p><p>When engaging with employees one-on-one, take time to listen to their concerns. If they voice any issues, take action to address concerns they raise. An employee who feels unheard or ignored is likely to disengage from the organization. Conversely, employees who feel heard and supported are more likely to bring issues forward.&#160;</p><p><em>8. Be forgiving.</em><br></p><p>An empowered staff takes risks, and there are times when those risks yield unintended consequences. If adverse effects are handled improperly, staff might avoid taking any risks in the future—even those that could pay off. Employee empowerment is about enabling staff to feel confident to take calculated risks and make autonomous decisions.&#160;</p><p>In order for staff to grow, heal, and recover from the trauma of the pandemic and contend with all the COVID-related mandates, organizations need to re-examine how they handle the non-COVID mandates. By providing employee empowerment opportunities, facilities can engage staff to help guide those efforts.&#160;<br></p><p><em>Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, is vice president of education and certification strategy at the American Association of Post-Acute Care Nursing (AAPACN). She can be reached at <a href="mailto&#58;astewart@aapacn.org" target="_blank" title="Email Amy">astewart@aapacn.org​</a>.&#160;​​</em></p>2021-11-01T04:00:00Z<img alt="" src="/Monthly-Issue/2021/November/PublishingImages/HR.jpg" style="BORDER&#58;0px solid;" />WorkforceAmy Stewart, RNBuilding trust can be achieved through clear communication with staff members and encouraging and acting on their input.
The Health Care Applicant Experience<p>Staffing has remained a challenge for post-acute and long term care organizations since the late 2000s as baby boomers neared retirement age. This demographic shift resulted in an influx of senior care services and will only continue to grow and put more strain on the health care system.&#160;<br></p><p>According to the U.S. Census Bureau, in 2015 there were an estimated 47.8 million Americans over age 65. By 2050, 87.9 million Americans will be over the age of 65, an increase of nearly 84 percent. AARP reported that on average, 52 percent of people who turn 65 will require some type of long term care services in their lifetimes.&#160;</p><p>The pandemic has exacerbated these workforce challenges and put a major spotlight on an issue that post-acute and senior care providers have been dealing with for years. While there is no single solution to solve the current health care workforce shortages, facilities and communities can take action to improve their recruitment, hiring, and retention rates moving forward.&#160;</p><p>It starts with understanding the motivations of today’s job seekers. Hireology’s “2021 State of Hiring” survey recently surveyed thousands of health care job applicants to develop a profile of today’s health care job seeker. This article highlights some of Hireology’s findings and how health care employers can stay on top of today’s competitive labor market.&#160;​<br></p><h2>Applicant’s Experience Matters</h2><p>Today’s job applicants have more choices than ever, which means employers need to go above and beyond to exceed the expectations of the applicants they’re trying to court.&#160;</p><p>The applicant experience begins with the employment application. Research conducted by CareerBuilder1 has shown that 60 percent of applicants fail to complete an application due to length or complexity. Applicants know their time is valuable and have plenty of other opportunities available.&#160;</p><p>It’s the responsibility of the hiring manager to gradually collect the necessary applicant information throughout the hiring process rather than expecting an applicant to fill out lengthy applications.&#160;</p><p><img src="/Topics/Special-Features/PublishingImages/2021/1121/apps_submitted2.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px;width&#58;476px;height&#58;534px;" />Another important facet is the medium of how applicants are conducting their job search. The survey found that over 57 percent of health care applicants utilized their smartphone (Apple iPhone or Android phone) to aid in their job search, indicating that mobile devices are the preferred medium for managing their job search.</p><p>Additionally, 35 percent of applicants said they would feel negatively about not having the option to apply via mobile device. Therefore, career sites and online applications that aren’t mobile-friendly are inadvertently turning applicants away.</p><p>With job seekers conducting a majority of their job searches on their smartphones, text messaging has become the medium of choice when engaging with applicants. Mobilesquared reported that over 95 percent of all text messages are read within three minutes of being sent. In today’s tight labor market, keeping candidates engaged and reducing hiring velocity (the time it takes to make a new hire) will mean the difference between landing top candidates and settling for what’s left over.&#160;</p><p>Pre-pandemic, 55 percent of health care applicants were hired within two weeks of starting their job search. That number jumped to over 60 percent in October 2020, based on Hireology survey data from its “2020 Applicant Experience” and “2021 State of Hiring” reports. However, employers shouldn’t sacrifice quality and verification measures for the sake of making quick hires, but should instead focus on areas of their hiring process that affect efficiency and hiring velocity.