Automated Scheduling

Agencies Speak Out on Scheduling

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With restricted funding, labor shortages, and state and federal mandates continuing to pressure providers, human service agencies need to use their limited human and financial resources as efficiently as possible.

Ineffective employee scheduling directly impacts labor costs, productivity, and an agency’s ability to operate within budget. Effective scheduling solutions improve manager productivity and enable managers to make more informed scheduling solutions, while eliminating the inefficiencies inherent to a paper scheduling system.

In this article, agencies across the United States share their experiences using an automated time and attendance solution, how they implement optimal scheduling practices, and the benefits of effective scheduling.

An effective automated scheduling solution can improve efficiency and organization at an agency. Community Living Connections is a non-profit agency founded in 2004. With 300 staff providing community supported living services to approximately 200 individuals in Wisconsin, CLC supports individuals to live in their own homes and participate in community life, providing in-home staff to help with planning, personal cares, medical support, finances, relationship building, and more.

The Senior Scheduling Manager at Community Living Connections, Stephanie Stringer, has seen improvements since automating scheduling practices, “It is liberating to have schedules accessible, accurate, and up-to-date. Employees can check schedules from anywhere, which makes it easy.”

The benefits have been numerous, “I know how important it is for our systems to run well and be up-to-date. CLC can really have flawless transitions between shifts. This helps the employee be less anxious. Employees have said it’s a huge relief to know that they aren’t going to have to work late. Those comments usually come from people who previously worked at another agency or remember how it used to be here prior to MITC with unreliable schedules. Even my boss thinks that MITC and centralized scheduling have given so much consistency and reliability to the function of the agency.”

Developmental Services of Dickinson County is another agency that uses MITC. Developmental Services supports over 300 adults and children in a variety of home and community-based service settings in central Tennessee. The agency employs over 280 staff working in eight counties with an annual operating budget in excess of $9.0 million. The agency manages 3 day programs, 30 smaller group homes with 2 beds, and a home and community-based service program.

Barbara Brandon, Team Manager, and Amber Donegan, Payroll & Benefits Coordinator, have improved scheduling practices at Developmental Services. Prior to using MITC, “Managers maintained schedules in excel. Whoever was on call had to flip through pages and pages of schedules and employee information that may or may not have been updated to find people to cover shifts. MITC gives managers more opportunity to see what’s actually going on. We have a weekend supervisor who covers on call shifts. Working with accurate schedules saves a lot of time. We have cut down on wasting time with phone calls and avoid calling people to cover a shift who are already working.”

Centralized Scheduling

Some agencies perform scheduling in a centralized manner, with a dedicated individual or department put in charge of all scheduling concerns. For example, Community Living Connections has a scheduling department overseen by Stephanie Stringer. “In our scheduling department, we have 3 people. I supervise and direct a Scheduling Manager and a Scheduler under me. We roll out schedules 2 months in advance for all employees. Supervisors are each in charge of a certain number of locations, and are ultimately responsible for shifts that aren’t filled at their locations. We meet twice a week with the three teams of supervisors to discuss scheduling and open shifts. I talk with teams monthly at their individual team meetings as well.”

“Overall, centralized scheduling is really a relief and tool that frees people up to do other aspects of their job. We ask employees and other staff not to do certain functions in MITC to allow the scheduling department to be responsible for most updates. This works better for us because too many hands being involved increases the chances of mistakes. I find our department needs to micromanage to a certain extent just to make sure no one makes a mistake that we are unable to track. Some might see it as obstructionist, but it prevents mistakes that would be even more cumbersome to correct,” according to Stephanie with Community Living Connections.

Implementation

Gateway Services started in 1970 in an abandoned schoolhouse in Malden, Illinois, with a crew of three, one program, and $34,000. Today, Gateway has grown to support 10 programs, 2 main locations with day programs, 6 group homes, home-based supports, and a transportation program. During its long history, Gateway Services has had to implement many changes. One of the latest was to implement a new workforce management, payroll, and financial system.

