Best Practices for Staffing and Training in Senior Care - A Conversation with Jennifer Lagemann

Recruiters in all industries, including healthcare, often struggle with worker retention and satisfaction. This leads to staffing issues, higher turnovers, and instability within organizations. But there are ways around it. And to learn more about overcoming these challenges, we recently interviewed Jennifer Lagemann, expert in brand and storytelling for attracting senior caregivers and founder of NextJenn Copy, who provided us with several best practices for staffing and training in senior care.

This is what Jennifer told us:

Regarding best practices for staffing and training in senior care, what are your recommendations for companies to schedule an orientation?

JENNIFER LAGEMANN: Best practices I have when it comes to staffing is to match clients to caregivers based on personality and availability before evaluating technical skills. Oftentimes it's personality and soft skills that contribute to a reason why a client might not want somebody back or their demeanor. They're rude or something along those lines. Oftentimes it has nothing to do with our training so it's important to match based on the caregivers availability and their personality when scheduling them, because a lot of clients might be quiet and they prefer someone who is also quiet, or maybe they're loud and would benefit from someone who is also loud and matches their energy. But those synergies have to be in place first before you even talk about training. Because training for home care is really malleable. And let's say if somebody does need that type of training, you can train them on an ad hoc basis on that skill or that set of skills before signing them out to a client. But to get that personality and availability right is critical in order to contribute to retention and recruitment aspects. And the other part is to be in consistent communication with your caregivers. And other people as well. I call it the Triangle of Communication. How I've been taught to think about this is make sure that your clients, family members and caregivers are aware of the schedule. So, every time you fill a shift, that means three calls, at least. Sometimes there are siblings involved or other providers involved that need to be aware, so it may require more than three, but it's a minimum of three calls that need to be made unless they prefer a different mode of communication, which you should also note.

What should be included in a healthcare worker orientation? What procedures, policies, code of ethics, etc.?

JENNIFER LAGEMANN: The first thing I would make sure to go over is to go over your culture. I think that it's really hard to explain culture in an interview or a remote setting like via a call. So when you do have your people in orientation, really go over your culture and what do you do to enhance your caregivers experience outside of them working. Because caregiving, and home care especially, is a very solitary type of work. Your caregivers are working one to one with clients in their homes. So oftentimes they feel isolated alone and unsupported. So you need to explain how you're going to support your caregivers while they're working elsewhere, but also make sure that they feel like they're a part of a team and a community, even if they work independently because they still have a supervisor, they still have an office team, and maybe you have a peer mentorship program, and you need to make sure you talk about that in your orientation to make sure your caregivers know who is there to support them. And oftentimes they don't even know who their direct supervisor is. So, also make sure to tell them who their supervisor is and also explain and break down who to call about what. Who do they call about scheduling changes, time off, a client issue, a discipline issue or just in general; like listing out different scenarios and who they should contact when, how they should contact them. If it's an after hours situation, how to handle that type of call or explain when you're calling off, this can't be done via text, for example. Make sure you outline those types of communications because if you don't say it, you'll find out really quickly that you should have. Also make sure that your caregivers know what support systems are available to them, whether that's through email or they have a peer mentor. A lot of times your agencies are implementing peer mentorship programs, at least for the first 90 days of a new caregiver's experience, to make sure that they have a peer that they can talk to, someone that they can confide in, that they might not be comfortable talking to the office about, and that way they can relate concerns or someone to talk to training about. Like, I really want to get trained in dementia care, for example. They would have someone to talk to about that, who is a peer and someone who's been in their shoes. So it helps to develop that rapport and make sure they're comfortable for their first 90 days. And then they can kind of be left to their own devices with the offices additional support. But these are really great programs that I've seen with great success. So those are a couple of things that I would make sure to touch on in your orientation.

Regarding recruitment, what are the most effective channels to attract candidates?

