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Planning, Attracting, Engaging, and
Sharing Knowledge: -
A Human Resource Strategy for the
Community Health Workers, Residential
Care Aides and Licensed Practical Nurses
in BC’s Private and Not-for-Profit Seniors
Care Sector
Final Report to the Seniors Care HR Sector
Committee
January 2011
1
This report, outlining the Seniors Care HR Strategy has
been prepared by the Howegroup Public Sector
Consultants Inc.
Ministry of Jobs, Tourism and
Innovation
The Seniors Care HR Strategy is funded is in whole or
part through the Canada-British Columbia Labour
Market Development Agreement.
2
EXECUTIVE SUMMARY
Purpose
The purpose of the Seniors Care HR Strategy is
to identify emerging issues to recruiting and
retaining appropriate Community Health
Workers (CHWs), Residential Care Aides (RCAs)
and Licensed Practical Nurses (LPNs) and to
outline a strategy, inclusive of implementation
and evaluation plans, to improve the current
human resource situation within the private and
non-profit sector.
Key Supply and Demand Findings
This HR Strategy aims to balance forecasts from
the Provincial Labour Market Profiles of
Licensed Practical Nurses, Resident Care Aides &
Home Care Aides with the opinions of experts
from sector employers as well as post-
secondary and private training institutions. Key
findings suggest:
• A sufficient supply of RCAs (with exceptions
in the north and interior) and CHWs (with
exceptions in the Okanagan).
• A sufficient supply of LPNs with the
possibility of an oversupply of new LPNs.
• Challenges with retention of casual CHWs,
RCAs and LPNs (that is expected to become
more problematic among CHWs in the next
two years.
• More problems with retention of CHWs,
RCAs and LPNs than recruitment, suggestive
of turnover within residential care and
home care.
Key Risks
Considering the current state of supply and
demand, the HR Strategy was shaped primarily
by the risk that turnover in residential care and
home care is impacting the cost, acceptability
and safety of seniors care. The majority of
recommendations in the HR Strategy address
retention.
While the HR Strategy cannot predict how
external factors will impact supply and demand,
political, economic, socio-cultural and
technological factors promise to impact the
workforce. A consideration of these external
factors also pointed towards the risk that an
unstable work environment will impact the
ability of sector employers, especially those in
home care, to compete for a shrinking labour
force to provide safe and high quality care for
BC’s aging population. Several
recommendations specifically address
recruitment with almost all recommendations
having spill-over benefits to recruitment.
Overall, the HR Strategy is an opportunity to
strengthen the sector’s ability to retain CHWs,
RCAs, and LPNs so that it is better prepared to
endure the influence of political, economic,
sociological, and technological factors on its
workforce.
Levers for Change
An extensive stakeholder consultation was
conducted to understand the causes of and
opportunities to decrease turnover:
• The factors that influence the retention of
RCAs include turnover related to casual
employment and to unmet expectations of
labour force entrants. There is a potential to
decrease turnover by promoting meaningful
relationships between RCAs and residents,
their peers, and their managers.
• Turnover related to casual employment and
unmet job expectations in addition to high
workload and responsibilities impact the
retention of LPNs in residential care.
• As the home care setting is more vulnerable
to workforce shortages, barriers to
recruitment were also investigated to
identify effective levers for change.
Turnover related to casual employment and
insecure incomes influences the
recruitment and retention of CHWs. The
low recruitment appeal makes the
1
occupation vulnerable to worker shortages.
There is a potential to decrease turnover
through meaningful relationships with
clients and peers.
• While home care utilizes only 10% of the
sector’s LPNs, the most significant issue for
LPNs in home care is turnover related to
workload. A low recruitment appeal also
makes the home care LPN occupation
vulnerable to shortages.
Key Success Factors
Several key success factors are essential to
ensure this HR Strategy is implemented as
effectively and efficiently as possible. The
Seniors Care HR Strategy builds on the
collaboration between industry, labour,
government and education partners. Continued
collaboration is required to implement the HR
Strategy. A commitment to co-investment from
sector employers, labour unions and public
sector employers is required to sustain time-
limited provincial funding and to leverage
investments from other partners. Each
recommendation alone may not improve the
strength of the sector’s workforce; rather, it is
the impacts of a collective change that will. A
culture of continuous improvement will help to
drive the HR Strategy forward, benefiting the
strategic direction of seniors care human
resources and enabling a transparent and
accountable process.
The HR Strategy
Four themes - including Planning, Attracting,
Engaging and Sharing Knowledge - form the
basis of this HR Strategy. Goal 1, planning for
the future with the right partners, focuses on
continued collaboration with key stakeholders -
such as the provincial government, educators
and provincial committees, to support informed
decision-making on the demand for CHWs,
RCAs, and LPNs. Goal 2, attracting the right
seniors care workers, relates to supporting
informed decision making on the part of
individuals considering employment in the
sector so that sector employers can attract
workers who will stay in their occupations. Goal
3, engaging seniors care workers in the right
way, focuses on building and developing an
effective organizational culture that supports
communication and employee engagement,
recognition and training and development. Goal
4, ensuring sector employers have the right
knowledge, has two components. The first
focuses on all seniors care employers (including
health authorities) sharing knowledge and
resources for improved retention with
employers in this sector. The second relates to
motivating employers to improve recruitment
and retention, both by enumerating outcomes
of retention initiatives and publicly recognizing
the outstanding efforts of sector employers.
1
TABLE OF CONTENTS
INTRODUCTION 4
ABOUT THE WORKFORCE 7
CURRENT SUPPLY AND DEMAND AND RISK AREAS 10
LEVERS FOR CHANGE 13
KEY SUCCESS FACTORS FOR THE HR STRATEGY 20
THE HR STRATEGY 22
Goal 1: Planning for the future with the right partners 23 Goal 2: Attracting the right seniors care workers 26 Goal 3: Engaging seniors care workers in the right way 28 Goal 4: Ensuring sector employers have the right knowledge 32 2-Year HR Strategy Action Plan 37
EVALUATION PLAN 39
APPENDIX A: RELATIONSHIP TO COMMITTEE TERMS OF REFERENCE 43
Residential Care Best Practices 44 Home Care Best Practices 44
APPENDIX B: BEST PRACTICES 44
2
ACKNOWLEDGEMENTS
Seniors Care Human Resource Sector Committee
The Howegroup gratefully acknowledges the work of the following members of the Seniors Care Human
Resource Sector Committee. Their insights and guidance were much appreciated throughout the
development of the HR Strategy.
Sector Representatives
Cindy Corcoran
BC Recruitment Specialist
Good Samaritan Society, Kelowna
Barbara Stevenson
Executive Director
Alberni – Clayoquot Continuing Care Society
Robin Hancock
Recruitment Services Manager
Retirement Concepts, Nanaimo
Jas Khun-Khun
Senior Regional Operations Director, Western
Canada
Comcare Health Services
Elaine Price
Administrator/Director of Operations
Eden Care Centre, West Shore Laylum Care Centre,
Royal Crescent Gardens
Isobel Mackenzie
Chief Executive Officer
Beacon Community Services
Ms. Linda Wong
Human Resources Advisor
Revera Long Term Care
Ed Helfrich
Chief Executive Officer
BC Care Providers Association
Irene Cortejes
LPN
Christenson Village Care Home, Gibsons
David Hurford
Director of PR + Member Services
BC Care Providers Association
Stakeholder Representatives
Debbie McLachlan
Director, Health Human Resource Planning
BC Ministry of Health Services
Anita Zaenker
Staff Representative, Research and Campaigns
B.C. Government and Service Employees' Union
Lori Mackenzie
Director, Institutes and Health Programs
Paul Clarke
Health Education Coordinator, Institutes and Health
Programs
Ministry of Advanced Education
Chris Kinkaid
Research and Policy Director
Hospital Employees’ Union
Pat Bawtinheimer
Dean, Health Sciences Programs
Vancouver Community College
Neil Floyd
Partnership Development Consultant (non-voting)
Ministry of Jobs, Tourism and Innovation
Eric Peraro
Director of Research Services
Health Employers Association of BC
3
Geoff Stevens
Committee Chair
Stakeholders beyond the Committee
The HR Strategy also benefited from the contributions of stakeholders beyond the Committee. The
Howegroup also engaged the expertise of Marcy Cohen, Research and Policy Director from the Hospital
Employees Union and Carla Dempsey, Provincial Executive for the Health Services Component of the BC
Government and Service Employees' Union. The Howegroup also wishes to thank representatives from
post-secondary institutions, private training institutions, and other important agencies in the education
sector (Private Career Training Institutions Agency, BC Academic Health Council) for sharing their
knowledge about the current supply and demand for Community Health Workers, Residential Care
Aides, and Licensed Practical Nurses.
Most importantly, the Howegroup sincerely thanks the Community Health Workers, Residential Care
Aides, and Licensed Practical Nurses who volunteered to share their firsthand experiences with
recruitment and retention.
4
Background
The Seniors Care Human Resource Sector Committee (the Committee) was established under the
provincial Labour Market Partnership Program to oversee the development and implementation of a
comprehensive human resource strategy for the not- for-profit and private seniors care sector in the
province. Funding has been provided for this initiative under a formal agreement between the Province
of BC and the BC Care Providers Association (BCCPA).
Purpose
The Howegroup was engaged by the Committee in June 2010 to develop a sector HR strategy with the
purpose being:
� To identify emerging issues, gaps and barriers to hiring and retaining appropriate seniors care
human resources.
� To outline an HR strategy, inclusive of implementation and evaluation plans, to address recruitment
and retention issues within the sub-sector.
Scope
The HR Strategy is focused on:
� Community Health Worker (CHW), Residential Care Aide (RCA), and Licensed Practical Nurse (LPN)
human resources.
� Non-profit and private seniors’ care providers (not including health authorities).
� Current barriers to recruitment and retention.
� Levers for change that relate to the Committee’s Terms of Reference (training, career awareness) as
outlined in Appendix A.
Methodology
To develop the HR Strategy the Howegroup followed a comprehensive qualitative and quantitative
approach that included:
• Reviewing current labour market information.
• Conducting a human resource needs assessment.
• Conducting a best practice/literature review.
• Facilitating action planning sessions with key stakeholders.
• Validating draft recommendations and considering implementation requirements with key
stakeholders.
INTRODUCTION
5
Review of Current Labour Market Information
The Howegroup reviewed the Labour Market Information Report: Licensed Practical Nurses,
Resident Care Aides & Home Care Aides in Non-Health Authority Facilities released in June 2010 and
the update to this report for LPNS and CHWs in non-health authority home support facilities in
October 2010.1 The report was used to provide an overview of the recruitment, retention and
vacancies situations for CHWs, RCAs, and LPNs in the seniors care sector of BC, as well as detailed
demographics, workforce profiles and human resource forecasts, for each of the three occupations.
The findings of this report provided support for emphasis on retention efforts (above recruitment)
across all three occupation types. Please see Key Risks Shaping the HR Strategy on Page 12.
Human Resource Needs Assessment
The Howegroup conducted one-hour, individual, in-depth interviews with 11 employers, 9
recruitment experts, 13 health system partners and 12 frontline seniors care employees to gain
valuable insight into the human resource challenges associated with recruiting and retaining CHWs,
LPNs, and RCAs.2 Employers, recruitment and health system partners (including unions) were asked
for their perceptions of the current labour market situation, building on data gained from the Labour
Market Information Report. They were also asked to identify how they deal with recruitment and
retention challenges and to identify any known best practices. CHWs, RCAs, and LPNs were asked for
their perceptions of their current work environment – identifying positive practices and areas for
improvement. Key findings from stakeholders are detailed in the Levers for Change section of this
HR Strategy.
Literature/Best Practice Review
In order to gain a better understanding of the factors influencing recruitment and retention of
CHWs, LPNs, and RCAs and to validate the findings from interviews with frontline workers, a
comprehensive literature review was conducted. The Howegroup looked to provincial and national
best practices – searching literature available in the public domain. The Howegroup also conducted
one-hour, individual, in-depth interviews with human resource experts from public sector
organizations to identify how best practices could be translated to the private and not-for-profit
sector. Four best practices have been provided as appendices to the HR Strategy that address
residential and community care challenges with respect to retaining frontline seniors care staff.
