If you operate a residential program, you already know that hiring the staff to work in those residences is a very difficult. Doesn't make much difference. If it's group homes, homeless shelters, residential treatment centers, half-way houses, nursing homes, or supervised apartments; it's the same challenge. And while some may disagree with me on this, my opinion is that it makes no difference if we are talking about mental health clients, senior citizens, adults with developmental disabilities, children with emotional or behavioral problems or homeless families. Yes, the challenges in working with some of these groups are different than with other groups, but I have spent substantial amounts of time in all of these settings and for the most part, the things that lower the job satisfaction of all direct care staff are the same.
Why is this job such a challenge? In large measure, it's due to the negative characteristics of the work. First it involves 24/7 care. That means that sooner or later you are going to find yourself working when your family and friends are having fun together. Secondly, the pay is low. On the money you earn, you may have trouble living on your own. Depending on the part of the country you live in you may have to reside with family or double-up with friends. Third, sometimes the work is very unpleasant. You're breaking up fights, or being physically or verbally assaulted yourself. You're cleaning and cooking and assisting with personal care, with all that it entails. There's lots of paperwork; everything you do requires documentation. Fourth, and this may be the most powerful of the negative characteristics, direct care work is not respected. When you tell someone that you are a direct care worker or a "behavioral technician" or a "nurse's aide", they're likely to give you a funny look and say something like, "that must be rewarding." Parents don't raise children with the hope that they will be a direct care staff member. It's something you do when you can't get anything else. There are certainly non-financial rewards and they should not be overlooked but it's like sailing. They say sailing is an hour of boredom surrounded by 5 minutes of delightful, broad-reach sailing. As a sailor I know that there is some truth to that because I have been both bored and delighted on the water. And so it is with direct care work: 7.5 hours of difficult, gut wrenching work surrounded by 15 minutes of personal satisfaction that you are doing important work and doing it well. And then tomorrow you do it all over again.
So the challenge is how do we find, select and retain these super people whose hands-on work determines whether our programs are successful or not so successful? The answer comes in two parts. First of all, as counter-intuitive as it may seem, make the jobs harder to get. By making the job harder to get, we add to the importance of the job and add to the sense of self-worth of those who are selected. It is always a mistake to hire someone with a normal temperature because you desperately need coverage. Secondly, make a commitment to the success of every new employee. Here's the recipe - tips to successfully select and retain direct care staff.
1. For the applicants who get through the initial HR screening, those that remain should be given a personality inventory assessment. These instruments have been routinely used in private industry for the last 10 years or so and always increase the likelihood that hired employees will be a good match with the expectations of the organization. The outcomes of these assessments provide information about an applicant that could never come from a more traditional interview. Characteristics will be identified that could not be impacted by training and without the data from the assessment you will not find out about these characteristics until the person is on the job for 6-8 weeks. The challenge for those using these instruments is to trust the outcome. You want the assessment to select the strongest applicant from amongst those being considered.
2. Develop a structured interview process which focuses on the past performance of the applicant. So rather than asking someone what "would they do" you are asking them what "have they done." Questions are developed ahead of time as well as a range of suitable answers to each question. Interviewers can then literally count the number of suitable answers that each candidate gave them. This allows for multiple interviewing to be done and for valid comparisons to be made between the findings of each interview.
3. Make sure job descriptions spell out specifically the outcomes that the organization is looking for from each employee in this job family.
4. Set up a structured plan of onboarding. This goes beyond the initial orientation and may continue for the first 90 days or more of employment. Onboarding programs ensure that the new employee is physically and psychologically comfortable in the new work environment. They can begin actually before the new employee starts with a "we can't wait till you start" note from current employees. On the new employees first several days, he/she will need to know where to park the car, hang the coat, where the rest rooms are; he/she will need someone to have lunch with. After that, onboarding can include, getting to know important people in the organization and learning the unwritten rules. A new employee should never be isolated and left alone for a period of time before they are welcomed into and made to feel comfortable within the work group. The point of onboarding is to make the new employee as productive as possible as quickly as possible.
5. Finally, supervisors need to establish a personal connection with the new employee and intentionally demonstrate their commitment to the success of the new employee. This means that the supervisor has to be a "people person" and fully prepared to provide the support and education the new employee will need to be successful. The problem is that too many supervisors were simply promoted from the direct care ranks themselves and still operate as though they were direct care workers, albeit more highly compensated.
6. Train, train, train. Training and performance improvement should be a part of the culture of your agency. Training is for everyone from the CEO to the janitor. Staff training always increases staff retention.
What we are trying to do here is increase the number of employees who possess the characteristics that the organization wants. Success will mean a lower number of persons who leave voluntarily or involuntarily within the first six months. When this happens, it is a mistake of the hiring system; it's a mis-hire and the financial and program costs of this mistake are huge. A new employee who makes it through the first six months may have a good chance of remaining with the organization for three or four years, or more. Just being able to add a few months on to the average length of employment will save the organization money and allow a much more robust program to emerge.
By Larry Wenger
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