The Complete Guide To Employee Scheduling In Senior Care Organizations

Staffing in long-term care and senior living is critical to the overall success of an organization. Unfortunately, the growing workforce shortage, high competition for talent both in and outside the industry, wage pressures and ever-changing staff reporting mandates have made staffing in senior care more complex than ever before.

The following workforce management best practices are proven to help long-term care and senior living providers increase efficiencies, reduce excess labor costs, boost staff satisfaction and engagement, all while ensuring providers are staffed consistently for quality care and service.


Right Size Your Staff

With a projected 2.5 million more workers needed to keep up with the nation’s aging population, and an industry plagued by high turnover, providers often feel like they could use more employees to meet their daily staffing challenges.

However, this is not always the case. Before you spend the time, money and resources needed to hire new employees, analyze how well your workforce is currently utilized. Make sure you have the data and processes in place to accurately identify actual job openings without alienating current staff members.

Identify Staffing Gaps

Gaps in your schedule may represent the biggest risk to providing high quality care and service. To identify staffing gaps be sure to regularly monitor the following:

Labor Budget Goals & Minimums

Ensuring quality care starts with establishing labor budget targets. Set an hours per patient day (HPPD) goal for each care position and use this information to drive staffing requirements for each shift. For an added layer of staffing compliance, establish minimum acceptable staffing levels. Management and schedulers should have real-time visibility into this data and know exactly what holes need to be filled to hit your daily staffing goals.

Open Shifts

It is important to have staffing requirements set for each shift based on census and resident/patient acuity and/or service levels. As those factors fluctuate, staffing plans should as well. To get a full understanding of staffing needs, it is important to not only examine open shifts in your master schedule but also those that could be created by fluctuations in census and acuity/service.

Overtime & Agency Use

When there is ongoing overtime and agency usage, there is also likely a gap in your schedule. Map the overtime and agency hours to specific shifts to determine if a pattern exists. If so, consider those gaps as shifts that need to be permanently filled.

Watch the video to learn how Milestone Retirement communities reduced agency usage.



Similar to overtime and agency use, providers should document and analyze call-offs by employee and shift to determine if there is a recurring pattern. For example, trends might develop where an employee tends to call off the Friday after pay day. If a pattern like this exists, a manager should have a conversation with those employees to determine if they are committed to work those shifts. If they prove not to be, consider those shifts as gaps.

Staff Utilization

Many employees would relish the opportunity to pick-up additional shifts if given the chance. Make sure to take full advantage of the talent already on hand by tracking how well current staff members are being used to fill open shifts. Document and track staff members’ true availability and compare that to the hours worked.

For example, if an employee is willing to work 24 hours per week but is only working 16 hours per week – they are underutilized (67%). Conversely, if an employee has a 40-hour threshold but is working 48 hours – they are over-utilized (120%) and that staff member has incurred overtime. In each case this has the potential to cause employees to be dissatisfied with their work schedules.


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Consider Part-Time & Per Diem Staff

It is important to have part-time and per diem employees within your staffing mix. A well-balanced staffing mix provides cost savings and greater flexibility in staff scheduling.

Why It's Important To Have a Mix

Some providers staff full-time employees only, which can lead to significant cost overruns. Staffing emergencies such as call-offs or unplanned demand for more staff almost always put communities into overtime situations. The use of full-time staff may provide continuity of care, but it’s important to have some part-time staff in your mix for flexibility and cost control.

With the availability of part-time and per diem employees, providers can easily fill open shifts while controlling overtime. Consider times during the year that regularly require additional staff and leverage your part-time and per diem pool to fill these needs, scheduling them in advance. With a well-balanced mix of full-time, part-time and per diem employees, senior care organizations gain greater flexibility to cover open shifts and avoid overtime so they can more effectively balance costs.

Once staffing gaps have been identified you’ll need to hire new staff members to fill the remaining shifts.

How To Recruit Employees From Outside The Industry

Competition for talent is on the rise. Here are six strategies to help you recruit workers from spaces like retail and hospitality.


