Providers Cope With Workforce Challenges

Part of: Member-to- Member Solutions During the Coronavirus Crisis

LeadingAge member stories of workforce innovations during the coronavirus crisis.

The Challenge: Recruiting, training, and maintaining a quality workforce is exceptionally hard during the coronavirus crisis. Workers—especially frontline caregivers—are working long hours and maintaining stringent health safety processes. They are also struggling with personal issues—childcare, family demands, and concerns about their own health—that the crisis creates.

Employers are also managing employees who must be reassigned to new jobs for the duration of the crisis, and/or may be working at home for the first time. Employers must support employees and find ways to make their jobs—and often their personal challenges—easier.

Member Story #18: A Many-Faceted Program to Boost Staff Spirits
Member Story #17: Dozens of Staff Live on Provider’s Campus to Protect Residents
Member Story #16: Supporting Staff With Rally & Resident-Donated Emergency Funds
Member Story #15: Provider Celebrates National Nurses Day With Parade
Member Story #14: Residents Line the Roads to Thanks Staff
Member Story #13: Provider Hiring Displaced Workers
Member Story #12: Staff and Residents Adopt All-Hands-On-Deck Approach
Member Story #11: Creating a Warrior Spirit While Preparing for COVID-19 Cases
Member Story #10: Staff Rises to Challenges of the Crisis
Member Story #9: Financial Incentives and Flexibility to Support Staff
Member Story #8: New Part-Time Position Eases Burdens on Direct Caregivers
Member Story #7: Appreciation Pay to Boost Staff Income, Plus Additional Sick Time
Member Story #6: Staff Becoming Leaders During Crisis
Member Story #5: Employee-Support Strategies: Hours, Food, PTO and More
Member Story #4: Recruiting Displaced Workers
Member Story #3: Reassigning Idled Staff to Crisis Line
Member Story #2: Creating New Position to Reduce Burdens on Frontline Staff
Member Story #1: Bonuses Given to All Full-Time and Part-Time Workers


Member Story #18: A Many-Faceted Program to Boost Staff Spirits

The staff at St. Andrew’s at New Florence, New Florence, MO, put together a video featuring residents and staff coping with the pandemic, accompanied by Tom Petty’s “I Won’t Back Down.”

Viewers will enjoy the video’s creative portrayal of a coronavirus being kept out of the building. (The community has had no COVID-19-positive residents.)

According to Mary Alice Ryan, president/CEO of the St. Andrew’s Resources for Seniors System, St. Louis, MO, the New Florence community is one of 16 communities that have so far kept the coronavirus out. Four other St. Andrew’s communities have accounted for a total of 19 COVID-19-positive cases among residents and staff.

“Our belief is you can’t do anything without good staff,” says Ryan. “It’s easy for someone to decide not to put themselves through this.”

The organization has instituted appreciation bonuses for staff, and done a number of things to let employees know that they are valued and supported.

All staff received t-shirts that say, “We Stand and Fight Against COVID-19.” Signage outside St. Andrew’s communities thank staff, and employees have been given signs to put up at their own homes, saying “I Work With HEROES: St. Andrew’s Resources for Seniors System.”

Ryan stands outside various communities at shift changes, holding a sign thanking staff. She also recruited a group of friends to sew cloth facemasks. There are frequent staff pizza parties and other events to build morale and teamwork. Walmart gift cards, donated lunches, and gift bags are distributed.

In light of current events, Ryan sent a personal letter to all employees talking about racism. “We have to stand together and treat each other right,” she says. “St. Andrews has to stand behind people being discriminated against. I gave them my email and invited their thoughts and concerns. One employee says her daughter is going to research best practices for companies on how they deal with racism/bigotry to find out more about what we should be doing at St. Andrews.”

Member Story #17: Dozens of Staff Live on Provider’s Campus to Protect Residents

Park Springs, Stone Mountain, GA, a life plan community and LeadingAge Georgia member, is protecting residents (which the organization calls “members”) by limiting human traffic to the bare minimum. That goal is advanced by the fact that more than 60 employees have volunteered to live on campus during the pandemic.

