Recruitment, Selection, and Turnover in Senior Care

By

Christopher R. Hudson, Jr.

M.S. Industrial-Organizational Psychology Student

at the University of Tennessee at Chattanooga

September 4, 2015

Introduction

The goal of this research is to investigate the recruitment and selection practices in the senior

care, home health, and related industries. The American Health Care Association (AHCA) has

recently set measurable targets in several critical areas in order to improve the quality of care

in skilled nursing and assisted living facilities. To increase staff stability, AHCA’s target goal is to

decrease turnover rates among nursing staff by 15% or keep rates at or below 40% by March

2018. The Centers for Medicare & Medicaid Services (CMS) plans into implement a nationwide

system of reporting turnover and retention by 2016. This project should shed light on employee

turnover and some of its effects on these organizations. I hope to contribute to the growing

research and literature on hiring, and assist in productive decision making. In order to obtain a

broad set of responses, organizations throughout the industry were invited to participate. The

following report summarizes the data and key findings captured in the research.

Methodology

Over 5,000 individuals were invited to participate in this research. Each contact was emailed an

invitation and a link to an online survey. The survey window was open from 5/20/15 to

6/20/15. The survey was hosted and the data was received using Qualtrics, an online research

software website.

Demographics

317 managers, HR directors, and administrators from organizations across the United States (Figure 1.1) responded to this survey. Participating organizations included single and multi-site companies (Figure 1.2) ranging in size from 3 to 82,000 with a median employee count of 150. The majority of respondents belonged to a primarily rural organization (Figure 1.3) and for profit and nonprofit organizations were about equally represented (Figure 1.4). Participants were then asked to select multiple options that best described their provider type (Figure 1.5).

13%

31%

44%

13%

0

50

100

150

US Region

Figure 1.1

North East South Midwest West

Rural 43%

Metro 25%

Suburb 32%

Figure 1.3

For profit 49%

Nonprofit 51%

Figure 1.4

0 50 100 150 200

184

106

76

73

62

49

44

36

33

Figure 1.5

Senior Day Care

Other

Hospice

Home Health

CCRC

Independent Living

Therapy

Assisted Living Facility

Long Term Care/Nursing Home

Single Site 55%

Part of Multi-Chain 45%

Figure 1.2

Recruitment

Participants were asked a series of questions regarding their recruitment methods. Of the 225 participants who knew their monthly amounts spent on advertising for job openings, 56% reported spending above $250 (Figure 2.1). Of the 243 participants who knew their average number of applicants per open position, 40% reported attracting less than 5 applicants (Figure 2.2). When asked if they post any job openings online, the vast majority reported “yes” (Figure 2.3). Over 60% of participants reported being neutral or moderately satisfied with the cost, service, and applicant quality of their online job posting process (Figure 2.4).

0

20

40

60

80

100

LessThan$250

$250 -$500

$501 -$1,000

MoreThan

$1,000

NotSure

99

69

30 27

38

Figure 2.1

Approximate $ Spent Advertising for Job Openings per Month

0

20

40

60

80

100

120

LessThan 5

5-15 16-30 MoreThan 30

NotSure

98 107

23 15

20

Figure 2.2

Average Number of Applicants per Open Position

94%

6%

Figure 2.3

Post Online Don't Post Online

0

20

40

60

80

100

120

Very Unsatisfied ModeratelyUnsatisfied

Neutral Moderately Satisfied Very Satisfied

Figure 2.4

Cost Service Applicant Quality

Selection

A series of questions were aimed at identifying the common selection practices of the respective organizations. 80% of participants indicated that their primary method for their determining which applicants to interview was the content of the employment application or resume (Figure 3.1). Most respondents reported being either moderately or very satisfied with their organization’s method for determining the appropriate candidates to interview and determining the appropriate questions to ask each candidate (Figure 3.2). Participants reported “behavioral fit” as the trait most important for a new hire, and “good judgment” as what most positively impacts the quality of care provided by the new hire (Figure 3.3).

