10 X 15 WIN-WIN STAFFING STRATEGIES Presenter: Shelly

10 X 15 WIN-WIN STAFFING STRATEGIES Presenter: Shelly Szarek-Skodny President/CEO Diversified Health Partners, LLC Moderator: James M. Berklan Presenter: Editor Peter Corless McKnight’s Long-Term Care News & EVP of Enterprise Development McKnight’s Assisted Living OnShift Tuesday, August 16, 2016 1:00 PM ET

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Today’s Agenda Identify Major Workforce Issues Impacting The Industry Discuss Predictive Staffing Strategies To Improve Cost & Care Provide Modern Practices To Attract & Retain Staff Show How To Avoid Common Payroll-Based Journal Reporting Pitfalls

Staffing Challenges Growing Workforce Shortage Rising Cost Pressures Continual High Turnover Rates Additional Staffing Level Scrutiny

Population Growth – 80-84 Years Source: American Health Care Association

More People To Need Post-Acute Services Source: SNF Volume from Avalere projection model; Medicare enrollment from 2015 Trustees’ Report

Registered Nurse Shortage Predict 260,000 RNs short by 2025 Nursing schools do not have faculty, clinical placement sites or funding to match demand In 2013, more than 50,000 qualified applicants could not find schools to enroll in Looming workforce shortage – 2.5 million additional workers needed to meet demand according to study by UCSF

Tip #1: Identify The Staff You Need Set a labor budget – By position, per shift – Consider Five Star Quality Rating Analyze key metrics to determine gaps – Open shifts, call-offs, overtime, census/occupancy fluctuation Pay attention to staff utilization to potentially fill holes – Hours worked vs. desired hours Start hiring while considering parttime and PRN mix to add flexibility

Attracting Talent To Fill Staffing Holes

The Millennials Are Here Source: U.S Census Bureau

Has Your Organization Adapted For Millennials? 78% 35% Of new hires in senior care are millennials Of providers have changed their tactics to attract and engage millennials Source: McKnight Senior Living News and OnShift Senior Care Workforce Survey

Tip #2: Brand Your Organization Be up front and clear about what your company stands for Promote the benefits of working for your company Pay attention to your Glassdoor ratings Promote your great work and fun! Source: OnShift, 5 Things Senior Care Executives Must Know About Attracting and Retaining Millennials

Tip #3: Get Staff Involved In Recruiting Create a referral program Quicker and cheaper to hire than a traditional candidate Referred hires stay at their job longer than other hires Identify top talent and ask them to be brand ambassadors Consider incentives for referrals Top 4 Ways Millennials Hear About Companies: 1.Friends 2.Job Board 3.On Campus 4.Social Media Source: CollegeFeed

Tip #4: Go Mobile & Social To Maximize Applicant Pool Keep job applications brief – 60% of candidates have quit an online application mid-process due to its length and complexity – 1-2 minutes to complete and should be mobile friendly 9/10 job seekers say they’re likely to use a mobile device Post jobs where millennials are—social media – Expand reach by encouraging employees to post open jobs on their personal social feeds

Keeping Talent Engaged

Turnover At Crisis Levels In Senior Care 24% 44% Turnover in Assisted Living and Skilled Nursing Source: : American Health Care Association & National Center for Assisted Living’s Vacancy, Retention, and Turnover Survey

Millennials & What They Value Personal Development Flexible Work Schedules Collaborative Work Culture Work-Life Balance Real-Time Feedback Making the World a Better Place Companies with engaged employees outperform those without by 202% Source: Dale Carnegies, Engaging Millennials in the Workplace

Tip #5: Offer Training & Career Growth Opportunities 65% of millennials said personal development was the most influential factor in their current job Training & onboarding should be offered to meet various learning styles – Offer online learning – Engage them with quick hit content – Use shorter sessions Design career tracks for each position – Show employees that they have the potential to move up – Identify & track measurable goals

Accept Technology At Work Millennials LOVE their phones – 96% of millennials said their phone is the most important product in their lives – Phones were more important than their toothbrush (93%) and deodorant (90%) Source: Bank of America Survey, 2014

Tip #6: Give Feedback Often Employee evaluations once a year not nearly enough for millennials Regularly track and incentivize the behavior you want to see – Behavior tends to improve when it is tracked – Offer perks for those that perform above certain levels Call-out good work as part of your team huddle

Tip #7: Provide Employees A Voice Ask millennial employees to help make your work place millennial-friendly Conduct regular surveys – Quick daily surveys using smart phones – Identify problem shifts – Predict and prevent turnover – Trend happiness Follow up – Let employees know you got their suggestions – Communicate a plan to improve issues

Tip #8: Give Staff More Control When employees feel they have some control over their schedule, they’ll be more engaged Utilize mobile technology – Scheduling – Managing call-offs – Shift changes – Employee communication Allow employees to request their preferred schedule Take requests into consideration when building schedule “It’s so convenient to have my schedule on my phone. It’s great!” Senior Living Communities

Offset Wage Pressures

Minimum Wage Is Rising Across The U.S. Highest State Minimum Wages Effective 1/1/2017 Washington D.C. ( 11.50) Massachusetts ( 11.50) California ( 10.50) Connecticut ( 10.10) Vermont ( 10.00) Source: Economic Policy Institute, “Minimum Wage Tracker.” National Conference of State Legislatures, “State Minimum Wages: 2016 Minimum Wages by State.