Action-Planning Sessions
The Committee, with its broad representation of senior leaders and labour representatives from the
not- for-profit and private seniors’ care sector in BC was a valuable resource throughout the project.
The combined experience of Committee members was critical to identifying the partnerships and
resources required for the successful implementation and sustainability of recruitment and
retention strategies. Consequently, the Howegroup called upon this Committee during three action-
planning sessions on Sept 13th, 14th and 15th, 2010. Two-hour action planning sessions focused on
determining the feasibility and fit of draft solutions presented in an Idea Seed document to address
recruitment and challenges within this sector. Committee members were asked for their input on
how strategies could be practically implemented. The recommendations at the end of this report
are the culmination of the Committee’s valuable input.
1 The data was obtained from British Columbia Non-Health Authorities Recruitment and Retention Survey, conducted in 2010 by
the Health Employers Association of British Columbia on behalf of the BC Seniors Care HR Committee. 2 All Committee members fall into one of these categories, and were, as such, all interviewed during this process.
6
Validation Interviews
Five 90-minute validation sessions were held with individual and groups of Committee members to
solidify their commitment to recommendations and to determine implementation implications and
possible partnerships required for a successful HR strategy. Validation interviews served as a final
reference point before presenting a preview of the recommendations within the HR Strategy to the
Committee on November 10th, 2010.
Input into Final Report
The results from the above phases were compiled into a draft report that was submitted to the
Committee for their review and input on November 26th, 2010. Comments from the Committee
were addressed and a final report was issued on December 22nd, 2010.
About the HR Strategy
This report begins by describing the CHW, RCA and LPN workforce, including an overview of the current
picture of supply and demand. Both the current state of and the external factors that may influence
supply and demand indicate key risks for the sector. These key risks shape the HR Strategy. As an
important preface to the recommendations, the following section discusses the implications of turnover
and the importance of an HR Strategy for the sector. Next, the Levers for Change in residential care and
home care are detailed. Key success factors for the HR Strategy then demonstrate the importance of
collaboration, co-investment, and evaluation. The recommendations cluster around four motivations:
• Planning for the future with the right partners
• Attracting the right seniors care workers
• Engaging seniors care workers in the right way
• Ensuring sector employers have the right knowledge to do so
The report concludes with a project management plan with suggested implementation timelines and an
evaluation plan.
7
About Community Health Workers and Resident Care Aides
Community Health Workers3 administer bedside and personal care, such as aiding in ambulation,
bathing and personal hygiene, to clients in their homes. They work under the general direction of a
home care agency supervisor or nurse with detailed instructions that explain when they are to visit
clients and what services need to be performed.
Residential Care Aides4 provide basic resident care. They provide residents with assistance in activities
of daily living - such as bathing, dressing, grooming - and often serve meal trays and feed residents. As
directed by nursing staff, they take basic measurements, such as patients' blood pressure, temperature
and pulse. They are also the frontline workers who are called upon to collect urine, feces or sputum
specimens, as just some examples of these essential duties.
CHW and RCA Education and Training
RCAs and CHWs are unregulated health care providers. There is no regulatory organization (like
the College of Licensed Practical Nurses of BC for LPNs) to ensure program graduates have the
skills necessary for licensing. A broad range of institutions offer Home Support/Resident Care
Attendant certificates. In 2008, the Health Care Assistant (HCA) Program Provincial Curriculum
was established. Institutions offering the HCA program are expected to comply with the
standardized content and curriculum hours outlined in this curriculum. As well, private career
training institutions offering the HCA program must be registered with the Private Career
Training Institutions Agency (PCTIA) and may voluntarily participate in its accreditation process.
Health care delivery organizations have and will continue to review the skill mix needed to
deliver health care services to British Columbians, especially to meet the increased demand for
health care services for BC’s seniors. There are provincial bodies and committees in place to
ensure HCA graduates are prepared to meet the needs within health care delivery organizations.
For example, the BC Academic Health Council is a not-for-profit organization linking the health
care and advanced education sectors with a mandate to strengthen health profession education
in BC. Presently, the Council currently includes representation from health authorities and public
post-secondary institutions in each region of the province as well as government ministries.
Additionally, a provincial articulation committee meets to share information and engage in
discussions related to curricular matters, particularly those affecting student.
While there is variation in training across private career training institutions, there is movement
towards closing this gap and ensuring provincial standards are in practice across all private and
public institutions. There are several initiatives to bring greater consistency to the education,
level of knowledge and skill of those providing seniors care in BC; two of which include:
3 Source: Adapted from Achieve BC Job Profiles (NOC 6471).
4 Source: Adapted from Achieve BC Job Profiles (NOC 3413).
ABOUT THE WORKFORCE
8
1. CHWs and RCAs in the public sector (i.e. employed by health authority operated
facilities) are required to register with the BC Care Aide & Community Health Worker
Registry (Registry). The Registry is also extended to CHWs and RCAs working at facilities
in the private and not-for-profit sectors, and is encouraged, especially for those planning
to work in the public sector in the future.
2. The Province has also struck a working group to develop an HCA program approval
process. The early stages of this process will likely require public post-secondary
institutions and private career training institutions to self-report compliance with
provincial curriculum. The long-term objective is to standardize the CHW and RCA
education provided by private career training institutions in BC to ensure all new
graduates have standardized the entry to practice skills required in today’s health care
environment.
Participation of the Domestic Workforce in RCA and CHW Occupations
According to employers and educators participating in the stakeholder consultation, the
domestic workforce tends to be comprised of females making a career choice in their late 20s to
30s or re-entering the workforce (e.g. after childrearing) and males displaced from other
industries (e.g. forestry).
Participation of Internationally Trained and Aboriginal RCAs and CHWs
The HCA program also tends to attract those that had a health care career before immigrating
and who cannot be certified, registered or licensed in their occupation in Canada. Relatively
short in duration, the HCA program gives immigrants the potential to be employed in a fairly
short time frame. Not-for-profit employers who also have government funded employment
training programs (that are targeted toward immigrant populations) under their umbrella of
services have demonstrated success in integrating new Canadians into the RCA and CHW
workforce. One such example is SUCCESS – a multi-service agency mandated to promote the
wellbeing of all Canadians and immigrants by encouraging their participation in the community
through delivering employment, training and education health services.
There are several programs that have focused efforts on increasing the participation and success
rate of aboriginal learners in HCA programs. For example, Vancouver Community College (VCC)
is offering a stream for Aboriginal students and BC’s aboriginal post-secondary institution, Nicola
Valley Institute of Technology (NVIT), also offers an HCA program.5 There are a strong number of
applicants for the HCA program and nearly all of the graduates from NVIT’s HCA program (most
are aboriginal) have been employed within the RCA or CHW occupation.
About Licensed Practical Nurses
Licensed Practical Nurses (LPNs) 6 work in a wide variety of health care settings, acute care being the
most common. This HR Strategy focuses on LPNs in the residential and home care settings. LPNs in
5Vancouver Community College. (2010, July 7). VCC health care assistant program to add stream with focus on Aboriginal
students [Press release]. Retrieved from: http://www.vcc.ca/about-vcc/news.cfm?NEWS_ID=6685 6 Source: Adapted from Achieve BC Job Profiles (NOC 3233).
9
residential care provide routine bedside care, including the distribution of medication to patients and
performing personal treatment. They also help evaluate residents' needs, develop care plans, and
supervise RCAs. LPNs employed as supervisors in home care evaluate clients’ needs, develop care plans,
and supervise CHWs.
LPN Education and Training
To work as a LPN in BC, completion of a Practical Nursing program or other approved programs
is required, followed by licensing with CLPNBC. Graduates of a Practical Nursing program are
eligible to write the Canadian Practical Nurse Registration Examination (CPNRE) and to apply for
licensing with the CLPNBC to become a LPN. New competencies are currently being established
for the CPNRE. With increasingly challenging competency requirements, PCTIA enrolment data
indicates that attrition from the LPN program may be approximately 20%.7 CLPNBC is
responsible for a program recognition process to ensure both new and existing programs
prepare students with the entry-level competencies for the profession so that they meet the
CLPNBC registration requirements upon program completion. CLPNBC’s decision to grant or
withhold program recognition is not affected by the supply or demand for LPNs in regions of BC.
As for the HCA training, provincial bodies, such as the BC Academic Health Council, PCTIA and a
provincial articulation committee, fulfill distinct and important roles in ensuring practical nursing
graduates are prepared to meet the needs within health care delivery organizations. Several
educational institutions, most notably VCC and several rural training institutions that have
partnered with VCC, offer an Access to Practical Nursing Certificate for individuals who have
already completed HCA training.
Participation of Internationally Trained and Aboriginal LPNs
The Ministry of Advanced Education has focused efforts on ensuring the accessibility of this
occupation to Aboriginal people and internationally educated professionals. In 2006,
approximately 3.4% of LPNs (185) in BC, the highest proportion in the country, identified
themselves as internationally educated.8 There are also programs to ensure that Aboriginal and
non-Aboriginal people can participate equally in practical nursing programs. For example, Simon
Fraser University, in partnership with other BC post-secondary institutions, offers a tuition free
program for students of Aboriginal heritage. Supported by Health Canada through the
Aboriginal Health Human Resources Initiative, students of Aboriginal heritage are provided an
opportunity to explore various health career options while building the necessary academic pre-
requisites for these programs.
7 Attrition for NOC 3233, including dental assistants, was 20% for the Vancouver region.
http://www.pctia.bc.ca/documents/enrolment/2007_region_noc_enrol_web.pdf 8 Canadian Institute for Health Information, Workforce Trends of Licensed Practical Nurses in Canada, 2006 (Ottawa: CIHI,
2007). Available at: http://secure.cihi.ca/cihiweb/products/Workforce_Trends_LPN_2006_e.pdf
10
The current state presents key facts on the balance of supply and demand according to the BC Non-
Health Authorities Recruitment and Retention Survey of sector employers (as detailed in the Labour
Market Information Report: Licensed Practical Nurses, Resident Care Aides & Home Care Aides in Non-
Health Authority Facilities released in June 2010), as well as provincial and federal occupational profiles.9
Significance of Private and Not-for-Profit Sector
If there is any one important aspect of the seniors care workforce that decision-makers must weigh, it is
size. In BC’s evolving health care system, the private and not-for-profit sector plays a substantial role in
the delivery of health care services to BC’s seniors:
• The sector employs an estimated 60% of LPNs10, 34% of RCAs and 33% of CHWs in the province.
• The sector employs a combined total of more than 14,000 British Columbians in these occupations
(7,288 RCAs, 4,224 CHWs and 2,823 LPNs).
Workforce Overview
This HR Strategy aims to balance forecasts from the Provincial Labour Market Profiles of Licensed
Practical Nurses, Resident Care Aides & Home Care Aides with the opinions of experts from sector
employers as well as post-secondary and private training institutions. The Labour Market Information
Report enumerated shortfalls for LPN and RCA occupations and, beginning in 2011, for the CHW
workforce. However, few sector employers reported challenges with recruitment of these occupations.11
Stakeholders indicated a:
• Sufficient supply of next generation LPNs to meet current demand of the sector overall. The
majority report no to low problems with recruitment. New LPNs, especially in some of BC’s
urban areas, are actually having difficulty securing regular employment.
• Sufficient supply of RCAs to meet current demands of the sector overall. The majority report no to
low problems with recruitment. Some areas of the province, such as the north and interior, are
experiencing a short supply of casual RCAs.
• Sufficient supply of casual CHWs to meet the current demand of the sector overall. The majority
report no to low problems with recruitment. Some areas of the province, such as the Okanagan, are
experiencing a short supply of casual CHWs.
