The New Wave of Foodservice Technology in Senior Care

March 1, 2004 | by I Advance Senior Care

Tackling Staff Turnover: A Novel Approach

Tackling staff turnover: A novel approach

This innovative program helps entry-level employees surmount life’s roadblocks to stay on the job

BY LINDA ZINN, EDITOR

Starting a new job can be a bit daunting for anyone. There are new schedules to follow and new information to learn, not to mention new people to get to know. Add to those challenges unreliable transportation, overwhelmingly expensive childcare, and no savings for emergencies, and you’ll have atypical scenario for people starting lowwage, entry-level jobs such as those found in long-term care. This scenario also accounts, in large part, for the high rate of turnover for these jobs.

Achieve, a job-retention program based in Cuyahoga County, Ohio (Cleveland area), is trying to rewrite the script for a better ending. Currently targeting the long-term care workplace, its goals are to “increase entry-level employee retention, promote skill building for employee success, and reduce employee absenteeism and turnover.”

This unique program pairs social workers and job coaches with long-term care employers to help recently hired low-wage, entry-level workers keep their jobs. The program defines a “low wage” as anything less than $13 an hour, but the employees Achieve currently serves are making an average of just $8.59 an hour. The program is also designed to encourage low-wage workers to set their sights higher for future advancement, which in turn also improves job retention. Most of the employees served by Achieve are single minority women with children; almost a third lack a high school diploma or GED certificate.

Achieve was developed by Towards Employment, a nonprofit organization in Cleveland that helps low-income people find and maintain employment. According to Towards Employment’s Director of Retention Services and Program Development Jill Rizika, what makes Achieve unique is that besides serving employees, Achieve views employers as its clients, as well.

Also unique is the fact that Achieve’s services are work-site based. Its case managers, called Achieve Advisors, keep office hours each week at the nursing homes where they serve. They are also available by telephone around the clock, seven days a week. Currently, 11 Northeast Ohio long-term care facilities (both nonprofit and for-profit) are participating in the Achieve program.

In addition to their regular office hours, Achieve Advisors hold 30- to 45-minute interactive “Lunch & Learn” education sessions at each facility every other week that feature either a speaker or a skill-building presentation. These sessions are held on more than one shift, so that all workers can take advantage of them. They cover a wide range of topics within four core competencies (Personal Wellness, Workplace Skills, Money Matters, and Continuing Education). Among employees’ favorite topics have been personal budgeting, understanding the Earned Income Tax Credit, dealing with difficult people in the workplace, goal setting, and stress management.

Essential to encouraging participation in these sessions, Rizika says, are “recognition, food, and fun.” The Lunch & Learn certificate program awards a certificate and a prize to participants who attend 10 sessions. Each session includes a free lunch and ends with a raffle, with prizes that are tied to the theme of the session, such as insulated lunch bags when a budgeting strategy called for bringing a lunch to work to save money, or a relaxation CD and candle for stress management. Phone cards and gift cards to local grocery stores are also popular prizes.

As part of Achieve’s service package to employers, the advisors also provide training to the frontline supervisors who oversee the day-to-day work of entry-level staff. The supervisory training, originally planned as a one-time, eight-hour workshop, with a short follow-up session after six months, has been so well received that several nursing homes have requested additional sessions, to cover specific issues or to provide the training to newly employed supervisors.

Sometimes advisors perceive a conflict between an employee and a supervisor that isn’t really the employee’s fault. In such cases, they might offer supervisory training to the worker and supervisor’s department, which lets them extend a helping hand without singling out a particular supervisor as being problematic.

Rizika points out that because employers know that Achieve staff hear about all kinds of concerns, the employers sometimes look to the advisors to share this information in order to better address those concerns. She says, “We need to be careful about keeping the identities of people who have complained confidential, but we can inform employers in a general way about concerns raised. For example, we might tell them, ‘At Lunch & Learn, everyone was up in arms about the schedule changes, and they don’t understand why the changes were made.’ This reveals to the administrator that there was a communication breakdown, which can then be corrected by providing an explanation.”

