Profile Picture
The senior living industry has a voice. You can hear it on Bridge the Gap podcast!

CW 81: Cara Silletto

Senior care is facing a workforce crisis that is unprecedented on top of the pandemic’s lasting effects. This industry has its unique challenges with attracting applicants, keeping employees longer, and competing based on wages. 

On this episode, workforce thought leader Cara Silletto gives a workforce recap from her Contributor Wednesday episodes with an overview of this year’s retention strategies. She also gives her final advice for the future of the workforce. Learn how organizations can operationalize turnover moving forward to prepare for a never ending revolving door.

Welcome to Bridge the Gap Contributor Wednesday, I’m Cara Silletto from Magnet Culture, and believe it or not my friends today is my final recording for the Contributor Wednesday series. It has been such a pleasure reviewing so many aspects of the workforce and the competitive landscape that continues to change in this space, and so I wanted to start with a quick recap of some of the things that we’ve covered this year, as well as giving my final advice on the future of the workforce going into 2022. So if you recall, back in January, we started with a conversation about why people truly leave, and making sure that we are not running off of assumptions. Then we dove into generational dynamics in February, talking out today’s new workforce and making sure that we don’t ever get set in our ways, and just look through the lens of the way that you or I, how we were raised over time. We broadened our horizons. We broadened our lens of how we see the workforce and how people see differently than we do. 


Then in March, we did a deep dive on the financial case for change and the true or hidden costs of turnover. In April and May we did a deep dive of our retention framework, M-A-G-N-E-T, and those six different strategies for reducing turnover. So it took us two months to get through those strategies, which was fun. In June, I discussed the disconnect that I see happening between leadership and the front line in so many of our communities, and how we can overcome that disconnect and stay in tune with our people. July, we took that to the next level and focused on the importance of emotional intelligence and being able to read the room to pick up on the nuances of how our staff are feeling, and being able to tune in to the differences of those dynamics on your team.


In August, we shared some theory about the constraining bottleneck that has happened with managers, and how in many cases we have overloaded our managers and not given them the data, the time, nor the proper training to do their jobs very well. And so we really dove into some ways that organizations, and particularly, those home office leaders can better support the management in those positions. September, we hit a full on recruiting crisis here in the states. And so we’ve decided to focus on onboarding, making sure that we were making it the best possible new hire experience that we could for all these new hires that we were bringing into our organizations on a daily or weekly basis. Then of course, wages started skyrocketing, the competitive landscape changed dramatically this fall, and we started talking about wages and wage compression in October. 


Of course, with all of those challenges, we started to see more and more burnout, and in November we took some time to just breathe, and we focused on some resilience tips, and ways that managers can not only take care of themselves, but also to take care of their teams, knowing that we are not yet out of the woods. While we have seen over the last two years some light at the end of the tunnel at different times, sometimes, unfortunately, that light has then diminished. As we’ve been blown another challenge, one on top of another, throughout this pandemic. 


So I did wanna say a huge thank you to Bridge the Gap for giving me twelve episodes this year, instead of just six, because there was so much to talk about. And that way, I was able to build off of each one of these episodes to dive a little bit deeper, and to really cover so many of the things that senior living providers and leaders across the country are calling me to talk about when they need help with retention.


So what I’d like to leave with today, is some final advice on the future of the workforce and what does that look like moving forward? Now, my first piece of advice is, if you missed any of those other eleven episodes, that’s your homework. Because first, we have got to understand our workforce and to really be able to read the room and flex and use that emotional intelligence, because one size no longer fits all. But as I’ve been on the road, since June, it kind of went famine to feast for those of us out in the speaking and training world as we were halted and sent home to do virtual for about eighteen months, and now I have been on the road every single week, since the beginning of June, working with providers and leaders like yourself, except that week of Thanksgiving, I did get a break with my family. But all of those other weeks I’ve been out working with leaders to figure out how to crack this code.


What in the world are we going to do moving forward? And one of the things that has continued to bubble to the top in our conversations is, this idea of how low do we truly believe turnover will ever get again? You know, pre-pandemic, I would talk to organizations that were in the 40, 50, maybe 60% turnover range. And at that time, do you remember back then when we just flippantly used the word crisis? It was like we had a workforce crisis on our hands, and yet today, most organizations I talk to are running at 80, 90, even over a hundred percent turnover. And they laugh saying, oh man, I wish I only had 50% over. Looking back at those good old days before the true workforce shortage and this massive workforce crisis has hit this fall. 


