Ep.11: How the Social Determinants of Health Can Help Post-Acute Care Businesses Overcome Workforce Shortages

Linda Leekley (00:16):

Hey Everyone, this is Linda Leekley, chief Clinical Officer from hcp.

Amanda Sternklar (00:20):

And I’m Amanda Sternklar, our director of Marketing,

Linda Leekley (00:23):

And you’re listening to Vision, the podcast for leaders and forward thinkers in the care industry. Today we’re going to discuss how benefits are an underutilized tool when it comes to combating that dreaded workforce shortage. And to do that, we are so lucky to be joined by Dr. Lindsey Schwartz, founder of Workforce and Quality Innovations.

Amanda Sternklar (00:44):

Dr. Schwartz has spent the last two decades in long-term care serving several roles, including direct care case management, researcher, and policy analyst. Dr. Schwartz is a nationally recognized expert on quality and assisted living and workforce issues in long-term care. In 2022, she launched her consulting firm workforce and Quality Innovations. In this role, Dr. Schwartz works with states and organizations to implement workforce initiatives including recruitment activities, education and retention of staff. Thank you so much for joining us.

Lindsay Schwartz (01:15):

Thank you.

Linda Leekley (01:16):

Yeah, it’s such a pleasure to have you with us, Lindsay. And you know at this point it, it feels sort of like there are more opinions on how to handle the workforce shortage than there are candidates available on the market. So what’s different? Tell us what’s different about how you approach what is probably the biggest challenge in our industry?

Lindsay Schwartz (01:36):

Sure. Thanks for the opportunity to be here today. I really think there needs to be a significant culture change supporting our workforce. We have to provide better jobs, which includes not only good pay and benefits, and those aren’t just any more insurance sick days and vacations. They’ve become so much more. And it also includes looking at social determinants of health that impact individual success in their chosen occupation.

Amanda Sternklar (02:04):

For folks who may be less familiar with the term, can you describe what you mean by social determinants of health?

Lindsay Schwartz (02:09):

Social determinants of health are factors including education, socioeconomic status, neighborhood and physical environment, employment, access to healthcare, access to transportation, and other social support networks, including daycare.

Linda Leekley (02:26):

And, you know, I I think a lot of us in in healthcare are used to talking about social determinants of health in relation to patients or the people receiving care. Right. But what are, what have you found to be the most impactful social determinants of health for employees? And and how do these determinants affect them?

Lindsay Schwartz (02:45):

Yeah, so social determinants of health that impact our workforce include where they live. Is it a safe neighborhood which can impact your stress levels leading to poor health outcomes? Do you have access to affordable and accessible transportation? How you get to work each day? Are you late? Are you unable to get to work if you don’t have good transportation? Access to childcare are, the majority of our workers are women. And many of them do have children and need childcare and access to good quality healthcare. If you aren’t healthy or your kids aren’t healthy, you’re gonna start missing work. And also, if you don’t have stable housing, it’s hard to keep a job if you’re living out of your car or you’re staying on a couch of friends. And then access to nutritious food is vital to overall health and wellbeing and all of these impact how an employee not only feels, but how they do their job and if they can work.

Amanda Sternklar (03:41):

Absolutely. Are there any specific indicators that employers can look out for, you know, things like different metrics or just anecdotal things they may observe that can help them identify what the most, most important social determinants of health are to address for their staff?

Lindsay Schwartz (04:00):

Yeah, it’s challenging because of course, they may vary a by where you’re located, where your staff is coming from, because remember, not all our staff are able to live in the same neighborhood or close to where they work, and then also just with individual staff. So you may have staff who need childcare help and others that don’t have kids. So it’s really asking, I think what, you know, talking with your employees, asking what they need, what they need support in to be successful, and just getting to know them, getting to know what they need just in general. And if an employee is late or calls off, ask them why. Be nice about it and tell them that you wanna help them. You know, here’s my quality background talking. Get to the root cause of the problem instead of just focusing on that they didn’t, you know, come to work or they called in late. And that’s why communication’s important. And we talk a lot about resident satisfaction, but it’s really important to be looking at employee satisfaction and how important that is to retention.