“Limiting human traffic was the single most important thing we could do,” says Donna Moore, COO. “We got 60 volunteers, and now we’re up to 75. Some of us live in tents (set up indoors) on air mattresses; some [live] in model homes or guest suites, which we use for sales prospects, which are available because we’re closed to sales.”

The hardest part for the live-in staff, says Moore, is what they have given up in their personal lives. “With the type of person attracted to our business, I wasn’t surprised I got so many people,” she says.

Live-in staff are paid for 40 hours per week, plus overtime and a weekly stipend for living on campus.

As of May 14, Park Springs had one COVID-positive resident in short-term rehab after returning from hospital. In April, another resident had tested positive upon returning to short-term rehab from hospital and has since recovered. All residents returning from hospitals are isolated and tested. One resident in independent living tested positive in her final days after hospice care, and family were allowed to visit; however, doctors have stated that COVID-19 had no bearing on her death. In March, 4 employees tested positive, but have recovered and returned to work. Contact tracing, says Moore, found no other infections.

Staff living on-site include people from many departments—food and beverage, plant operations, security, sanitation, CNAs, administrative staff, and nurses. Within the large campus (61 acres), people are also isolating by building.

“We practice relationship-based care,” says Moore, “and living on campus has allowed us to fulfill that mission. We’re able to love on our members, hold hands, have the sense of family. In addition to keeping COVID out, the unintended consequence is how we’ve gotten to know our members. It’s fascinating to watch!”

Member Story #16: Supporting Staff With Rally & Resident-Donated Emergency Funds

Senior management, team leaders, and residents of Cypress Cove, Ft. Myers, FL, held a 2-day sign-waving rally near the life plan community’s main entrance to express their support and appreciation for employees during the COVID-19 crisis.

Residents also joined in. Signs, with messages like “Thank You” or “Our Heroes” were greeted enthusiastically by employees coming and going. See a video of the event.

Residents of Cypress Cove have also raised about $145,000 for the organization’s employee disaster fund.

Residents began contributing when reports of employee economic hardships began to surface. Employee families have been hit with unemployment, closed schools and daycare centers, food insecurity, and mounting bills.

Childcare issues were resolved for most employees when Cypress Cove contracted with the nearby Heights Center and Glad Kids to care for employee children aged from 6 weeks to 14 years. More than 300 staff members in need received thank you gifts in the form of tax-free grants.

“It’s a community that seems to continually rise to the occasion in caring and philanthropic ways,” says Cypress Cove Executive Director Tim Ficker. “We are truly amazed and impressed by the response. It is obvious that they (residents) really care about the well-being of our staff.”

Member Story #15: Provider Celebrates National Nurses Day With Parade

When May 6—National Nurses Day—came around, St. Paul's Senior Services, San Diego, CA, organized recognition parades at 6 different sites. The whole staff pitched in to help celebrate the nursing team. See a video of the parade by Communications Specialist Lauren McCormick to enjoy the celebration.

Member Story #14: Residents Line the Roads to Thanks Staff

At Carol Woods Retirement Community, Chapel Hill, NC, residents lined the roads, cheered, and banged pans for Carol Woods’ staff as they drove in for the morning, and again in the afternoon. See video of the events, and photos, on the Carol Woods Facebook page.

Member Story #13: Provider Hiring Displaced Workers

Christian Horizons, which operates communities in Illinois, Indiana, Iowa, and Missouri, is seeking displaced workers to help support frontline caregivers and to keep residents engaged.

Jenelle Bertolino-Ishmael, chief strategy officer says the organization has created a “helping hands” position: a non-certified worker who can be brought through a fast-tracked onboarding process, and trained using Relias. The workers perform non-nursing activities such as making beds, light housekeeping, labeling, answering call lights for simple tasks, passing trays from the dining room, or participating in activities to keep isolated residents engaged.