So as we’ve had those conversations, I began to think about what is our reality, moving forward? Is it the case that we need to, at this point, simply cut our turnover in half as a number, all right, so I’m gonna use 80% and 40% just as my example here. So if we’re running at 80% turnover right now, it is my feeling, such a strong sense, that we are very unlikely to get below 40% turnover within our profession anytime soon, if ever again. Now I know that’s not great news to everybody, it’s not music to your ears, I’m sure. But the good thing is if we can acknowledge that, if we can embrace the revolving door, if we can slow the revolving door from 80% back down to 40 or 50, then we can operationalize the turnover. That to me is the only way we are going to be able to get our head back above water, and the only way we are going to become sustainable organizations again, and the only way that we can get back to providing the greatest quality care possible. In a realistic way.


All right, now we have challenges within our profession that are not going away. Let’s just face it. You know, everybody I talk to, they complain about, we’re not the sexiest profession out there, it’s really hard to get a lot of folks even interested in senior living and senior care. It’s difficult to shift anybody’s mindset away from, for example, hospitals, over to our space, or anyone outside of healthcare to even think about this area, oftentimes because they don’t have very much exposure to this as a career path, for example. So, you know, we always are going to have that challenge to draw in more applicants, and certainly we can do work to improve that over time. I know a lot of folks work with the schools and students and their communities out in their county and their city. So there are strategies for that, but in general, it will be quite a hurdle for us to get past some of the reputation of the industry and just that it isn’t as attractive in some cases to other full industries, right? Completely different industries like hospitality or whatnot. 


So another challenge that we have is that we actually have a lot of lower wage stepping stone positions. Which means that if we’re not requiring degrees or requiring very extensive certifications and credentials for folks, then that means people can job hop. They can industry hop. So we’re not gonna get away from that. We are always going to have some of those positions that have a fairly low barrier to entry, which is good because we can attract people and get them through the CNA certification, for example, and get them into other positions within our organizations pretty quickly, but as quickly as they can come in, that is just as quickly as they can walk away. So we’re not gonna get rid of those stepping stone positions anytime soon.


And another challenge we have is that we know, particularly this fall, we have learned that it is very difficult for us to compete against the big box wages and benefits. A lot of other organizations that do not need to be named, are continuing to raise their wages, continuing to increase their benefits, continuing to offer new things, such as student loan debt repayments, and more tuition reimbursement and other perks and things like that, right? So, those challenges, and more, tell me that we are very unlikely to get our turnover, ever. below 30, 40, 50% moving forward. So again, I want to, instead of upset anybody and worry anybody, I want to empower you to take that information, and if you say, yes, you know what, let’s be honest, I agree, and I think that we’re gonna struggle to ever get down to lower than half of the turnover we’re at now, but the turnover we’re at now is not sustainable.


So instead of pretending like we can get it back down to near zero, let’s operationalize this, let’s plan for it my friends, let’s budget for it. Let’s talk about it. Let’s put it on the books and put it in our staffing strategy that this is our plan. In my mind, that is the only way we’re going to get our head back above water is, to set that baseline and start worrying about how do we reduce turnover down to something manageable and sustainable moving forward? Alright, so some of the strategies that I wanted to share today, as we close this up with a nice ribbon, some of them I have talked about in the previous episodes. Maybe they weren’t all put together specific to this idea of operationalizing that baseline of turnover, but I wanted to pull some different things together and help you and your leadership team have this more productive conversation about what would that look like?


So first things first, we must get a handle on the workload for the department leaders. I am predicting right now, mark my words, my friends, while we thought the fall of 2021 was The Great Resignation of our frontline and most of our team members who turned over this fall. Mark my words that 2022 is going to be The Great Resignation of the department heads. Because not enough organizations are supporting those department heads in a way that is meaningful and sustainable. There is still too much of this, hang on, just hang on, just work with me here, work your magic, as I’ve heard some people say, and then those department heads look at me and go, what does that even mean? Work my magic? What magic? I’ve got nothing about my sleeve here. Right? So one thing, very specific, that I’d love for you to consider and even talk about with your team is, this concept of hiring managers.


