LeadingAge Magazine · July/August 2015 • Volume 05 • Number 04

Building Staff Competencies: New Tools Help Providers Evaluate Employees’ Skills

July 15, 2015 | by Gene Mitchell

An interview with the co-chairs of the LeadingAge Workforce Cabinet, on two new “competency development guides” to strengthen the long-term services and supports workforce.

The LeadingAge Workforce Cabinet has been developing tools aging-services providers can use to strengthen the workforce across the full continuum. This summer, the Cabinet has released a pair of “competency development guides” against which members can measure their own employees’ job descriptions and competency levels:

  • Personal Care Attendant Competency Development Guide (download)
  • Mid-Level Manager Competency Development Guide (download)

Each guide uses a model based on four broad competency areas. The Personal Care Attendant guide focuses on technical skills, applied understanding, interpersonal skills and self-directed care. The Mid-Level Manager guide focuses on interpersonal, operational, financial-legal and human resources areas.

For each competency area there is a detailed table that breaks the area down into its constituent domains, and for each domain there is also a checklist of specific tasks associated with performing the job function.

The Workforce Cabinet says the two guides have broad uses, including continuing education, performance evaluation, professional development, recruitment, on-the-job training and coaching/counseling.

LeadingAge interviewed the co-chairs of the Workforce Cabinet, Frances Roebuck Kuhns, president-CEO of WRC Senior Services, Brookville, PA, and Barry Berman, CEO of the Chelsea Jewish Foundation, Chelsea, MA, to learn more about the Cabinet’s objectives and the value of the two guides.

LeadingAge: What were the issues or challenges the Workforce Cabinet addressed by creating these competency guides?

Fran Kuhns: My motivation to be part of the Workforce Cabinet was a personal passion for workforce and talent development. The idea behind development of three core competencies was to bring recognition to our care partners, assistants and middle managers, who are the backbone of what we do, and to elevate them to professional status so the public, not just aging-services providers, but acute-care providers and the public could truly recognize there’s a level of professionalism and skill development that’s necessary, and a very sophisticated set of competencies they must demonstrate in order to care for elders.

Barry Berman:
I feel strongly about that as well. There was a big concentration on middle managers, because without the middle managers buying into this whole concept, none of what we do is really is going to work. Any time we can educate the public and our own staff about these issues, we’re all the better for it.

LeadingAge: Regarding the development of these competencies, was your work based on something done in another field or is it an extension of existing practices in our field?

Fran Kuhns: When we first did some brainstorming and identified these three main positional categories, Natasha Bryant [managing director/senior research associate for the LeadingAge Center for Applied Research] did the literature search. She would bring the work of all these different stakeholders who had in one way or another done work to develop competencies for these three positions. She helped frame it, by saying here’s all the work out there in the literature, much of which Robyn Stone had firsthand experience with because she was part of the teams putting these things together in different venues. We also have a broad membership in the Cabinet; we had people from operations, education, and a lot of the different components of the aging services field who could bring their individual expertise and experience. It was a marvelous group offering diverse backgrounds and experiences.

Barry Berman: It showed that the field is so much more than just taking care of old people, especially with all those different disciplines bringing things to the table. [We knew] this is important work we’re doing, and professional work.


LeadingAge: You’ve mentioned three job categories, but there are only two competency development guides. Can you explain?

Fran Kuhns: we wanted to include core competencies in the area of care transitions and care coordination. As we were doing our work, and based on the evidence we researched, [we realized] we’re not quite there yet. The care coordination area is much more complex. The preliminary work was not done to the extent it was done for those [other two] other core competencies. Halfway through we realized we’d need another two years to wrap our arms around care coordination.

From a deliverable perspective we decided, let’s give LeadingAge some real deliverables with these two positions and then whet its appetite for having another group wrap its arms around care coordination and transitions. The time is right for that because of what we’re doing now in creating transitional care models.

Barry Berman: We didn’t want to water it down. We would rather concentrate our effort and do two things well than add more positions.


LeadingAge: What is typical practice in our field with respect to core competencies? Are there a lot of organizations that do not follow a “competencies approach”?