&#160;</p><p>The “2021 State of Hiring” report found that hiring velocity is important because over 69 percent of applicants surveyed applied to five or more jobs during their job search, indicating that their desire to get to work quickly was elevated.&#160;</p><p>If a company’s hiring process takes too long, that applicant is likely already in conversations with other organizations.​</p><h2>​​​Employment Enhanced by Benefits<br></h2><p>Seventy-one percent of respondents in the “2021 State of Hiring” report indicated a neutral or positive perception about working in a health care position, however, 80 percent of health care hires responded that they would be open to working in a new industry if the right opportunity came along. The latter ties into the negative numbers associated with employee burnout and turnover in the health care industry.</p><p>Keeping quality candidates around can be done by focusing on offering attractive employment benefits. Twenty-four percent of respondents indicated that seeking better pay was the main reason for beginning their job search.&#160;</p><p>While increased pay may be an unsurprising top motivator, the survey results were extremely positive, stipulating alternatives when increasing pay is either prohibitive or not possible. Flexible hours are very important, especially in the midst of the pandemic, because parents are dealing with new challenges at home such as school closures, taking care of elderly parents, or dealing with other pandemic-related problems.&#160;</p><p>Offering career advancement opportunities is another way that organizations can remain competitive when increasing pay is not an option. Creating opportunities for employees to participate in training or continuing education programs are also great ways to increase employee engagement and satisfaction scores.</p><p>LinkedIn’s “2018 Workforce Learning Report” revealed that 94 percent of employees would stay at a company longer if it invested in their career development, so to keep team members around, organizations should give them long-term advancement opportunities.&#160;</p><h2>​Maintaining a Good Employer Brand<br></h2><p>In order to attract applicants, it takes a concerted effort to invest in an organization’s employment brand—especially when employers are trying to convince quality applicants to apply to their roles.&#160;</p><p><img src="/Topics/Special-Features/PublishingImages/2021/1121/motivator.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;476px;height&#58;535px;" />An excellent employer brand will serve as an organization’s best recruitment tool to persuade job seekers that they are an employer of choice.&#160;</p><p>An important first step in building up a strong employer brand starts with developing a meaningful career site. Organizations should strive to create a career site that excites visitors and provides the pertinent information that job seekers are looking for—including culture, list of open positions, employment benefits, mission and vision statements, employee testimonials, and any other information that differentiates that organization from the rest.&#160;</p><p>Job seekers are doing their research, utilizing resources like Glassdoor, to gather relevant employee reviews on companies that they are considering applying to. Prospective applicants will use that feedback to determine whether they apply or look elsewhere, regardless of the merit of those reviews.</p><p>According to a “2018 Reputation Management Study” by MRINetwork, 70 percent of job seekers wouldn’t accept an offer from an employer with a bad employer brand. Business owners need to take ownership and address any negative reviews head on without getting defensive or casting blame elsewhere.&#160;​</p><h2>The Ideal Candidate Experience<br></h2><p>In today’s applicant economy—an occurrence in the job market where there are more open positions than there are available workers—employers need to intensify their approach to landing high-quality talent. Health care business owners and operators must review applicants quickly, engage with applicants through text messaging, and communicate how their hiring process works—including what to expect at each step—if they want to be successful.&#160;</p><p>Lastly, employers need to deliver on promises that were made in order to provide an excellent candidate experience. Follow-through is important to candidates, whether or not they’re offered a role. Sixty-three percent of health care respondents said they would feel negatively about a company that didn’t respond to their application, so even rejection emails are essential.</p><p>Understanding what applicants are looking for throughout the recruitment and hiring process can help health care organizations better attract and retain talent. It’s imperative to prioritize the things that matter to applicants so that post-acute and long term care organizations can remain competitive and hire great people quickly. n</p><p><em>Christopher Mercer is the director of healthcare market growth at Hireology, responsible for managing and growing Hireology’s healthcare strategic partnerships with a focus on post-acute and long term care facilities and communities. He can be reached at 858-822-9395 or <a href="mailto&#58;cmercer@hireology.com" title="Email Chris" target="_blank">cmercer@hireology.com​</a>.​</em><br></p><p>​​​</p>2021-11-01T04:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2021/1121/ChrisMercer.jpg" style="BORDER&#58;0px solid;" />WorkforceChristopher MercerUnderstanding the mindsets and practices of today’s health care job applicants can help employers meet and exceed their expectations.