JENNIFER LAGEMANN: I'll start with where you shouldn't be. I know that Indeed is a terribly common recruitment channel and it's really good for volume but when it comes to retention, it's very difficult to retain applicants that come through. They have the highest turnover rates, according to the latest Home Care Post report. So I would definitely try and steer clear of Indeed if possible. I mean, I understand that it is really good for volumes. And there's also no silver bullet, though, when it comes to a best recruitment channel. The best bet you can make is to be where your caregivers are. Where do they live online? And study that. Do you notice that a lot of caregivers are on TikTok? Or have you seen them on Clubhouse? Be where they are. You don't need to be on every channel. I think that every everyone tries to be everywhere at once, and you don't need to do that. You don't need to be on every social media channel or outlet, but know where your caregivers are. Do they prefer texting? Make sure that you incorporate that into your recruitment mix when it comes to communication or add them into a recruitment drip after they apply. Make sure you utilize the channels that you already have and make it as personal as possible and make it feel like it's custom to them. So they're really talking to me individually. Or, what if you got a customized video from the owner of an agency saying "Hey, blah, blah, blah, I really appreciate getting your application and would love to talk to you. Can you schedule a 30 minute interview at this link? I would love to chat with you soon." Imagine how that applicant might feel if they got a video like that or a quick voice message like that. That would change their experience. Or maybe don't take ten days to get back to them. What is the average get back to you date when it comes to how many days after a caregiver replies that they get a response. So if you're taking your sweet time and getting back to applicants, you're going to have a very hard time recruiting, so make sure you're on top of getting applications and respond to them. Even over the weekend. You still want to be getting back to them within at least an hour of their time through your application.

Once companies have identified potential candidates, what are the best interview questions they could ask during the interview process?

JENNIFER LAGEMANN: I think there's a lot of different questions out there that people are asking, but you really can't get a full understanding of how a caregiver is truly going to work with you until they start. But there are a few questions that I think you could ask that could give you kind of a gauge of how they would perform on the job. One of them being "if you had a personal conflict that interfered with your work, how would you handle that?" You'll hear, oh, I might have a babysitting issue. I have a parent or sibling in place that could take care of them while I'm gone. And just understanding how they organize their life, how they prioritize things, but also make sure that as an employer that you are backing your employees up. "Hey, I understand if you have a personal conflict that comes up, we don't want to impede on your personal life." That's an interview question for you as well. It's not just for the applicant. It's a choice for you to kind of turn it around and give applicants a sense of how you would take care of them, because it's a two way street. Interviews are not just one way streets. And I feel like a lot of people are just using these as ways to vet out caregivers, but it's also a way for them to vent out you as a potential employer. Are you going to support them if they needed a day off? A lot of places I've worked with in the past, you don't get any time off, including unpaid time off, until a year after or they don't offer paid holidays. So this is a really great opportunity for you to showcase what you truly offer in terms of culture and environment for your applicants. So, definitely make sure that you take the chance to answer that as well when you're on the employer side of things and also ask "when you're working with a client living with dementia, for example, and they start yelling at you, what would you do next? It's kind of like a clinical competency question and helping them to give you an answer that gives you an understanding of how they perform. And that could be various things that can also indicate a lack of training and even if they give you a poor answer or maybe not the right answer or the one that you're looking for, this is an opportunity for you to provide training and for you to provide correction, redirection, and showcase what you know. Because if you know the correct answer, maybe you've taken the training yourself or you're a dementia care expert and you can be an authoritative figure that helps mentor them into a better caregiver. And I think that's super valuable. Because caregivers want education and a lot of people aren't giving them the proper training and education that they're looking for. A lot of caregivers want to pursue higher education and don't have those opportunities and doors open for them simply because of the wages that they make. And that's an opportunity for you too as an employer to justify why a caregiver should work with you. And lastly, "what's a challenge you've run into at work and how did you overcome it?" Understanding how an employee approaches a challenge is super critical to how they'll respond to challenges with you. And also approach this as an employer as well. We encountered an employee that wasn't performing up to par, and we put them in a performance improvement plan and over three months we helped to develop them professionally, personally, and they were promoted at the end of it. Wouldn't that be a great success story share? You know, don't penalize people for getting things wrong; show them the right way, help them understand where they got it wrong, and then help them understand where they can go next, what their next steps are. So really think about interviews as a two way street that it's an opportunity for you to be on the chopping block as well or justify why you shouldn't be. And those are my couple of interview questions you should ask.

What are the most common staffing issues you have identified so far and what do you recommend companies do to solve them?