Fran Kuhns: We have regulatory guidance that, at least from the personal care assistant perspective, helps us define these positions. And that’s about it. So if our goal was to elevate the profession and the field of aging services as part of the health care/social care continuum, we needed to articulate that in the form of evidence-based competencies. This is something that won’t ever go away as we deal with the aging tsunami, whether metropolitan or rural. The candidates to do the work we need to do, and to do it at the cultural and quality levels we want, are tougher and tougher to find.

Barry Berman: It’s the biggest problem we have; it’s a bigger issue than money. It’s constant.

Fran Kuhns: By having these core competencies, and [outlining them] by domains, we’re hoping it will help our members in looking at how these positions work in their communities. It’s almost stepping back and saying, “Am I as the employer properly equipping the people who are my workforce with the skills we need to personally be successful and help us further our mission?”

Barry Berman: This is about the people we’re recruiting as the direct care workforce, but if the middle managers who they’ll be working for don’t have the buy-in and understanding of all this then what you’ll try to do won’t be effective. So you can have HR and some key people in management advocating for building competencies for direct care workers, but if middle managers are not getting this at all, it would be a complete waste of your energy.

Fran Kuhns: Truly, that middle manager position is one of the main drivers in all of our organizations because that’s the group that interfaces with the caregivers and with our customers and the larger community every day. As a provider you just can’t take that really good nurse and say “Now we’re going to make you the director of nursing, or the team leader in this department,” and not equip them with the skills and knowledge they need to be able to truly do that, and give the leadership training they need. If you look at that middle-manager core competencies document, that’s a pretty extensive list of all the competencies that person has to have.

LeadingAge: What do you tell LeadingAge members about why they should use these documents?

Barry Berman: Of all the things I spend my time on, I can’t think of anything that impacts residents and families more than these concerns. This really impacts the quality of life of people.

Fran Kuhns: We spend so much time training our staff on regulatory compliance that’s critical for licensure and quality, but sometimes we don’t see the forest for the trees. I believe our members can use these tools to do a gap analysis. How do you look at the functions of these people, and their performance criteria, to know if they are successful? How can I use this tool to say that here are the skill sets and core competencies people need to possess?

In your organization, are your folks being held to that standard? If they’re not, you don’t have to embrace the whole thing, but I believe that if my staff did embrace this and were properly trained in these competencies, what are the impacts on the quality outcomes I’m delivering to the consumer? I don’t see people taking these core competencies and saying, “Effective tomorrow these are the core competencies we’ll use for these two positions.” That’s not how this is supposed to work. I think of it as a gap analysis, [for] whatever quality improvement process you need to develop to enhance the quality and patient care outcomes you’re achieving. What’s your turnover rate, what’s your retention rate, what’s your employee engagement rate? This kind of evaluation and structure, I think, ultimately will improve employee engagement and retention.

Barry Berman: I feel very strongly that the CEOs of the organizations have to believe in this and buy into this.

Fran Kuhns: We’ve talked about this during our sessions: that workforce initiatives have got to be keyed on the strategic plan. If you have strategic plans around expansion or adding new services or enhancing your buildings or renovating, and you don’t have something on your plan that speaks to the investment you’ll make in workforce development, education and training, you’re not going to get anywhere. You’ll never be able to do all the other things on your strategic plan if you don’t have the workforce at as high a priority as everything else.

Barry Berman: It is ongoing, constant. I don’t think you ever achieve 100%. And the worst mistake to make is to think this is just an in-service you give in a couple of hours. It’s a way of life, a philosophy that has to start from the CEO on down.

LeadingAge: If you have used this approach within your own organizations, how did it work?

Fran Kuhns: At WRC Senior Services I’ve used these core competencies to help evaluate what’s missing from our education, care partner development and skill training. I’ve tried to use this tool to do that gap analysis and it’s what we do for every job description, using our core competencies. I cross-referenced what [the Workforce Cabinet] is doing with these two positions with what we’re doing at WRC.

Barry Berman: That is the only way you can effectively use the tools.

