LeadingAge Magazine · July/August 2016 • Volume 06 • Number 04

Staff Retention for Quality and Growth

July 13, 2016 | by Debra Wood, R.N.

With worker shortages mounting, keeping the employees you already have, and giving them a chance to grow, is crucial to quality and organizational stability.

Aging services remains a people field. Caregivers and clients build relationships, leading to better outcomes. That being the case, retaining frontline and other staff becomes a critical task for organizations.

“We want people with a heart for service,” says Cathy Cooper, chief human resource officer at United Church Homes and Services in Newton, NC, which operates 3 life plan communities in North Carolina and Virginia, a PACE, and 7 affordable housing communities. With changing demographics, “looking at the future, it’s going to become more difficult to find employees.”

At the same time the older adult population is growing, additional opportunities exist for traditional health care services personnel, she explains.

“With the challenges in the [field], attracting competent, effective and satisfied employees will be an area of great competition,” says Mark Pile, president/CEO of Diakon Lutheran Social Ministries, a provider of multiple services including life plan communities, senior and assisted living, and adult day and community programs based in Allentown, PA.

Diakon considers retention of engaged and competent employees a competitive advantage, because as the quality of care improves, relationships with residents strengthen. Pile has found a direct correlation between employee satisfaction and resident satisfaction.

“In the years ahead, retaining and engaging employees will be as big of a challenge as health care reform,” Pile adds. “It’s in the top 2 or 3 strategic focuses needed ahead.”

To meet these challenges, Diakon adopted the “stay interview” process advanced by author Richard Finnegan. While exit interviews are common, Diakon has taken this different approach to focus on retention.

“It’s an opportunity for a supervisor to engage with an employee, outside of the performance evaluation, and delve into what employees are happy about, what frustrates them, and what additional goals each person seeks,” says Jenn Rautzhan, acting vice president for human resource services at Diakon.

The stay interview might reveal that an employee hopes to play a different role within the organization or secure additional training. The manager may discover the employee plans to leave and can discuss what might change his or her mind.

“The manager and employee work together on an action plan,” Rautzhan explains. “It’s hoping the trust relationship has been established, and they can have an open conversation to improve areas together.”

In addition, the interviews provide a setting in which staff members can make suggestions to improve organizational efforts.

“We certainly welcome this type of collaboration,” says Pile. “We have promoted as much local decision-making as possible, which helps to improve employee engagement.”

Diakon retains nearly three-quarters of its employees and aims to increase that to 80% by 2020.

“The focus is on the employee’s satisfaction,” Pile adds. “Many people come to Diakon, because they have a vocational calling, and our mission is aligned with their personal values.”

Denise Boudreau-Scott, a Manasquan, NJ-based trainer and consultant for improving patient, resident and staff experiences, reports that learning about the employee and his or her goals allows the manager to create a more rewarding work experience.

“Knowing your people makes a difference,” Boudreau-Scott says.

United Church Homes developed supervisor-manager training classes in leadership, coaching employees, hiring the right people, the supervisory role, handling conflict and difficult situations, and conducting performance evaluations. The organization also changed its performance evaluations from a skill-based to a behavioral-based system to better shape the qualities it wanted in employees.

“Employees do not quit companies; they quit managers,” Cooper says. “We wanted to develop their engagement with supervisors. We wanted to build strong leaders who could communicate well.”

Additional training, including succession planning, will take place next year.

“We want to take good workers and build better relationships,” Cooper says. “Relationships are at the heart of our mission.”

Cooper encourages all managers and supervisors to be nice to their employees, to know them personally and to have an interest in them and their families.

“Those things are key, and that’s how we are going to retain people, if we have a good relationship,” Cooper adds.

Boudreau-Scott reports that untrained middle managers often lack the leadership skills to successfully manage a team, but those talents can be developed. Building bonds and relationships with employees leads to better retention.

In keeping with the relationship theme, United Church Homes also has implemented a peer mentorship program, based on a similar program at Mather Lifeways, Evanston, IL, which shared its materials.

A coordinator at each location oversees the program, and a task force develops the structure of the program. Co-workers or supervisors recommend potential mentors, who are selected for excellence in skills and enthusiasm.

“They have to be the best of the best,” Cooper says. “That’s who we want to bring on new employees.”

Mentors receive 6 hours of initial training and ongoing education to develop their skills.

The new employee meets with the mentor for 1 year. It gives them an opportunity to answer questions or diffuse concerns. Mentors receive bonuses based on the length of time the mentee stays with the organization during the first year.

“We want peer mentors invested in the [new employees] staying,” Cooper adds. “We need compassionate people, who understand our mission.”

Diakon also offers a peer mentoring/precepting program for new hires, pairing an experienced staff member in the same position with the new colleague. The mentor may reduce support as the new hire becomes more comfortable, but he or she remains available if the new staff member has questions or concerns. The mentors also experience personal growth.

Garden Spot Village, a life plan community in New Holland, PA, replaced annual performance reviews with a coaching model 4 years ago, as an outgrowth of its person-centered focus.

