Six years from now, the leading edge of baby boomers will turn 80 — roughly the age many start to consider full-service senior housing — marking a surge of significant growth for the senior-living industry. According to some industry officials, that swell will exacerbate an already sizable challenge to staff facilities with everyone from food servers, van drivers, maintenance staff, and medical personnel, to experienced property managers.
In fact, Argentum — a national association supporting professionally managed, resident-centered senior-living communities and the older adults and families they serve — projected in 2016 that the senior-living industry will need to attract more than 1.2 million additional employees by 2025 to accommodate for industry growth and to replace current employees leaving the industry.
Some say the labor challenge is most pronounced for clinical staff, such as nurses and nursing assistants, in communities that provide assisted living, memory care, or 24/7 skilled nursing as they compete for labor against hospitals, home healthcare, and staffing agencies. Senior-living communities run the gamut from independent living to 24/7 care, with communities containing one or more populations or, in some cases, all of them, such as Franke Tobey Jones, a nonprofit Continuing Care Retirement Community in Tacoma.
Senior-living leaders have responded to the labor crunch and anticipated senior tsunami by offering attractive employee benefits and engagement initiatives, special training programs for positions like nursing assistants and department directors, and by underscoring the intrinsic rewards of caring for the elderly, among others. Washington State University, driven by input from industry leaders, is developing a new major in senior living management to help the industry respond by training the industry’s next senior community and corporate leaders.
Bob Beckham, chief operating officer at Franke Tobey Jones, said almost 40 percent of the 160 staff at his community work on the clinical side, and when he’s looking for nurses, he’ll often hire them from a staffing agency until he can permanently fill the roles. Hospitals and staffing agencies can pay more than his nonprofit, but he argues the benefit of working in a senior residential community has rewards many nursing staff don’t realize until they join.
“Senior living in general, no matter where you go to work, once you’re exposed to it, people are like, ‘Wow, I should have been here a long time ago because it’s a pretty special environment,’” Beckham said. “People getting to work where people live is a very unique relationship.”
But Beckham said it can be tough to sell senior-living jobs to hospital nurses who love hospitals’ hustle and bustle or operating room environment.
“There’s nothing sexy about senior living; but come spend a week on the senior-living floor and you’ll see why people love to be here,” he said.
Tacoma-based LeadingAge Washington — which represents not-for-profit and mission-driven organizations dedicated to improving the aging experience of more than 50,000 older Washingtonians in need of safe and affordable housing or healthcare in community and licensed residential settings — hopes to alleviate some of the clinical staffing crunch at member communities. It plans to launch a four-week course early this year, pending state approval, to train people to become Nursing Assistant Certified (NAC), said Laura Hofmann, director of clinical and nursing facility regulatory services for LeadingAge. NAC is equivalent to Certified Nursing Assistant (CNA).
Coursework will be online, with hands-on clinical training at a member community. Tacoma Lutheran Retirement Community will pilot the hands-on training for the LeadingAge-run program managed by Hofmann. Students who earn their NAC then can work anywhere.
“It is a big problem,” Hofmann said of the clinical staffing shortage plaguing not just senior living, but home health, hospice, and other healthcare organizations.
Nursing shortages persist throughout healthcare, but it hits senior living especially hard, Beckham said. Dining roles also are tough to fill because of restaurant competition, he said. But hiring is a challenge throughout all positions, he added of competing for staff with other industries.
“It’s a significant issue,” Beckham said. “It’s probably the No. 1 issue we face on a regular basis and, frankly, I don’t see it changing.”
Across all jobs, it can take three to six months to fill a position, he said, but he’ll pay agencies for nursing help until he can find the right permanent employee who fits the community.
“We meet at least on a weekly basis, our clinical management team, trying to come up with new ideas: What’s working, what’s not working, what incentives, what can we afford, what’s the most we can afford?” Beckham said. “What bonus can we give to get somebody to come here to work because they’re going to be great and we need people. Some people will hire a warm body and we don’t.”
Bill Pettit, president of Seattle-based R.D. Merrill Co. — which operates 33 Merrill Gardens senior-living facilities in eight states, including Washington, where it has eight Puget Sound facilities that include communities in Kirkland, Seattle, Renton, Burien, Auburn, and Tacoma, and a future property in Sammamish — has been involved in the WSU planning and also sees a great opportunity in the industry.
Merrill Gardens offers independent living, assisted living, and memory care. About 65 percent of its population is in independent living, and 35 percent use assisted living and memory care services, for which care aides and licensed nurses are available.