“Our accounting assistant maintains the staff schedules. The schedules are used to ensure everyone has only 40 hours scheduled. This allows us to produce the early overtime warning report. This report gives us the opportunity to minimize overtime. The benefit of putting in the schedules is we can cut staff hours to reduce overtime where we can,” according to Mandi Johnson, CFO with Gateway Services.

Mandi believes Gateway is still working toward the ideal scheduling system. “We didn’t force management to do things,” she says. “In my opinion, schedules should be set up 4-6 weeks in advance with adjustments made as needed. We have one program that won’t do that. They start from scratch every 2 weeks. If we’d have said, “you’re going to do it this way and that’s it” things would have been smoother.”

Time Savings

Developmental Services of Dickson County gained time to focus on other tasks after implementing a scheduling solution. “Using scheduling with MITC makes your life a whole lot easier, especially when you have a lot of employees on the payroll side. I’ve been able to do a lot more accounting work that I didn’t get to do before. I can’t imagine the headache without MITC. MITC is a huge timesaver overall to everyone in administration.”

According to Stephanie Stringer, “When I first joined CLC, 50-60% of calls to the eCell manager were scheduling questions from employees! We found that our paper copies of schedules posted in the houses were inaccurate or not up-to-date. Once we started training and getting staff used to looking online for themselves, calls to the on-call phone were greatly reduced. Keeping schedules accurate and verifying assigned shifts has been much easier. The number of calls pertaining to scheduling are rarely an issue. On-call scheduling questions are seldom brought up as a problem in our bi-weekly meetings.”

“Developmental Services has definitely saved time on the approving of payroll. We have better control of what employees are actually doing as compared to schedules.”

MITC scheduling offers additional features to improve agencies’ operations.

“We use MITC availability selection criteria to help fill open positions. MITC allows CLC to screen or filter for available employees. All of our managers have access. We use MITC scheduling daily,” says Stephanie Stringer.

Self Service

With MITC, agencies have the option to give employees access to schedules. Stephanie Stringer shared that, “Community Living Connections allows employees to view their timesheets and make edit requests. Employees can view and request PTO through their calendar. Employees cannot edit their own information or restrictions.”

Most employees are able to benefit from self-service. “There are a handful of folks who struggle with self-service. It is largely because they are in a certain age range or lacking tech savvy. A good 90% of staff understands how to use MITC and use self-service,” according to Stephanie Stringer with CLC.

Developmental Services also gives employees access to self-service. “Employees use self-service, and the employees that I’ve talked to like having the access to it. Since we’ve started doing scheduling on the web as well, they can see schedules.” Additionally, the agency has 10 clients working for it, and they use client timesheets.

Overtime Reductions

Gateway Services has experienced reductions in overtime since implementing a time & attendance and scheduling solution from MITC. Mandi Johnson, CFO shared that, “Three years ago, overall overtime was 23%. Now it’s down to 5.77%. In the CILA program it is now 11.23%, down from 36% due to using scheduling and early overtime reports. At first, I ran reports and would give mangers notes about which employees were in danger of going over. They would look at schedules and adjust them as necessary to prevent overtime. Now, managers are on the web checking daily reports themselves.”

Scheduling can definitely help agencies reduce overtime. However, the nationwide staffing shortage has made many agencies reconsider their ability to focus on overtime reductions.

According to Stephanie Stringer, “In certain households, when there is a good pool of staff, CLC would be able to control the flow of overtime. It’s a great idea, but with our staffing shortage, reducing overtime isn’t a priority. We are happy to contain it! We’ve weighed whether it’s ok to go with the overtime, decided it is, and we build a percent into the budget to pay for it.”

Barbara and Amber with Developmental Services are in the same position. The agency is down about 30 people, so it has not seen any overtime reductions yet. However, they say: “Overtime might have been higher than what it is today without scheduling. It is helpful to see at a glance how many hours employees are scheduled for to make sure the agency isn’t giving any one employee more overtime than anyone else.”