Although supply was generally sufficient, employers responses to the Labour Market Information survey
indicated:
9 The data was obtained from British Columbia Non-Health Authorities Recruitment and Retention Survey, conducted in 2010 by
the Health Employers Association of British Columbia on behalf of the BC Seniors Care HR Committee. 10
The Provincial Labour Market Profiles of Licensed Practical Nurses, Resident Care Aides & Home Care Aides reported 10,198
LPNs working within the province in 2009. In 2008, the majority of LPNs are employed in the acute care setting (54% of LPNs in
BC in 2008). More LPNs work in residential care settings (36% of LPNs in BC in 2008) as compared to community health (4%). 11
The forecasted demand for these occupations used growth rates, supplied by the Ministry of Health Services, of 2.45% in
home care and 2.91% in residential care. Some stakeholders explained that the forecasted demand might be more than the
actual demand because some employers in the province had not yet implemented changes in their skill mix or changes in the
direct care hours per client.
CURRENT SUPPLY AND
DEMAND AND RISK AREAS
11
• Challenges with retention of casual employees from all three occupations: CHWs (50%), RCAs (50%)
and LPNs (59%).12
• More problems with retention of CHWs, RCAs and LPNs than recruitment, suggestive of turnover
within residential care and home care.
• Expectation that retention of casual CHWs will become more difficult in the next two years (60%).
External Factors
While the scope of this project was to respond to the current state of supply and demand of CHWs,
RCAs, and LPNs in the affiliate sector, there are a number of external factors that promise to impact this
workforce. These factors will influence whether forecasts within the Labour Market Information Report
(i.e. a shortage of 466 CHW FTE, 1534 RCA FTE, and 451 LPN FTE by 2019) will be greater or lesser. While
the HR Strategy cannot predict their impact on supply and demand, these political, economic, socio-
cultural and technological factors provide important context for the HR Strategy.
Political Factors
• An increased pressure on the limited funds available for health care is leading governments
to explore alternative options to finance and deliver high quality health care. Over the last
decade, the Province of BC has opened up seniors care to not-for-profit and private
operators. This direction represented an effort to see public funds delivered in a more cost-
effective manner.
• Many of the services delivered by not-for-profit or private operators continue to be publicly
funded so clients pay the same rate regardless of ownership. Residential care facilities, for
example, receive a certain number of labour hours per day for any given level of patient
need. Co-payment rates for most BC seniors in residential care are increasing. The Province
is allocating these increases directly towards increasing the number of direct care hours that
seniors receive.
Economic Factors
• Health care costs have continued to rise and public funding for seniors care is limited.
• Both operators with the objective of making a profit and balancing revenues and expenses
have pursued labour cost minimization strategies.
• Casual employment offers operators lower labour costs, the opportunity to match labour
usage to fluctuations in demand, greater administrative convenience, and enhanced control
of employees.
• Some private operators have contracted out the professional and personal health care
services provided by CHWs, RCAs and LPNs at more competitive rates.
• Unfavourable economic conditions has delayed the retirement of some CHWs, RCAs, and
LPNs and increased the acceptability of casual employment and lower wages.
Sociocultural Factors
• Approximately 15% of BC’s population is aged 65 or older. This proportion is expected to
grow to 25% by 2030.13
12
Indicated that retention of these employees was a major problem or quite a problem in the 2010 BC Seniors Care Human
Resources Committee Recruitment and Retention Survey. 13
Population Estimates and Forecasts. BC Stats. P.E.O.P.L.E. 33 (Revised, March 2009)
12
• Reduced availability of family support and other informal caregivers will increase the
demand of this population for formal health care services.
• Seniors will increasingly be looking for both quality and choice, especially the option of
managing their care within their own homes.
• As the working-age population shrinks, so will the availability of public funds and workers to
deliver health care services for seniors.
• Opportunities for youth, immigrants, women, mature workers, aboriginal people and the
disabled to participate the workforce will be critical to mitigate the consistent slowing in
labour force growth.
• A workforce of Generation X and Y will require more innovative approaches to work-life
balance and employee recognition.
Technological Factors
• The utilization of technology, especially in home care, for complex scheduling tasks and
managing the workforce has reduced opportunities for personal contact between
occupations.
Key Risks Shaping the HR Strategy
Considering the current state of supply and demand, the HR Strategy was shaped primarily by the
following risk area:
� Turnover in residential care and home care is impacting the cost, acceptability and safety of
seniors care.
The majority of recommendations in the HR Strategy address retention.
A consideration of external factors also pointed towards the following risk area:
� An unstable work environment will impact the ability of sector employees, especially those in
home care, to compete for a shrinking labour force to provide safe and high quality care for BC’s
aging population.
Several recommendations specifically address recruitment with almost all recommendations having
spill-over benefits to recruitment.
Overall, the HR Strategy is an opportunity to strengthen the sector’s ability to retain CHWs, RCAs, and
LPNs so that it is better prepared to endure the influence of political, economic, sociological, and
technological factors on its workforce.
13
LEVERS FOR CHANGE
Implications and Importance of an HR Strategy for the Sector
A clear tension exists between the province-wide desire to provide consistent, high quality care to BC’s
seniors and the economic pressures to lower labour costs, often through casual employment. The
extensive use of casual employment is known to increase the likelihood of turnover.
• High turnover depletes the complement of
experienced staff. New recruits are less experienced
than seasoned staff. They need time to develop a
detailed working knowledge of a facility's
philosophy, procedures, protocols, as well
as client needs and preferences, and to
develop relationships with colleagues.
Naturally, this also impacts the
satisfaction of other team
members.
• Until such organizational and client
familiarity is developed, the inflow
of new personnel can significantly
impact the quality of care
delivered to BC’s seniors.
• For a variety of reasons, most
employers do not tend to compute
the range of direct and indirect effects
of staff turnover in financial terms.14 The
direct cost of turnover per frontline worker
is at least $4,100, based on a conservative
working estimate.15
• High turnover costs have serious financial impacts on
the provincial government, the funder of the majority of
residential and community care. The ultimate impact of the costs of
turnover will eventually be felt by public taxpayers.
An extensive stakeholder consultation identified causes of, and accordingly, the opportunities to
decrease turnover within the sector. These Levers for Change are described for both RCAs and LPNs in
residential care.
14
http://www.personneltoday.com/articles/2010/05/20/55647/staff-turnover-are-employers-managing-it-correctly.html 15
The average cost of turnover for a long-term care employee was estimated at $3,500 in 2004. The inflation rate since this time
has been estimated at 17%. Seavey D. The Cost of Frontline Turnover in Long Term Care. Better Jobs Better Care. 2004. Available
at: http://www.bjbc.org/content/docs/TOCostReport.pdf.
Figure 1 Significance of Sector HR Strategy to BC
14
Levers for Change in the Residential Care
An extensive stakeholder consultation was conducted to understand the opportunities to decrease
turnover in residential care.
Factors Influencing Retention of Residential Care Aides
Stakeholders revealed that there are a number of important factors influencing recruitment and
retention of RCAs:
Turnover Related to Casual Employment
An estimated 43% of RCAs work on a casual basis, with no guarantee of hours per week.
Employers cite insufficient work hours as one of the primary reasons for retention challenges.
Casual RCAs will switch to employers that offer more hours or public sector employers that offer
better wages and benefits.
A limited number of direct patient care hours in residential care, coupled with casual RCAs
balancing multiple jobs and working too many days in a row, contributes to a high rate of
workload related stress and injury. It is conservatively estimated that 487 RCAs are injured
within the sector each year for a cumulative total of 22,572 lost work days.16 These avoidable
financial and health human resource losses are increasingly evident to employers.
Recommendation 1.1 notes an opportunity for the Committee to link with WorkSafe BC as it
examines initiatives to prevent lost work days due to injury, stress and illness of CHWs, RCAs,
and LPNs.
Turnover Related to Unmet Expectations of Labour Force Entrants
Young, newly graduated RCAs are more
likely than more mature labour force
entrants to find the nature of the work
unappealing. As well, the promise of job
opportunities does not match up with
reality. After graduating, they find that
they either cannot make ends meet or
must juggle multiple casual positions to
make a living. Because the occupation has
a low barrier to entry into the field, it is
relatively easy for RCAs to leave the
career in search of another opportunity when they find the working conditions unappealing.
Recommendation 2.1 of the HR Strategy includes efforts to provide individuals considering
employment in residential care with a true picture of job opportunities and employment
expectations (more realistic marketing) so there will be fewer disappointments when they begin
working in the sector.
16
The proportion of BC RCAs that were injured in 2008 and average lost days per RCA was applied to the number of RCAs
working in the sector. Source: WorkSafe BC. (March 2009). Home and Community Care in BC Factsheet. Retrieved from
http://www2.worksafebc.com/PDFs/Healthcare/long_term_care_Mar09.pdf
Most Care Aides consider working for a health
authority operated facility the best
employment you can get. The pay is $3-4 more
per hour and there are benefits. The health
authority can pick and choose applicants and
usually will hire someone with at least 6
months experience.
- Educator
15
Potential to Decrease Turnover through Meaningful Relationships
RCAs’ relationship with residents is the chief reason they stay in their jobs. However, the limited
number of direct patient care hours in residential care precludes RCAs from developing and
nurturing these meaningful relationships.
Relationships with peers is the second most important reason RCAs stay in their jobs. Good
relationships can mitigate work-related stress and support retention. However, few employers
dedicate resources to support stronger workplace relationships, such as engaging employees in
team-building opportunities, bridging the
gap between a multitude of cultural
backgrounds, and arranging work and
social functions.
Relationships between RCAs and their
managers are important to keep the lines
of communication open (a factor that
influences retention). Management has changed across many organizations over the past few
years due to contracting out and the restructuring that has ensued. Effective relationships have
been interrupted and an increased ratio of RCAs to managers is evident. Management in some
residential care facilities is increasingly disconnected from the day-to-day working environment
of RCAs. This disconnection brings with it the potential to undervalue the work of RCAs.
Employers that involve RCAs in resident care conferences in meaningful ways set themselves
apart by demonstrating the value of RCAs. Recommendation 3.1 of the HR Strategy includes
training health care team members who supervise RCAs to involve them in meaningful ways, like
planning care for residents. Additionally, Recommendation 3.2 focuses on province-wide
appreciation of RCAs.
Factors Influencing Retention of Licensed Practical Nurses
Consultation with stakeholders revealed that there are also a few important factors that are important
to recruitment and retention of LPNs in residential care:
Turnover Related to Casual
Employment and Unmet Job
Expectations
Casualization of the occupation has
reduced employers’ commitment to
employees. Consequently, casual LPNs
are equally uncommitted and will switch
to employers that offer more hours or
public sector workplaces, particularly in
acute care, that offer better wages and benefits. Younger next-generation LPNs are attracted to
the occupation with the promise of abundant job opportunities. However, the supply of LPNs
throughout the province is not monitored on a regular basis. After graduating, next generation
LPNs are disappointed to find that a lack of regular positions available especially in urban areas
of BC. Having made a significant investment in the career, they are less likely than RCAs to
I’ve left other jobs because there is no
communication and no teamwork. Money
doesn’t matter to me. In other jobs, I’ve made
$23 an hour. I currently make $16.
- Residential Care Aide
One local place I had considered, for example,
is being privatized within the next few weeks
and the pay for Care Aides AND LPNs will be
less. There are many that won’t be coming
back and the contractors are replacing them
with new graduates who have no experience
and will accept the pay.
- LPN, displaced from home care and re-
entering residential care
16
pursue another occupation. In 2006, the proportion of LPNs that had multiple employers was
higher in BC (28%) than any other province.17 They are eager to work and more likely than
experienced LPNs to accept lower wages when professional services in residential care are
contracted out. This is placing newer LPNs in situations where their experience doesn’t
necessarily match the demands of the job. Recommendation 1.3 and 1.4 of the HR Strategy
includes collaboration with key stakeholders - such as the provincial government, educators and
provincial committees - to support informed decision-making on the demand for LPNs.