“Even today, so many of the positions that we are competing to fill are talented people in marketing; care, certainly, across the board from caregivers to nurses; food and beverage operations; even to physical plant maintenance because the low level of unemployment, the amount of job growth, has left us competing for people with other industries,” Pettit said.
That competition includes construction trades for building and physical plant maintenance personnel; restaurants and hotel and hospitality companies for food and beverage workers; and the hospital industry, urgent care, and home healthcare for caregivers, care aides and nurses, he said.
“It doesn’t make any difference today which technical skill we have working in our industry, we’re finding almost direct competition amongst industries for the similar type of talent, and that’s just going to get more intense as we see the number of seniors double towards 2025,” Pettit said.
With the growth in seniors seeking senior housing and need for additional staff to handle them, Pettit sees ample potential for workers entering the field.
“It’s a time when I’ve never seen more opportunity in the industry to build a career than we have at this point in time and over the next 15 years,” he said.
Kris Engskov, president of Bellevue-based Aegis Living, which has 32 senior assisted living and memory care communities in California, Nevada and Washington, more in development and more than 2,500 staff, said Aegis’ rapid growth is driving a lot of the staff challenges, across the board.
“I wouldn’t even make the distinction between clinical and other parts of our communities,” Engskov said of Aegis, which has properties throughout Greater Seattle, the Eastside and Kent. “It’s not something that I’d see as such a challenge that it’s any way impacting our growth; but, at the same time … my No. 1 or 2 top priorities at any one time is constantly find ways to bring people into this business — and great people. So, we see it as a challenge, but we also see it as an opportunity.”
With the “aging tsunami wave” that will begin to land in the U.S. in the next five to 10 years, he sees a great need for senior-living communities and workers to serve them.
While technology might help people stay in their homes longer, “at some point, though, people need assisted living — that’s where we think we come in,” Engskov said.
Analysts in a November Wall Street Journal story suggested “aging-in-place” technologies making it easier for seniors to remain in their homes pose a threat to growth in the senior-living industry.
“At some point, you really need help everyday with just kind of basic activities,” Engskov said. “But the other thing people vastly underestimate is community. As you get older and you become less mobile and perhaps even a little less social, having a community and being social is critical to living, right? … That is what I think we can do for people that gets underestimated many times, is give them a built-in community every day, but they can still be as socially active as they’ve ever been and maybe more so. And you know, we believe that will improve their health.”
For younger people, he sees the industry as a great career opportunity. “Frankly … we need to make it more attractive and show people the benefits,” he said.
Aegis in early 2019 launched Aegis University, a new career development and training program aimed at helping employees at all levels of the organization improve leadership skills and advance their careers within the company.
The program kicked off by selecting and training care director candidates interested in advancing to director of operations. The eight-month training program includes classroom training, job exposure, and assignments to test learning and readiness for a new role. Other training will cover a variety of positions and functions — from marketing director to certified nursing assistant (CNA) certification, and more. Aegis will launch a company-run CNA training certification program in early 2020.
“As an employee-first company in a highly competitive healthcare market, Aegis stands out as an organization that is fully investing in its people to grow loyalty from within and attract new talent to the meaningful work we do every day,” the company said in a statement.
Nursing Interventions Impactful
Olympia-based Koelsch Communities — which has 32 communities in eight states, including 10 in Washington and three more under development in Puyallup, Bellevue, and Kirkland — has found it important in a tight labor market to respond quickly to prospective employees. It, too, has found the competition more acute for CNAs and nurses.
“Part of the challenge we face as an industry is nurses and caregivers often don’t even understand the geriatric opportunities or have any sense of connection to that,” said Benjamin Surmi, a gerontologist and director of people and culture at Koelsch, which offers independent and assisted living, memory care, and respite and hourly care.
One message that’s difficult to convey in the geriatric field is that nurses and caregivers have more power to make quality-of-life changes and dramatically impact people’s lives, unlike hospitals, where doctors have most of the life-changing power, he said. In senior-living communities, a nursing intervention can make all the difference in somebody walking or eating again, or laughing and enjoying life instead of staying in bed all day, Surmi added.
“Simply providing quality nursing interventions can radically change someone’s life and can change their whole family’s life because now family can perhaps interact with their loved one in a whole new way and they have grandma back,” he said. “And you don’t have to be a doctor, you can be a nurse or caregiver to do those things.”