Linda Leekley (05:02):

So do you think that that’s one of the, are there, are there other things that you have found that once you’ve identified these social determinants of health for employees and that that employers can really do to, to help address them? You, you’ve talked about communication and satisfaction surveys. What else can they do?

Lindsay Schwartz (05:19):

Yeah, I’ve been really lucky to talk to providers that have done what I consider innovative. They will tell you they are not, but they truly are innovative things and that help. And so it may feel overwhelming if you’re listening to this and thinking, I can’t address all those for every single one of my staff members. I get that. A couple things for transportations for transportation, some employers will do stipends or they’ll provide a bus pass or subway pass. A provider I met in Michigan, so I’m from the Midwest, we have really rough winters. He was realizing staff weren’t able to keep, keep up with fixing their cars and doing things like regular oil changes, which can make a real difference in the longevity of your car. Mm-Hmm. <Affirmative>. And so he worked with a local place that did oil changes.

Lindsay Schwartz (06:09):

He covered his staff to get oil changes all year and regular ones and make sure they were going in. And I said, that must be very expensive. And he said it’s a lot cheaper than turnover of one staff member. So he got that. Another person that I talked to, a provider in Idaho, provides school supplies to his workers’ kids. So they have a big event every year. Each kid gets a backpack and gets to go like shopping with their parent at the assisted living, and they get all the school supplies they need. And then lastly, I have heard of providers bringing food pantries actually in where they have a room for staff if they’re having trouble buying food that they can just shop from. So it’s just, you know, I say innovative. I hate to say that because I think people are doing really innovative ideas, but they don’t see them as innovative. Mm-Hmm. <Affirmative>. But it doesn’t take a lot in the grand scheme of things. And a lot of this, these ideas and initiatives are so much cheaper than having to pay for turnover.

Linda Leekley (07:15):

Absolutely. Yeah. I mean, what I hear you saying then is just think outside the box of the insurance and, you know, Ben, the, the, the check checkbox benefits, right. That that everybody thinks about and think what your staff really wants and needs. So that’s, that’s really excellent advice.

Lindsay Schwartz (07:31):

Yeah. And I’ll just also add real quick too, it’s about communicating benefits. I worked with someone and they said that to me and I said, what do you mean? And he said, we don’t do a great job of telling people what kind of benefits in explaining them that benefits and salary. It’s a whole package. And it, I was like, that makes sense. My sister’s in hr. I know that she’s always like, don’t just look at your salary, look at the entire benefits package. And so we in the provider world need to be better as employers of explaining the types of benefits and making sure staff are actually accessing them.

Linda Leekley (08:07):

Mm-Hmm. <Affirmative>, absolutely.

Amanda Sternklar (08:08):

Something that really struck me that you said when we were preparing for this call was that employers can create interventions for most, if not all, social determinants of health. And I think hearing that there’d be kind of like, well, I don’t know how to help with all these things. But what you’re saying shows it just takes a little bit of creativity and really you can’t intervene in in so many of these. But for, you know, an owner, administrator, HR professional and post-acute care who’s listening to this cuz they’re just getting started. Are there two or three key benefits you’d recommend that they start with?

Lindsay Schwartz (08:42):

I think very least, and this is what people expect now especially coming out of covid and the great resignation. People want and need a living wage, and they want paid sick days. They need paid sick days. We, we don’t want sick staff in our buildings. We know that now it’s, it’s not good. So incentivize them to stay home and not get our residents sick vacation days. It’s so important. And there’s a lot of research that backs that. When staff take vacation days, they come back refreshed, ready to work, and you keep people longer, it improves retention. And then, you know, lastly, affordable healthcare insurance. Just making sure staff can be healthy, can address any issues, you know, easily accessed for their families. Those are like the bare basics. And then from there, I think really talking to staff about what else you can do. I think people would be really surprised. It doesn’t take a lot. And again, if you calculate the cost of in turnover for just one staff member, it’s significant. And these little things don’t cost, don’t even add up to the full cost of what turnover ends up costing.

Linda Leekley (09:51):

And it would seem to me that working with like, like the seller you mentioned with the oil changes working with the community to see how the community can can help your agency and you sort of, you know pat each other’s back if you will, you know and to me that’s just so important. You know, so that, that people listening, the admins, the owners, the HR folks, they real, you, you’re, they’re not alone. Reach out to the community and see what, what help you can get there, don’t you think?