Turnover Related to Capacity for Workload and Responsibilities
A limited number of direct patient care hours in residential care, coupled with casual LPNs
balancing multiple jobs and working too many days in a row, contributes to a high rate of
workload related stress and injury. It is conservatively estimated that over 200 LPNs are injured
within the sector each year for a cumulative total of 7,891 lost work days.18 These avoidable
financial and health human resources losses are increasingly evident to employers, just as is the
case for RCAs. Although the opportunity to help residents is the chief reason LPNs stay in their
job, an increasing division of labour in residential care is decreasing the direct patient contact
they value. Additionally, many experienced LPNs do not feel adequately compensated for the
level of responsibility. Most LPNs leave residential care in their mid-fifties because of the
physical demands and stress of work in residential care. At the same time, younger LPNs do not
feel adequately prepared for the level of responsibility and are likely to leave jobs in their first
few years after graduation because of this. BC has the greatest proportion (64%) of LPNs with 0-
10 years experience and the smallest proportion of LPNs with over 10 years experience when
compared with other provinces. Although changes to the terms of employment are out of
scope for this HR Strategy, Recommendation 3.5 of the HR Strategy includes an opportunity for
experienced LPNs to be released from a portion of this physical workload to share their
knowledge and wisdom to next generation LPNs so they are better prepared to deal with
demanding leadership, as well as clinical responsibilities.
Levers for Change in the Home Care
An extensive stakeholder consultation was conducted to understand the causes of, and accordingly, the
opportunities to decrease turnover in home care. Because this care setting is also more vulnerable to
workforce shortages, barriers to recruitment were investigated to identify effective Levers for Change.
Factors Influencing Recruitment and Retention of Community Health Workers
Consultation with stakeholders revealed that there are three important factors influencing recruitment
and retention of CHWs:
Turnover Related to Casual Employment and Insecure Incomes
17
Canadian Institute for Health Information, Workforce Trends of Licensed Practical Nurses in Canada, 2006 (Ottawa: CIHI,
2007). Available at: http://secure.cihi.ca/cihiweb/products/Workforce_Trends_LPN_2006_e.pdf
18 The proportion of BC LPNs that were injured in 2008 and average lost days per LPN was applied to the number of LPNs
working in the sector. Source: WorkSafe BC. (April 2010). LPN Fact Sheet. Retrieved from
http://www2.worksafebc.com/PDFs/Healthcare/LPN_FactSheet_Apr10.pdf
17
The demand for home care services is relatively unpredictable. Home care organizations use a
large pool of casual workers to absorb fluctuations in demand. The majority (58%) of CHWs are
employed on a casual basis with no guarantee of weekly hours. Many home care employers
have high expectations of casuals with respect to their hours of availability. It is challenging for
casual CHWs to supplement their insecure
incomes and meet availability
requirements, with last minute shift
changes, and split shifts being
commonplace. The level of commitment
of employers to CHWs is low. CHWs often
work mere 2 hour shifts. Making a living as a CHW is undeniably difficult. The increased
utilization of technology to organize home care services also places an increased onus on CHWs
to check in with head office on their own time and frequently, at their own expense.
Reimbursement for travel expenses has not increased in the last 4 years even though the cost to
CHWs has. Casual CHWs will switch to employers that offer more hours or public sector
employers that offer better wages and benefits. Additionally, because the occupation has a low
barrier to entry, it is easy for CHWs to leave the career if making a living becomes too difficult.
Employers do not expect an improvement in this turnover in the next year.19 Although changes
to the terms of employment are out of scope for this HR Strategy, Recommendation 1.2 includes
investing in training for schedulers so CHWs are provided with more desirable schedules (and
that employers may realize resource efficiencies) within the boundaries of client needs and
union regulations.
Potential to Decrease Turnover through Meaningful Relationships
CHWs’ relationships with home care clients is the chief reason they stay in their jobs. Sometimes
the home care services they provide to clients are sub-contracted out by their employer to other
home care agencies for the short-term or long-term. This disrupts CHWs’ relationships with their
clients. As workers are re-assigned to accommodate changing client needs (i.e. client is in
hospital so doesn’t need home care for a period of time), seniority rules in the collective
agreements also have the potential to disrupt CHWs’ relationships with their clients. However,
when work environments support the development of these relationships with clients, these
relationships have the potential to retain CHWs’ even when other conditions of the work are
unsatisfactory.20 Recommendation 1.2 includes investing in training for schedulers (as noted
above).
Considering the reasons that RCAs stay in their jobs, there may be potential for relationships
with peers to also improve the retention of CHWs in home and community care. However, the
current approach to delivering home care services does not give CHWs the opportunity to
develop relationships with their peers.
There is frequently friction in the
relationships between those that deliver
home care services (CHWs) and those
that organize home care services
19
While the home care industry has undergone consolidation in the period during which terminations were reported, home
care employers did not expect fewer staff terminations in the future (17% expected more change and 75% expected the same). 20
Sharman, Z. The Recruitment and Retention Of Community Health Workers in Small Cities, Towns, and Rural Communities.
Diss. University of British Columbia, 2010.
A lot of people that are attracted to completing
these programs aren’t young kids. They have
families and they’re looking for sustainable
employment opportunities.
- Employment training agency
I truly love working with seniors in their homes.
That’s why I am still doing it.
- Community Health Worker, 22 yrs experience
18
(managers and schedulers). There are several reasons for this friction:
• Organizational change: CHWs’ relationships with both managers and schedulers have
been interrupted by contracting out, restructuring and industry consolidation. These
organizational changes have also resulted in an increased ratio of CHWs to LPN
supervisors, schedulers and managers.
• Workload: Managers and schedulers struggle with a tremendous workload and are
impacted by the challenges of managing a large and sometimes unstable workforce –
contending with last-minute unavailability, sickness absence and vacation requests.
• Distance between CHWs, Supervisors & Schedulers: Both the high ratio of CHWs to
supervisors and schedulers and the increased use of technology (electronic schedules,
IVR systems, GPS tracking) have decreased the personal contact between these two
groups. More often than not, CHWs do not feel they have enough support as they
deliver care in client homes and feel that their own needs in terms of work schedules
and the needs of their clients are disregarded.
Recommendation 3.1 of the HR Strategy includes training schedulers and supervisors to involve
CHWs in meaningful ways, like planning
care for clients.
Low Recruitment Appeal Makes
Occupation Vulnerable to Shortages
Historically, home care has not tended to
be publicly funded to the same extent as
institutional care, meaning that RCAs generally earn more than CHWs. Home care requires
experienced and confident workers capable of independent decision-making; yet with the least
attractive job offer, home care cannot recruit and retain the best candidates for the setting. The
incentive for graduates from HCA programs is to go to where the pay rates are higher, thus
leading to difficulty in recruiting CHWs in home care. As well, many HCA graduates do not
complete practicums in home care and naturally only pursue work in the residential care setting.
Recommendation 2.2 of the HR Strategy includes increasing the capacity of home care
employers to offer practicums for HCA students.
Factors Influencing Recruitment and Retention of LPNs
Home care utilizes 10% of the sector’s LPNs. However, LPNs occupy important positions in home care
including roles as supervisors. Consultation with stakeholders revealed that there are also a few
important factors that are important to recruitment and retention of LPNs in home care:
Turnover Related to Workload
The majority of home care employers within the sector are expecting challenges in retention of
casual LPNs over the next 2 years. 21 LPNs already working in home care revealed that the
increasing workload is making them think about leaving their current place of employment of
their occupation all together. Examples include additional responsibilities with respect to
technology and scheduling. Some LPNs report feeling unprepared for these responsibilities and
that these tasks do not make best use of their nursing skills. LPNs also referred to a lack of
21
HEABC. Labour Market Information Report Update: Licensed Practical Nurses & Home Care Aides in Non-Health Authority
Home Support Facilities.
For some reason, even though Community
Health Workers need more maturity,
discernment and decision making ability, home
care pays less than residential care.
- Educator
19
consultation or communication by employers about changes that impact their work as another
reason they thought about leaving their roles.
Low Recruitment Appeal Makes Occupation Vulnerable to Shortages
LPNs value their hard-earned professional designation and clinical skills. Most believe that the
greatest opportunity to use their designation and clinical skill is in acute care, followed by
residential care. In comparison, next-generation LPNs see home care as the setting with the
lowest pay, with little to no direct patient contact or opportunity to utilize clinical skills in the
supervisor role, and in some cases, where their professional designation ‘does not matter’.22
These are barriers to recruiting next-generation LPNs.
22
For example, LPNs reported that employers had asked them to remove their professional designation from their signature on
reports.
20
KEY SUCCESS FACTORS FOR
THE HR STRATEGY
Several key success factors are essential to ensure this HR Strategy is implemented effectively.
Planning Together
In the development of this Strategy, the Committee facilitated the coordinated actions of important
industry, labour, government and education partners. The Seniors Care HR Strategy builds on the
momentum of many of these partners in improving the work environment of CHWs, RCAs, and LPNs. For
example, some of the recommendations include adapting a recruitment or retention practice that have
been piloted or established in other sectors or jurisdictions (Please refer to the Best Practices in
Appendix B). The collaborative approach, exemplified during the development of this HR Strategy, is
critical to the success of this HR Strategy. The implementation of recommendations can only be
successful with the participation and insights of partners – continuing to collaborate and share
knowledge. The success of this strategy begins with a collaborative approach – no one single
stakeholder can lead this strategy in
isolation.
Investing Together
The recommendations require financial
and in-kind contributions from a
partnership of sector employers, labour
unions and public sector employers,
including BC’s health authorities. The
commitment of co-investment from these
partners is required to sustain time-
limited provincial funding.
Further investments of these strategic
partners are required to ensure positive
changes to the work lives of CHWs, RCAs,
and LPNs are sustainable and have an
appreciable impact on retention. These
investments are also needed to leverage
continued and new investments from
other partners in the province in this
sector.
Changing Together
The Seniors Care HR Strategy recognizes that improvements to retention and recruitment require a
multidirectional approach. Each recommendation alone may not improve the sector’s capacity to recruit
Planning
Together
Seniors HR Planning
Committee
Stakeholder Consultation
Investing
Together
Sector employers
Labour unions
Public sector employers
Changing
Together
Province-wide recognition
Sector employers
improving organizational
culture
Evaluating
Together
Co-investors see impact
Responding to changes in
marketplace
Figure 2 Key Success Factors for HR Strategy
21
and retain; however, the culmination of recommendations addressing employee training and
development, employee recognition, employee selection and recruitment, management development
and organization development will.
An improved recruitment and retention picture will depend on many change-makers. For example,
many recommendations in this HR Strategy depend on the participation of sector employers, including
those that represent small and large, urban and rural seniors care providers. Outside of the scope of this
Strategy, partners may lead other important efforts to improve the recruitment and retention CHWs,
RCAs, and LPNs. For example:
• Changes in organizational culture at sector employers have the greatest potential to improve
retention of CHWs, RCAs, and LPNs. This will require a culture shift that demonstrates the value
of including frontline senior care providers as a key partner in delivering (and making decisions
about) client-centered service.
• The provincial government and related agencies may utilize the improved information about
demand for these human resources to monitor the supply of LPN and HCA graduates.
• Networks, initiated and led by RCAs and CHWs for RCAs and CHWs, can strengthen the identity
of CHWs and RCAs and contribute to education, research, policy development and advocacy for
these occupations.
• Future rounds of collective bargaining may consider: addressing RCA wage disparity between
public and private sector, increasing wages for LPNs to reflect increased responsibilities, and
including more fixed hour positions and
cluster care for CHWs in home care.
Evaluating Together
Individual recommendations have a limited scope
and budget. The intention of evaluating
recommendations is to demonstrate whether
changed practices bring sufficient improvements to the recruitment and retention of RCAs, LPNs and
CHWs in this sector. Evaluating recommendations tells co-investing partners whether the sector is
achieving the desired changes and whether the HR strategy is moving forward. Evaluation is an essential
component of this strategy in order to be responsive. If strategies do not appear to be effective or if
conditions in the marketplace change, partner organizations must be prepared to respond quickly and
adjust the tactical goals and action plans. While evaluations are most often required by funding
organization, it is the culture of continuous improvement that will help to drive the HR Strategy forward,
benefiting the strategic direction of seniors care human resources and enabling a transparent and
accountable process. An evaluation plan has been included on Page 39 of this HR Strategy.