Achieve Advisors, in addition to helping employees build their job performance, improve their life skills, and adjust to new jobs, also provide supportive services. These might include assistance with childcare, transportation, uniforms, and other practical needs that might interfere with an employee’s attendance or job performance. Employees in the program have been assisted, for example, in repairing their credit, obtaining financing for continuing their education, starting a GED program, getting eyeglasses, learning how to manage their time better, and tapping into employee benefi ts.

For situations that require financial assistance, if Achieve doesn’t have the resources to help directly, its advisors refer people to other social service agencies in the community for help. Rizika explains: “Our general approach for the short term is to resolve the issue with direct support services or referrals to other agencies; for instance, we might help with a childcare payment until a longer-term plan has been developed. These resources are fairly limited and reserved for emergencies. In a limited number of cases, we have helped employees with larger payments, such as a late mortgage payment or a car repair bill.”

Rizika adds, “The long-term goal is to help employees examine their resources and devise plans and back-up plans for dealingwith issues that affect their ability to get to work on time and be ready to work. That might mean requesting a change of shift, for example, to ease an employee’s childcare burden. Of course, employees must be in good standing to request such a change, so the advisors encourage them to identify their goals and be aware that performing well will put them in a better position to ask for what they want.”

Achieve began in 2001 as a pilot program at five Northeast Ohio companies (including one nursing home) where a large number of low-wage, entry-level workers were hired and where turnover rates were high. Entry-level staff turnover was reduced by an average of 50% at the fi ve locations.

Based on the success of the pilot, Towards Employment wanted to expand its activities and include a rigorous evaluation component. In 2002, Achieve joined the Employment, Retention and Advancement (ERA) demonstration project, a national study of programs that help low-wage workers sustain employment and advance in the labor market, funded by the Department of Health and Human Services (HHS).

One of 15 sites in eight states, Achieve is the only program in the study that partners with employers at the work site. It is also the only one that is run by a private, nonprofit agency, independent of the welfare system. Outcomes monitored will be retention rates of the employees participating in the study and turnover rates for all entry-level employees at each work site.

According to Rizika, the study is being conducted in two “Waves,” to provide a large enough sample size for statistical analysis. In Wave I, which began in the last quarter of 2002, 22 nursing homes in Northeast Ohio were chosen to participate in the study. These were randomly assigned either to participate in the Achieve program or to serve as controls. To participate in the study, a nursing home had to have hired 20 new low-wage, entry-level employees during the previous six months.

Individual employees at study facilities were included in the study based on the following criteria: on the job less than six months at the time of data collection, and employed in entry-level positions, defined for the nursing home industry as any position in the following five categories:

  1. Health staff, including state-tested nursing assistants (STNAs; most Achieve participants at the 11 participating nursing homes and the 11 control job sites fall into this category)
  2. General office staff, including receptionists, bookkeeping, and mailroom
  3. Protective services staff, including security
  4. Food services staff, including dietary aides and cooks
  5. Building services staff, including maintenance and housekeeping
Although not all workers at the program facilities are included in the study, all of a participating facility’s employees are eligible to receive Achieve’s services. The only difference is that data for those employees who met the study’s inclusion criteria will be collected for the study’s data analysis, while information on the employees not participating in the study will not. Data are being tracked and analyzed by MDRC (Manpower Demonstration Research Corporation, a nonprofit, nonpartisan social policy research organization). Achieve staff track all participants’ level of involvement and progress for overall program monitoring purposes.

Achieve’s midterm report, released in July 2003, indicates that the program has been successful:

    At six months, MDRC, as part of the ERA study, took stock of Achieve’s progress to date. MDRC reviewed program participation data and conducted dozens of interviews with administrators, supervisors, and employees at 6 out of the 11 program sites, adding qualitative feedback to the midterm assessment. Based on their assessment, MDRC recommended to the federal government that Achieve continue in the ERA study and be included in future research activities. The qualitative feedback suggested that Achieve services are appreciated by administrators and are well received by those who are actively participating.

