Momma's assisted living has a high turnover of staff and nurses. She has been living there for a little over four years and they have gone through a number of nurses, aides and cannot keep a housekeeper. Right now they are on their second president.
My experience is that, yes, it is normal. Most of the ASL centers in my town are understaffed. When I question this, they always say that they have the "required" number of people employed. I find this ridiculous. The number of staff that you employ should be based on the care needs of your residents, not what is "required". I believe the turnover is due to the caregivers being overworked and underpayed. I've been in these facilities and see the frustration with the caregivers trying to keep up with the demands put on them. The ASL where my mom resides has many residents who complain constantly about the littlest things. The tomato soup is too thin, you only brought me 3 washcloths instead of 4, you were 30 minutes late giving me my meds, why can't the temperature in my room CONSTANTLY remain at 74° and stop going to 73 or 75°? And on and on. My mom is one of the constant complainers and she is in the best facility in my area. She literally doesn't have to lift a finger if she doesn't want to! I tell the caregivers every single time that I talk to them that I greatly appreciate them and I have no idea how they do their jobs as I could NEVER do it. It just always seems to me that they are overworked and underpaid. I absolutely could not put up with the physical, emotional and psychological demands on a daily basis. They must feel so unappreciated... :(
If they are taking care of husband the way you want them to, and you are able to communicate with them in a timely manner, I would not worry about the high turnover.
The industry typically has a high turnover as it is a high stress job, variable hours, and with certain jobs, does not require much advanced education. As people get their nursing degree or realize there are better opportunities if they move to a new job or get to the limit to where they cannot progress anymore, they will leave.
It is kind of like teachers. They don't get paid nearly as much as they should. The difference is teachers get much better benefits and get some long periods of time where they don't have to work nearly as hard as the rest of the time.
A lot of older people died in nursing homes and at the hospital - the nurses and caregivers are burnt out - that’s the reason . Plus we have so many boomers and the Family unit is not strong in America . I have seen assisted living places and Memory care at nursing homes - it’s really about whose running the place . My Brother was in a Carribean nursing home and they treated the staff and nurses well - people were happy to work there .
There is a high turn over. There was also language barriers between the caregivers and residents in my situation. I agree with many comments that the turn over is related to management and the processes they develop. You need a clear care plan that is communicated to all levels of the caregivers. Managers need ways to ensure that the caregivers are completing their task. A thankless job but, in my case, management had no idea if the requirements for care were being met. I ended up going daily and journalizing the daily experience. I kept records of baths, eating, clothing, bed changes. I was able to use that detail to communicate the gaps to management but would not have seen improvement without that documentation. Management did not have the processes to monitor the care. Great caregivers will stay where there is clear direction and the right patient to caregiver ratio. That responsibility falls entirely on management and owners.
djenning6msncom: The high staff turnover rate at assisted living facilities makes perfect sense since caregiving has to be one of the most underappreciated jobs.
It's not that it is an underappreciated job; I greatly, or rather infinitely, appreciate all the employees at the assisted living facility where my father is. I believe the turnover is so high is because the pay is too low for what they do. In my father's facility it seems every time I go there there are new employees. In fact only about 30% I recognize from only a few months ago. These are mostly those that have the most responsibility, like nurses and managers. The good thing is almost everyone that I have interacted with there is very friendly, caring and competent.
I recently heard on the news that there is a major shortage of professional caregivers in the US. This to me would suggest that the pay would therefore be higher but this is apparently not the case. The facilities can only pay so much, if they want to stay in business. What are all these employees doing when they leave? I have no idea.
Yep. Very common. The complaints I heard from staff was facilities do not hire enough people and exhaust the ones they do hire. You can tour a facility (doesn't matter what kind) and will be told there are x number of staff on an area and each person handles 4-6 patients. In reality if you go there and actually observe, they have hired on person to handle about 15 people...impossible task.