Lindsay Schwartz (10:25):

Absolutely. And really from Covid, the community realizes our workers are healthcare heroes. I mean, and so I think people wanna help and I love that you go to your community, you know, and ask, I I’m trying to do something, you know, help my staff out. You know, can you help me? Mm-Hmm. <affirmative> yeah, I think community really wants to help these healthcare heroes.

Linda Leekley (10:47):

Well, and we, you know, we need to, right? Because we are all going to be in the situation someday. I’m, I’m gonna be there sooner than you, like these are, you know, where we’re gonna need that help ourselves. And, and if there’s nobody to provide that help, what the heck are we gonna do? So Right. As a community, we need to work together to solve this shortage problem.

Lindsay Schwartz (11:07):

Absolutely.

Linda Leekley (11:09):

I think that’s a really key point. I know Lindsay, that that you have spent so much of your career focused on quality and, you know, collecting data and research about quality standards. What kinda impact have you seen the focus on S D O H and benefits have on the quality of of care?

Lindsay Schwartz (11:29):

Yeah, I mean, you know, of course we talked about earlier you mentioned, you know, social determinants of health have a big impact on resident outcomes, but when we look at it with employees and how what we can do to address those mm-hmm. <Affirmative>, we think about they’re not missing work. They’re getting to know a resident. And when staff know a resident really well, they can tell if something is wrong, maybe they’re not eating enough and we can intervene where someone may not know a sta know a resident and that resident may end up in the hospital, but by intervening early on when we know the resident, they may avoid, you know, an avoidable hospitalization. Mm-Hmm. <affirmative>. And then, you know, also developing quality measures and bringing in staff. I mean, I saw this time and time again around quality awards and quality initiatives. When you bring in staff to help with quality improvement programs, they take ownership.

Lindsay Schwartz (12:24):

And so I think you tend to see quality is better. And then when your staff are happy, you see this a lot and you’ll hear people tell you this, when staff is happy, residents are happy mm-hmm. <Affirmative>. So it all goes together and you really can’t, as I always told people, you know, staff’s turnover and retention is really the foundation of that house. And if you don’t have solid retention of your staff, it’s really hard to do any quality improvement at all. And if you have, you know, the stable retention of staff, bring them in and they’ll help you build that house so you can provide the best quality of care and your residents can have a great quality of life.

Linda Leekley (13:02):

Mm-Hmm. <affirmative>, I, I totally agree. And now you’re talking about residents and senior living, but everything you’ve said applies to home-based care as well.

Lindsay Schwartz (13:12):

All of it. And it’s all kinds of, you know, post it’s ev it, it goes across with employees and residents. Absolutely.

Amanda Sternklar (13:21):

I was thinking of that very much, especially when you were talking about oil changes because so frequently, you know, home-based care staff that it doesn’t just impact their ability to get to work, it impacts their ability to then continue to, to do their work throughout the day. Mm-Hmm. <Affirmative> that’s such a, i i it is innovative. You know, it’s, I think it’s kind of encouraging that that owners don’t see it as that huge step, as, you know, as more just the, the right thing to do. But I do think that’s such an innovative way of also just showing you really understand and are committed to addressing the challenges that your employees are seeing. Yeah. I wanna jump back. You mentioned involving your staff in quality improvement programs. Can you expand on that a bit?

Lindsay Schwartz (14:05):

Yeah. You know, if you’re looking at trying to improve quality, ask your staff ways or issues that they’re seeing and, you know, bring them into, if you have a quality committee, I always tell people, you should have a representative from each of your different teams. So dietary, direct care, housekeeping, you know, housekeeping are typically the ones that notice when someone has a U T I and dietary typically realize when someone isn’t eating or drinking enough mm-hmm. <Affirmative>. So by bringing them in and having them help and identify is just, you know, identify issues, help collect data, it’s just, it’s important. They really get this kind of sense of, you know, ownership and wanting to improve quality. Mm-Hmm. <Affirmative>. And it’s also important because again, they see, they see things that others don’t. And so those are issues that a lot of times administrative staff may miss because they’re not with the residents, the amount of time that the direct care staff are.