“MDRC will continue to follow study employers for a year after the active study period and will follow individual employees for two years, even if they move to another job,” Rizika says.

Wave I of the ERA study was initially scheduled to last 12 months but was extended to 15 months to end in December 2003 and February 2004, depending on participating facilities’ starting dates. According to the midterm report, the study was extended to allow for some needed adjustments, geared toward “[encouraging] more intensive contact with those already participating, as well as to broaden participation; increase the involvement of staff who directly oversee entry-level employees (frontline supervisors); and actively coordinate Achieve activities with the employer’s own strategy for retention, staff development, and staff recognition.”

Another industry that hires large numbers of low-wage, entry-level workers was targeted for the yearlong Wave II, slated to begin in the first quarter of 2004.

The analysis of the HHS data for Wave I of the ERA study has not yet been completed, nor have the data been publicized. Rizika says, however, that the data Achieve has gathered internally show retention rates for program participants that average 96% after 30 days of employment, 87% after 60 days, and 82% after 90 days. As a point of comparison, Towards Employment contracts with city and county programs that serve similar populations and set performance targets at 70% retention after 30 days and 50% retention after 90 days.

As of September 2003, more than 400 employees had received more than 2,600 program services, including 320 Lunch & Learn sessions and 27 supervisory training and follow-up training sessions.

Rizika explains that implementing the Achieve program was not without challenges. Some of these relate to problems inherent in the three-shift schedule nursing homes must keep. Also, because of state-regulated staff-to-resident ratios, scheduling breaks for Lunch & Learns and other training sessions has sometimes been difficult. Achieve staff have had to be creative to overcome these obstacles. Some Lunch & Learn sessions, for example, have been held as early as 7 a.m. and as late as 11 p.m. to accommodate workers’ schedules. Also, by scheduling Achieve activities on payday and presenting information during regularly scheduled staff meetings, it’s been possible to increase the number of employees reached. “We learned in implementing the program in the 11 nursing homes how important it was to customize it to the demands of each facility and its residents,” Rizika says. “Part of the reason for our success has been our flexibility.”

Another problem, Rizika says, was that some employees were afraid to seek an Achieve Advisor’s help because they didn’t want to be seen as having problems. “We’ve learned to marry social work skills with marketing skills to encourage employees to use our services,” Rizika says. “We have had to focus more on presenting Achieve as an opportunity for advancement, for goal achievement, for defining a pathway to success-in short, as a benefit.”

To help counter any possible negative perceptions about participating in Achieve, its staff have produced a new booklet and brochures around the theme “Achieve: Your Pathway to Success,” emphasizing that Achieve can help employees set and reach career and personal goals. Because employees most often contribute to turnover rates within their first 90 days of employment, a number of administrators have asked that Achieve staff introduce the program and these materials at new-employee orientations. This helps Achieve Advisors and facility personnel identify early on who might benefit most from Achieve’s services.

At this time the Achieve program is funded with support from Cuyahoga County and from private donors; therefore, all its services can be provided at no cost to the participating nursing homes and their employees. Rizika says that in the future the program might have to charge employers for its services, but that the cost would be much lower than the expense of losing staff to turnover-which has been estimated at $3,000 per employee for hiring and training a replacement.

“We’re starting to explore with the 11 employers in the study the idea of continuing to receive our services for a fee once the study is over and funding is no longer available to us. We already have that arrangement with one of the companies that took part in our pilot program,” says Rizika. “We have customized the services to respond to the needs of this employer, which has contracted with us for more than two years.”

“Achiever” Profiles Employees participating the Achieve program, sometimes called “Achievers,” come to program with a variety needs. The following two profiles are representative of the employees Achieve serves.