Ease of Use

There are benefits of an MITC Solution that Stephanie at Community Living Connections had not experienced previously. “I was in a similar role at a different agency doing the same type of work prior to coming to CLC. In that job, all schedules were Excel spreadsheets. I was responsible for having 25 schedules up-to-date and ensuring they were understandable. After starting this job at CLC, I thought “if I’d have had MITC, I never would have left the other job, and it would have been so much better. I have worked with other scheduling systems. We get some mixed reviews from managers. Scheduling can be the scapegoat, and be blamed as the reason people are frustrated.”

She continues, “I prefer just a few people working with schedules as opposed to every single manager. Their real function as a manager is the advocacy and care of clients and the supervision of staff. Managers take these jobs because they want to work with people, certainly not to spend their time on scheduling.”

Help Wanted - Labor Shortage Worsens

Labor Shortage Gets Worse

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An acute labor shortage among home care workers across the country is threatening care for disabled and elderly individuals. Many agencies are struggling to retain employees. Scheduling is also difficult, as as agencies move around a shrinking pool of workers to cover open positions.

The labor shortage endangers a vulnerable population. In Minnesota and Wisconsin, nursing homes denied admission to thousands of patients because they lack essential staff. Patients living in rural ares of New York have injured, soiled, and starved themselves because paid caregivers aren’t available. In Illinois, the independence of developmentally disabled people is being compromised, as agencies experience staff shortages of up to 30 percent.

The emerging crisis has several causes. First, state Medicaid programs are unable fund higher wages. Second, the pool of workers willing to perform this physically and emotionally demanding work is shrinking. These problems portend even worse difficulties to come. Experts warn that America’s senior population will swell to 88 million people in 2050, up from 48 million currently. They will also require more assistance with chronic health conditions and disabilities.

“If we don’t turn this around, things are only going to get worse,” said Dr. David Gifford, senior vice president of quality and regulatory affairs for the American Health Care Association.

Rising Demand, Stagnant Wages Contribute to Labor Shortage

For years, experts have been predicting that demand from a rapidly aging population will outstrip the capacity of the direct care workforce. The U.S. Bureau of Labor Statistics estimates an additional 1.1 million workers of this kind will be needed by 2024 — a 26 percent increase over 2014.

Yet, the population of workers who tend to fill these jobs, overwhelmingly women ages 25-64, will increase much more slowly. After the recession of 2008-2009, Medicaid-funded agencies filled positions rather easily. Now, however, the improving economy has led these workers to pursue other higher-paying alternatives. In response, turnover rates are soaring. Falling immigration and refugee rates may make the situation even worse in the future.

At the same time, wages for nursing assistants, home health aides, and personal care aides are stagnant, making recruitment difficult. The average hourly rate nationally is $10.11. This rate is a few cents lower than it was a decade ago, according to the Paraprofessional Healthcare Institute. Workers in a handful of states are pushing to raise the minimum to $15 an hour.

Hardest to cover are people with disabilities or older adults who live at some distance from a city center and need only one to two hours of help a day. Workers prefer longer shifts and less time traveling between clients, so they gravitate to other opportunities.

Hard Times in Wisconsin

Some of the best data available on the labor shortage comes from Wisconsin. Here, several long-term care facilities and agencies serving disabled and elderly individuals surveyed their members over the past year.

One of seven caregiving positions in Wisconsin nursing homes and group homes remain unfilled, one survey discovered; 70 percent of administrators reported a lack of qualified job applicants. As a result, 18 percent of long-term facilities in Wisconsin have had to limit resident admissions, declining care for more than 5,300 vulnerable residents.

The situation is equally grim for Wisconsin agencies that send personal care workers into people’s homes. According to a separate survey in 2016, 85 percent of agencies said they didn’t have enough staff to cover all shifts, and 43 percent reported not filling shifts at least seven times a month.