Amanda Sternklar (15:06):

You mentioned that you’ve talked to several folks who say that their main problem is really in communicating the, the benefits and, and the full benefits package. Do you have advice for, for employers on, on how to ensure their employees really understand the full value of the benefits package?

Lindsay Schwartz (15:24):

Yeah, I, I had an employer that they had this great, like, I don’t wanna call it a packet because it sh you know, it, you don’t want it to be a packet. I mean, you may have a packet of individual information, but like a one pager that has bullet points that’s easy to understand, it’s inlay language, you know, and it’s, you know, this, we have this benefit if you want it, it costs this much. But just very, you know, breaking it down. And then every year having a meeting with your staff, talking about the benefits, making sure they know how to access them and asking, you know, are there benefits that you’d like rather see cuz you may have a benefit that no one’s utilizing, so you may as well maybe change it to something else. Mm-Hmm. <affirmative>, it’s just really kind of making sure everybody understands, because I think there are benefits. I mean, I’ve worked at jobs where someone’s talking about like an education benefit and another person goes, I had no idea we had that. You know, so I think it’s, some of us don’t always do our due diligence. I myself have done that before where I forget about a benefit, but I think it’s consistently letting new staff know and having an annual meeting to make sure all your other staff remember that they have these benefits that they can access.

Amanda Sternklar (16:39):

I also like what you mentioned about ensuring that staff are, are using them and, and listening to them. Someone brought up recently I had a friend who mentioned having an, an issue with the health health insurance center work. And another friend recommended, oh, well just like tell your HR department that there, there’s a problem with this health insurance. They may be able to help you out. Or it’s just valuable information for them to know when they’re selecting a provider for the next year. It had never occurred to, to me or or to that friend to, to give feedback on whether the benefits were working out for them. And that’s likely the same of of your employees as well. They don’t, a lot of us think of the benefits of something that’s,

Linda Leekley (17:22):

It’s a one

Amanda Sternklar (17:23):

Stone. Yeah,

Linda Leekley (17:23):

Yeah.

Amanda Sternklar (17:24):

Yeah. so employers aren’t getting the information that could, could really help them. And employees are, you know, either underutilizing or not utilizing benefits at all.

Linda Leekley (17:34):

Mm-Hmm. <affirmative>. Well, Lindsay, is there anything else about benefits, social determinants of health that you think our listeners should know to get them really rolling on this approach to combating staff shortages?

Lindsay Schwartz (17:50):

Yeah, I think just getting an understanding of those same social determinants of health. We always talk about with residents that they really do impact people throughout the life course. And so your employees really may ha, well, not really, everybody has social determinants of health mm-hmm. <Affirmative>. And so figuring out which ones maybe they’re struggling with or, you know, are impacting their ability to be successful at work and then doing something about ’em. And I think just knowing that it, I, I know providers feel overwhelmed. We’re still in a pandemic <laugh>. And that feels overwhelming and I get that. But these little, you know, initiatives or things they can do to help staff could greatly improve retention and honestly improve recruitment. Because when you have staff that are happy, they’ll tell others. And so you may also see an increase in, you know, employees that are bringing in new staff.

Lindsay Schwartz (18:48):

So it’s just a, it’s a win-win. And it’s also, you know, I think Amanda, you said the right thing to do and when we’re taking care of our employees, they’re gonna take good care of our residents. And that’s just the bottom line of it. And it’s just the right thing to do. And you can keep staff longer and you want to, because without staff we can’t provide care. You know, we’re not a restaurant. We can’t shut down like we’ve seen you know, we have to have staff. It’s, you know, so I think just getting to all of that and like I said, treating your staff well, they will treat your residents well.

Linda Leekley (19:25):

Absolutely. Have you found in all that or do you have any tips for how administrators and owners can, can approach their staff about SD o h in a, in a delicate way? Because, you know, you certainly don’t wanna say to a staff member, well, I know you live in a crappy neighborhood. You know, I mean

Lindsay Schwartz (19:44):

Right.

Linda Leekley (19:45):

You know, it’s, it’s so any tips for that? You have to be very tactful.