Corners that may be cut are person assigned to shower 7 or 8 people on one side of hall, however those on other side ring their bell for some kind of help. Staff member leaves one person on a shower chair to answer call bell. If person falls in the shower, there's a good chance it won't be reported if all is well. Another example is long wait times to be helped to the bathroom. Answer to that is slap a diaper on the person.
If you're seeing high turnover, then you need to be going regularly at various times to observe first hand what care your loved one may be getting neglected on. Don't stop and chit chat with everyone on your way in the door. Enter and observe. Then bring issues to the attention of the person who runs the show, ask for how they will resolve, and follow up to see if problem fixed.
So true. My friend, who I call my adopted mother, I visited her in a dementia care facility that was supposed to be one of the best. As we sat during lunch she urinated in her diaper which leaked onto the floor. I called an attendant to come assist her and he looked at her and said we’ll do it after lunch. I told him he would do it now. I felt bad being demanding in on one hand, but on the other hand this is what you’re supposed to do. How long would she have sat in that overly wet diaper had I not been there?
Reply for cmotta re question about the "Zurich Plan": In context, this commonly refers to Voluntary Assistance in Dying (VAD), which is legal in Switzerland. In the U.S., variations on that option involve the medical industry and are severely restricted to the point of being less than useful for many. (Bioethics arguments may exist but are a separate issue IMO.) Even in states where it is legal, VAD or MAiD (Medical Assistance in Dying) may be possible but only under explicitly defined and documented conditions. In Switzerland, it is potentially available to any older adult who determines that s/he has lived a "completed life" even if they are not suffering from a terminal illness that is expected to end in natural death within 6 months.
The catch? For non-residents of Switzerland, the arrangements for VAD are complex and very expensive! Speaking only for myself, however, I would seriously consider expending my last $15-20K on a one-way trip to Switzerland vs. who knows how many years I might "live" in a NH or ALF costing $80-100K+ per YEAR, payable out of pocket until my funds run out, then by Medicaid.
Prior to Covid, the industry had a 135% turnover rate in employees. This turnover rate is for employees at all levels. This is one of the highest turnover rates in any industry. Since Covid, the turnover rate is significantly higher. The industry is challenged by both high labor costs and high capital expenses. They must balance the needs of the patients with the needs of their employees, operating expenses and regulatory compliance. For example, if the staffing ratio in a memory care unit is five patients per caregiver and they have two empty beds, they are not receiving revenue for two empty beds, but they are paying the wages for five full beds. The margins in the industry are especially low compared to other industries. The companies do not have much wiggle room for wage increases. Any increase in wages is passed on to the patient.
Caring for people with disabilities and handicaps is both physically and emotionally taxing. It takes a very special person with a very high level of selflessness to care for others day-in and day-out for years. Even if the wages are high, staffing would still be a challenge. Letting the staff know you appreciate the care they are giving your LO is one of the best things you can do to help your own family member. We all need acknowledgment for our efforts on a regular basis. Show the staff how much you care for them and they in turn will give your LO better care.
I absolutely concur that front line care work should be paid very well and come with good benefits, along with respect, which is certainly not the case currently. I agree that low pay, coupled with often-unpleasant working conditions, probably largely explain high staff turnover although, as others have noted, a wide variety of industries are experiencing staffing shortages.
I understand that many elder care facilities across the nation are being bought out by private equity companies, whose ONLY interest is return on investment. These companies have eviscerated local news organizations and are moving on to healthcare as their next cash cow. That does not bode well for any moderate-income older adult who may need care. Affordable care isn't a problem for the wealthy or for the low-income (Medicaid eligible), but there is a HUGE unaddressed cohort in the middle. Many moderate-income retirees did their best to prepare for their "golden years", but the ground has shifted.