“The words ‘unprecedented’ and ‘desperate’ come to mind,” said John Sauer, president and chief executive of LeadingAge Wisconsin, which represents not-for-profit long-term care institutions. “In my 28 years in the business, this is the most challenging workforce situation I’ve seen.”

Reaching a Breaking Point

Sauer and others blame inadequate payments from Medicaid, which funds about two-thirds of nursing homes’ business. In rural areas, especially, operators are at the breaking point.

“We are very seriously considering closing our nursing facility so it doesn’t drive the whole corporation out of business,” said Greg Loeser, chief executive of Iola Living Assistance. Iola offers skilled nursing, assisted living, and independent living services about 70 miles west of Green Bay.

Like other short-staffed operators, he’s had to ask employees to work overtime, increasing labor costs substantially. A nearby state veterans home, the largest in Wisconsin, pays higher wages, making it hard for him to find employees. Last year, Iola’s losses on Medicaid-funded residents skyrocketed to $631,000 — an “unsustainable amount,” Loeser said.

Wisconsin Gov. Scott Walker proposed a 2 percent Medicaid increase for long-term care facilities and personal care agencies for each of the next two years. However, that won’t be enough to make a substantial difference, Loeser and other experts say.

Due to the labor shortage, it is increasingly important for agencies to have the right workforce management tools to help retain employees and manage the changing schedules of a shrinking workforce. To learn more about how workforce management can help your agencies minimize turnover and improve retention rates, contact MITC.

Pennsylvania Agencies Share their Thoughts on EVV

Agencies Speak Out on EVV in Louisiana

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The State of Louisiana has not had a lot of success with EVV. It previously attempted to mandate Sandata for EVV in 2013 and then First Data for EVV in 2015. It ended up cancelling both. On April 18, 2017, the state announced its third EVV mandate plan.

The state and providers have wasted an enormous amount of money, time, and energy with nothing to show for it. All mandates have involved the state selecting a single vendor. The third mandate offers a state system, but leaves the providers to pay for all the technology with no freedom of choice! The Louisiana approach to EVV was very different than the approach other states took. In Missouri, for example, providers could choose any vendor, as long as it complied with general regulations for Medicaid electronic documentation. Over 600 providers in Missouri have successfully been using EVV for billing and payroll since 2015.

On April 18th, the Louisiana Department of Health released a memo outlining the EVV requirements that will take effect on January 1, 2018. The plan requires providers to use GPS verification via tablets which are kept in the client’s homes. Providers will incur the cost of the tablets and data plans. This memo contains misleading information regarding the use of GPS as it pertains to the Cures Act and the perceived monetary neutrality to providers. According to providers, the memo wildly underestimates true costs and exaggerates savings. As evidenced from the testimony of Louisiana providers in this article, the state has not adequately addressed many concerns with the selected technology and the cost burdens they will place on providers.

In this article Dr. Laura Brackin with Brackin & Associates, along with representatives from Care, Inc., The Arc of Baton Rouge, and Options, Inc. share their thoughts on EVV in Louisiana. Many providers in Louisiana have been using EVV systems for years; they hope their feedback will be helpful to their state and others considering EVV implementation.

The State’s Case for EVV

The Community Provider Association (CPA) represents many providers in Louisiana. In 2015 the CPA wrote a letter to the state outlining questions and concerns regarding the state’s plans for EVV implementation. The letter said:

“The Community Provider Association supports the implementation of an EVV system, as it has the potential to streamline billing and other administrative processes, and reduce waste, fraud, and abuse. However, if the system is not an appropriate system for Louisiana and/or is implemented inappropriately, it will not achieve the desired outcomes and could harm a system that is already on the brink of collapse.”

Brackin is the former head of the Louisiana Office for Citizens with Developmental Disabilities and current President of Brackin and Associates, a disability consulting firm. She represents the Community Provider Association, which has been actively involved with Louisiana’s EVV considerations for the past few years.