Quality care is directly dependent on how
workers who provide the care are supported.
This is ultimately about people. Conditions of
work need to make people feel valued. It comes
down to investment.
– Labour union representative
22
Four themes - including Planning, Attracting, Engaging, and Sharing Knowledge - form the basis of this
HR Strategy. Goal 1, planning for the future with the right partners, focuses on continued collaboration
with key stakeholders - such as the provincial government, educators and provincial committees - to
support informed decision-making on the demand for CHWs, RCAs, and LPNs. Goal 2, attracting the
right seniors care workers, relates to supporting informed decision making on the part of individuals
considering employment in the sector so that sector employers can attract workers who will stay in
their occupations. Goal 3, engaging seniors care workers in the right way, focuses on building and
developing an effective organizational culture that supports communication and employee engagement,
recognition, training and development. Goal 4, ensuring sector employers have the right knowledge,
has two components. The first focuses on increasing the desire and capacity to share knowledge and
resources to advance retention from all seniors care employers (including health authorities) with sector
employers. The second relates to motivating employers to improve recruitment and retention, both by
enumerating outcomes of retention initiatives and publicly recognizing the outstanding efforts of sector
employers.
Figure 3 HR Levers and Four Goals of the HR Strategy
THE HR STRATEGY
23
Goal 1: Planning for the future with the right partners
Recommendation 1.1
Develop a continuation plan for the Committee to oversee ongoing sector recruitment and
retention initiatives
It is recommended that the Committee develop a continuation plan to transition the Committee’s role
from one of planning and analysis to an implementation-focused role. The continued goal of the
Committee will be to support improved seniors care HR planning for the private and not-for-profit
sector. The purpose of the Committee will be to prioritize and oversee the implementation of sector
recruitment and retention initiatives outlined in this HR Strategy. This provincial body will continue to
engage stakeholders as required to implement sector-wide initiatives.
It is recommended that the following be considered and developed as part of the Committee’s
continuation plan:
• A revised scope and mandate of the Committee (i.e. focus on sector recruitment and retention
improvements).
• A revised Terms of Reference.
• A review of current membership. This may include inviting current members to remain on the
Committee and providing an opportunity for new members and/or representatives/delegates to
join (e.g. the BC Care Aide & Community Health Worker Registry, WorkSafe BC, representation
from private training institutions).
• A decision making protocol.
• An evaluation plan to facilitate maximum accountability to sector stakeholders (included in the
Evaluation section of this report).
Resource Estimated Budget
Contracted Chair to lead the development of a
revised Terms of Reference (inclusive of scope,
mandate and membership) and decision-making
protocol
$2,500
Recommendation 1.2
Establish a formal relationship with the Scheduling Joint Policy Table and invest in their work
to improve scheduling practices in home care
The need for more effective and efficient scheduling practices was identified as a top priority by all
stakeholders. Recognizing that the Scheduling Joint Policy Table is tasked with reviewing scheduling
practices across home care organizations, it is recommended that the Committee develop and foster
strategic alignment with the Scheduling Joint Policy Table rather than initiating its own separate
scheduling improvement strategies. To enhance the voice of sector issues, strategic alignment may be
operationalized by having a common member sit on both the Committee and the Scheduling Joint Policy
Table.
Together with the Scheduling Joint Policy Table, the Committee may contribute resources towards
BCGEU’s Re-Training Fund to ensure strategies designed to improved scheduling practices are also
24
piloted and/or implemented within the private and not-for-profit sector. Preliminary recommendations
of the Scheduling Joint Policy Table include a train-the-trainer approach whereby experienced and
skilled schedulers would work with employers, unions and newer schedulers to review current
scheduling practices and suggest more effective and efficient approaches to scheduling. Highly relevant
to this sector, this train-the-trainer approach also promises to develop the internal capacity of home
care organizations and minimize costs.
It is recommended that initiatives and learning be shared at the knowledge exchange forum
(Recommendation 4.2) and on an ongoing basis within the Community of Practice (Recommendation
4.4). Additionally, relevant materials can be placed on the shared electronic infrastructure
(Recommendation 4.3).
Resource Estimated Budget
Resources to support BCGEU’s Re-Training Fund
(i.e. Train-the-Trainer resources)
$30,000
Recommendation 1.3
Work with the BC Academic Health Council towards the increased involvement of private
sector employers and private training institutions in enacting the Council’s mandate
The BC Academic Health Council is a not-for-profit organization linking the health care and advanced
education sectors with a mandate to strengthen health profession education in BC. The Council
currently includes representation from health authorities and public post-secondary institutions in each
region of the province, as well as government ministries. The Council aims to strengthen regional
capacity and engage in province-wide activities that involve all health professions along the entire
continuum of health care. Private and not-for-profit employers employ approximately 33% of the RCAs,
CHWs, and LPNs in the province. Private
institutions train a large portion of these health
professions. These groups can make important
contributions towards the Council’s aim.
It is recommended that the Committee
collaborate with the BC Academic Health Council
to identify the best ways to include private and not-for-profit sector employers and private training
institutions in this strategic forum. The following opportunities may be considered when discussing
approaches for including private and not-for-profit sector employers and private training institutions in
this strategic forum:
- Increasing dialogue between sector employers and ministries, post-secondary institutions and
private training institutions about regional demand for RCA, CHW and LPN graduates.
- Contributing to and promoting awareness among private training institutions of the demand for
CHWs, RCAs, and LPNs in the province.
- Encouraging private training institutions to realistically portray BC employment prospects for CHWs,
RCAs, and LPNs.
Resource Estimated Budget
No budget allocated
As an educator, we need to know what the
demands are in various regions. Right now, we
are relying on conversations we have with the
health authority.
-Stakeholder from Private Training Institution
25
Recommendation 1.4
Collaborate with health system partners to measure and monitor supply and demand for
CHWs, LPNs and RCAs within the sector
As set forth in performance expectations from the Ministry of Health Services, the Health Employers
Association of British Columbia (HEABC) conducts the British Columbia Health Authorities Recruitment
and Retention Survey on an annual basis to inform provincial planning for health human resources. The
Committee initiated the first Recruitment and Retention Survey for the private and not-for-profit sector
as part its work through the Labour Market Partnership Agreement in 2010. It is recommended that this
work be undertaken on an annual basis to improve the decision-making ability of regulatory bodies and
educational institutions. The scope of work for HEABC includes survey design, data collection (often
including follow-up with employers), supply and demand analysis, and forecasting. It is recommended
that the Committee engage public sector partners in investing in this annual measurement. If successful,
it is recommended that the Committee also contribute to the design of the measurement instrument,
encourage participation of sector employers, and ensure their information needs are met in the report
of survey findings.
Resource Estimated Budget
Contract with HEABC to carry out Recruitment
and Retention Survey for the sector annually
$25,000
Total over 2 Years $50,000
Recommendation 1.5
Evaluate HR Strategy
An important component of the HR strategy is a comprehensive evaluation plan. The evaluation
framework will help to guide the Committee in determining whether the suggested recommendations
were implemented as intended and whether they achieve (or are on the way to achieving) intended
outcomes. The evaluation framework included in the Evaluation section of this HR Strategy has been
designed with a continuous improvement lens to determine whether recommendations are on the right
track toward accurately addressing specified retention and recruitment challenges. The evaluation plan
has also been designed to be practical and commensurate with the magnitude of the implementation
budget.
In keeping with a continuous improvement model, it is recommended that the Committee:
• hire an independent consultant to evaluate progress on an annual basis
• use findings to determine subsequent years’ priorities and adapt/develop further
recommendations.
Throughout the recommendations, specific evaluation components have been noted. The costs below
account for a strategy-wide evaluation on an annual basis. Findings may be shared at the BCCPA’s AGM
or the knowledge exchange forum for health system partners described in Recommendation 4.2 as a
way of enhancing transparency with partner organizations.
Resource Estimated Budget
Contract with consultant to evaluate
recommendations
$15,000 annually
Total over 2 years $30,000
26
Goal 2: Attracting the right seniors care workers
Recommendation 2.1
Develop and launch a “warts and all” campaign for the CHW, RCA and LPN occupations
It is recommended that the Committee develop a campaign that sheds light on both the realities (casual
employment, shift work, and the nature of the work) as well as the significant intrinsic benefits of each
career. The campaign could build upon the BC Cares program by encouraging employers and
educational institutions to use similar, realistic career outlooks in their advertising. The campaign will
feature seniors care workers telling their own stories about what motivates them to work in the sector
and key facts about employment in the occupation. The campaign may include the following materials
featuring seniors care workers in each occupation:
• Downloadable poster.
• Print public service announcements
(PSAs) for publication in magazines or
newspapers.
• Campaign brochure for each occupation.23
• 5-10 minute documentary style video.
The Committee may wish to select a contractor
who can assist the campaign through appropriate
social networking channels and encourage viral
distribution of campaign materials (especially
videos). For ease of uptake, it is recommended
that campaign materials be made available in an
online toolkit.24 The Committee is encouraged to
engage existing and new partners in the launch of
the campaign. Through distribution partnerships
with stakeholders in the education sector, the
campaign will aim to encourage labour force
entrants with more realistic expectations that will
stay within the occupation. Through distribution
partnerships with stakeholders in the health
sector – such as sector employers, the Health
Employees Union (HEU), HEABC, and CLPNBC – the campaign will promote recognition of the essential
nature of services provided by these occupations. The intrinsic value of work – the belief that their job is
important and they are needed - can continue to motivate seniors care workers even when work
conditions are unsatisfactory.25 Please see Recommendation 3.2 (Seniors Care Appreciation Days) for an
example of how the campaign may be used to plan an event.
23
The content in the A Day in the Life of a Fire Protection Inspector
(http://www.hrsdc.gc.ca/eng/labour/news_events/2007/071023.shtml) provides an example of some of the content that could
be covered in a brochure. 24
The National Heart Lung and Blood Institute’s online toolkit for The Heart Truth Campaign provides an excellent example of
this. (located at http://www.nhlbi.nih.gov/educational/hearttruth/materials/index.htm) 25
Andersen E. (2009) Working in Long-Term Residential Care: A Qualitative Metasummary Encompassing Roles, Working
Environments, Work Satisfaction, and Factors Affecting Recruitment and Retention of Nurse Aides. Global Journal of Health
Sciences.
I tell the students if you are in this for the
money, you might as well leave now because
you are going to be so stressed out and tired
that the money won’t even matter. You’ll be
emotionally overwhelmed. It will be difficult to
be part of the residents’ and families’
experience at the end of life. However, if you
are doing this because you really care about
people, stay in this occupation. You will fall in
love over and over with the seniors.
– Residential Care Aide and part-time
instructor for Health Care Assistants
Educating the public about these occupations is
very important to recruitment and retention. –
Educator
27
Resource Estimated Budget
Contract with designer to develop campaign
materials and launch online
$12,500
Contract with Communications specialist to
develop campaign videos
$10,000
Contract with Communications specialist to
develop and execute social media strategy
$5,000
Recommendation 2.2
Develop workshop for CHWs in the mentorship/preceptorship of HCA students
It is recommended that the Committee engage an educator to develop a workshop and materials for
CHWs in the mentorship/preceptorship of HCA students. The scope of work should include
recommendations of the CHWs that would be best qualified and suited to mentor/preceptor HCA
students. Large sector employers with an in-house Educator may deliver the workshop to prospective
CHW mentors. Other home care employers that are looking to boost recruitment by investing in
practicums may wish to utilize the shared Educator position (Recommendation 4.1) to deliver this
workshop to their staff. This recommendation addresses just one of the barriers to practicums within
home care so HCA students have greater exposure to work in the home care setting. The workshop
materials may be shared with employers using an online resource sharing infrastructure (see
Recommendation 4.3).
