ANCOR Connect 2024: The Power of We
MITC recently conducted a staffing survey in which 137 agencies employing nearly 40,000 staff from across the USA participated. The majority of agencies have reviewed hiring, retention, and scheduling to try and manage the situation better.
Across the board, from smaller agencies with less than 50 staff to the largest providers with over 2,800 employees, agencies reported an excessive number of open positions, primarily for direct support professionals. The average agency employed 320 staff when fully staffed and had 25 open positions, or nearly 8% of all positions open. The total number of open positions was over 3,000.
Struggling to deliver vital services to a vulnerable population, agencies have responded by authorizing, or at least paying, more overtime. Of the agencies who participated in the survey, 65% reported overtime was higher than they wanted.
Turnover rates varied quite a bit, indicating that some agencies may be doing a better job with retention practices than others. Some agencies in South Carolina, North Carolina, Indiana, and Illinois reported turnover rates for direct support professionals as high as 80%. Turnover carries both direct and indirect costs. Turnover costs include:
- Additional overtime for other staff to cover vacant positions
- Lost billing if services cannot be delivered
- Management and HR time to interview, hire, and on-board replacements
- Training time and costs
Direct costs related to HR issues, such as off-boarding administration, recruitment and replacement hire activities, and fill-in staffing. Less obvious, but no less costly, are the negative impacts to staff morale, productivity, and performance, which can lead to the potential for adverse client outcomes and diminished quality of client care.
On the other hand, agencies in Maryland, New York, and Pennsylvania reported turnover rates under 10%. Not surprisingly, the agencies with the lower turnover rates were in states where paying around 20% higher pay rates for direct support professionals is feasible, but pay is probably not the only difference between agencies.
Ways to Improve Retention and Hiring Rates
Almost all agencies participating in the survey have taken steps to improve retention and hiring. Steps taken included:
- Better applicant screening to concentrate resources on those most likely to stay
- Emphasizing total compensation value, rather than hourly rate
- Improved, more organized on-board training
- Referral hiring bonuses
- New hire bonus on completion of training
- Mentoring programs
- Buddy programs
- Annual review of retention and on-boarding process
- Awards, award trips
- Employee appreciation days and events
- Gift cards
- Monthly staff newsletter
- Graduated pay scales with incremental increases
- Shift differentials
- Early access to benefits
- Creating new positions to focus on hiring direct support staff
- Working with local colleges, such as nursing schools
- Developing career ladders and career paths
- Profit sharing
Using small bonuses to thank employees is common. For example, one agency with a large number of group homes has a monthly attendance competition. The group home with the best attendance record gets a pizza party at their location.
Providing adequate training makes sense. Inadequately trained staff members are more likely to leave. We recommend agencies provide opportunities for people to improve their skills via training sessions, presentations, and team assignments. Employees like to share what they know; the act of teaching others ensures the employees own learning.
Apart from pay, agencies reported problems with the quality of applicants among those who are available. Common problems were:
- Applicant can’t pass drug and background checks
- No-shows for interviews and training
- No relevant skill sets
- Failure to complete training successfully
- Poor concepts of attendance responsibilities
How Scheduling Can Help Retention
Of all the agencies participating in the survey, 42% are considering new scheduling systems. This makes sense. With more open positions, agencies are forced to move staff around more. As well as minimizing overtime, improved scheduling practices can also help with retention.
Unfortunately, one of the biggest complaints employees have is lack of advance notification and planning for schedules. Poor scheduling or last minute schedule changes can cause conflicts with employee’s home lives and cause them to seek alternative employment, even at a lower pay rate. Frequent rescheduling leads to a culture of frustration and uncertainty in your workforce, and encourages absenteeism and turnover. A DSP will be much less motivated to show up if they are constantly being rescheduled, especially at short notice, even if they get overtime.