54% 26%

8%

5% 5%

2%

Figure 3.1

EmploymentApplication

Resume

Assessments

Other

References

First Available

8

19

51

133

48

11

29

45

107

67

0

20

40

60

80

100

120

140

VeryUnsatisfied

ModeratelyUnsatisfied

Neutral ModeratelySatisfied

VerySatisfied

Figure 3.2

Candidates to Interview Questions to Ask

0 20 40 60 80 100 120

Mo

st P

osi

tive

lyIm

pac

ts t

he

Qu

alit

yo

f C

are

Pro

vid

edM

ost

Imp

ort

ant

for

Ne

w H

ire

108

62

53

71

92

110

3

12

1

2

Figure 3.3

Resume Content Availability Behavioral Fit Strong Job Knowledge Good Judgment

Turnover An aim of this research was to provide insight on turnover within senior care and related industries. 26% of the respondents reported not knowing the average annual turnover of their organization (Figure 4.1). Of the 74% that knew their turnover, most reported it to be between about 21%-40% (Figure 4.2). Participants then reported that about 1%-20% of newly hired employees were no longer with the organization after 90 days (Figure 4.3). Lastly, AHCA’s goal to reduce turnover rates by 15% or keep rates at or below 40% was shown to the participants. When asked if changes needed to be made to their organization's current recruitment and selection process in order to meet these standards, 48% said “yes” (Figure 4.4).

195

70

Know

Don't Know

0 50 100 150 200 250

Figure 4.1

62

81

34

18

0

20

40

60

80

100

120

140

1%-20% 21%-40% 41%-60% Above 60%

Figure 4.2

Approximate Annual Turnover

129

44

16 6 0

20

40

60

80

100

120

140

1%-20% 21%-40% 41%-60% Above 60%

Figure 4.3

Hires No Longer Employed After 1st 90 Days

48% 52%

Figure 4.4

Yes

No

Conclusion The purpose of this research was to provide insight into recruitment, selection, and turnover among senior care and related industries. I believe the results presented in the previous sections will serve as a valuable resource to those working in various health care organizations that want to continue to improve their hiring practices. A few additional take away points are as follows:

Over ¼ of the participants consisting of hiring managers, HR directors, and administrators stated they did not know their average annual turnover. This is surprising because of the threat high turnover can have on an organization.

A correlation analysis revealed that there was a small but significant positive relationship between the number of applicants for an open position and the reported satisfaction with the applicant quality produced by the job postings process, r(227) = .224, p < .001. In other words, participants reported to be more satisfied with their applicant quality the more applicants they had for a position. This seems to indicate that increasing the number of applicants will raise the likelihood of quality applicants.

The vast majority of organizations appear to be posting jobs online in some way (Figure 2.3). This is likely the easiest strategy for increasing your applicant pool.

“Behavioral fit” was the most popular trait chosen as most important for a new hire, with “strong job knowledge” coming in second place. However when asked which trait most positively impacts the quality of care provided by the new hire, “good judgment” surpassed “behavioral fit” in popularity for first place (Figure 3.3). This proposes a question: What are organizations looking for in an employee that’s more important than the employee’s ability to provide good quality care?

Related to the previous point, “behavioral fit” and “good judgment” are obviously important to hiring managers, however only 8% of participants reported using assessments as their primary method for determining who to interview (Figure 3.1). It is very clear to this researcher that due to the importance of behavioral fit and good judgment, it is very important to discover a method to assess for these traits rather than depend on the resume and application to determine these attributes.

An interesting observation is that although the majority of participants reported that their annual turnover was less than 40% (Figure 4.2), nearly half of the respondents agreed that changes needed to be made in order to meet ACHA’s new turnover standards (Figure 4.4). This curious discrepancy could have a number of explanations.

The points raised above will hopefully inspire organizations to tackle these conclusions with further research and new policies. It is the author’s opinion that there appears to be a disconnect between what is being done and what is indicated as important. For the continued success of health care industries, it is vital to continue practices that work and reform or abandon practices that do not. Being a competitive organization and providing quality care starts with who you hire. It is for this reason that recruitment and selection must be addressed in order to impact turnover. I hope the information presented in this study serves as a benchmark for the industry of senior care and stimulates the development of new solutions to the problem of turnover.