Lindsay Schwartz (19:52):

Yeah, you do. And I think, you know, getting a rapport with staff, knowing staff and just having a good rapport with them, talking with them is important because you can ask more sensitive questions and of course you have to be careful because there are some questions we can’t ask, but Right. We can always say, is there anything, you know, that we can help with outside of work that is impacting your work here? And we’re trying, you know, do a survey, meet with staff, you can also allow them to do anonymous submissions, whether it’s writing or, you know, you do a survey monkey. It’s just, you have to be tactful about doing it and you also have to be careful because you don’t wanna violate any you know, laws, employment laws, asking them questions. But yeah, you wanna get to know your staff and I always think when you get to know staff, you, you hear things, you know, staff may have an issue with childcare.

Linda Leekley (20:48):

Mm-Hmm. <affirmative>, it’s a, it, it’s a trust trust issue that trust develops over time. Yeah.

Amanda Sternklar (20:54):

Yeah. Where my mind went earlier when you were talking about this was coming at problems from a place of curiosity mm-hmm. <Affirmative>, you know, you mentioned that if, if someone’s late rather than jumping to you can’t be late, you need to be here on time. Coming to it from a point of like, what, what happened? Is there something that we can change? Coming from a Yeah. A place of curiosity rather than being punitive.

Lindsay Schwartz (21:19):

Yeah. Having and having empathy.

Linda Leekley (21:22):

Absolutely.

Lindsay Schwartz (21:23):

Yeah.

Linda Leekley (21:25):

Yeah.

Amanda Sternklar (21:25):

I wanna jump back a little bit cuz you started to allude to talking about using benefits in recruitment. And I think that’s, you know, obviously the other big half of, of addressing a workforce shortage. I know you and I talked a lot about how improving benefits can really contribute to that culture shift that will help us recruit more folks to post-acute care. Do you have any advice for employers on how to promote their benefits in their recruitment efforts? How they can, how they can utilize their benefits?

Lindsay Schwartz (21:53):

Yeah, I see it all the time when I’m out and about now I feel like it was bef somewhat before Covid and during covid and now you’ll see, you know, signs and they’ll say things like, you know, they’ll say what the pay is like starting at 20 an hour or, you know, we provide health insurance on billboards and ads wherever they are. So I think including those kind of top important things as you’re doing recruitment ads or talking to potential staff is important. And I know too, I I, someone told me that when they used to give, I think it was an assisted living or an independent living, when they would give tours for families or residents, they would say, oh, we’re hiring. And they would give them a card. They’re like, if you know anyone, let us, you know, let them know. And so that was, I thought that’s, you know, clever. But yeah, I think just making sure any type of advertising has some of those like top key benefits that you have.

Linda Leekley (22:54):

Absolutely.

Amanda Sternklar (22:56):

And I like the idea that you mentioned of just handing out the, the card to kind of let folks know that you’re recruiting. And I can see that being successful with letting employees know as well. You know, we we’re seeing a lot more folks include referral programs, but again, it might be one of those benefits that folks aren’t entirely aware of.

Linda Leekley (23:16):

Mm-Hmm. <Affirmative>. Well this has just been amazing advice for all of our listeners. It’s, it’s always good as, as Amanda said in the beginning to, to take a different approach to a, a common problem that’s impacting all of our listeners. And we thank you so much, Lindsay, for joining us today.

Amanda Sternklar (23:37):

Thank you so much. So for, if you would like to listen to more episodes of, of Vision, you can find [email protected] slash podcast. If you have a story that you’d like to share on vision while you’re there, you can also fill out our application form to join us here on the podcast. Lindsay, thank you so much for joining us. If folks have more questions about this or about workforce quality innovations, where’s the best place for them to reach you?

Lindsay Schwartz (24:04):

Sure. They can email me. It’s lindsay l i n dsa y wqi innovations.com.

Amanda Sternklar (24:11):

Awesome. Thank you so much. And I am on, LinkedIn is the best place to reach me as Amanda Stern Klar. And Linda.

Linda Leekley (24:19):

Hi, I’m also on LinkedIn. Linda Leek, l e e K L E Y. I look forward to hearing from anybody.

Amanda Sternklar (24:26):

Great. Thank you all so much for your time. We’ll talk to you in two weeks.

Linda Leekley (24:28):

Thank you so much. Thanks Lindsey.