Resource Estimated Budget
Contracted educator to develop workshop
materials
$5,000
28
Goal 3: Engaging seniors care workers in the right way
Recommendation 3.1
Develop workshops for the health care team members who supervise CHWs and RCAs to
appreciate their competencies and contributions
In 2007 the release of the Framework of Practice for Community Health Workers and Resident Care
Attendants, introduced formal competencies RCAs and CHWs. It is recommended that the Committee
oversee the development of a workshop to further educate health care professionals who
supervise/manage RCAs and CHWs in the competencies of these team members. This recommendation
was also brought forward in the aforementioned Framework and aligns with the work of the Facilities
Bargaining Association Joint Policy Committee on Care Aide utilization, outlined in the Effectively
Utilizing BC's LPNs and Care Aides in 2007. A better understanding of capabilities equips RNs and LPNs in
residential care and LPNs and schedulers in home care to: better utilize RCAs and CHWs, involve them in
care planning, and act on their suggestions. Contributing to seniors care in these ways makes RCAs’ and
CHWs’ work - both through their relationships with coworkers and clients - more meaningful and
improves retention. Having their experience
valued in care planning has a proven significant
positive effect on RCA turnover, more so than
other types of retention initiatives.26 It is
recommended that the Committee contract an
educator to develop the half-day workshop
curriculum, utilizing existing resources where
possible (i.e. resources made available on the
shared online infrastructure). It is recommended
that the Nurse Educator engage CHWs and RCAs
to determine opportunities for involvement in curriculum development and co-presentation. As a way
of demonstrating the importance of including
CHWs and RCAs in the health care team, it is
suggested that CHWs and RCAs be encouraged to
co-present several topics on the workshop agenda
(e.g. a day in the life of a CHW or an RCA). The
workshop curriculum would be made available to all health care team members who supervise CHWs
and RCAs, including schedulers.
Workshop curriculum may be available for download on the online infrastructure (Recommendation
4.3). Additionally, Community of Practice (Recommendation 4.4) members may discuss lessons learned
from workshop session curriculum and participant feedback as a way of continuously improving future
sessions.
Resource Estimated Budget
Contracted Shared Nurse Educator to develop
curriculum
$3,500
26
Banaszak-Holl J & Hines MA. (1996). Factors Associated with Nursing Home Staff Turnover. The Gerontologist. 36(4): 512-517
Retrieved from: http://gerontologist.oxfordjournals.org/content/36/4/512.full.pdf+html
The number one issue is respect. To me, care
aides are an integral part of making facilities
function. They are not given respect of what
they’re capable of doing from nurses and
physicians. We need to start respecting each
other and recognizing what we’re all capable of
doing.
– Health System Partner
I think we (RCAs) should be involved more. We
should be part of the care conferences.
- Residential Care Aide
29
Recommendation 3.2
Develop and launch an appreciation day for Seniors Care Workers
It is recommended that the Committee collaborate with partners to launch an annual Seniors Care
Worker Appreciation Day. The Committee is encouraged to engage the Ministry of Health Services to
coordinate Ministerial announcement of the Appreciation Day. The online toolkit (described in
Recommendation 2.1) may be expanded to contain activity ideas and materials to help partners,
especially sector employers, plan their own Appreciation Day events. For example, the campaign
materials for each occupation (Recommendation 2.1) may help sector employers bring their employees
to center stage during an event. The Committee is encouraged to engage other partners in promoting
the Appreciation Day. For example, labour unions may be willing to broadcast an appreciation message
to their members, host a regional event, or encourage any sector employers they have contact with to
develop their own Appreciation Day activities. Additionally, associations or societies focused on BC’s
seniors (e.g. the Alzheimer Society of BC) may also wish to sponsor, host or implement an appreciation
activity. An activity registry may also be included in the online toolkit, allowing sector employers and
other organizations to share what they have done and learn about what other groups across the
province are doing to appreciate CHWs, RCAs, and LPNs.
Resource Estimated Budget
Contractor to develop online events toolkit $5,000
Recommendation 3.3
Identify areas throughout the province where opportunities for cluster care exist
Cluster care has been identified as a best practice for providing home care to seniors (see Appendix B).
Benefits include improved client and worker satisfaction and fewer sick days and injuries. Recognizing
geographic differences and variances in employer priorities across the province, an interim step is
suggested before recommending cluster care pilots be established thought the province. It is
recommended that the Committee commission a review of feasible areas within BC for cluster care
pilots to take place. This will provide an accurate scan to help inform the allocation of financial resources
to support future cluster care models (see Workflow pilot, Recommendation 3.4). The Committee may
contract a consultant to undertake a practical review, eliciting input from stakeholders, including
schedulers.
In identifying regions of the province where cluster care opportunities exist, it is possible that the
definition of cluster care may be expanded to include scheduling by geographic grids (i.e. areas of a
community in addition to the current definition of high density buildings). An expanded definition may
allow for more flexible approaches to cluster care that support improved client and worker outcomes in
less densely populated areas of BC, such as smaller and more rural communities. To ensure efforts
remain aligned, it is recommended that the review and/or the consideration of an expanded definition
be an agenda item with the Scheduling Joint Policy Table, (See Recommendation 1.2) as well as with the
Ministry of Health Services.
Resource Estimated Budget
Consultant to conduct environmental
scan/feasibility study
$10,000
30
Recommendation 3.4
Pilot Workflow positions in home care provider organizations co-investing in the
development of cluster care
Public sector employers across the province have piloted workflow (team leader) positions to help
provide coordination and support for CHWs. These positions have also helped to increase opportunities
for CHW input into client care planning, particularly in a cluster care environment. Another benefit of
the workflow position is that this role serves as a liaison between the CHW and the supervisor –
enabling a more neutral and client-centric approach. It is recommended that the Committee pilot 5 part-
time workflow positions across the province for a 12-month period. This recommendation is based on
the best practice described in Appendix B. This recommendation requires financial and in-kind
contributions from a partnership of sector employers, labour unions, and public sector employers.
To ensure the objectives have been met and the benefits of the workflow positions outweigh the costs,
it is also recommended that the Committee undertake an evaluation of the pilot at the end of the 12-
month period. Anticipated outcomes are relevant to CHWs and labour unions, employers, and clients:
• decreased staff turn-over and sick time (benefitting employers), and
• improved communication between health care team members and job satisfaction (benefitting
CHWs).
• improved quality and continuity of care (benefitting clients and their families).
Resource Estimated Budget
Training/start-up $2,000
Workflow positions (cost estimated at 1 hour/day/
leader for 12 months at $21/hour (inc. 20%
benefits) for 1-2 positions at 5 organizations
$45,360
Evaluation $3,000
Total Cost $50,360
Recommendation 3.5
Pilot 80/20 Late Career and New Mentorship Program
It is recommended that the Committee pilot an 80/20 Late Career and New Mentorship Program within
the sector. This recommendation is based on the best practice described in Appendix B. The pilot would
include an 80/20 staffing model, releasing several late career LPNs from their workload for the
equivalent of 1 day (20%) a week, to mentor next-generation LPNs. The most significant costs of
implementing the pilot will be the 20% backfill required to assume the workload of the Mentor LPN. The
pilot will require financial and in-kind contributions from a partnership of sector employers, labour
unions and/or public sector employers. The Committee would work with potential partners to
understand their desire and capacity to support this pilot through in-kind or financial contributions, and
to formalize commitments through Letters of Support and Memorandums of Understanding. To increase
the feasibility of obtaining partner commitments to the pilot, it is recommended that the pilot run for 6
months and be offered for 15 LPNs in the province. After securing sufficient commitment, it is
recommended that the Committee establish a Sub-Committee to:
• determine criteria for the selection of pilot sites
31
• engage contractors to develop and/or deliver pilot resources, and
• oversee the development, implementation, and evaluation of the pilot.
The evaluation should enumerate the costs of the program as well as anticipated benefits from multiple
perspectives. These may include: increased job satisfaction, delayed retirement and reduced injuries for
late career LPNs (mentors), increased job satisfaction and reduced turnover for new nurse graduates
(mentees), decreased workload for LPN and RN supervisors, and decreased human resource and training
costs for employers.
Resource Estimated Budget
Estimated late career LPN salary (54K + 20% benefits) x
½ year x 20% backfill x 15 participants
$97,200
Project coordinator to develop and coordinate pilot $30,000
Educator to deliver workshops to pilot participants $5,000
Pilot evaluation $10,000
Total $142,200
Recommendation 3.6
Collaborate with the Ministry of Advanced Education to train new Canadians in the expected
responses and practices within home care and residential care.
It is recommended that the Committee collaborate with the Ministry of Advanced Education to adapt
curriculum on Professional Communication for Internationally Educated Health Professionals (IEHP) for
RCA and CHW occupations. The Ministry’s curriculum is aimed at training unemployed IEHPs and new
Canadians in the expected responses and practices in health care settings. This curriculum is shared with
partners and delivered at a post-secondary institution by a team of instructors, including experienced
health professionals that can coach participants in context-appropriate responses and practices. The
Ministry is currently adapting this curriculum so it is applicable to employed health professionals and
estimates that this curriculum can be delivered in 60 instructional hours. It is recommended that the
Committee meet with the Ministry to express its interest in seeing the curriculum tailored to RCA and
CHW occupations and participating in a pilot of this curriculum.
Resource Estimated Budget
Cost of adapting the curriculum cannot be estimated at
this time
--
Cost of piloting the curriculum at one facility $10,000
32
Goal 4: Ensuring sector employers have the right
knowledge
Recommendation 4.1
Develop a shared Nurse Educator position for sector employers
It is recommended that the Committee facilitate a joint initiative for sector employers that do not have
the in-house resources to deliver curriculum described within this HR Strategy. A shared service for an
Educator to deliver education to CHWs, RCAs, and LPNs (including collaborative learning) will be
designed to enable sector employers to achieve more collectively than one could independently. The
Committee (or contractor) could issue an Expression of Interest to sector employers for the
development of a shared Educator position. This should include an Educator Needs Assessment to
estimate the number of annual educator hours each sector employer could/would utilize, as well as to
understand the desired skills and experience for this shared resource. The implementation of
recommendations within this HR Strategy could support approximately a 0.5 FTE (see Recommendations
2.2, 3.1, 2.5, 4.3, and 4.6). Based on the Needs Assessment, the Committee would identify the cost of
the service to each prospective sector employer. Provided there is sufficient interest from sector
employers, it is recommended that the Committee develop an agreement between two or more sector
employers to contract a Nurse Educator. It is recommended that this shared service be evaluated after
one year, considering: employer satisfaction with the service, perceived value for money, as well as any
changes in employee satisfaction and/or retention. If the shared service is successful, the Committee
may want to extend the pilot and collaborate with partners on regional shared services for other
support functions, such as management of casual pools.
Resource Estimated Budget
Contractor to conduct Needs Assessment,
develop position description and estimate costs
to participating employers
$5,000
Contractor to interview, engage, contract and
evaluate Educator on behalf of participating
employers
$5,000
Total $10,000
Recommendation 4.2
Host a knowledge exchange forum for health system partners to share best practices
A multitude of innovative practices to support retention already exist across the health system. The
stakeholder consultation revealed that public sector best practices have not been transferred to affiliate
residential care facilities or contracted home care providers within this sector. Health system partners
agree that all employers, but especially sector employers, would benefit best practices, spread
knowledge, and build sector capacity. It is therefore recommended that the Committee host a
knowledge exchange forum for health system partners to this end. Benefits of bringing health system
33
partners together include informal networking, sharing of best practices (including details of approach,
tools), and overcoming incorrect assumptions and perceptions.
Topics of discussion may include sharing evaluation findings from recruitment and retention pilots, as
well as sharing other practical and innovative practices to support retention, such as split-shift
scheduling in home care, cultural training and orientation, maximizing use of communication tools (such
as Let’s Talk), RCA peer mentorship (i.e. ceiling lift coaching), and Return to Service Agreements.
It is recommended that the Committee work closely with the BCCPA to plan the knowledge exchange
forum. It will be crucial that other health system partners are engaged leading up to and during the
forum. For example, having education, labour, industry and government partners co-present speaks to
the importance of multi-disciplinary collaboration in implementing best practices. There may be an
opportunity to liaise with public sector employers by inviting health authority speakers to present on the
successes of pilot projects in the public sector environment. It is anticipated that outcomes of the
knowledge sharing forum include the development of an online resource infrastructure
(Recommendation 4.3) and a Community of Practice (Recommendation 4.4).