JENNIFER LAGEMANN: Sometimes I find that families are set up with a poor expectation of what they're actually getting themselves into. A lot of families may come from a private caregiving situation where they hired somebody directly and only work with them. So setting up as clear communication expectations like you will be speaking with the agency and we will send a caregiver to you. But outside of the caregiver being there, you will communicate with the office. And we will kind of handle all the administrative and other things, but also make sure they understand how many caregivers are going to be working with, or at least a range, because a lot of families will be like "I've cycled through three caregivers in the last three months and this is not what I wanted." It's a really tough recruitment market. Nowadays, we are experiencing a gigantic caregiver shortage, or at least that's what they're portraying it to be. And a lot of families are set up with an expectation that they only have one caregiver, or at least that's the expectation they have in their head. And so make sure you're being honest about what the situation actually looks like for a family because once they've only had one caregiver for, let's say, a couple months and that caregiver needs some time off or they're going to be switched on to another client for X, Y, or Z reasons, make sure that you set them up with that expectation too. If you just take a caregiver away from a family, you're going to need to explain why or at least to the degree that you can, because obviously you don't want to give away private information that's protected, but make sure that you're setting people up with honest expectations. Caregivers too. If they're expecting to work with one client for 40 hours a week, is that actually going to be the case or are they going to be working with three different clients for various hours? They don't have breaks in between, make sure you let them know that. Will you be working with five clients? Maybe not, or maybe you will, but make sure you're honest about those things and communicate with them when there's a schedule change because families generally don't have a problem with a schedule change, but if they don't know who's coming or somebody else comes that they weren't expecting that's when the issues start because they're like "Well, I wasn't expecting this person to be here. Who is this? Who's a stranger coming into my house?" That's their approach because they don't know who the person is. So what if you took the call and said "Hey, I have so-and-so coming over to your house, they are new to you, they are not new to us, and they've been with us for a while. Here are some of their experience and they really enjoy cooking." Perfect. A family would probably really appreciate a call like that to have some context or history as to where this person came from, or "they have a senior license or they have a bachelor's degree in so-and-so doing this in context I think that would be helpful." And also making sure that you respect a caregiver in their work life balance. Don't expect people to pick up every shift that you have available, so don't bombard them with so many text messages because that was one thing I hated as a scheduler, that I was supposed to send out a text for every shift that we had but I knew full well that not every caregiver was going to pick up the shifts that I sent out. So I was like "Why don't I just send out the shifts that I know a caregiver will want or should be available for and only send those to them so they're not seeing things that they know they aren't available for or I know that they're not available for". So just make sure that you're respectful of the caregivers time, their phone, their availability, and also not double booking. Make sure that they are prepared when it comes to training and really just overcommunicate is what I would suggest when it comes to staffing issues.


About Jennifer Lagemann

Jennifer is a wife, writer and former family caregiver based in Kansas City. She works as a senior living/senior care content writer and strategist, helping healthcare organizations like home care agencies, hospices, rehab facilities, and assisted or Independent living communities with their content marketing needs.

"I first started as a caregiver for my grandmother at home in Massachusetts, and it was a really wholesome and comprehensive experience. I was around 12. My grandmother had a stroke, and then she developed cancer. Eventually she was admitted into hospice care. And it was just a really eye opening experience. It really showed me how health care works. She didn't speak any English, only Vietnamese. So, I was bilingual growing up, and it was really a challenge making sure that she got the health care that she needed because she couldn't communicate directly with her providers. So that was something that I had in the back of my mind as I was growing up," says Jennifer.

She adds that "I was wanting to be an advocate for other patients and to make sure that they get the care that they need because, let's say she was in senior living, for example, she wouldn't have thrived because nobody would have been able to talk with her. They wouldn't have created the food that she liked. And they wouldn't have had activities that she enjoyed doing. And those three things really made me think about the fact that all care isn't created equal and I wanted a way to create something that would help prevent this from happening to other people."

Jennifer also says that when her grandmother passed away, she was able to see things differently. "I was a biology major and my grandmother passed away during my first semester of college, and it really made me rethink my trajectory in life and where I wanted to go. I wanted to be a geneticist, and I thought I had my whole life planned out ahead of me. So I switched to became an English major and really leaned on my writing skills and wanted to hone my craft. And eventually I found my way into health communication as a major in a degree program. And then I started working at home care agencies as a caregiver. Shortly after that, I started working in offices as a scheduler intake manager, training these after hours persons. So I got to dabble in a bunch of different roles that coincided with other departments. A lot of my work was networking, marketing, building relationships, I was taking intake calls, and I really got a holistic sense of how a home care business operates from the inside out. And I saw the same problems from Massachusetts to Nebraska to Kansas."

Jennifer concludes explaining that "I've had the chance to work with a lot of other agencies through my consulting work and I wanted to create my own thing during the pandemic because I got my hours cut in half as a scheduler, and decided to get back to home care agencies and clients and caregivers by being a marketing operations consultant. So, I was able to utilize my writing skills to support my family and give back to our community. So I've been able to work with agencies in Manitoba and California, and all across the US, and able to get a holistic sense of how business works and helping them grow their operations, build their training programs, make suggestions, change their operations, and streamline things so they're easier for the owner. And I've been doing that ever since, and it's been a really great journey so far, and I've been trying to develop and grow my career as a writer. So it's been a really great time."

To listen to the full interview with Jennifer, visit our podcast or our YouTube channel.

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