“Our team wanted EVV, and felt it would be helpful to providers because a lot of the processes with the state were time consuming and labor intensive. We also knew some providers across the country were billing for things they wouldn’t have been billing for with EVV, either intentionally or unintentionally. That money could be better redirected toward services for individuals and increases in reimbursement rates.”

“Data from 2012 indicated EVV saved states money due to a reduction in ineffective or inappropriate billing. The cost savings could range between 10 and 20 percent. The cost of Louisiana’s largest DD waiver is well over $400 million per annum, which would mean there could be cost-savings of $40-$80 million per annum. Even a more conservative estimate of 5% in cost savings would still yield significant results of $20 million. That’s a lot of money and we need to make sure we’re spending it appropriately in our service system.”

The Vendor Debate

“Several providers in the state were already using an EVV system; however the state wanted to implement a single system for all providers. We did not think this was a good idea. We pushed for the state to allow providers to choose their own EVV vendor from a state approved vendor list. But the state had already made the decision to hire the first vendor.”

“There are several benefits for the state to use an approved EVV vendor list, as opposed to implementing a single EVV system.”

“First, when the state contracts with one entity, it’s very labor intensive for the state. It takes a lot of time and resources for state staff to understand the complexities of an EVV system in order to develop the Request for Proposals (RFP). It then takes time to evaluate those proposals, initiate a contract, and manage that contract. It’s much easier and faster for a state to implement EVV statewide by setting criteria and then approving the vendors who meet that criterion. With the deadline for the Cures Act in 2019, allowing for multiple vendors is the fastest way for states to get an EVV system in place.”

“Another benefit to the state is that allowing multiple EVV vendors means that the state isn’t tied to one vendor. Therefore, if the state has a problem with one particular EVV vendor they can eliminate that vendor from the list without threatening the entire EVV system for the state. Whereas if the state uses one vendor and then has problems with that vendor, they are stuck until they can develop a new RFP, go through the selection process, and implement a new system.”

Cost Savings of a Multiple-Vendor Solution

“Using multiple vendors is also a benefit to the state financially. It takes the state much longer to implement a single system than it does to use multiple vendors. And time is money. EVV saves states money by reducing fraud, waste, and abuse in the system. The longer it takes the state to implement EVV, the longer it takes to reap the cost-saving benefits of EVV. Think of the money the state could have saved over the past four years if Louisiana would have implemented EVV in 2013. We are now four years down the road, facing a state budget crisis year after year, when we could have been saving millions of dollars. It doesn’t make sense.”

“Louisiana is again proposing the use of one state-wide system. However, the state has agreed to build a bridge between the EVV systems providers are currently using and the state’s system. But it is my understanding that providers who are not currently using an EVV system will be required to use the state’s EVV system. The state will only allow exceptions for those providers who are already using an EVV system. That may have changed.”

“Providers initiated EVV legislation several years ago to push the state to move forward with EVV. The bill passed and became law, but implementation has not been what we expected. We’re now considering whether we need legislation to ensure that providers be allowed to choose the EVV solution that works best for them, because that’s best practice.”

What Louisiana Agencies Love about EVV

Some providers in Louisiana have been using EVV systems for years, and they know what works best for them. For example, Options, Inc. in Hammond has used multiple EVV systems in the past. CFO Sue Bush prefers a system that allows caller-ID. The agency once used a system that was not caller-ID based; employees had to enter a 6-digit pin for each client. This caused many mistakes. In 2009, the agency switched to MITC, and the new system eradicated those mistakes.

However, that is not the biggest benefit of the new EVV system. Bush says: “The biggest advantage of using MITC for our EVV system is during audits. Anytime we use MITC and another entity uses paper timesheets and there is an overlap within the state, we don’t have a problem because our records are electronic. That means we get paid.”