Resource Estimated Budget
Committee to contract management of the
Forum ($20,000 annual budget)
$20,000 annually
Total over 2 years $40,000
Recommendation 4.3
Compile existing curriculum from health system partners to develop an online resource for
collaborative learning
To retain the frontline care providers necessary to provide high quality care to seniors, stakeholders
have identified the need and desire to share practical resources with sector employers. Resources to
support retaining CHWs, RCAs, and in particular LPNs, include people development resources, such as
training modules in dementia, alzheimers, palliative care, and stress management that are suitable for
collaborative learning. It is recommended that the Committee develop an electronic infrastructure to
support the Community of Practice (Recommendation 4.4) and sustain the learnings from the
knowledge exchange forum (Recommendation 4.2). It is recommended that the Nurse Educator
contracted by the Committee (Recommendation
4.1) compile the resources, with input from health
system partners. The rationale behind this
approach is that there are expected synergies
with the compilation of resource materials and
the education sessions to be delivered.
Resource Estimated Budget
Nurse Educator to compile resources $4,000
Online software/web application (e.g.
Sharepoint)
$14,000
Maintenance of online forum $2,000
Total $20,000
Education is priority. It’s another way to
engage staff and for them to connect with each
other.
- Employer
34
Recommendation 4.4
Develop a Community of Practice to encourage health system partners to share best practices
and resources
The establishment of a Community of Practice (CoP) is recommended to support and sustain the sharing
of best practices, spread of knowledge, and increased sector capacity to retain CHWs, RCAs, and LPNs. It
is recommended that the Committee initiate a multidisciplinary CoP created specifically with the goal of
sharing knowledge related to recruitment and retention challenges in seniors care. It is through the
process of sharing information and experiences that group members learn from each other and also
have an opportunity to develop themselves personally and professionally. It is recommended that the
CoP be one of the outcomes from the knowledge exchange forum (Recommendation 4.2) and that it be
supported through a tangible resource sharing mechanism, such as an online resource sharing
infrastructure (Recommendation 4.3). Like the knowledge exchange forum, membership should be
inclusive of education, labour, industry (i.e. sector employers) and government partners (e.g. health
authorities). This membership will ensure that members have access to best practices and knowledge
from a complement of health system partners. The Committee may wish to Chair the first meeting and
then seek rotating chairs to demonstrate commitment to collaboration. While the CoP does not have a
reporting structure per se, it is recommended that minutes be taken and key points be shared with the
Committee though a common member.
Resource Estimated Budget
Membership development, initial meeting start-
up (including Committee Chair to facilitate first
meeting) and resources to support ongoing
meetings
$7,500
Recommendation 4.5
Conduct an environmental scan of Fixed Hour pilots and projects in the province
Several public sector employers have piloted and/or are continue to offer Fixed Hour positions to CHWs.
It is recommended that the Committee engage a contractor to conduct an environmental scan of Fixed
Hour Positions in the province to understand the feasibility for private sector employers. This
engagement would begin by working with sector employers to understand the information required
before attempting a Fixed Hour pilot. The environmental scan would likely include understanding
variations in the design of the Fixed Hour positions (e.g. 4-hour, 6-hour or 8-hour), CHW eligibility for
Fixed Hour positions, as well as enumerating costs and benefits, lessons learned and key success factors
associated with each design. It is recommended that the findings of the environmental scan be shared
with employers at the knowledge exchange forum (see Recommendation 4.2) and be used to
collaborate with partners on a Fixed Hour pilot for the sector.
Resource Estimated Budget
Contractor to conduct environmental scan $10,000
35
Recommendation 4.6
Bring resources for Responsive Shift Scheduling to residential care employers
Responsive Shift Scheduling refers to a scheduling approach that matches patient/resident needs with
care givers scheduling preferences. A province wide Responsive Shift Scheduling pilot project was
completed at 6 residential care sites in 2008 and proved to positively impact employee’s attitude, level
of energy, and time to spend with residents and pursue education. (Please see Best Practice in Appendix
B.) Responsive Shift Scheduling was sustained in several of the participating sites following the pilot.
While an affiliate residential care site participated in the pilot and a resource binder from the pilot is
available for public download, the benefits of responsive shift scheduling has not spread to other sector
employers. It is recommended that the Committee make the Responsive Shift Scheduling resources
available to sector employers. The scope of this work would include adapting the established resource
materials to the sector as necessary. More importantly, the scope of work will include the Committee
establishing the knowledge resources required to implement Responsive Shift Scheduling, including a
project coordinator, labour union endorsement and advice, and access to scheduling experts. Sector
employers would be invited to participate (potentially at the forum described in Recommendation 4.2)
and guided through implementation by a contracted Responsive Shift Scheduling coordinator.
Resource Estimated Budget
Contractor to adapt resources for sector $3,500
Contractor(s) to provide scheduling expertise $5,000
Project coordinator available to sector employers $12,500
Evaluation and knowledge sharing activities $5,000
Total $26,000
Recommendation 4.7
Invest in improving manager’s ability to relate to as well as the skills of new Canadians that
are employed as RCAs and CHWs
During the stakeholder consultation, several employers and educational institutions commented on the
significant number of new Canadians/immigrants entering or working in these occupations, and the
barriers to these CHWs and RCAs succeeding in these occupations. Sociocultural competence is a term
used to describe a person’s ability to express their ideas in a new language in a way that is appropriate
to social and cultural context. Training in sociocultural competency applied by VCC to many of its
programs, is a proven approach for improving the interpersonal skills newcomers and immigrants need
to succeed in the workplace. VCC offers the training that is specific to the health care work environment
and equips participants to become sociocultural competency facilitators. This training represents an
opportunity for sector employers to invest in developing the key staff that supervise, manage, or
educate RCAs or CHWs that are more recent immigrants or Canadians. It is recommended that the
Committee sponsor the training of 10 employees (supervisors, managers, and educators) from sector
employers. An anticipated outcome would include participants at the supervisor level having an
increased understanding of cultural values and practices. They would also be expected to assist RCAs
and CHWs (and perhaps other managerial staff) in learning of and translating contextualized and
culturally appropriate norms and behaviours into practice.
Resource Estimated Budget
36
$625 each for 10 participants from sector
employers
$7,000
Recommendation 4.8
Develop and launch awards for excellence in seniors care to recognize sector employers for
outstanding work environments
Both private and not-for-profit employers in the sector are operating with very lean budgets. Even so,
the stakeholder consultation uncovered several sector employers that were offering training and skills
development, in addition to other innovative approaches, to make a significant difference in the quality
of their employees’ lives. These employers merit recognition. Similarly, other employers who may not be
investing in retention may be motivated to do so if they knew these efforts would be recognized and
have the potential to translate into recruitment and retention benefits. It is recommended that a
strategic partner (e.g. Ministry of Health Services) or the Committee – as a group also representing
employers, labour unions, and educators - establish an Excellence in Seniors Care Awards to recognize
sector employers for outstanding work environments. The Excellence in Seniors Care Awards recognizes
this truism: the way you treat your employees is the way they will treat clients.
The Excellence in Seniors Care Awards may include award categories such as scheduling practices or
professional development initiatives that
positively impact the work lives of CHWs, RCAs,
and LPNs. The Committee or strategic partner
may consider offering an award in partnership
with HEABC’s Excellence in BC Health Care Awards
for one of these categories (e.g. their program’s
Workplace Health Innovation). CHWs, RCAs, and LPNs will be invited to nominate any company that
they believe goes above and beyond and should be recognized as one of the private or not-for-profit
sector’s top employers. The Committee is encouraged to engage partners in promoting this opportunity
to CHWs, RCAs, and LPNs. For example, labour unions and/or professional associations may advise their
members of the opportunity to nominate sector employers. Nomination submissions may ask for a
description of the initiative, its implementation, and results, such as measures of workplace satisfaction
(i.e. recruitment, retention, engagement, performance). It is recommended that the Committee or
strategic partner leading the awards establish clear awards criteria and an Awards Committee with a
screening process whereby the Awards Committee reviews the nomination forms and conduct on-site
interviews to establish eligibility for the award. It is recommended that announcements of award
recipients be split between at least two events throughout the year, one of these perhaps being the
BCCPA AGM and another at the knowledge exchange forum described in Recommendation 4.2.
Resource Estimated Budget
Development of award categories, eligibility
criteria, and nomination process
$3,000
Promotion of awards program $2,000
Ongoing operating costs for Awards Committee $5,000
Treating employees well and getting them to
love their work is a core business principle.
- Employer
37
2-Year HR Strategy Action Plan
Recommendation Lead Role Dependencies Suggested
Implementation
Timeframe
Estimated
Budget
Planning for the future with the right partners 1.1 Develop a continuation plan for the Committee to oversee
ongoing sector recruitment and retention initiatives
TBD at future
Ctte meeting
-- Jan/Feb 2011 $2,500
1.2 Establish a formal relationship with the Scheduling Joint Policy
Table and invest in their work to improve scheduling practices
in home care
-- Feb/Mar 2011 $30,000
1.3 Work with the BC Academic Health Council towards the
increased involvement of sector employers and private training
institutions in enacting the Council’s mandate
-- Feb 2011 $0
1.4 Collaborate with health system partners to measure and
monitor supply and demand for CHWs, RCAs and LPNs within
the sector
$ TBD* May 2011 & May
2012
$50,000
1.5 Evaluate HR Strategy Dec 2011 & Dec
2012
$30,000
Attracting the right seniors care workers 2.1 Develop and launch a “warts and all” campaign for the CHW,
RCA and LPN occupations
April 2011 $27,500
2.2 Develop workshop for CHWs in the mentorship/preceptorship
of HCA students
4.1 Dec 2011 $5,000
Engaging seniors care workers in the right way
3.1 Develop workshops for the health care team members who
supervise CHWs and RCAs to appreciate their competencies
and contributions
4.1 Dec 2011 $3,500
3.2 Develop and launch an appreciation day for Seniors Care
Workers
2.1 May 2011 $5,000
3.3 Identify areas throughout the province where opportunities for
cluster care exist
1.2 July 2011 $10,000
3.4 Pilot Workflow positions in home care provider organizations $ TBD*, 3.3, 4.5 Mar/Apr 2012 $50,360
38
Recommendation Lead Role Dependencies Suggested
Implementation
Timeframe
Estimated
Budget
co-investing in the development of cluster care
3.5 Pilot 80/20 Late Career and New Mentorship Program $ TBD*, 4.1 Dec 2011 $142,200
3.6 Collaborate with the Ministry of Advanced Education to train
new Canadians in the expected responses and practices within
home care and residential care
-- Jan/Feb 2012 $0
Ensuring sector employers have the right knowledge
4.1 Develop a shared Nurse Educator position for sector employers -- Oct 2011 $10,000
4.2 Host a knowledge exchange forum for health system partners
to share best practices
-- Oct 2011 & Oct
2012
$40,000
4.3 Compile existing curriculum from health system partners to
develop an online resource for collaborative learning (and
maintain)
4.1 Nov 2011 to Dec
2012
$20,000
4.4 Develop a Community of Practice to encourage health system
partners to share best practices and resources
4.2 Oct 2011 $7,500
4.5 Conduct an environmental scan of Fixed Hour pilots and
projects in the province
3.3 Aug 2011 $10,000
4.6 Bring resources for Responsive Shift Scheduling to residential
care employers
4.2 Oct 2011 $26,000
4.7 Invest in improving manager’s ability to relate to as well as the
skills of new Canadians that are employed as RCAs and CHWs
$ TBD* Jan 2012 $7,000
4.8 Develop and launch awards for excellence in seniors care to
recognize sector employers for outstanding work
environments
Jun 2011 $10,000
Total $486,560
*Dependencies include obtaining commitment of financial contributions from a partnership of sector employers, labour unions and public sector employers.