One strategy Koelsch has used to attract CNAs at some communities includes creating partnerships with CNA training schools to conduct students’ clinical training at a Koelsch community. Oftentimes, students end up applying for jobs at the community after experiencing connections with residents and the company’s culture, Surmi said.
In another effort to build CNA and nursing staff, and to equip them for success working with sometimes challenging behaviors in memory care, Koelsch has gone outside the U.S. to tap evidence-based training used throughout Europe and Japan. Koelsch has flown in trainers from Portugal who conduct intensive staff training under an outcome-based program called Humanitude. Within four days of training, staff are changing the lives of people with challenging behaviors — such as refusing to eat or shower, or hitting — that make it difficult for caregivers to work in some memory care settings, Surmi said. Koelsch has piloted the program three times and plans to roll it out in other communities, starting with one in Longview and another in Fresno, California.
“Many caregivers simply do not get that training when they leave CNA school,” he said. “There’s no wonder why they leave, because they aren’t equipped, they don’t have the tools; and, so part of my perspective is that if you can equip your front-line staff with the tools they need to be successful, you’re going to have people who actually are going to stay and you’re going to have long-term employees.”
Koelsch plans to bring Humanitude experts to Seattle next spring to do educational workshops with area doctors, social workers, and nurses to increase awareness of the modality and its tools.
Koelsch in 2019 also changed its entire orientation experience for every employee, moving beyond just paperwork and videos.
“We decided we wanted to create an experience where, when folks come to work and their first day on the job, or first couple weeks on the job, they get to experience our culture,” Surmi said.
That includes exercises where they meet residents and build relationships with them, learn their life stories, get to know one another and their executive director in a deep way, plus games and other efforts to help them understand Koelsch’s culture, he said.
“That’s been really cool,” Surmi said. “We call it Happiness 101 because our mission statement is we create happiness by providing the finest living experiences anywhere.”
WSU Steps in to Help
Ironically, the senior wave set to flood properties will come as many senior-living managers reach retirement age, another reason to train future senior-living leaders, Merrill Gardens’ Pettit said
He’s among industry executives who have helped WSU develop a program to train future senior-living leaders to get a head-start understanding the complexity and intensity of operating buildings and communities in the industry. The effort started 10 years ago with a training program in one class, an elective course, “Introduction to Senior-Living Management,” that’s part of WSU’s hospitality program. In early 2018, WSU added an online, on-demand noncredit-bearing certificate program for the introductory exposure to the industry.
Now, WSU, again with help from industry leaders, is developing a curriculum for a full major in senior-living management offered in the Carson College of Business’ School of Hospitality Business Management, a major targeted for a fall 2020 launch to train senior-living managers.
The new major, through WSU’s newly named Granger Cobb Institute for Senior Living, will include core business classes — the degree will be a business degree in hospitality — plus additional human development education to bring a broader knowledge about the aging population to the degree, said Nancy Swanger, who’s on the front lines of developing the curriculum at WSU. Almost every college on WSU’s campus will offer curriculum input, including fields of psychology, sociology, aging and human development, construction management, interior design, and more, she said.
Swanger is scheduled to become associate dean and founding director of the Granger Cobb Institute for Senior Living on Jan. 1, transitioning from the role of associate dean and director of the School of Hospitality Business Management in the Carson College of Business. The Granger Cobb Institute is housed in the Hospitality School.
The plan is to offer a Bachelor of Arts in Hospitality Business Management, with a major in Senior Living Management, which would be available at all WSU campuses, including Everett, Swanger said. The major will address senior-living management that includes independent living, assisted living and memory care, but not 24/7 skilled nursing care, which is more of a medical model, she said. However, nursing faculty, including a gerontologist and other medical professionals, are contributing to curriculum development, she said, noting assisted living and memory care facilities include nurses and nursing aides.
Many boomers retiring today won’t consider senior living facilities until their 80s, but WSU wants to help the industry prepare, she said.
“When the boomers really put the demand on, we want to be at the front of the pack helping solve these workforce challenges and others as well,” Swanger said, noting a “real concern” among operators to groom future property leaders.
WSU’s operations-focused program will be training students to become the next leaders and operators of senior-living communities. But as hospitality program majors, students also are required to have 1,000 hours of paid industry experience exposing them to entry-level and front-line roles through internships or other arrangements. The hope is students would transition upon graduation into a management-training position, she said.
“The thing about this project is, it impacts every human that’s breathing — everybody that’s alive, if you’re breathing, you’re aging — and there’s only one way to escape aging, and it’s not a good one necessarily,” Swanger said. “How do we make that better? That’s the goal.”