Options, Inc. can also automate pay differential calculations and integrate them directly from MITC into payroll. “MITC classifies shifts as different pay types before records are exported to payroll,” says Bush.

Another agency that has seen the benefits of EVV is Care, Inc., which has offices in Hammond, Covington, LaPlace, and Baton Rouge. The agency used paper timesheets before switching to MITC in 2014. Billing Coordinator Bridgette Wilson says EVV is worlds better than paper timekeeping. For example, when clients are admitted to the hospital, Wilson can make sure there is no duplication between administration, admission, and discharge. “We can see that nearly in real-time… Knowing where people are in real time helps you manage your employees.”

The Arc of Baton Rouge also prefers EVV over paper timekeeping. Business Manager Karen Monroe says: “Our data is accurate now that we are using MITC. It resolves problems we encountered spending hours and hours on paper timesheets.”

The Costs of EVV

Wilson worries about how the EVV mandate will affect agencies. She says, “The state plan is going to be a problem for everybody that has a payroll process. EVV changes your payroll process; it’s not just time & attendance. How will payroll and time & attendance work together in the state’s solution? I don’t see how the state is going to do that.”

Louisiana estimates the cost of EVV will be non-existent to the state in the long term. A 2014 studying claims that “the savings of implementing a statewide EVV system will more than offset the associated costs of implementation and administration” [1]. Additionally, the April 18th memo states that the “EVV system already in place for center-based, vocational, and transportation providers and utilizing smart devices with internet access is at least cost neutral, and in many cases will represent a cost savings to providers.”

Wilson disagrees: “I don’t know where they get the idea that agencies won’t incur any costs. The tablets are a cost, and my experience is that there isn’t any administrative savings with EVV. I don’t know where the state got those ratios regarding time spent on data, but they aren’t accurate for Care, Inc.”

Bush says the state’s proposed solution is based on faulty logic. “The LDH is saying that we can get rid of people who process billing because the automated system will eliminate data entry. What the state doesn’t recognize is we still have to do all the quality control by matching daily logs with billed shifts. The state’s system doesn’t eliminate anything as far as we’re concerned.”

Wilson agrees: “Fundamentally, implementing EVV did not result in a staff reduction; it changes the work. In my experience, implementing EVV does not generate a cost savings from eliminating positions.”

Agencies Take Issue with the Smart Device Requirement

Following the release of the Louisiana Department of Health Memo (LDH) on April 18th, questions remain regarding the required use of technology and the cost burden placed on providers. Mostly, providers are unhappy that the state wants to require smart devices for EVV.

Wilson is concerned about this requirement. “Who replaces a tablet when a client’s grandchild comes and breaks it? Who is accountable for that piece of equipment? Many people in rural areas don’t have Wi-Fi or computers. How do I, as a provider, get Wi-Fi in a home where there isn’t any?  [The memo] says data plans, and that the provider will pay for them. I don’t see how that is going to work.”

Wilson knows exactly how much it would cost her agency to purchase the tablets: $68,000 for the initial purchase alone. “The state also estimates the tables will last for three years, which doesn’t seem realistic. The $68,000 does not include data plans, replacement hardware, or tracking the hardware.”

Bush agrees, especially if the state restricts EVV to smart devices only. “The cost would be ridiculous. There is no way we could absorb the costs for providing tablets to 150 clients in addition to the data plans.”

Brackin points out that the administrative burden is also worth considering, especially when turnover rates are high. “It will be extremely time consuming for providers to issue smart phones to DSPs, train DSPs on how to use the smart phone for EVV purposes, and then ensure that the smart phones are returned when the DSP is no longer employed. A lot of providers have expressed to me that there are DSPs who just quit without returning anything,” she adds. “Who pays for that?”

Single-Vendor Problems

Bush is also concerned about the plan to integrate the state’s EVV system with payroll. “Our payroll is very complicated with shift differentials. How are our records going to be imported into a payroll system? How are we able to ensure people are paid correctly?” She thinks Missouri’s EVV model, which allows providers to select their own vendors, would be a better option.