For too long, we were asking department leaders to be hiring managers, which I’m just gonna say it, I think that’s a bit of a cop out of not having recruiters or not having enough of a recruiting team. Instead, it was, oh, we’ll decentralize this and just let every leader find and hire and train and onboard their own people. That’ll be better. Wrong. It is not better. So we use this term hiring managers, meaning we’re gonna put the recruiting and onboarding function onto each and every department head’s plate, and I will tell you that the senior living organizations who have actually taken that off the department head’s plate, now they’re still involved in the selection of course, but they are not leading the recruiting and interviewing, and selection and onboarding process. For the organizations who really have taken that off of the department leader’s plates, they are finally able to get their head above water.


They’re able to focus on the people who work there and focus on retention, instead of ignoring all the current staff because they’re constantly interviewing and working toward those new hire processes. I will tell you, because about 70% of my work is within senior living and then I’ve got 30% outside of that, I do keep my finger on the pulse of what’s happening around the country with different professions, and according to Bloomberg’s annual HR report, they have, the past several years, it’s been right around 1.4 HR people per 100 FTE’s. So if you look at your locations, and if you have 100 FTE’s, if you do not have one and a half HR people, one full-time position and even one part-time position on top of that, then you are far behind the HR averages across the country. Now I do think our profession lags behind that pretty significantly, making these department leaders hiring managers instead of hiring actual HR folks.


But what I have found is that we have got to shake off the way that it’s been done. In the past, we had so many people who were called to serve, so many people who were mission driven to do this work, and today, sure, we love getting those folks to come in, but a lot of the folks who work for us are here for a job. They are absolutely here. It’s great if they love the residents, it’s great if they feel connected to that mission, and sure we would love for everyone to do that, but the reality is, with this revolving door that we have, we’re just not going to get that level of commitment and motivation from everyone. So what that means is, we have to take the HR role more seriously. And if we are serious and I’m talking, put your money where your mouth is serious, about reducing turnover and obtaining the staffing stability that we need to provide great quality care, moving forward, we must have those HR hours in the buildings.


They need to be on location. I’ve had a lot of groups I’ve been working with recently try to get away with, we’ll just put a regional retention specialist, or we’ll just put a regional HR person in, and I’m telling you right now, your executive directors, your administrators, your directors of resident services, directors of nursing, they are begging you, begging you to put more HR resources. Meaning actual hours of a resource professional an HR, sorry, human resources, professional person, in the building. And that needs to cover the compliance aspects, employee relations are so time consuming now with so much of the different dynamics within the workplace, dynamics across different teams, and we need to have someone that folks can go to, instead of always bothering and pulling the attention away from those department leads. So we need the compliance, we need the employee relations piece, which is what a lot of people in HR do at other organizations, then we also need that recruiting function, which has multiplied fivefold, if not more, as far as the amount of time we are spending on job postings, and interviewing, and selection, and that training process, right? Getting the new hires in the door and all that. 


And then we hopefully will get to, let’s say, you already have those two in place, and you’re like, oh no, Cara I’m there. I’ve got these people, right? That is when we go back to one of the things that I love to implement for organizations, and that is the retention specialist. But we can’t just jump to a retention specialist if we don’t already have an HR team in place that is handling the more traditional HR functions as well. A retention specialist is not going to make up for not having proper HR within each of your communities, and yet we also need that retention specialist or someone on the HR team who can focus on creating a better place to work. 


So it is going to require an investment. It’s very likely going to be at least another part-time person, if not full-time, or you may be a large life plan community. CCRC, a large campus of any kind. And you may realize you are 5 years, 10 years, 15 years behind the times of where we need to be as an HR professional department. So it is gonna require that investment. Now I get it, I get it. Every time I mention those things it’s, oh yeah, Cara, well, where’s that money gonna come from? Seriously, what are you spending on overtime and temp agency use right now? 


And I did say, it was an episode or two ago, I remember talking about wages, and it is gonna sting a little bit, but we are going to take a hit on our profit margins. We are absolutely not going to come out of this workforce crisis, this workforce shortage, unscathed with profit margins where we want them to be. So instead of, just hear me out, hear me out, instead of skimping and trying to get all of your folks to just hang in there and do more with less, instead of doing that, put your money where your mouth is, get your team the support they need, and reconfigure a realistic and sustainable leadership team for your communities going through 2022. Now, if we happen to get out of this crazy workforce crisis at the end of 2022, which we don’t know how long this is gonna last exactly, but if we come out of it at that point, then we can always pull back.