Minimum Wage Increases Affecting Senior Care 30 cities and localities have increased their minimum wage above and beyond the state mandated wage minimum Private companies vie for talent by preemptively raising their starting pay. “As the minimum wage increase goes into effect in Chicago, 56% of our workforce at our Senior Suites Communities will average a 24% wage increase.” - Jon DeLuca, CEO, Senior Lifestyle Corporation Source: OnShift, The Staffing Advantage: Strategies to Reduce Labor Costs

New Overtime Rule Became Final OLD RULE NEW RULE 23,660 47,476 Previously, full-time, salaried workers who earned up to this amount annually ( 455 a week) were not eligible for FLSA overtime protection. Source: Society for Human Resource Management The DOL more than doubled the salary threshold, requiring employers to pay workers who make up to this annual amount ( 913 a week) overtime pay.

Strategy #9: Get Predictive To Balance Staffing Levels Develop a staffing ladder to hit daily targets Look ahead to identify census fluctuations and plan accordingly Be flexible by making staffing changes as census fluctuates Keep tabs on “clock-riders” Staffing at the right levels results in cost savings

Tip #10: Focus On Overtime & Agency Most overtime and agency use can be prevented Set overtime goals—monitor them daily Predict OT to prevent it before it occurs – Compute hours worked compared to remaining hours scheduled Put a plan into action today! – Set guidelines for acceptable use – Maximize utilization of current employees – Consider creating an internal pool of per diem and on-call employees Source: McKnight Senior Living News and OnShift Senior Care Workforce Survey Average Overtime (% of Labor Budget)

Tip #11: Develop A Plan For Filling Open Shifts Be proactive and plan ahead for holidays, summer vacations, etc. Top Drivers of Overtime 79% 74% Provide visibility to staff members 41% Source: McKnight Senior Living News and OnShift Senior Care Workforce Survey Av ai St aff ifi ed Ea En ou gh Qu al In av in g Pu nc hi ng No tH la at e r ly /O ut L ll Ca in ut e st M La pl oy ee s – Select the replacement by considering overtime risk Em – Identify and offer the shift to all staff that are available & qualified Off s Fill call-offs equitably bl e – Give all qualified employees have a chance to volunteer

Driving Significant Cost Savings Overscheduling Reduction Annual Savings, Single Facility (100 beds) .1 PPD 75,600 .2 PPD 151,200 Overtime Rate Reduction % Annual Savings, Single Facility (100 beds) 1% 24,000 – 60,000 5% 120,000 - 300,000

Strategies For PBJ Success

What Is Payroll-Based Journal? Payroll-Based Journal (PBJ) is a new system used by CMS to electronically collect: Employee tenure information Census data Direct care hours worked – including agency & contractor Failure to submit or reporting inaccurate data can be costly, potentially leading to citation and civil money penalties.

Accuracy Is Critical Inaccurate reporting could have several side effects Enforcement action down the road – Potential to use inaccurate data in civil liability cases – Inaccurate data used to justify regulatory action – Potential use within fraud and abuse situations - from false claims to anti-kickback

Additional PBJ Implications Tenure & Turnover Information on Nursing Home Compare Five Star Quality Ratings

Collection Has Begun Fiscal Quarter Date Range for Staffing Data Submission Deadline 1 October 1 – December 31 February 14 2 January 1 – March 31 May 15 3 April 1 – June 30 August 14 4 July 1 – September 30 November 14

Defining Direct Care CMS defines direct care staff as those individuals who, through interpersonal contact with residents or resident care management, provide care and services to allow residents to attain or maintain the highest practicable physical, mental, and psychosocial wellbeing. Direct care does not include individuals whose primary duty is maintaining the physical environment of the long-term care facility (for example, housekeeping).

Tip #12: Collecting Contractor Hours What providers are doing Contact agency & contractors to provide this data for upload Manually collect and enter into CMS Utilize systems to allow these caregivers to easily check-in and check-out

Tip #13: Reporting Boomerang Staff Issue with reporting rehires CMS only allows for one hire and one termination field per submission This creates errors or lost data if those staff are part of the same submission What providers are doing Submit separate files for rehired staff Submit PBJ reports more frequently to reduce odds of rehires overriding

Tip #14: Addressing The Day Divide Issue reporting shifts spanning 2 days Communities must report hours to the actual days worked. Most systems are not set-up to automatically report in accordance to these requirements What providers are doing Change shifts to start at midnight Manually adjust and enter to meet regulations Contract with vendors that can automatically allocate these hours

Tip #15: Trash Manual Schedules & Adopt Technology Predict and prevent overtime Automate scheduling & labor management Staff to resident need, service levels Gain visibility into staffing across properties Fill open shifts fast Get Payroll-Based Journal Reporting right

Staffing Strategies Where Everyone Wins! Higher Quality Care & Service Increase Employee Retention Improved Cost Control Better Performance & Efficiency Five-Star Rating Greater Customer Satisfaction

QUESTION & ANSWER Shelly Szarek-Skodny President/CEO Diversified Health Partners, LLC Peter Corless EVP of Enterprise Development OnShift