“We’re looking for people skills and cooperativeness,” says Bertolino-Ishmael. “We’ve hired 31 of them across the organization; some communities have hired up to 11 [people].”

Christian Horizons reached out to the hotel industry, small businesses, and churches to recruit employees.

Bertolino-Ishmael says the organization is also working to help staff with childcare. Indiana, she says, has a good alternative childcare system. Elsewhere, staff is exchanging shifts to accommodate children’s needs, and associates themselves are volunteering to care for children. Some communities work with local churches to open up childcare opportunities.

Supplies of PPE and other essentials are doing well enough. The organization manages its supply chain centrally, allowing it to shift inventory to the communities that need it the most from a central location in Illinois.

Member Story #12: Staff and Residents Adopt All-Hands-On-Deck Approach

Presbyterian Villages of Michigan (PVM) has taken an all-hands-on-deck approach to dealing with the pandemic.

A team called “PVM Strong” is a group of employees who are volunteering to put in extra hours without pay. The team members will assist with various tasks like cleaning, passing out trays, and other non-clinical duties.

According to Lynn Alexander, PVM’s senior vice president and chief marketing officer, it’s the embodiment of a line that CEO Roger Myers uses about “being calm and strong.”

The technology department at PVM has access to a 3-D printer, and is using it to produce 150 face shields a day.

A group of residents has volunteered to do wellness calls to other residents throughout the system. Alexander says, “Even with simple check-in calls, just hearing from someone makes a difference. That’s real resident engagement.” She notes that calls to skilled nursing residents will probably be left at the local level with staff.

Alexander says PVM has had tremendous support from the community and from within. CFO Brian Carnaghi donated money to set up a fund for employees, who are receiving appreciation pay. Board members, other managers, and outside donors have also made donations.

Member Story #11: Creating a Warrior Spirit While Preparing for COVID-19 Cases

Along with all the new obstacles, shortages, and additional work caused by the coronavirus crisis, the leaders of United Church Homes, based in Marion, OH, knew that plain old fear would become one of their greatest foes.

“Like all other organizations, we were getting daily briefings from governors and CMS, and wrapping our minds around how to create isolation units,” says Terry Spitznagel, senior vice president and chief growth officer. “We were getting a good understanding of how to set them up, and our PPE needs. But what I was sensing was that the mental health needs around this were increasing. You could just feel the anxiety of staff.”

Wanting to “normalize” the experience of having a COVID-positive resident, United Church Homes decided to create COVID-19 drills to prepare staff in all 14 UCH health care units. With a mock COVID patient, caregivers, housekeeping staff, dietary staff, and managers practice their protocols—in full PPE—doing it multiple times on every shift. (Some of the “PPE” used during practice is ersatz, in order to preserve the real thing.)

“The biggest benefit is that it has helped ease the anxiety of staff 100 times over,” Spitznagel says. “They talk it through with each other, and after doing it 5 times they feel better. The fear of this virus is on us 100% of the time, so we have to mentally prepare ourselves for this. It makes sure we’re prepared, but it also helps the staff know that they can and will do this all together, and we’re ready.”

The organization’s daily video conference calls include time for caregivers to ask questions and share their best ideas with each other.

The COVID drills are just one part of a larger movement among staff to look at themselves as “UCH Warriors.”

“We’ve decided we’re warriors and we’re preparing for an enemy that’s coming,” Spitznagel says. “We started recognizing that staff was getting motivated by this. As the employer, we wanted to make sure staff knows we have their back.”

It became an organic campaign. “Warrior Pay,” an extra $2 per hour, has been instituted until June 30. Meals and snacks are provided for staff. “Dance-off” competitions are building team morale. Employees are posting pictures of team members flexing their muscles (visit the UCH Facebook page for great photos). Hashtags, like #UCHFlex and #UCHWarriors, have been created.

“This has shifted the narrative,” Spitznagel says. “Now it is, ‘We are warriors and we are going to take this on. We are on the front lines and we’ll fight it and we’ll beat it.’”