We can always reevaluate and reconfigure those job descriptions and workloads, but I’m telling you right now that if we do not put the right human resources, resources, into our leadership teams, next year will be The Great Resignation of our department leaders and administrators. So instead of running the 80, 90% turnover, let’s shift those dollars that we’re spending on the overtime and temp agency and training costs and all the job recruiting costs and everything else, let’s invest that on the front end, hire the right leadership team with the right credentials in those right seats, reevaluate the positions and the workloads, and then we can start to get the people to, to stay longer. Which, ultimately of course, reduces those overtime and temp agency costs that you invested elsewhere. So this is the only way that I see us realistically surviving 2022, is by reevaluating that situation.


We also need to maximize the time we have with every single new hire. So I had a leader recently say to me, okay, okay, Cara, well, I’ll think about hiring a full time HR or retention focused person, but I just can’t imagine, what are they gonna do all day? I’m sorry to laugh, but come on. There is so much to be done in creating a better place to work. And one of those things, that I’ve talked about on multiple episodes this year, is about better onboarding, better processes, and better training for a better new hire experience. So we have to balance this concept of get ’em to the floor. Let’s streamline and cut the orientation down to just compliance and get ’em out there as quickly as we can. We know that comes back to haunt us because then people don’t feel connected to the mission, they don’t feel they got proper training, they don’t feel a sense of team and comradery with their colleagues, right? 


So we have to balance this, get ’em to the floor mentality of streamlining with setting proper expectations, connecting them to the mission, helping them understand who we are, why we do what we do, and how they are a major piece of that bigger picture puzzle. So we have to spend time building up the teams so that they have each other’s backs, instead of backstabbing one another. But in instead filling in for one another and wanting to help one another when they do have, for example, scheduling conflicts. So that is going to take someone’s time and attention to be very intentional about the way that we onboard folks. But back to the, who’s gonna do it? If we have all of our department leaders completely overloaded at this time, we can’t possibly get that new hire experience where it needs to be. So that would be one of the first things I would have your HR team focus on is, improving that new hire experience. 


And then ultimately we need to make sure that we as leaders keep developing ourselves. That we keep developing our teams. Things are changing faster than they have ever changed before, my friends, and one size no longer fits all, remember? So you cannot become disconnected from your people and make decisions and think that everything’s gonna be hunky dory, because that’s not how it works. We have to listen to our people. We have to stay connected to our people. We have to never stop evolving. You know, we reach a point in our lives when we feel like, okay, I’ve got this. I finally figured this out and now I can coast a little bit, take my foot off the gas. Ooh. Unfortunately we cannot. We cannot do that.


We’ve got a whole new generation of young folks coming into our workforce now and we have to continue learning from them, learning about them. And we have continue working to be a boss that they want to work for. So I encourage you to audit yourself regularly, evaluate your effectiveness, and to think about how you are coming across to others. Let me ask you, would you want to work for you? And then I’ll take it to another level. Would the 25 year old you want to work for you? We’ve all changed quite a bit. And maybe your style does jive with your style and you’d love to have a boss like you, but yet others have a very different style and that may not work for them. 


Now I totally understand that a lot of things right now are nearly impossible. The implementation of new things, getting our head back above water. And so I just encourage you to continue putting one foot in front of the other. Don’t say we don’t have time to train. Do microlearning. Don’t say we don’t have time to revamp our onboarding. Try one new thing every time you onboard somebody. Little bitty baby steps will get us farther than we are today. So even if you don’t have time for complete overhauls, but instead we can just take one step at a time toward creating a better place to work, that, my friends, is our goal. 


So that’s all for me for 2021. Thank you again to the Bridge the Gap team. Sara, Lucas, and Josh, you all are amazing. And thank you so much for what you’re doing to move the senior living profession forward to that team, because they are just incredible, and continue, that is the epitome of a group that continues to evolve and never look back, but instead say, what do leaders need next? Now I hope each and every one of you listening today is going to keep in touch with me. Please connect and keep bridging the gaps in your communities across the country. Be that bridge builder for your team that connects the dots from one difference to another difference on your team. This is Cara Silletto from Magnet Culture signing off today and for 2021. Thanks for listening to this year’s episodes of my Bridge the Gap Contributor Wednesdays. Take care.

Comments are off this post!

CW 81: Cara Silletto