The cost of even subpar NH or ALF care is often out of reach for all but the relatively wealthy if it is needed for more than a year or two. Long term care insurance can help, although ours recently notified us of changes that are decidedly not in our favor. Many of today's older adults (me included) have lived longer than we intended or wanted to. That, coupled with inflation/the high cost of living and the current labor market, has created a "perfect storm" for remnants of The Silent Generation and the coming influx of boomers. I don't have the answer--wish I did!
you’re so right. It’s so scary to think of the future in these terms seeing what we see now. Some thing we try not to think about and you pray for a healthy life and then die overnight.
Unfortunately, it seems to be. I have found in my eleven years with my mom in AL/MC and the two years of my sister being in AL/MC, that turnover is directly related to how well the employees are treated by the company they work for. I have even suggested that people looking for the right ALF for their family member should find the smoking area and talk to the employees out of sight from management. If the employees feel respected and well-treated, they stay. Happy employees = happy residents. Happy employees are more engaged with the individual residents and their families. Always ask about the turnover rate.
Caregivers—staff— are very underpaid for the work they do. Calming a dementia patient who yells or cries incessantly, toileting a patient, cleaning up an incontinent patient, feeding them, cleaning them and changing their clothes, answering call lights—all take time and energy. Top all this off with 12 hour shifts, understaffing and low pay, and it’s no wonder people won’t stay. Medicare has nursing home ratings. A four or five star rating for resident care reflects good care by staff, which means stable staffing. I got my brother into a five star resident care nursing facility and they were excellent. The same staff cared for him for eleven months. Unfortunately Medicare doesn’t rate assisted living since they don’t pay them. But it’s still possible to find ratings for ALF online. An elder law attorney might provide suggestions in a quick, free consultation. Our elder law attorney recommended one that was excellent for the short time he was there.
I would caution folks to be skeptical of online reviews. The facility my mother resides in gets 5 stars online (from a few reviews) and I can tell you for a fact it is far from 5 stars. It suffers from the same problems iterated by the original poster. Go yourself, try to talk to a another family member you may meet, and to staff (if they will talk to you).
The United States - and in particular members of certain political parties - doesn’t feel that health care is important whether that means for children, young mothers, healthy adults, or the elderly. It is evident not just in how we treat our elderly but in how we treat everyone. My mother’s side of the family is European (France and Netherlands) and they don’t have these problems with high costs, low levels of care, and staff turnover because most of the facilities are state run and not for profit.
Doctors visit people at their homes, caregivers are provided for free, and when the time come you are eligible to move to a government owned apartment complex with other seniors that we would call assisted living - all free of charge. The people who work there are employees of the state, are paid well, and have good benefits.
My relatives are always shocked when I tell them that here you pay $6000-10000 per month and what you get for that money. They say “I thought America is the wealthiest country!”
The only solution to this problem is to eliminate private insurers and offer a lot more public senior care facilities. This country’s emphasis on letting private corporations manage our healthcare for profit is killing us all.
That's not the solution at all! In some western Europe countries they do in fact have major issues related to healthcare that we do not have in America. The wait times for appointments and procedures is often months, as your relatives who live there will verify, and the care can be substandard, even dangerous, depending on the country. It's true these countries contain their costs very well for the citizens but this is the result of the culture, of long history and homogeneity of people, as a whole agreeing and paying for it. America has a totally different history and culture and this could not be done, at least for the foreseeable future. Look at the Affordable Care Act. How has that worked out?What the solution is: To privatize everything and get rid of all the unnecessary regulations, many of which appear to favor special interests. This will allow private companies to compete to provide the best care at the lowest prices. In this way the culture of, or should I say brainwashing of, insurance will disappear as people realize that the best way to handle health care costs is like any costs - pay it yourself! My doctors love the fact that I am "self-pay" and I always get a discount.
Would you be happy to work in that environment? I believe the present administration is looking for care workers and slaughter house employees amongst all the illiterate border crossers. Many visitors/relatives can't even bare to visit.