The organization trained more than 100 people as coaches, and all 500 employees were assigned a coach. That training included a personality profile. The full-time employee and coach must meet 3 times per year, part-timers twice annually. They set goals and work toward them. It’s a forward-looking process, rather than a look back at past performance. Employees often come up with ideas to improve processes and are encouraged and guided by the coach to try out those ideas. Garden Spot continues to have a remedial performance program to handle disciplinary issues.

“It’s a good change and has allowed some people to get positions they would not have otherwise,” says Bryan Groff, director of human resources at Garden Spot Village, explaining that homemakers have become CNAs, LPNs and RNs. The community offers tuition reimbursement to help with education for those more advanced roles.

For many organizations, especially those in human services and health fields, “staff satisfaction” is no longer enough. Employers are recognizing that an “engaged” workforce, which is not only happy with its work but actively committed to furthering the organization’s mission, is crucial to success.

A useful introduction to engagement is a white paper, Employee Engagement: A Strategic Game Changer for Senior Living Providers, available on the LeadingAge website. Written by Holleran, Mountville, PA, the guide offers a roadmap to building employee engagement. It categorizes employees into five “zones.” The two “Orange Zone” categories (Catalysts and Advocates) are the most engaged; the two “Blue Zone” categories (Endorsers and Contributors) are not engaged but have potential to be brought to engagement; and the “Green Zone” staff (Resistors) are the most disengaged employees, who may in fact be toxic to the organization. Also included is a list of 25 indicators of employee engagement, 15 of which are used to develop an employee engagement index. The other 10 are more traditional satisfaction measures.

LeadingAge spoke with Holleran’s Connie Wolfe, executive vice-president, to learn more about building engagement in an organization.

LeadingAge: Let’s start with a definitional question: How does employee engagement differ from employee satisfaction?

Connie Wolfe: While satisfaction measures contentment—how happy and content employees are—it doesn’t necessarily measure interaction between employee and organization. It’s more one-sided, a kind of a “What are you doing for me” question. You do want staff to be satisfied, but what you really want is higher engagement. You want to know how passionate and committed somebody is. Is she an employee who will go above and beyond for the good of the organization? I look at it as “What’s in it for us?”

A highly engaged employee is teaming up with the organization to move it forward.

LeadingAge: Why does employee engagement matter? How much better can engaged employees be than simply satisfied employees?

Connie Wolfe: When you think of a highly engaged workforce, we see a higher percentage in that Orange Zone. The culture within an organization plays into it. If it’s a very transparent culture there is much more success in implementing new ideas and new initiatives. It’s just a better environment to work in. If you’re doing the great task these staff have—caring for residents—engagement creates a better climate for families, residents, everybody.

Engagement also means making sure employees have a voice, that they are heard. Not every suggestion can be taken, but it’s making sure employees also have a stake in the game.

LeadingAge: In the white paper you say that some senior living organizations “have decided to take the leap from pure satisfaction to measuring both satisfaction and engagement.” What proportion of providers do you believe have done this?

Connie Wolfe: It’s now a year since the white paper was written. Organizations are conducting their staff surveys every year or every other year, so we’ve gone through the full gamut [with some clients] of [research] over 2 years. I don’t see it as either/or; it’s not satisfaction or engagement, it’s an and, so you still have satisfaction measures.

Looking at our client base, I’ll say that 60% to 70% are making that switch to engagement. Actually, it’s better to say that it’s not a switch, it’s a value-add.

LeadingAge: The white paper includes data suggesting that senior living has more “resistors/highly disengaged” employees than corporate America. To what do you attribute that? Is the nature of the work of frontline caregivers, especially in skilled nursing, part of the issue?

Connie Wolfe: Let’s look at both sides. Yes, we have more resistors. When we indicate engagement we break it down by department. There clearly are pockets that have lower levels of engagement, have more resistors. Nursing, dining, perhaps environmental services, those are areas where we might see a higher percentage of resistors. However, that’s not true across the board in all organizations.

When you look on the flip side, at those catalysts and highly engaged employees, we have more of them than corporate America does.

LeadingAge: Isn’t there an assumption that the managers who put this program into place are themselves engaged? How do we know they are?

Connie Wolfe: From our research we can [identify] if managers/supervisors are not engaged. To answer that we have a leadership engagement workshop where we work with the client, giving 4 workshops over 6 to 9 months, [with] a core group of 25 participants. When you think about how important employees’ relationships with their supervisors are, that has a huge impact on the level of engagement.

In the workshop we’re helping managers look at themselves first. How am I viewed by others, what is my relationship to others, to the team?

If you see that you do have a lower level of engagement within management or supervisory staff, you work through this program with that group, and then reassess afterward to see movement. What we sometimes find is that maybe there’s a higher [number] of catalysts, but maybe there’s a higher percentage in that green zone group, that disengaged group. There, culture change is occurring; employees are picking sides, you’re getting rid of those middle-of-the-road fence-sitters. People decide to either join this community and be part of the success of the organization, or they might have to jump ship.

