Long-term and post-acute care publication
If you want to attract and keep good staff, you need to think beyond just salaries and traditional benefits. Being innovative with benefits and perks can showcase your organization as a great place to work and give you a competitive edge in attracting and keeping great employees.
In 2018, the Centers for Medicare and Medicaid Services (CMS) issued additional details relating to the Payroll-Based Journal (PBJ) requirements, the staff reporting system that CMS uses to calculate the staffing measures under the five-star ratings.
The electronic submission of PBJ data is now required, including all data on staff ratios and RN-specific hours, for which there is a federal minimum of eight hours. The PBJ software must be updated immediately upon every new hire or termination, and the database must be kept current for all staff credentials and certifications.
In April 2018, in anticipation of the switch to all-PBJ reporting of staffing data, CMS amended the staffing measures and clarified the definitions of some job codes. Facility staffing ratings are now based on two measures: Total staff hours per resident per day (RNs, LPNs and nurse aides) and RN-specific hours per resident per day.
CMS uses the following job codes in the calculations for staffing measures:
All staff under these job codes 5-12 are included in the PBJ data reporting, whether they are full-time, part-time or contract employees. Among those not included are housekeeping staff, hospice staff, feeding assistants and private-duty nurses hired by the resident or family. If an employee is in the PBJ system under the wrong job code—or if an employee is performing tasks that should be considered a different job code or multiple job codes—it can skew the staff ratios once the CMS PBJ formula is applied.
The other big factor is the resident-to-staff ratio. If the organization’s PBJ system shows a deficiency in staff coverage per resident day, the organization’s penalty could be the automatic loss of a star in the staffing section of its CMS five-star ratings. The greater the deficiency, the more stars could be lost—and the loss remains for the rest of the quarter.
Ensuring compliance with PBJ mandates is a concerted effort among clinical administrators, IT and HR. While clinical directors are responsible for scheduling the nursing coverage, HR directors should review PBJ data on a regular basis to ensure employees are placed in the correct job codes. If some employees seem to be performing duties of a job code above them (such as “helping out” with RN duties on a regular basis), it may be in the organization’s best interest to offer enough training to elevate that employee to the higher job code, which will improve the PBJ staffing ratios.
For information on other 2018 changes, see the CMS Design for Nursing Home Compare Five-Star Quality Rating System: Technical Users’ Guide (PDF). The Staffing Domain section of the report details how the changes affect five-star quality ratings.
The new longevity economy includes a robust range of environments and services meant to attract residents well before skilled nursing care is needed. But are long-term and post-acute care (LTPAC) providers paying equally diligent attention to acquiring and cultivating the workforce needed to successfully operate those new models and do more than merely survive as businesses?
As the long-term and post-acute care (LTPAC) sector moves into value-based models, organizations are looking for ways to differentiate themselves. Today, employees at all levels can play key roles in driving traffic to your website, encouraging customer engagement, and gaining the attention and loyalty of residents, families and staff.
“Brands are waking up to the impact activated employees can have on marketing goals,” says Michael Brenner, founder and CEO of Marketing Insider Group, in a blog. “Your employees are consumers. They are the human face of your company and so are more trustworthy in the eyes of your audience.”
So how do you engage and inspire employees to be active in the business culture without adding to their workloads? It may be easier than you think.
First things first: Establish your organization as socially engaged. You may want to start with staff satisfaction surveys to assess how engaged, happy, and open your employees are. The more engaged staff are, the more likely they are to feel ownership within the organization and work with management to promote successes and serve as advocates in the community, Brenner notes.
Tools are available to assess staff engagement, including pulse surveys and mobile apps that let employees see each other’s comments and responses. Some of these next generation tools can be used to capture feelings, trends, social engagement, and other information in real time. Some organizations have found success with more traditional tools such as the Press Ganey assessments.
Create opportunities for internal conversations with LinkedIn or Facebook groups online and live events that bring people together to share ideas, news, and information. Get everyone on the same page regarding your organization’s missions and values as well as any new developments and changes. While encouraging social media postings, ensure that all employees are properly trained in the Centers for Medicare & Medicaid Services (CMS) guidelines for appropriate use of resident images and other regulations protecting residents’ privacy.
Consider an avenue for employees to share their stories internally. For example, have a monthly story contest with a small prize (i.e., gift card, free lunch) where employees can share on different themes such as a resident who touched their lives, a co-worker who served as a mentor, or life lessons learned from a resident. Even better, try a problem-solving workshop to encourage employees to share their experiences with a job challenge and how they solve them.
