The workforce crisis plaguing health care continues to dominate the national conversation, with employers and employees alike feeling the pain. And post-acute providers, namely SNFs, remain the sites of care most acutely affected due to the existing structural issues exacerbated by the pandemic.

With a 35% turnover rate of CNAs in 2021, a 20% change in total employment of LPNs from pre-pandemic to peri-pandemic¹, and a reallocation of RNs away from post-acute care, it is more vital than ever that post-acute providers make themselves a desirable place to work to slow the exodus of staff.

Staff working in SNFs are often paid less than their counterparts at hospital systems—with annual salary for CNAs dropping in 2021 compared to 2020. In addition, 38% of CNAs rely on some form of public assistance, and 32% do not have access to affordable housing.

Although compensation is a must to retain and attract post-acute staff, it's a baseline lever and not the primary issue moving the dial on becoming an employer of choice. Improving working conditions, enabling staff to work at top-of-license, and alleviating unnecessary stressors are among the top objectives employers need to take on.

Our take: The state of the post-acute workforce

Failing to do so puts organizations at risk to lose out on an extremely slim pipeline or lose current employees to other employers. Providers must focus on understanding what your organization offers to staff, and build an attractive employee value proposition.

Why post-acute care

Post-acute care may not be the first setting of choice for many staff entering the field or looking for a new employer, but it has great advantages that not everyone knows about. Post-acute care provides opportunities to employees that can't be experienced in other settings—and helping them see what makes it unique can assist in bringing staff to the industry.

• Autonomy and decision-making: Without 24/7 physician support in post-acute settings, many RNs are tasked not only with leading the patient care plan, but using their specialized knowledge to make important, in-the-moment decisions. This increased responsibility provides enhanced experience for RNs. As RNs take on more top-of-license responsibilities, the door opens for more autonomy for LPNs and CNAs as well.
• Different goals of care: Goals of care in many post-acute settings differ from those in acute care roles. Working to rehabilitate patients or provide dedicated focus on improving their quality of life could interest some staff, attracting them to these sites of care.
• Skill development opportunities: Rising acuity in post-acute care offers new challenges and new opportunities for professional growth. This factor, coupled with different specialization needs compared to acute care, allows staff to become experts in specific patient types and conditions.
• Longer-term patient and family relationships: Compared to the relatively short stays of patients in acute care, post-acute allows for employees to foster meaningful, longer-term relationships with their patients. This has the potential to be a high value draw to those with a desire to make these types of connections.

4 sample strategies to become the employer of choice

Demonstrating the upsides of post-acute work is only one step to win staff over. Improving their experience and making their day-to-day lives easier is even more important—and there are numerous ways leaders can do this.  Below are four—but this list is in no way exhaustive.

1. Daily pay: As mentioned, many staff working in post-acute settings, particularly CNAs, are of lower socioeconomic status.  Daily pay has begun being offered as an option by some providers, allowing for staff to clock out at the end of their shifts and collect the day's accrued earnings. Providing an alternative to the biweekly payment model can directly make a difference for staff that need to access their funds immediately after their shift ends. Not only is this tool helping build workforce loyalty, but it meaningfully supports the staff that need a more regular income stream.
2. Flexibility: As more millennials and Gen Zs enter the workforce, flexibility is becoming an increasingly vital lever in being an employer of choice—especially as younger candidates seek a work schedule that fits with their lifestyle. Additionally, for those in the workforce with children, finding appropriate, affordable childcare, and ensuring that these employees are able to work their schedule around that care is more important than ever. Examples of this include offering shorter or longer shifts, per diem roles, afternoon-only positions, and weekend options to those it best suits.
3. Uninterrupted, guilt-free time off: Due to the 24/7 nature of long-term care needs, exhaustion and stress levels for staff are constantly a threat to resiliency. Giving staff the time off that is needed can reduce stress, clear up thinking, and lead to more efficient productivity. However, truly moving the dial with this strategy includes encouragement from managers and leaders that staff can and should take this time off. Doing so acts as reassurance for post-acute employees in need of a guilt-free recharge away from work.
4. Growth opportunities: While there is a portion of the post-acute workforce who is content with their current role, many come aboard to grow within the company or progress into different roles. Providing the opportunities and time to teach and cross-train employees will enable a culture of learning. Regardless of the tenure of the employee, these opportunities lead to improved emotional investment and interest in their work and can help empower staff in their day-to-day duties. 

End notes

¹October 2018-December 2019 compared to April 2020-June 2021