Member Story #10: Staff Rises to Challenges of the Crisis

Amy Schectman, president and CEO of 2Life Communities, Brighton, MA, described a few examples of how the organization’s employees stepped up to meet challenges caused by the coronavirus crisis. Her thoughts were included in a message to stakeholders:

“We are doing everything in our power to help keep our precious elders safe in our communities. Not surprisingly, our staff has risen in ways that parallel the miracles of the story:

“When there was a delay in procuring face masks to protect our on-site staff, colleagues began sewing homemade ones and got their friends, spouses, and in-laws to do the same—and we immediately had enough supply until our first order arrived.

“When we realized that going to the supermarket was risking bringing in more virus, our kitchen team worked extra hours including weekends to produce over 5,000 healthy meals so we could offer them to all residents—and we are replenishing the stock so quickly that we are offering now 7 meals/week to every resident at no cost to them—we were only able to do this because of the generosity of our supporters.

“When our desire to call every resident with some frequency ran into some challenges with the languages people speak, an email went out to all staff asking for additional volunteers speaking Mandarin, Cantonese, Russian, Albanian, and Haitian-Creole. It literally took MINUTES for typically non-resident-facing staff to offer their services and fill all the gaps.”

Member Story #9: Financial Incentives and Flexibility to Support Staff

The New Jewish Home in New York City is doing a variety of things to try to keep staffing levels up and support employees.

Audrey Wathen, senior vice president, human resources, says new financial incentives are structured to focus specifically on uncovered shifts. By offering flat bonuses, the organization is incentivizing workers to take uncovered shifts (in addition to their own schedules). The incentives are offered to RNs, LPNs, and CNAs.

“We’re putting everything in the hopper to see what works,” says Wathen, who says the system went into effect March 26.

Another new creation is called “staffing central,” where one team manages a database of employees who are able to be reassigned to different tasks: staff from the closed adult day centers; CNAs and home health aides from the organization’s Geriatric Career Development program; staff from external sources, and others. The organization is also bringing in agency staff—and paying a premium for them.

Wathen says about 110 staff from HR, finance, IT, clerical, and other functions are working from home, however, if needed will be called back to work to help in clinical settings.

The organization is also providing some meals to staff onsite because of the generosity of outside donors.

Wathen says the organization is providing N95 facemasks, to keep staff at ease. The manager of supplies updates leaders daily on supply inventories and burn rate.

“The biggest thing we’re managing is fear,” Wathen says. “That’s why it’s good that there are many resources for staff managing their jobs and their families. We created our own resource guide for staff. New York City, The Department of Health, and other entities have been great about providing information as well.”

Member Story #8: New Part-Time Position Eases Burdens on Direct Caregivers

Bethany Home Association, Lindsborg, KS, has eased the burden on direct care workers by creating a new position called “resident care assistant.” According to CEO Kris Erickson, the job description was created in 2019 as a way to deal with shortages of direct care workers.

“Our team started discussing options, and the idea of hiring people not licensed or certified,” says Erickson.

Four resident care assistants were hired last year, and 5 more came on board in January. Bethany Home Association now employs 20 of them. Erickson says that 16 of the current ones have been hired since the coronavirus crisis began.

Most of the resident care assistants are college students, now idled by school closures.

“They now have a source of income,” Erickson says, and notes that some now look to health care as a career option. “Four of our first 5 have applied to become nurse aides,” he adds.

They work 8 a.m.-8 p.m., on 4-hour shifts, with varying duties. Tasks include working at the reception desk, logging screenings and passing out PPEs; making beds; tidying rooms; delivering trays; distributing water, towels, and washcloths; answering call lights and bringing in certified staff if necessary; and sanitizing by wiping down handrails, keypads, and more.

“We’ve not seen more than 1-2 licensed certified staff take extra time off,” says Erickson, “but now we have more than enough to help.”