Thanks to all for the insightful comments. My great aunt was on a ventilator but still cognizant. Her son walked in as she removed the tube (she was a retired nurse) and had it put back in and restraints put on her. She never opened her eyes again when he was there. She knew when I was there, and was responsive with hand squeezes and gestures. I guess the lesson is for all of us to make sure our nearest and earest KNOW our wishes and will carry them out for us.
Are you saying your great aunt wanted to end her life? (If so, options could have included Palliative, Hospice or Death with Dignity?). Also, are you advocating for us all to get our affairs in order with lawyers who can document our "end of life" wishes?
Not sure I understand why she would not open her eyes again when her son visited.
Discuss your caregiver/staff needs with administrator. -Put in writing. -Follow-up and keep a journal of calls/interactions (date, time, person you spoke to, what transpired).
In addition to addressing needs with administrator, it can only help to develop personal positive connections/relationships (at / on-site, not off site) with line staff. As you show interest and appreciation for them / their work, they will be aware and want to give 'better' service/attention to your loved one.
-I would not tip w/$ although a gift card now and then is appreciated. I did this at the end of the year although do anytime. Even $20 gift card is appreciated. THEY DO WORK HARD and most have to do this work due to English as a second language and no other skill sets. Some are excellent and care; some do not want to do this work, are not trained (well) and do not care. Yes. The turnover is huge and not only line staff (CNAs, Aides - it is also management, nurses, etc.). I believe there is a shortage everywhere in many industries, not just elder care / nursing homes.
There is high turnover in all areas of healthcare. There is a huge shortage of healthcare workers. The people who do stay and continue to work are pressured to work harder than ever due to the shortage. Good workers are getting burned out. This is likely to continue.
Lisa this is sooo true! I am getting ready to retire from one of the biggest/best hospitals in the country.. and every time I think "maybe not yet" I go to work,,, LOL and think "yep, its time" I have been with the same hospital for 26 years and boy have things changed!
I, foresee, the younger generation, the one that calls their elders boomers to their faces, will device a plan to effectively deal with the problem.
Nobody wants to deal with mean, abusive adults that cannot care for their own hygiene at any wage, but, especially not bottom dollar, they are demeaned and degraded until it is no longer safe for the caregivers to have a hand in caring for these vulnerable populations because they are resentful towards them. This is why we see the number of people willing to work these jobs on a downward trajectory. The only way to change that, pay the ones doing the boots on the ground work, being treated demeaningly, degradingly and oft abused, enough money to make it worth it to put up with it all. It shows we respect and appreciate them, which helps heal the other unavoidable portions of dealing with demented elders and just mean people.
We should all pray for this solution because the alternative is very him indeed.
The staff turnover is a great concern for my Dad’s ALF also. And each time there are new staff, we the family have to make sure they know dads individual needs (how to use the lift chair, make sure he is taken to the bathroom at least enough not to sit in a wet depends, make sure he is encouraged to leave the room to eat, how to encourage him to let them shower him). Just as a caregiver seems to be familiar with him, they leave. And the facility is understaffed for the 48 residents they have. And he is in one of the nicer ones. The dilemma is if they pay more to the workers, Which they should, they would have to raise rates and so many already can’t afford an ALF even though they need it. Dad only affords it due to his veterans benefits of disability (if your loved one is a vet, check this out with the VA) I think our country needs to worry less about other countries and sending money around the world and help finance the ALFs so they can pay staff more. Pay the ones directly working with the residents not just the managers.
No . That ms not normal at all. Something is going on. Rather it’s the training, ppl they’re hiring, pay, it’s something negative going on snd it’s not good for the ppl staying there. They have to feel safe and secure by seeing the same ppl u become a family. Like at my job it’s like that it’s in health it’s bc they’re young going back to college, moving, tired of health care, pay is low snd over worked. It’s time to get a better place for ur parent. It’s too much of a revolving door.
