The “Wall of Fame” at Manor Park, Inc. is likely to get a lot more crowded now that person-centered care and the Household Model are leading to less staff turnover.

The wall is lined with photos of staff members who have worked five years or longer at the Life Plan Community (LPC) in Midland, TX. With turnover plummeting from 44 to 30 percent for all employees over the past four years, more photos are sure to be added as more staff reach the five-year threshold.

“When I came to work here in 2011, we averaged 12 to 16 certified nurse assistant (CNA) openings per month,” says Jay Hobbs, Chief Operations Officer. “For the last year and a half, we’ve averaged one to two per month.”

Manor Park has 300 employees serving 600 independent, assisted living, nursing home, memory care, and rehab residents. In 2010, the LPC engaged Action Pact to guide its culture change journey to neighborhoods and households. In 2014, it opened two skilled nursing households, each accommodating 22 residents. Continuously full and with a waiting list, the households currently have no CNA openings and have never used agency staff.

Caregivers stay even as jobs become available elsewhere

It’s the person-centered model that attracts and keeps employees wanting to work, says Ellen Gossett, Director of Staff Development. “They see such high quality care being given and they love it.”

Having worked at Manor Park since before culture change, Gossett had seen how CNAs applied for work there in hard economic times, but left when the economy rebounded and more attractive jobs became available elsewhere. But in the new culture, caregivers are staying even as the local economy fueled by the Texas oil and gas industry heats up.

“I attribute that to folks enjoying working here,” says Hobbs.

Melina Rodriguez, a CNA turned Household Coordinator, agrees. “We all have a positive attitude and everyone is so appreciative of the work we do. Everything is a team effort and that inclusion makes it work. It’s all about the residents and their choices. This approach makes them and us happier.”

Nationally, turnover rates in long-term care range from 55 to 75 percent for nurses and often are more than 100 percent for CNAs. With the direct costs of onboarding a new employee estimated at $2,500 – $3,000, the savings from better retention are substantial.

At Manor Park it means more money to spend on residents, like taking them on outings into the broader community, says Hobbs. Besides lowering costs, better staff retention has improved care, facilitated positive relationships, and resulted in fewer complaints from residents and family members, he says.

Get ‘em, keep ‘em, grow ‘em strategies for retaining staff

Self-directed action teams were instrumental in shaping the new culture that entices workers to stay. There were 19 action teams at one point, says Hobbs, including the “Get ’em, Keep ’em, and Grow ’em” team that devised new processes for hiring, orienting, and encouraging employees to grow on the job.

Now, job applicants are interviewed by a peer group of staff, including a neighborhood or household coordinator, clinical leader, and cross-trained CNA. And it’s not unusual for a resident to be part of the interview team. Interview questions are of a behavioral nature. (For example: “What have you done to prepare personally for culture change?” “Ms. Jones moves into our household. How do you determine her needs?” “What is the best way to respond to a family member who is voicing a complaint?” “You work with Sue and she is always 15 minutes late to relieve you. What would you do?”) The peer group scores the applicants’ answers and decides which person would best fit the team.

Orientations for new employees emphasize relationship building. They have lunch with the neighborhood or household coordinator at the campus Wildcatter’s Grill and spend a day getting to know the residents. It’s like a scavenger hunt, says Hobbs, with new staff asking residents about their lives, likes and dislikes.

Once on board, employees receive Action Pact’s PersonFirst® training on how to create and sustain person-centered support for residents including those living with memory loss. Learning circles to address issues within the household or neighborhood are a staple of their daily routine.

“When (through learning circles) you feel you have a part in deciding how your daily flow of activities and tasks are going to happen, you feel energized and want to stay and make a difference,” says Hobbs.

Employees are encouraged from day one to grow into leadership roles. Job descriptions include an addendum that explains the responsibilities of the neighborhood/household coordinator position. Staff who choose to work toward becoming a coordinator receive mentoring and a 25-cent per hour raise.

“We’ve discovered that CNAs seem to be a great fit for this role as they are more in tune with the frontline staff and seem to have an easier time with staff schedules,” says Hobbs.

“At first, I was so apprehensive (in applying to be Household Coordinator),” says Rodriguez. But she became more at ease with constant encouragement and mentoring by Healthcare Administrator, Stephen Nelson, who she says “led by example.” (Nelson, who began his career at Manor Park as a volunteer intern and became a CNA through classes provided at Manor Park was recently named recipient of the 2017 Emerging Leader Award presented by Leading Age Texas, partly for his work nurturing entry-level staff into leadership roles.)

Watching Rodriguez grow in her abilities as a household coordinator able to create relationships with family members and speak in front of groups “is just amazing,” says Hobbs.

Move over, Stephen Nelson. Melina Rodriguez is now eligible to join you on the Wall of Fame.