The organization recruited via Facebook, and Erickson says it was surprisingly easy. “We’ve had more applications than we can use now,” he says.

The organization has also instituted a “Hero Bonus” program that gives staff an extra $1 per hour during the COVID crisis.

Bethany has boosted its video conferencing capabilities to enable communication with families. And, he says, “our big push was to focus on the positive and show what we’re doing in house to keep spirits up […] to put up social media posts about the positivity occurring, so people aren’t overwhelmed. We’re prepared, we’re ready, and making the best of it.”

Member Story #7: Appreciation Pay to Boost Staff Income, Plus Additional Sick Time

Emerald Communities, Redmond, WA, is giving a $5-per-hour appreciation pay bonus to the majority of the 400-plus employees at its 2 communities, Emerald Heights and Heron’s Key, during the COVID-19 pandemic. The additional pay represents an increase of 10-30% for most employees.

All employees will also receive an additional 80 hours of sick time if they receive a positive diagnosis of COVID-19 or need to be quarantined at home. This benefit will allow employees to stay at home during recovery without using their available PTO balance. The new benefits are retroactive to March 8, 2020, and will be in effect indefinitely.

Lisa Hardy, Emerald Communities president/CEO, says the organization’s COVID-19 Emergency Fund was created specifically for employee support.

Member Story #6: Staff Becoming Leaders During Crisis

Parker, based in Piscataway, NJ, is seeing a common phenomenon during these difficult times: staff becoming leaders in the midst of crisis.

Parker President and CEO Roberto Muñiz, in his March 31 blog post titled “Shining Moments During These Difficult Times,” says, “We have seen leaders and more importantly the front-line staff rise up in the midst of all the work we are doing to keep our residents and employees safe. It’s not surprising to me that even the quietest caregivers have stepped up to take the helm and lead others. Everyone on our team is doing their part, and it’s really a joy to see.”

Muñiz gave several examples:

“Without being able to socially interact with friends, venture out, or have visitors, the days could get lonely. Yet our staff has brought moments of meaning to a whole new level. Our horticulturist, Lee, recently provided a session from the ground courtyard of our assisted living while residents watched from their balconies. One of our Landing Lane nursing residents celebrated their 60th anniversary over Skype with their spouse. Some of our recreation staff created a happiness cart which delivers assorted beverages, music, dancing, bubbles, spontaneity, and some good old-fashioned silliness to our residents at their doorstep. Rehab and personal exercise therapies are being given in resident rooms and suites.”

Read the entire post here.

Member Story #5: Employee-Support Strategies--Hours, Food, PTO and More

The Jewish Home Family, based in Rockleigh, NJ, is supporting staff and boosting morale with a variety of practices:

  • Accessing extra staple foods from its suppliers and offering them at cost to staff, to reduce their need to go into stores. Staples like milk, eggs, rice, toilet paper, and more are offered.
  • A program for employee engagement each week, including theme days and special treats.
  • A PTO bank with donated hours from other staff.
  • Regular reassurance and thanks from management.
  • Offering extra hours, and additional training to be able to work extra time in other capacities.
  • Working with staff to offer employment to family members.
  • Telehealth services through insurance.

Member Story #4: Recruiting Displaced Workers

Garvey Manor, a skilled nursing, personal care, and independent living provider in Hollidaysburg, PA, is recruiting displaced workers—such as people idled or laid off during the coronavirus pandemic.

A notice on the Facebook page says: “Displaced workers, college students, are you looking for a place to work where you can make a difference in the lives of others. Call our Human Resources Department today. We have various positions available.”

On the Garvey Manor website, a notice says, “DISPLACED WORKERS: If your business or school has closed and you are looking for work, we have various positions available. Please contact Human Resources for more details.”

According to Director of Human Resources Joann Kasun, the organization has also been in contact with a local career and technology center whose practical nursing and health occupations students have done clinical rotations within our building.

“These individuals have already been oriented to the [community] and could be hired and put into positions relatively quickly,” Kasun says.