Flex Staffing

Nothing is more important to achieving your staffing goals than the daily management of schedules.

Today’s senior care residents have more complex care needs, with an average of 2-3 ADLs in a senior living community and 4.21 ADLs in a long-term care facility. It’s no wonder that due to the increase in resident acuity levels, it’s often said that today’s assisted living organization is like yesterday’s skilled nursing community and today’s skilled nursing community is like yesterday’s hospital.

Measure Staffing Levels Daily

Schedulers should evaluate census/occupancy every day, including shifts in the future. By evaluating near-term census/occupancy in advance, schedulers can make appropriate staff adjustments to better align with planned move-ins/outs and admissions/discharges. For a short-stay population, consider creating a policy to ensure that staffing levels are checked and potentially modified daily or every shift.

Adjust for Acuity & Staff Activity

Make staffing adjustments not only based on census/occupancy, but also on resident acuity. When resident acuity or service needs escalate, consider redeploying staff or adding staff to ensure resident needs are met. When resident acuity levels dip, this might present the opportunity to reduce staffing hours while still providing high quality care and service.

In addition, it’s important to pay close attention to the activities of staff members. Family meetings, staff in-services, resident outings or unexpected admissions can consume more time than anticipated, taking caregivers away from providing direct resident care. To minimize impact, create a policy that manages activities like an employee absences or call-offs.

Watch the video to hear how Altercare saved on labor costs with better staffing visibility. 


Eliminate Overstaffing

Consistently staffing to levels that meet residents’ needs, without overstaffing, can drive significant savings. For example, a 100-bed community that overstaffs by .1 hours per patient day can save $75,600/year with tighter staffing level alignment. This is another reason proactive labor budget management is critical to an organization’s success.

Meet Payroll-Based Journal Staffing Requirements

PBJ reporting mandates are extremely important for skilled nursing providers, particularly as it now drives their Five-Star Staffing rating. To ensure you receive credit for the resident care you provide, a process to document, track and verify staffing must be established. This includes care provided from employees (both salaried and hourly), as well as contracted and agency hours.

Looking To Ditch Your Manual Scheduling Process?

Staffing in senior care can be hectic. And unfortunately, not all scheduling software is built to meet the unique and often complex needs of the industry. Learn the features and functionality to look for when evaluating scheduling and labor management software.


Manage Open Shifts Fairly

Many common practices of managing open shifts in senior care must end. For example, last minute call-offs are often handed to the same group of “go-to” employees because the scheduler knows that the answer will be “yes.”

While it may be critical to fill the shift to avoid understaffing, management must be aware that a practice like this causes major dissatisfaction among staff since the majority of staff never see the notification of the open shift.

Avoid Hostility Among Staff

Make the process of managing open shifts and overtime what it should be – equal and open. Establish a process whereby all available and qualified staff members are made aware of open shifts when they happen. Email and text messages can go a long way in such a scenario, and further keep employees engaged.

Track Responses

Be sure the scheduler tracks responses and the shift recipient. This is important for two reasons:

  1. The history of who received bonus shifts should always be considered when a new shift becomes available to ensure fair distribution
  2. Tracking responses can come in handy during an employee performance review, indicating responsiveness or willingness to help out when needed

Create A Cost-Effective Call-Off Management Process

Even the perfect schedule can be quickly derailed by employee call-offs. Call-offs put schedulers in a tough position, often leading them to rely on employees known to pick-up extra shifts. The problem? Overtime implications are often not considered. And in the event an internal employee is not available, organizations find themselves relying more and more on costly agency workers. To combat this, implement a process where call-offs are communicated equally to all qualified and available staff. Prioritize assignments based on an employee’s risk for incurring overtime.

Pay Attention To Overtime

While there are numerous ways to reduce costs, careful attention should be paid to your largest expense – labor – which is typically 50-70% of a provider’s operating expense. Managing employee punch overages and overtime are two of the easiest ways to realize immediate savings.