We were running into the same issue and came to find out the place she was in was using agency staff only. They had also changed management 3 times in less than 2 years. We moved her out of state and to a place that has been under the same management for its 11 year existence. They also hire their own staff. Most staff members have been there for over 3 years. It’s an amazing staff, they all know everybody in the place by name. I very rarely see a new face (on occasion they need to bring in agency staff due to vacations etc.). Do some investigating as to what type of staff your facility uses.
Let’s be real, as this has been addressed here a time or 10 before, the primary reason for high turnover in these places if the staff who interacts with the seniors are vastly underpaid ( and under appreciated). Most of the cost a resident or their family pays for them to live there is definitely not going to the caregivers and aids on staff
Yes high turnover is the norm. The work is incredible hard. It requires clinical accuracy, satisfying the patient, and their family, and the management pressures staff to be faster and do more with less. More than 90% AL's are corporations, mostly run by people who have little to no healthcare experience nor education.
It can be normal at times for their to be a high staff turnover in some places more than others . Sometimes carers dislike Management etc , pay rate , bullying & not given enough shifts at one facility etc . I myself only have one job , but a lot of people of different nationalities have several jobs in the same sector for all different companies & sometimes work excessive amount of hrs , putting other staff & residents at risk . Try not to be overly concerned to which I know is hard , if you have concerns speak to management to ensure he is getting the same care staff on a daily basis, within reason . To assist with your concerns . As care staff form a relationship with their residents if their attending to him daily & this will also help him as much as you . Nothing hurts to ensure the best care is provided .
I have seen low pay, not enough staff so the workload is unbearable, and stupid decisions by the management in the nursing homes I have visited where my family has been in residence so unfortunately it does seem normal. We need a sea change in this country in how we treat our elderly and handicapped,
You can say that again. You don't need to, though -- almost everyone I know -- either old or younger-and-taking-care -- is saying exactly the same thing. The elder-care situation in this country is a huge mess. I read in the Washington Post recently that a significant number of elderly people, many with dementia, are ending up living on the streets.
I believe the turnover is due to the caregivers being overworked and underpayed. I've been in these facilities and see the frustration with the caregivers trying to keep up with the demands put on them. The ASL where my mom resides has many residents who complain constantly about the littlest things. The tomato soup is too thin, you only brought me 3 washcloths instead of 4, you were 30 minutes late giving me my meds, why can't the temperature in my room CONSTANTLY remain at 74° and stop going to 73 or 75°? And on and on. My mom is one of the constant complainers and she is in the best facility in my area. She literally doesn't have to lift a finger if she doesn't want to! I tell the caregivers every single time that I talk to them that I greatly appreciate them and I have no idea how they do their jobs as I could NEVER do it. It just always seems to me that they are overworked and underpaid. I absolutely could not put up with the physical, emotional and psychological demands on a daily basis. They must feel so unappreciated... :(
The industry typically has a high turnover as it is a high stress job, variable hours, and with certain jobs, does not require much advanced education. As people get their nursing degree or realize there are better opportunities if they move to a new job or get to the limit to where they cannot progress anymore, they will leave.
It is kind of like teachers. They don't get paid nearly as much as they should. The difference is teachers get much better benefits and get some long periods of time where they don't have to work nearly as hard as the rest of the time.
I recently heard on the news that there is a major shortage of professional caregivers in the US. This to me would suggest that the pay would therefore be higher but this is apparently not the case. The facilities can only pay so much, if they want to stay in business. What are all these employees doing when they leave? I have no idea.
Corners that may be cut are person assigned to shower 7 or 8 people on one side of hall, however those on other side ring their bell for some kind of help. Staff member leaves one person on a shower chair to answer call bell. If person falls in the shower, there's a good chance it won't be reported if all is well. Another example is long wait times to be helped to the bathroom. Answer to that is slap a diaper on the person.
If you're seeing high turnover, then you need to be going regularly at various times to observe first hand what care your loved one may be getting neglected on. Don't stop and chit chat with everyone on your way in the door. Enter and observe. Then bring issues to the attention of the person who runs the show, ask for how they will resolve, and follow up to see if problem fixed.