LeadingAge: What do you recommend for managing the green zone, disengaged employees?

Connie Wolfe: We’re not ignoring them, but why focus your energy on someone who doesn’t even want to be there? That middle group, those blue-zoned folks in the endorser and contributors categories, they’re the ones you need to focus on. They’re showing up, doing their job, but maybe they just need a little more effort.

One employer had conversations with small groups in each department and as a group they identified engaged behaviors, and all agreed upon them. Then when some folks weren’t exhibiting that behavior, they could be honest: “You told us you were engaged and we agreed these are the behaviors.” Sometimes there may have to be a separation.

LeadingAge: What are the most important factors in boosting staff engagement?

Connie Wolfe: How do you boost staff engagement? Quarterly stay interviews, one-on-one between employee and supervisor. They are 30 minutes, not meant to be a long meeting, and not meant for talking about workload or process. They are strictly focusing on that individual’s growth in the company, “What can we do to help grow your career?” It’s making that employee feel important. That piece is just crucial.

While everyone might think pay and benefits drive employee engagement and satisfaction, that is typically not the case. It is feeling appreciated by the organization, feeling it cares for them, that there is trust in leadership. You can’t put that up on a poster that says “Trust us.” It’s in [the employers’] actions, and how it feels on a campus. When I walk on a campus to present results, the feeling I get usually matches the results I’m about to report. Am I greeted by staff members, or is someone just walking through the hall with their head down, not even recognizing an unfamiliar face in the community?

Part of it is training leaders and managers to respond to engaged employees. Just a thank-you at the end of the day goes a long way. Something like, “I know how hard it was to deal with Mrs. Jones today, you were very patient and saw that through.”

Several years ago, Garden Spot Village launched a sabbatical program for people employed for 15 years. In addition to paid time off, the community gives the employee a 2-week block of time to do something memorable—a cross-country trip with the family, a mission trip or hiking around the base of Mt. Everest.

“They are bucket-list things they would not have done without the block of time we gave them,” Groff says.

The organization also sponsors mission trips to the Dominican Republic, Honduras or disaster areas in the United States, matching the time the employees take from their paid time off bank. The residents also may take part in the trip.

“It’s an intergenerational, multicultural mix,” Groff says.

Garden Spot recognizes employee longevity with a buffet luncheon. A resident speaks about how much he or she appreciates the services received.

United Church Homes also recognizes employees’ years of service. Several employees have been with the organization for 30 years or more.

Diakon also regularly recognizes exemplary performance. In addition, it allows employees time off to help other organizations, such as orphanages or care programs in other parts of the world.

Everyone we spoke with agreed that salaries and benefits remain valuable. With retailers paying $10 an hour, suddenly, positions requiring no skills are competing for the same employees as aging-services providers.

“It’s important to be competitive,” Cooper says. “We want people who have a heart for the service of others, and you are going to have to pay for that.”

Boudreau-Scott says organizations should accentuate to employees the difference they can make in people’s lives. That will not happen at Walmart or McDonald’s.

Diakon has conducted salary and benefits analyses to ensure it offers a competitive package and has increased pay scales as needed to retain staff. The organization allows part-time employees to participate in the health insurance plan and offers a tuition reimbursement benefit.

While Boudreau-Scott agrees living-wage salaries are important, she relates that a low-income dietary aide at one client’s location said, “Don’t worry about what you pay me; worry about how you treat me.”

“A Gallup survey found the number-one predictor of engagement is ‘I get to do best what I do every day,’” Boudreau-Scott reports. “There is a tremendous opportunity to find out want people want and what is standing in the way of doing their best. And we don’t know unless we ask.”

Employee satisfaction surveys and exit interviews have helped United Church Homes decide what human resources areas it wanted to tackle first to address retention.

Knowing what an organization’s employees are thinking becomes critical for developing a retention plan, adds Boudreau-Scott. She will conduct focus groups for clients.

“We find the things that are motivating or demotivating the employees,” Boudreau-Scott says. “So often we don’t know what people are thinking, because they do not want to tell their boss.”

Once the organization discovers what concerns exist, it can develop a plan to align what is happening now with what can be.

“That requires training and a commitment to looking at policies that may be standing in the way of a great experience,” Boudreau-Scott adds. “Change is possible.”

LeadingAge Thrive provides resources to help members better serve seniors and their communities. The 7 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 have a comprehensive orientation program for new employees across all staff levels and settings?
  • Do we provide ongoing state-of-the-art training for administrators, midlevel managers, clinical staff and frontline providers across all departments and settings?
  • Do we conduct employee satisfaction and engagement surveys, provide employee feedback, and use the data to make organizational decisions?
  • 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?
  • Are your leaders fully engaged in the mission of the organization?
  • Do we have in place a comprehensive employee orientation program?
  • Do we provide clinical placements and internship opportunities for those who are or may be interested in pursuing a career in aging services?
  • Do we conduct performance evaluations to provide employee feedback and improve performance?

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.