Member Story #3: Reassigning Idled Staff to Crisis Line

Institute on Aging is a San Francisco-based organization that offers a variety of home care and case management services, adult day programs, a Program of All-Inclusive Care for the Elderly (PACE), and a free community referral service.

Another service, The Friendship Line, is the only accredited crisis line in the country for people aged 60 years and older, and adults living with disabilities. It also makes on-going outreach calls to lonely older adults.

The coronavirus crisis has brought 2 important changes to the Friendship Line.

First, call volume is up, meaning that callers are spending more time on hold than usual.

“During high volume periods, which we’re trying to remedy, folks are waiting longer than they normally would,” says Preston Burnes, vice president of strategic partnerships. “We usually see drop-offs because they call back later, but now we’re seeing them hang on 10 or more minutes. Folks are very lonely and in need of socialization.”

Secondly, with the call center shut down, operators must work at home. About half of them are volunteers, who do not all have the technology required to work remotely.

Institute on Aging is planning to invest in more people and a systems expansion to handle the Line’s demands.

“We typically have a few hundred thousand calls in a year,” Burnes says. “I’m not sure we’re seeing a significant increase in volume [yet], but it has trended up, the urgency and need is going up, and we anticipate hitting a hockey stick soon.”

He says the roster of operators will be boosted to about 20, with a greater percentage of them paid staff. The Friendship Line also requires a robust 20-30 hour training program over several weeks; operators are trained to deal with escalations, potential suicides, and methodologies for social conversations. Because of the pressing nature of the crisis, training time will need to be cut, so the organization is looking to internal staff that may have been idled from their regular jobs by the crisis, but who have strong one-on-one people skills. They will probably include adult day staff, PACE center staff, and social workers.

Takeaway: “One thing we know will happen, demand-wise,” says Burnes, “is that many of our own programs are not regularly able to engage with their clients anymore. We often do a ‘call-out’ model instead of waiting for [people] to call in. Many of these folks will develop some social isolation.

“You can’t replace the impact of a face-to-face intervention, but we can provide some socialization and a check-in in on how folks are doing.”

Member Story #2: Creating New Position to Reduce Burdens on Frontline Staff

At Gurwin Jewish Family of Healthcare Services, Commack, NY, a large skilled nursing provider, every employee who comes into the building must be screened with a digital, no-contact thermometer. This has required diverting some staff. Some employees have been available for diversion from the Gurwin adult day programs, which are closed.

The organization has also created a new job description it calls “a resident care coordinator.” These employees would supplement the work of CNAs—duties such as making beds, delivering trays, and answering phones. Outreach so far has generated responses from people interested. Gurwin will screen applicants first by phone to help expedite hiring.

Member Story #1: Bonuses Given to All Full-Time and Part-Time Workers

St. Ann’s Community, Rochester, NY, has announced that it will give approximately $400,000 in bonuses to 875 employees. Workers are helping to provide around-the-clock care to residents and patients.

Appreciation bonuses will be paid on March 27, to all full-time and part-time workers. Full-time workers will receive $500 and part-time workers will receive $250. Senior managers are excluded from the bonus.

In addition to the bonuses, smaller measures are also being implemented to show support for staff members. St. Ann’s is providing complimentary food to all workers while on duty, and has also relaxed the uniform and dress code for all employees.

Takeaway: “Our team members are balancing work with the support and care they need to provide to their own families, especially during this anxious and difficult time for all of us,” says President and CEO Michael McRae. “They are incredible, and we are completely in awe of their willingness to go above and beyond the call of duty.”

Visit our COVID-19 resources section for more resources.

LeadingAge wants to hear from you! Tell us stories of how your organization is adapting and innovating to manage with the coronavirus crisis. We are looking for stories about: staff management, worker welfare, and recruitment; childcare; care and services for residents and clients; personal protective equipment (PPE); communication; food services; advocacy; resident engagement; and more.

Contact Gene Mitchell at or 202-508-9424.