The catch? For non-residents of Switzerland, the arrangements for VAD are complex and very expensive! Speaking only for myself, however, I would seriously consider expending my last $15-20K on a one-way trip to Switzerland vs. who knows how many years I might "live" in a NH or ALF costing $80-100K+ per YEAR, payable out of pocket until my funds run out, then by Medicaid.
Caring for people with disabilities and handicaps is both physically and emotionally taxing. It takes a very special person with a very high level of selflessness to care for others day-in and day-out for years. Even if the wages are high, staffing would still be a challenge. Letting the staff know you appreciate the care they are giving your LO is one of the best things you can do to help your own family member. We all need acknowledgment for our efforts on a regular basis. Show the staff how much you care for them and they in turn will give your LO better care.
I understand that many elder care facilities across the nation are being bought out by private equity companies, whose ONLY interest is return on investment. These companies have eviscerated local news organizations and are moving on to healthcare as their next cash cow. That does not bode well for any moderate-income older adult who may need care. Affordable care isn't a problem for the wealthy or for the low-income (Medicaid eligible), but there is a HUGE unaddressed cohort in the middle. Many moderate-income retirees did their best to prepare for their "golden years", but the ground has shifted.
The cost of even subpar NH or ALF care is often out of reach for all but the relatively wealthy if it is needed for more than a year or two. Long term care insurance can help, although ours recently notified us of changes that are decidedly not in our favor. Many of today's older adults (me included) have lived longer than we intended or wanted to. That, coupled with inflation/the high cost of living and the current labor market, has created a "perfect storm" for remnants of The Silent Generation and the coming influx of boomers. I don't have the answer--wish I did!
Doctors visit people at their homes, caregivers are provided for free, and when the time come you are eligible to move to a government owned apartment complex with other seniors that we would call assisted living - all free of charge. The people who work there are employees of the state, are paid well, and have good benefits.
My relatives are always shocked when I tell them that here you pay $6000-10000 per month and what you get for that money. They say “I thought America is the wealthiest country!”
The only solution to this problem is to eliminate private insurers and offer a lot more public senior care facilities. This country’s emphasis on letting private corporations manage our healthcare for profit is killing us all.
Not sure I understand why she would not open her eyes again when her son visited.
-Put in writing.
-Follow-up and keep a journal of calls/interactions (date, time, person you spoke to, what transpired).
In addition to addressing needs with administrator, it can only help to develop personal positive connections/relationships (at / on-site, not off site) with line staff. As you show interest and appreciation for them / their work, they will be aware and want to give 'better' service/attention to your loved one.
-I would not tip w/$ although a gift card now and then is appreciated. I did this at the end of the year although do anytime. Even $20 gift card is appreciated. THEY DO WORK HARD and most have to do this work due to English as a second language and no other skill sets. Some are excellent and care; some do not want to do this work, are not trained (well) and do not care.
Yes. The turnover is huge and not only line staff (CNAs, Aides - it is also management, nurses, etc.). I believe there is a shortage everywhere in many industries, not just elder care / nursing homes.
Nobody wants to deal with mean, abusive adults that cannot care for their own hygiene at any wage, but, especially not bottom dollar, they are demeaned and degraded until it is no longer safe for the caregivers to have a hand in caring for these vulnerable populations because they are resentful towards them. This is why we see the number of people willing to work these jobs on a downward trajectory. The only way to change that, pay the ones doing the boots on the ground work, being treated demeaningly, degradingly and oft abused, enough money to make it worth it to put up with it all. It shows we respect and appreciate them, which helps heal the other unavoidable portions of dealing with demented elders and just mean people.
We should all pray for this solution because the alternative is very him indeed.
I think our country needs to worry less about other countries and sending money around the world and help finance the ALFs so they can pay staff more. Pay the ones directly working with the residents not just the managers.
There are many varied reasons for this. Also,staffing shortage results and is often the norm.