Nicole. The first thing you notice about Nicole is that she is in constant motion. “I can’t just sit still. I like to work hard. I just get into trouble if I’m not busy all the time,” says this single mother of two young children and recently promoted ward secretary at the nursing home where she works. Nicole has cycled through many different jobs-including Navy construction worker, corrections officer, nurses’ aide, and medical assistant-none of which offered any significant advancement over the previous one. But after earning her recent promotion and raise, she notes regarding her workplace, “I have found a home here.”

Nicole started as a nursing assistant working the night shift. This allowed her to be at home during the day with her newborn child. However, over time, the grueling schedule became too much for her, and she applied for a Unit Clerk position. The welcome change in schedule was accompanied by another, unwelcome change: She and her husband separated, and he left her with a mountain of debt. Facing significant transition in both her job and family life left Nicole feeling stressed and insecure. She felt she didn’t fit in at work. As one of the original participants in the Achieve program, Nicole took advantage of the one-on-one advising sessions to talk about her concerns and chart a course for resolving some of the challenges she faced.

The first major challenge was financial: how to get out from under the debt her exhusband had left her with. Achieve was able to help her access resources to clear her credit and worked on budgeting exercises to help her establish a money management plan for the future. Her second challenge was getting comfortable in her new position. Getting along with coworkers was not always easy. She worked with her Achieve Advisor to develop ways to communicate her concerns in a professional manner. “My Achieve Advisor is my confidence booster. He helped me to initiate the 3S rule that I have grown to live by: Set Goals, Stay Focused, and Support Your Decisions. Weekly he would ask me, ‘Have you done what you wrote that you would do [in your Achieve planner]?’ And if it wasn’t complete, he stayed on me until it was.”

Now that Nicole has settled into her new position, she plans to enroll in school to obtain a social work degree. She also works tirelessly to recruit new employees into the Achieve program. “I don’t think anyone is really aware of the gold mine that we have come across by having the Achieve program and such great mentors by our sides. I want to be the first to say ‘thank you for being there.'”

Angela. Angela has been taking care of others since she was 13 years old-first as a volunteer in a nursing home after school, then as a home health aide, and now as an STNA. She also cares for her two young children, one of whom has chronic medical problems; a husband, who after 10 months of unemployment has only recently started working again; and a father who is undergoing chemotherapy for cancer. Recovering from recent surgery on her own knee, Angela says she can’t wait to get back to “her residents.” “The job is difficult, for sure, but it is all about caring for them,” she says, smiling.

Angela had been working six weeks at the nursing home when she learned about the Achieve program. During one of the first Lunch & Learn sessions, she completed a “Time Wheel,” an exercise designed to illustrate whether one’s work-home life is in balance. “I held it up and it was all red-all about work-totally out of whack.” She had been working full-time and going to school five nights a week since September 2002 for her Medical Assistant certificate, an additional credential that would allow her to earn more money and work better hours. While there wasn’t much room to maneuver in her schedule for as long as she was in school, an awareness of the imbalance as a cause of stress helped her to better cope with it. She recently graduated from the program. “I never could have done it without Achieve. My Achieve Advisor guided me through the stress and wouldn’t let me quit, although I thought I wanted to many times!” When Angela realized she would need knee surgery, her Achieve Advisor helped walk her through the Family and Medical Leave Act so that she better understood how to talk with her employer and to plan responsibly for her time off. When her husband lost his job and the family fell behind on their mortgage payments and lost their health insurance, her Achieve Advisor helped Angela access resources to help.

Angela works hard to care for her family and “her residents.” However, it doesn’t take much to send a family into chaos when an illness or sudden job loss occurs. Achieve provided the back-up support to allow Angela to weather these difficulties, remain on the job and in school, and to ultimately gain a stable, positive work history and additional credentials in order to move her family toward self-sufficiency and success.

Says Angela, “I don’t call the staff of the Achieve program ‘advisors’-I just call them ‘friends.'”

-Jill Rizika, Achieve Director of Retention Services and Program Development

For more information on the Achieve program, call (216) 696-5750. To comment on this article, please send e-mail to zinn0304@nursinghomesmagazine.com. For reprints, call (866) 377-6454.

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