Monroe from The Arc of Baton Rouge hopes the state does not go to a single provider. “There is no way our in-home services could go to the state provider because it cannot provide us with the information we need on the backend. I’m talking about things like the payroll reports and other items MITC provides, like tracking training and leaving messages. It just doesn’t have that ability. It would cost us more money if we used the state program, because we would have to hire someone else to convert data for payroll purposes and tracking training.”

Bush also has concerns about the GPS accuracy of the state’s technology. When an employee clocks in from a landline phone, caller-ID guarantees the employee’s location. If an employee clocks in from a mobile device, someone needs to check the GPS coordinates. That gets tricky when employees pick up clients from various locations. “It could be anywhere. It’s all over the place. I think it would be way more difficult,” says Bush.

She says the messaging capability of the state’s technology is another issue. With MITC, employees must listen to automated alerts before clocking in or out over the phone, or they receive them on the web portal. If her agency must use another system that does not support these alerts, the agency’s communication will suffer.

Lessons Learned

Monroe hopes that as the state considers how to proceed it listens to Louisiana providers. “I think EVV is great because there is so much fraud going on. There just needs to be a single way to streamline EVV and get the state on board to allow providers to know the parameters. Providers need to be able to choose our own vendor and get the information as we need it. Going to sole provider, I can’t see how that would work.”

Brackin has advice for other states based on her experience: “Decide what the state needs from an EVV system, develop a list of approved EVV vendors, and then allow the providers to choose their own system. Providers are all different. Some offer only one service to a small number of individuals; others may operate in multiple states offering multiple services to a large number of individuals. As long as the EVV vendors all meet the state requirements, a state should be able to give providers the flexibility to choose the EVV system that works best for them.

Brackin advises other states to start advocating now for the right to choose different vendors.

[1] http://new.dhh.louisiana.gov/index.cfm/faq/category/105

Staffing Survey

Agency Staffing Survey Reveals Acute Labor Shortage

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MITC recently conducted a staffing survey of 137 agencies employing nearly 40 thousand people across the United States. The results showed a severe shortage of direct service professionals (DSPs). As they struggle to deliver vital services to a vulnerable population, agencies are looking for ways to hire more employees and retain the ones they have.

Across the board, from smaller agencies with less than 50 employees to the largest providers with over 2,800 employees, agencies reported an excessive number of open positions, primarily for DSPs. The average agency employed 320 people when fully staffed and had 25 open positions (nearly 8 percent). The total number of open positions was over 3 thousand.

The Hidden Costs of a Labor Shortage

An employee shortage is not just inconvenient; it is costly. For example, agencies have responded to the shortage by authorizing more overtime. Of the agencies who participated in the survey, 65 percent reported overtime was higher than they wanted.

Overtime is not the only cost of the labor shortage. Turnover costs money, both directly and indirectly. Direct costs include overtime, lost billing if services cannot be delivered, recruitment activities, and fill-in staffing. Indirect costs include lost productivity while managers are busy interviewing and training new employees. Less obvious, but no less costly, are the negative impacts to staff morale and performance, which can lead to diminished quality of client care. Among the survey respondents, turnover rates varied quite a bit. For example, agencies in Maryland, New York, and Pennsylvania reported turnover rates under 10 percent, while some agencies the Carolinas, Indiana, and Illinois reported DSP turnover rates as high as 80 percent. This is not surprising, since the states with the lower turnover rates are able pay about 20 percent more for DSPs.

As if the shortage isn’t difficult enough, agencies also reported problems with the quality of applicants among those who are available. Common problems were applicants who failed drug or background checks, had no relevant skill sets, failed to complete training, had poor concepts of attendance responsibilities, or did not show up for interviews/training.