It’s not enough to put communication networks in place. It’s important to identify where communication is flowing and where there are gaps and blockages. Consider:
Doing a little detective work can identify strengths, gaps, and barriers. However, depending on what you uncover, you may need to narrow down communication channels to one or two. It is essential to make sure employees know how to use these. Make sure you track how employees are using communication channels, what information they are accessing and sharing, and what information they want that isn’t readily available.
Just as care in your organization should be person-centered, your staff engagement also should be focused on the individuals:
People who feel socially engaged at work are more connected to each other, inspired and optimistic about their company’s future—and 20 percent more likely to stay, Brenner notes. Making employee engagement part of your organization’s culture can drive results through a workforce that is dedicated, enthusiastic, and focused on quality.
Even with ideal hiring processes in place, sometimes HR directors face the situation of a potential employee termination. Dismissing an employee is never easy, but well-communicated procedures and consistent, complete documentation can help prevent surprises and minimize the stress and anxiety of a difficult situation.
Dismissing an employee for performance or behavioral reasons is rarely a sudden event. It usually begins with a pattern of behaviors or repeated offenses—such as frequent absences or no-shows, conflicts with other employees or a consistent inability to handle job responsibilities. While it may be tempting to wait and hope the person improves, it is best to begin a conversation with the employee as early as possible, since a proactive conversation can alert HR to the need for more training or counseling, problems at home or special challenges that might be easily remedied.
Prompt intervention, while key, doesn’t necessarily require formal disciplinary action. In many instances, such as when someone is constantly late or seems to be struggling with some aspect of their work, involving the employee in a problem-solving approach is much more effective than instituting discipline upfront.
The goals of initial conversations should focus on the specifics of the employee’s performance or behavior while involving the employee in finding solutions, suggests Martha Abercrombie, SHRM-SCP, SPHR, vice-president of strategy, Vikus Corporation, in an article on healthcare employee discipline. A diligent approach between HR and an employee should:
During onboarding, all employees should receive formal documentation of the organization’s policies on specific behaviors and any other events that would result in termination. All conversations and meetings related to an employee’s performance or job expectations should be documented by date and time, even if they’re casual ones—as issues arise, documentation provides due diligence that the organization attempted early intervention prior to any disciplinary actions.
If things escalate beyond an informal conversation, all documentation of poor performance or violations of company policy should be made in writing, even if it is just via email, suggests Stephen McDonnell, Esq., Partner at Gawthorp Greenwood, in an article in Entrepreneur. Avoid any vague statements and veiled threats of not being up to snuff—choose direct statements that refer to specific deficiencies instead. “I recommend a written memorandum signed by the employee and placed in their personnel file,” he says. “Undocumented issues leading up to termination are a recipe for expensive litigation or a costly settlement.”
Be sure to enforce the company’s disciplinary policy, which all employees should receive and review on their first day of employment, including those who are hired “at will,” he adds. “When you make exceptions, even with the best of intentions, you risk claims of disparate treatment due to race, gender, age or disability.”
If a separation is imminent, handle the termination with as much dignity as possible. Conduct the firing in a private area away from other employees, but have at least one witness. Be brief and clear, polite but not apologetic. State the reason for the termination and immediately be able to provide the employee with the documentation of conversations, warnings and any formal disciplinary actions taken over time. Communicate all legal requirements and separation details, including any COBRA benefits, last paycheck procedures and unemployment options.
In advance, review the employee’s files for any post-employment obligations, such as confidentiality or non-compete agreements and be sure to discuss these with the employee, suggests Amy Joseph Pedersen, SPHR, attorney at business law firm Stoel Rives. She also recommends getting IT involved to ensure the proper protocols of severing the employee’s access to network computers. Arrange to get any company property back, including phones, tablets and keys. If the person needs to return company items or pick up personal possessions at a later date/time, determine in advance how this will be done. When possible, it is useful to have severance policies that require the employee to return company-owned property and sign a release in order to receive his or her final payment.
If an employee needs to be terminated, following these tips can help prevent complications such as angry outbursts or legal complaints by the employee:
If you have a strong organizational culture that emphasizes teamwork, mutual trust, and communication, then your employees should understand the job expectations and responsibilities and should know the consequences of unacceptable actions and behaviors. This may not make terminations easier, but it will help all employees see that the organization is fair, equitable, and caring not only about quality outcomes but also about the people who work there.