Everyday, employees clock in and clock out for proper record keeping and payroll management. But when employees start to clock in early and out late, additional minutes add up.

Eliminate Overtime From The Master Schedule

Having overtime built into the schedule puts you at an immediate disadvantage. Schedulers must remove overtime from the schedule before posting to staff. If open shifts remain, schedulers should first recruit non-overtime employees to fill those shifts or better yet, provide a method for those employees to request them.

How Well Do You Know Your Overtime?


Scheduled Overtime

This overtime is built right into the staff schedule and can happen as a result of making promises during hiring, or can simply be an oversight during schedule creation and maintenance. It can also occur because you are short staffed.


Incremental Overtime

This overtime occurs when employees punch in early and punch out late. While a common source of excess labor costs, it adds up a little bit at a time and can be difficult to identify and control.

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Frictional Overtime

This overtime happens when a nurse calls in sick or a CNA does not show up for a scheduled shift. These staffing emergencies are the most common and most visible type of overtime.

Address Potential Time Theft As It Happens

According to the American Payroll Association (APA), 75% of all businesses are affected by what’s known as “time theft.”  The most common types of time theft include clock-riding, in which an employee clocks in a few minutes early and/or a few minutes late to earn a few extra dollars; and buddy punching, in which an employee asks a fellow co-worker to clock in for them, something nearly 23% of employees admit to doing.

While it may seem innocent enough for employees to add a few extra minutes at the start and end of their shift, the cost implications for providers can be staggering. By monitoring punches in real-time, providers can quickly spot potential clock-riding and address the issue quickly before it become a habit.

Additionally, the introduction of biometric timekeeping systems, such as fingerprint, iris scanner or facial recognition can help greatly reduce buddy punching. In fact, facial recognition timekeeping systems can completely eliminating buddy punching as it is the only visually auditable biometric available in the market today.

Set Realistic Overtime Goals

Set overtime goals and make sure community leaders manage overtime each day, equipped with visibility into incurred and upcoming overtime across their properties. In addition, community leaders should establish policies for managing staff absences and call-offs, so schedulers go to non-overtime employees first to fill the gaps.

Set Policies That Require Approval

Finally, set policies that require management approval to incur overtime. Track and report on overtime goals, rates and costs. Proactively managing overtime will help keep labor costs under control and drive significant savings through overtime reduction. For example, just a 1% cut in overtime can save a community $24,000 - $60,000 annually (depending on community size). Collectively, these steps will help control costs and promote adherence to the labor budget, while still maintaining quality care, service and resident satisfaction.

Gain Visibility Into Staffing

Gaining visibility into key staffing events and metrics is critical to success. Labor is a community’s largest expense and one of the strongest determinants of quality for an organization. Easily understanding labor management costs, risks and performance within and across communities, in real-time, is the conduit to making better, more informed decisions that enhance your organization on a day-to-day basis.

Actionable Metrics

As a provider, actionable staffing information should be available at your fingertips. Combine staffing metrics from multiple systems, including time clocks, payroll, HR, clinical and scheduling systems.

Keep in mind that decisions based on the last pay period or even yesterday’s data will fall short in helping you achieve objectives. Providers need insight and analysis into staffing needs to be predictive and proactive. Work to implement processes where management can be alerted before staffing risks occur, so teams have time to course correct.

A predictive approach can help avoid unnecessary labor costs, as well as mitigate staffing risks that could lead to perceived negligence and potential litigation.

Gain a 360° workforce management view

Staff scheduling and labor management software can help focus your daily efforts with predictive analysis and real-time data that provides a 360° view into organizational performance by compiling information from disparate sources and systems.

Labor Metrics That Matter In Senior Care

What’s measured is managed. And for senior care, what’s measured is also what drive operational success. Get a breakdown of the labor metrics senior care operators need in their KPI scorecard to ensure success.

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Empower Employees Through Scheduling

Ask most long-term care and senior living operators what their biggest concerns are and they often mention employee engagement as top on their list.