Ways to Improve Retention and Hiring Rates

Almost all agencies participating in the survey have already taken steps to improve their hiring and retention rates. These steps include:

  • Better applicant screening to concentrate resources on those most likely to stay
  • Annual review of retention and on-boarding process
  • Improved, more organized on-board training
  • Working with local colleges, such as nursing schools
  • Emphasizing total compensation value, rather than hourly rate
  • Developing career ladders
  • Referral bonuses and new hire bonuses
  • Graduated pay scales
  • Early access to benefits
  • Mentoring/buddy programs
  • Contests and awards
  • Employee appreciation days and events
  • Monthly staff newsletter
  • Shift differentials
  • Profit sharing

In addition to these things, agencies can focus on several areas to increase retention and attract workers.

Follow Good Scheduling Practices

One of the biggest complaints employees have is lack of advance notification for schedules. Poor scheduling or last minute changes can cause conflicts with your employees’ home lives. A DSP will be much less motivated to show up if they are constantly being rescheduled, especially at short notice. Frequent rescheduling leads to a culture of frustration and uncertainty in your workforce, and it encourages absenteeism and turnover.

When scheduling employees, it is important to track their preferences and restrictions. This will help you avoid calling them in to cover shifts they can’t take. Capture these preferences during the new hire process. Also, allow enough time between shifts for employees to rest, and avoid calling employees who have just finished a shift back in. Also, planning for holidays well in advance can avoid disruption and lead to better attendance.

Good scheduling practices, together with an accurate time & attendance system, help your agency track frequent offenders who regularly show up late, leave early, or call in sick. These employees set a bad example to others, causing lower productivity and more overtime.

Of all the agencies that participated in the staffing survey, 42 percent are considering new scheduling systems. Additionally, agencies reported that they had already changed some of their scheduling practices by:

  • Investing in new scheduling software
  • Allowing flexibility in how different sites schedule staff
  • Introducing rotating weekend shifts (one on, one off)
  • Creating more full-time positions
  • Increasing the number of part-time staff
  • Creating scheduler position(s)
  • Monitoring hours to ensure employees get breaks
  • Scheduling longer shifts on fewer days
  • Using salaried staff to cover open shifts

Empower Employees Through Self-Service

Employee self-service refers to a system that gives employees a certain amount of autonomy. For example, an online self-service system allows employees to see their schedules, who they are working with, which shifts are open, their PTO balances, and more. This saves time for you and your staff. It also reduces the amount of phone calls and emails between you.

Another popular self-service feature is an automated text or email alert system to remind employees about licenses, training deadlines, upcoming reviews, and more. An alert system can also send birthday and anniversary greetings or HR updates. It can improve communication between employees and managers, too, by sending notices when PTO is requested or approved. Using text/email reminders to notify employees of their next shifts can also reduce absenteeism and helps motivate employees. On the same token, including a digital checklist to assign duties helps employees know what they are meant to do; this is especially helpful if an employee is covering a shift for someone else.

Recognize Excellent Employees

Employees like to feel like their hard work is being rewarded. To do this, make sure your agency provides clear career paths for DSPs. Give them written guidelines on what factors will help them advance, such as good attendance records. Reward hard-working DSPs by gradually increasing their responsibilities. A DSP who has advanced from an entry-level position to a manager role is more likely to be loyal than one who has done the same job for years. For this reason, try to promote from within your agency workforce, rather than recruiting outsiders.

Also, employees want to know where they could be headed and how they can get there. Annual reviews or mid-year check-ins are one obvious venue for these discussions, but also encourage workers to come to HR with career questions and wishes throughout the year.

When excellent employees leave your organization, conduct exit interviews. You may even consider asking longer-tenured employees why they stay. Ask questions such as: Why did you come to work here? Why have you stayed? What would make you leave? What are your non-negotiable issues? How about your managers? What would you change or improve?

While there are no quick fixes for overtime or turnover, making a few key changes can increase caregiver retention and help alleviate the challenges agencies face by caregiver shortages.