Assisted living facility turnover, any opinions?

Dear Betsysue2002,
I hear and certainly understand your concerns. However, it is the nature of the beast -- long-term care facilities, nursing homes etc. have high turnovers. There could be a whole myriad of reasons for these turnovers. The list can become endless. You would really have to "dig" to find out what they are and then the question becomes "where" are you going to find sufficient information that will satisfy you. I do find it odd too that the ad for a receptionist included nurse aide duties. I would go over all the information again with a fine tooth comb and look for any red flags - make notes if you have to. It reminds me of back in the day, when you would see employment ads. You would see a specific position open at a company, the ad is no longer needed as presumably it was filled and then maybe a month later you see the exact one again and then again and again. The first thing we ask ourselves is "what is wrong with either the company itself, the position or is it possibly management issues"? Even if you decide to apply and get an interview. You could ask "why does the position seem to have a high turnover"? Do you really think they are going to be truthful. Yes, in some cases it could be positive such as there is quick advancement within the company but, more often than not - there's a problem somewhere. Unfortunately, I don't think you can really know with 100% certainty "why" it is. Even if they tell you a half-truth, will someone tell you the "whole" truth.

I definitely think you should "question" and be "concerned" about a turnover in management at this place. Be very careful of going by aesthetics. When I put my mom in an assisted living facility in 2015, I went to eight places before picking one. My mom never wanted me to place her in a nursing home (which I didn't) so with that in mind, I would look around and ask myself: does it "look" like a nursing home or have a stark, sterile look and feel to it as a hospital does, does it smell of (fill in the blank). Are resident's apartment doors left open so you can see in... you get the picture.

Don't get tripped up by the use of the word "chef vs. cook". I think it's become a trendy word do use in their descriptions. I am not saying that they don't have good food being served - what I'm trying to get at is the fact that it's all in the presentation of the facility otherwise known as "marketing" to lure potential residents in as the competition is fierce. Also, we so desperately want to think of these places as having extremely caring, conscientious, do what's best for the resident attitudes but, I can't stress enough if you think like I did (as yes, this was my "first rodeo" so to speak) you will be disappointed to realize it is a business.....and a BIG one at that. All we have to do is look around at the rapidly aging population and see all kinds of facilities popping up all over the place.

When I first put my mom in the one that I ended up choosing, it was built and owned by a husband and wife. After twenty years of running it, they decided to sell so they could retire. That was hard for me because one of the reasons I did choose it was because it was family-owned and not run by a big conglomeration. So even if you try real hard to make the right decision, you just never know what will be coming down the turnpike. Good luck!

There are no silly questions.... really!

if it’s the director / gen manager of the facility that’s changing every few months, I’d put a bet that the place has a very no nonsense DON - director of Nursing. If your place is an AL and NH, there's going to be a DON and in my experience is the ruling goddess & power center for the place. Should they not get along, it’s the DON that’s way way more important & determines just how place is run.

if it’s just AL and lots of overall management turnover, I’d bet Corp pays really low salaries and benefits are crappy. Once staff has experience they can find another place that values them more.

Personally if there’s a DON whose been there forever & they have 1 senior RN answerable to them per wing or per floor, it’s probably well run for how health care is done. Nursing (& therefore medical) has lots of required compliance to be done, so they have to run a tight ship or get demerits or worse from MediCARE, medicaid, the state or city, etc. Nursing care is what imo to focus on rather than amenities or how a place looks.

Unless this place is a CCRC & one with a huge buy-in for each of you.... like its 300/400k in my area but 500/700k other more higher income states. For CCRC, your paying $$$ big time for staff, & staff that better be attentive to those in IL & AL. If it’s a CCRC and having lots of turnover, place is paying crap and residents likely way too demanding or demeaning.

If CNA, other aides, dietary workers, housekeeping staff are not ever getting posted as “wanted”, it just might be that these positions are NOT actually employees of the facility or the main Corporation. So not ever posted. That instead those positions are going thru a subcontractor who has a big contract with HQ or the parent company/ Corp to provide X’s of aides, foodservice, etc. systemwide. The subcontractor can draw from their pool of folks (full & part time) to go to each facility as needed & fluctuating based on beds in service that day or week. It’s really expensive to staff a facility based on 100 beds but only at 86 most weeks. So using subcontractor makes sense to do.
Some may work 5 days a week at a single location since forever so they seem like employees but not when it comes down to thier actual paycheck. If there's never ever “wanted” in some areas, either these workers are beyond happy or jobs getting filled by subs.

As an aside on this, several NHs in TX had Covid outbreaks that could be traced back to dietary & transportation subcontractors that worked at different NHs. NH were being asked by the state to test their employees & did & reported dutifully to state or city health Dept. But the subcontractors fell into a grey area as to getting tested. It was unanticipated glitch on where transmission was coming from.

I would say that turnover in lower positions is typical but turnover in management is a red flag/problem in any organization. Is this a newer facility that is not very established? This may be a reason, but it still is a problem. For comparison, the management at my MIL's facility has been the same for that past 10+ years and it is extremely well run and was proven before and during the pandemic. My MIL is in a faith-based place run by the Presbyterian Church and is non-profit. I recommend considering these types of places since they see the care as a mission and approach it as such, not just about $$. Also, they have a larger structure supporting it (the Presbyterian Church state and nationally). In our area we have facilities run by the Catholic, Lutheran, and Moravian churches, and Jewish organizations. You do not need to be of the faith to be a resident. Wherever you consider for your LO, I recommend it have a continuum of care, from IL, AL to LTC, MC and hospice so that once she's there she will never need to be uprooted AND the facility accepts Medicaid.

I think that it is a consideration. DO know that in covid-19 times people are going to want to work anywhere but in such a facility, and overall it is very difficult work; sometimes people find they simple cannot continue to do it. The facility that my brother was in, an assisted living, did REALLY well at both keeping staff and at promoting staff from within. That is ALWAYS a good sign. However, looking at it from another way you could say that needing more staff COULD just suggest that staff is required to really perform well in order to stay. I think you cannot know unless you live there.