Fran Kuhns: We’re so engaged, and have been for the last couple of years, in relationship-building with acute care providers that I have found these tools, especially [the one] related to middle managers, helpful when we sit at the table with our two care partners and talk to them about what the people in their organizations are doing in terms of their jobs, and how that compares to what our people in aging services are doing. We can see some commonalities in terms of professionalism and skill training, and we can see that a transitional model will work. We can take someone in the hospital and move them into WRC in long-term care … and know we’ll still have a high-quality, well-trained, knowledgeable professional providing services so these individuals don’t get readmitted to the hospital. It’s a tool to use when talking to hospitals and your acute care partners about why they should trust you as a provider—why you can deliver a good outcome, less expensively, but produce as much or even greater quality than they can produce in the acute care area.


LeadingAge: Are there any public policy implications related to the Workforce Cabinet’s work?

Fran Kuhns: In one of our very first meetings, Robyn Stone said we’ve got to use whatever we accomplish as a springboard to elevate the profession. The consumer and other providers, from physicians to acute care to all the other disciplines, are now looking at long-term care and aging services and saying it’s another branch of professional health care delivery. In the past we’ve been an afterthought: “Oh, by the way, what if they need long-term care?” Now, we’re sitting at the table with all the other professionals and asking what’s in the best interest of this consumer. Where is the best place for this person to receive the care and services they need and want in the least restrictive environment at a cost they can afford?

We have a lot of work to do; there’s a whole lot of advocacy that has to be done. Hard work, low pay, and lack of status [are] still part of that aging services professional’s life. We’ve got to do something to change that from a public policy perspective. By doing this work in a scholarly way, and doing it in terms of evidence-based models and testing it through our members and what they can accomplish themselves, it’s a way to address public policy deficits.

Barry Berman: We’ve been spending the past several months on pro forma after pro forma on how we can make $15 per hour the minimum wage for our CNAs. It’s not that we won’t get there, but to get there is so challenging, especially when we have such a high Medicaid population. For a good CNA today, even $15 an hour is an insult for the work they do. If we could get $15 an hour for our nursing assistants we’d be thrilled.

Fran Kuhns: In terms of public policy, if it’s a heavy Medicaid population or even a private-pay population, in the world we live in today people are living longer and it doesn’t matter how much they set aside, it’s not enough for what their needs are going to be. It’s a tsunami and in our region, being rural, you just see that great divide. We see that so much in our area; there are fewer people of means who live longer and are spending down, and those with no means but complex care needs are increasing. How do you care for them with such limited resources? Now more than ever you need a trained workforce to do that, and an engaged workforce; someone who’s doing it, certainly not for the paycheck … who says, “I love caring for someone who cared for me all these years and now it’s my turn to give back to society.” There’s a lot more work that needs to be done on a public policy perspective.

LeadingAge Thrive provides resources to help members achieve peak effectiveness at serving seniors and their communities. The seven major topic areas in Thrive include questions designed to stimulate discussion among your leadership team and board of directors. Thrive also includes resources such as white papers, articles, tools, presentations and business intelligence.

Under the “Workforce and Leadership Development” section of Thrive, see the resources connected to these questions:

  • Do we use evidence-based management best practices (e.g., supervisory training, open communication, empowerment of frontline staff, self-managed work teams, peer mentoring and support) to set organizational priorities, solve problems, improve the working conditions and the quality of the job and minimize turnover and instability in the workplace?
  • Do we offer competitive compensation and benefits for staff at all levels and across all settings?
  • Do we have specific plans to strengthen our workforce by putting into practice competencies and competency-based training? If so, do you build these competencies into your performance evaluations?
  • Do we provide specific opportunities to develop the leadership skills and core competencies of staff for future success?
  • Do we provide mentoring and peer support initiatives to enhance frontline supervisors’ and workers’ self-image and encourage them to grow in their job?
  • Do we have a comprehensive cultural competence strategy to support healthy staff-to-staff and staff-to-resident/client relationships and quality service delivery?

 

Under the “Strategic Planning” section of Thrive, see the resources connected to these questions:

  • Do we have a process to regularly and rigorously assess internal core competencies as well as external market opportunities and threats?
  • Is staff informed about our priorities for the next several years?

Thrive is a LeadingAge member benefit, and access is limited to members. Use the MyLeadingAge login page to log in or create an account.

Visit the Thrive main page.