This is because research shows an engaged workforce is one of the most powerful and cost effective ways to improve productivity, reduce turnover and increase profitability.

Watch the video to learn how to engage employees with better work-life balance.


Pay Close Attention To Scheduling Practices

While engagement and retention strategies can go in many directions, there are a few key tips for executive directors and community managers that will make employees happier and your organization more successful.

Start by paying closer attention to employee schedules and scheduling practices. Encourage employees to engage in the process. Find out what their preferences are – desired days, shifts and locations, time-off requests, etc. Also, schedulers must communicate changes clearly, share extra shifts equitably and make schedules visible and accessible, thereby promoting fairness and openness among staff.


The Top Perks Senior Care Providers Offer

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Ask Employees For Their Schedule Preferences

To do this, start by asking each employee about their work preferences – what days do they prefer? What shift times? Where are they most comfortable working? Once preferences are identified, do your best to balance these requests with the needs of the organization. It’s unlikely that staff will get 100% of their requests, but showing that you are listening and attempting to meet their scheduling needs will not go unnoticed.

Provide Some Consistency

While employee schedules may need to occasionally change due to fluctuations in occupancy or resident needs, being able to provide each employee with some consistency in their schedule can help improve overall staff satisfaction and engagement. It takes the guesswork out of their expected income and allows them to plan their life outside of work.

Be Flexible With Shifts

Given the current staffing challenges senior care providers face, it’s hard to say ‘no’ when an employee can only work certain days, times or shift lengths. Consider implementing more flexible scheduling options by allowing employees to work part of a shift, or offering flexible shift times.

Recognize & Reward Top Performers

Everyone likes to be recognized for a job well done. Boost engagement and motivate staff by recognizing and rewarding employees for positive behaviors such as not calling off, filling an open shift, punching in/out on time and going above and beyond the call of duty.

Give Employees A Say

Give employees a say in when they work by allowing them to view and request open shifts and instantly reply to call-offs. And rethink how you communicate. More and more, workers rely on text messages and mobile apps for instant communication.

Put Schedules In Your Employees’ Pockets

Providing on-the-go schedule access can have a major impact on staff satisfaction. Implementing scheduling software like OnShift gets everyone on the same page with access to schedules through the web and mobile apps. With real-time visibility into schedules, you can eliminate phone tag with employees and get your shifts filled quickly and efficiently.

“OnShift has been a hit among staff. They are smiling more. This is apparent to other employees, our residents and their families"
Ben Thompson, Senior Living Communities
Ben Thompson, Executive Vice President
Senior Living Communities

Streamlining Scheduling

Scheduling manually for long-term care and senior living organizations comes with a lot of:

  • Late-night hours
  • Hassles due to last minute call-offs
  • Time-off requests
  • Unexpected absences
  • Occupancy/Census changes
  • Department transfers
  • Employee turnover and shift swaps

Watch the video to learn how scheduling software built for senior care relieves scheduling headaches.


Manual Scheduling = Lack of Alignment

Manual scheduling makes measurement and goal alignment very difficult. If schedules are in spreadsheets or hand-written papers, and punch data is contained in time clocks, it’s difficult—if not impossible—for a community to be able to predict or manage overtime proactively. Integrating schedule data with time clock and census data will give you the information required to stay on top of staffing issues, meet regulatory standards and control costs.

Provide The Right Tools

Give your schedulers the appropriate tools and systems to help make them successful. Consider an automated approach to scheduling to drive efficiencies, and free up your employees so they have more time to do what they do best – provide quality care and service. Leveraging workforce management software built for senior care allows providers to eliminate inherent scheduling complexities and reduce time spent on scheduling from days and hours to just minutes.

Meet Your Workforce Management Goals With OnShift

OnShift’s proven, affordable, easy-to-use suite of software is purpose-built for long-term care and senior living. Spend less time scheduling and more time on what matters most with proactive software to lower costs and staff properly, each and every shift.

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