When scheduling employees, it is important to track employee preferences and restrictions to maximize employee satisfaction with their shifts, and to avoid calling employees to fill an open position they can’t take. MITC recommends integrating capturing schedule preferences and restrictions into the new hire procedures. Allowing sufficient time between shifts for employees to go home and rest helps as well. Try to avoid calling employees who have just finished a shift back in.
Using text/email reminders to notify employees of their next shift with instructions of what they are meant to do can also reduce absenteeism and helps motivate employees. Using task scheduling to assign employees specific duties creates a check list for them to tick off. People like to know what they are meant to do.
Planning for holidays well in advance can minimize overtime and avoid disruption. Even though DSP’s get extra pay for working on a holiday, few want to work on a holiday. Planning holiday schedules well in advance will lead to greater satisfaction and better attendance.
Using scheduling and time & attendance to monitor frequent offenders helps identify employees who regularly show up late, leave early, or call in sick, and set a bad example to other employees. This in turn, causes lower productivity and overtime.
As well as working on the hiring and retention process, agencies reported that they had changed some of their scheduling practices by:
- Investing in new scheduling software
- Allowing different sites greater flexibility in how they schedule staff
- Introducing rotating weekend shifts (one on, one off)
- Creating more full-time positions
- Increasing the number of part-time staff
- Creating dedicated scheduler position(s)
- Monitoring hours to ensure employees get a break to avoid burn out
- Implementing longer shifts on fewer days
- Using salaried staff to cover open shifts
Empower Employees Through Self-Service
Improved employee self-service can also help with retention and improve productivity.
Try publishing schedules on the internet. Allow employees see their schedule for the week and who they are working with, open positions, check their timesheets, view PTO balances, and more. This saves time for you and your staff. Empower employees to request PTO online. This avoids employees getting frustrated if they end up playing telephone or email tag with their manager and saves everyone time. Once employees are used to looking at your website, use the website to make organization-wide announcements and engage your employees in your projects.
Use automated text or email alerts to remind employees about license expirations, upcoming training, reviews, and more. Sending automated happy birthday and anniversary greetings all help. An HR email blast can keep different groups of employees updated about changes that affect them. Simple emails of praise at the completion of a project, monthly memos outlining achievements of a team to the wider division, and peer-recognition programs are all ways to inject positive feedback into a workforce. Also, consider reporting accomplishments up the chain. A thank you note to the employee is good, but copying higher-ups makes that note even more effective.
Employee Recognition Can Make All the Difference
Make sure your agency is on top of review dates and provide career paths for DSP’s. Employees want to know where they could be headed and how they can get there. Annual reviews or mid-year check-ins are one obvious venue for these discussions, but also encourage workers to come to HR with career questions and wishes throughout the year. Employees like to feel like their hard work is being rewarded. Part of making sure your employees feel this way is giving DSP’s the opportunity to achieve the non-tangible benefits of recognition and advancement. Reward exceptionally smart, resourceful, and hard-working DSP’s by gradually increasing their responsibilities and giving them more important titles. A DSP who’s advanced from an entry-level position to a manager role is much more likely to be loyal than one who’s done the same job for years.
It’s not enough to simply offer the potential for advancement — it’s also important to make sure that DSP’s understand how they can advance in your agency. Provide DSP’s with written guidelines on what factors will help them advance, such as good attendance records.
Try to promote from within your agency workforce, rather than recruiting outsiders. While this may sometimes be unavoidable, hiring an outsider to fill a vacancy when there are qualified employees with years of experience who could conceivably do the job can give the impression that you don’t care about your employees’ accomplishments.
Lastly, conduct exit interviews. If they don’t yield enough information to help solve a retention problem, consider asking longer-tenured employees why they stay. Ask questions such as: Why did you come to work here? Why have you stayed? What would make you leave? And what are your nonnegotiable issues? What about your managers? What would you change or improve?
While there are no quick fixes for turnover, making a few key changes can increase caregiver retention and help alleviate the challenges agencies face by caregiver shortages.