39
The evaluation framework below is designed to provide the Committee with a continuous improvement lens through which to determine
whether recommendations are on the right track toward accurately addressing specified retention and recruitment challenges. The majority of
indicators in this evaluation plan are output rather than outcome indicators. The outcomes, or impact, of the recommendations (i.e. changes in
behaviour and knowledge) likely won’t be realized within the two-year time frame of this strategy. Additionally, outcomes are not solely within
the control of the Committee whereas outputs, the direct products of activities, are.
The majority of the indicators below can be gleaned from interviews with key stakeholders (i.e. measures of satisfaction and perceptions) and a
review of administrative data. This practical approach is intended to provide a feasible and cost-conscious evaluation.
Recommendation Indicators
Planning for the future with the right partners 1.1 Develop a continuation plan for the Committee to oversee
ongoing sector recruitment and retention initiatives
• Stakeholder satisfaction with Sector recruitment and retention prioritization
process
• Committee Terms of Reference revised (including scope, mandate and
membership)
• Decision making protocol developed
• Stakeholder satisfaction with the development of the decision making
protocol and the degree to which it is followed
• Stakeholder satisfaction with engagement in implementing sector-wide
initiatives
1.2 Establish a formal relationship with the Scheduling Joint Policy
Table and invest in their work to improve scheduling practices
in home care
• Committee member regularly sits on Joint Policy Table
• Stakeholder satisfaction with degree of alignment between Committee and
Joint Policy Table scheduling priorities
• At least 2 scheduling improvement initiatives developed and implemented
with joint funding
• Stakeholder satisfaction with implementation (and outcome(s), if possible) of
EVALUATION PLAN
40
Recommendation Indicators
scheduling initiatives
1.3 Work with the BC Academic Health Council towards the
increased involvement of sector employers and private training
institutions in enacting the Council’s mandate
• Stakeholder perception that dialogue between sector employers and
ministries, post-secondary institutions and private training institutions about
regional demand for RCA, CHW, and LPN graduates has increased (year 1
baseline, year 2 aim for 15% increase)
• Stakeholder perception of increased awareness among private training
institutions of the demand for CHWs, RCAs, and LPNs in the province (year 1
baseline, year 2 aim for 15% increase)
• Stakeholder perceptions that private training institutions are increasingly
realistically portraying BC employment prospects for CHWs, RCAs, and LPNs
(year 1 baseline, year 2 aim for 10% increase)
1.4 Collaborate with health system partners to measure and
monitor supply and demand for CHWs, RCAs and LPNs within
the sector
• Private and not-for-profit sector Recruitment and Retention Survey
undertaken on an annual basis
• Report developed and shared with stakeholders
• Stakeholder satisfaction with sector employer participation
1.5 Evaluate HR Strategy • Stakeholder satisfaction with degree to which evaluation findings are used to
generate continuous improvements (year 1 baseline, year 2 aim for 75%
satisfaction)
Attracting the right seniors care workers 2.1 Develop and launch a “warts and all” campaign for the CHW,
RCA, and LPN occupations
• # poster downloads
• # print PSAs published in magazines or newspapers
• # campaign brochures downloaded
• # videos downloaded
• # social media links
• Stakeholder satisfaction with degree to which campaign aims to encourage
labour force entrants with more realistic expectations that will stay within
the occupation
• Stakeholder satisfaction with the degree to which the campaign sheds light
on the realities and significant intrinsic benefits of each career
2.2 Develop workshop for CHWs in the mentorship/preceptorship
of HCA students
• Stakeholder satisfaction with quality of workshops and relevance/usefulness
of materials
• # workshops delivered
41
Recommendation Indicators
• # and type of workshop attendee
• # downloads of materials
Engaging seniors care workers in the right way
3.1 Develop workshops for the health care team members who
supervise CHWs and RCAs to appreciate their competencies
and contributions
• # workshops delivered
• # and type of workshop attendees
• # RCAs and CHWs who co-present
• # workshop curriculum downloads
• Stakeholder satisfaction with content educated health care professionals
who supervise/manage RCAs/CHW in their respective competencies
3.2 Develop and launch an appreciation day for Seniors Care
Workers
• #/type of media announcement downloads
• # toolkit downloads
• # and type of partners engaged
3.3 Identify areas throughout the province where opportunities for
cluster care exist
• # and type of stakeholder engaged in review
• Greater awareness of areas within BC where cluster care pilots are feasible
• Increased employer interest in conducting cluster care pilots
• Expanded definition of cluster care provincially adopted and endorsed by the
Ministry of Health Services
3.4 Pilot Workflow positions in home care provider organizations
co-investing in the development of cluster care
• Financial and in-kind contributions secured from a partnership of sector
employers, labour unions and public sector employers
• Detailed workflow evaluation plan to be developed
3.5 Pilot 80/20 Late Career and New Mentorship Program • Financial and in-kind contributions secured from a partnership of sector
employers, labour unions and public sector employers
• Detailed 80/20 Mentorship Program evaluation plan to be developed
3.6 Collaborate with the Ministry of Advanced Education to train
new Canadians in the expected responses and practices within
home care and residential care
• Increased interest by Ministry of Advanced Education Ministry to tailor RCA
and CHW curriculum and participate in a pilot of this curriculum.
• Curriculum on Professional Communication for Internationally Educated
Health Professionals for RCA and CHW occupations adapted
• # and type of partners curriculum shared with
Ensuring sector employers have the right knowledge
4.1 Develop a shared Nurse Educator position for sector employers • #/type of expressions of interest from employers
• Detailed shared Nurse Educator position evaluation plan to be developed
4.2 Host a knowledge exchange forum for health system partners • #/type of attendees
42
Recommendation Indicators
to share best practices • #/type of co-presented sessions
• Stakeholder satisfaction with networking opportunities and sharing of best
practices
• Increased stakeholder awareness of best practices
4.3 Compile existing curriculum from health system partners to
develop an online resource for collaborative learning
• Stakeholder satisfaction with relevance and usefulness of resources
• #/type of material downloads
4.4 Develop a Community of Practice to encourage health system
partners to share best practices and resources
• #/type of members
• Member attendance
• Member satisfaction with relevance of meetings and resources
4.5 Conduct an environmental scan of Fixed Hour pilots and
projects in the province
• # and type of variations in the design of the Fixed Hour positions
• Costs and benefits enumerated
• # downloads of environmental scan
4.6 Bring resources for Responsive Shift Scheduling to residential
care employers
• Resource materials adapted to the sector
• Stakeholder perception of usefulness and relevance of materials
• #/type resources secured
4.7 Invest in improving managers ability to relate to as well as the
skills of new Canadians that are employed as RCAs and CHWs
• #/type of employees who participate in training
• Increased participant understanding of cultural values and practices
• # RCAs/CHWs assisted in learning contextualized and culturally appropriate
norms and behaviours
4.8 Develop and launch awards for excellence in seniors care to
recognize sector employers for outstanding work
environments
• #/type of employers nominated
• #/type of innovative practices highlighted
• #/type of media announcement downloads
43
This HR Strategy includes recommendations that specifically address the following expectations in the
Committee’s Terms of Reference:
Expectations of Committee included in Terms of Reference Recommendation
� Facilitate communication and develop the partnerships
needed to research, plan, and develop a subsector-wide
strategy that can be implemented by the key stakeholders,
such as the associations, career information and employment
service providers, educational institutions and other training
providers.
1.1,1.2,1.3, 3.3, 3.4, 3.5, 4.2, 4.4, 4.5,
4.8
� Improve the matching of, or balance between, the supply and
demand sides of the non-profit and private seniors care
sector.
1.3,1.4, 2.1
� Develop workforce measures to ensure that the sector has
the capacity and human resources required to sustain and
support the growth and adjustment of their Sector.
1.4
� Continue the momentum and work of the BC Cares initiative
in order to design and implement a province-wide strategy in
response to the labour market shortages.
o Undertake targeted initiative for Sector /
occupational promotion & career awareness
2.1
2.2, 3.2
� Address the range of adjustment issues specific to their
sector including retention and training capacity.
o Undertake targeted initiative for additional training
capacity
2.1, 3.1, 3.2, 3.5, 4.1, 4.3, 4.6
o Undertake targeted initiative for active training of
under-represented groups
3.6, 4.7
APPENDIX A:
RELATIONSHIP TO
COMMITTEE TERMS OF
REFERENCE
44
Residential Care Best Practices
• Responsive Shift Scheduling
• 80/20 Positions for Late-Career LPNs to Mentor Next-Generation LPNs
Home Care Best Practices
• Fixed Hour Pilots
• Clustering of Home Visits
APPENDIX B: BEST
PRACTICES
45
Residential Care Best Practice: Responsive Shift Scheduling
Brief Description: Responsive Shift Scheduling (RSS) refers to a
scheduling approach that matches
patient/resident needs with care givers
scheduling preferences. A province wide RSS
pilot project was completed at 6 residential care
sites in 2008. This project is known as Moving
Ahead with Responsive Shift Scheduling in BC.
The project produced an excellent, publicly
available resource binder describing the “nuts
and bolts” of RSS rotation development. Each
RSS initiative begins with the agreement of a
manager to lead the change and encourage unit
staff to participate. It is essential to have a
commitment between participating employers
and unions to work with staff to develop
schedules which consider employee
preferences, promote quality patient/resident
care, and meet operational requirements. In the
pilot, this took the form as a Memorandum of
Understanding.27 This initial collaboration is also
important so HR and FBA/HEU representatives
can provide support when staff approach them
with questions.
RSS requires a local team of28: • Staff Liaison to work with the staff to
identify their scheduling preferences
using the tool established in the pilot,
the Survey of Staff Scheduling
Preferences. Together with the
manager, the Staff Liaison develops a
framework for a new rotation.
27
The Health Employers Association of BC (HEABC) and
Facilities Bargaining Association (FBA) agreement included
a Memorandum of Understanding (MOU) entitled “Shift
Scheduling & Rotations for LPNs & Care Aides.” 28
Responsive Shift Scheduling in BC Resource Binder. June
2009. Retrieved from:
http://www.npsec.ca/files/FBARSS%20Resource%20Binder
%20June%202009.pdf
• Scheduling/Rotation Expert to work
with Staff Liaison and Manager to
develop a new rotation from a
framework of staffing requirements and
staff scheduling preferences.
• Local FBA/HEU steward to participate
in reviewing proposed rotation.
The project also produced and applied
structured evaluation tools. Evaluation findings
suggest that RSS is best suited for larger sites
with staffing requirements that can
accommodate a wider array of staff scheduling
preferences. Recommendations for future RSS
initiatives also include more time spent helping
staff understand what RSS can and cannot
achieve, as well as more face-to-face meetings
between project resources. The success of RSS
depends on the involvement of a team member
with significant scheduling experience and
expertise.
Recommended Partners: • Employers
• Unions
• Shared scheduling/rotation expert
Impact to Employer: • Time of Staff Liaison and Manager to
develop rotations
• Improved productivity (more energetic
staff)
• Improved recruitment and retention
Impact to Employees: RCAs and LPNs have shift schedules that best
meet their lifestyle needs. For example, a
working parent may prefer a 0900-1400
weekday shift or job sharing. Other RCAs and
LPNs may include a regular fixed shift and
regular days off, a compressed work week, or
46
shorter shift lengths. Care Aide/LPN participants
reported that RSS had:
• Improved their attitude towards work
• Increased their energy at work
• Allowed staff to spend more one-to-one
time with residents
• Increased their availability to
participate in professional development
and pursue continuing education
Impact to Patient-Clients: RCA and LPN participants in the RSS pilot
reported the following benefits for residents:
• Greater continuity of care
• Improved quality of care as staff are less
rushed and can spend more one-to-one
time with residents
47
Residential Care Best Practice: 80/20 Positions for Late-Career
LPNs to Mentor Next-Generation LPNs
Brief Description: Beginning in 2008, the Canadian Federation of
Nurses Unions invested in ten pilot projects to
increase the retention and recruitment of
nurses across the country. Several of these
projects, including the collaboration with an
acute care facility in BC’s Interior Health region,
were based on an 80/20 staffing model:
participating LPNs and RNs would be released
from their workload the equivalent of 1 day
(20%) of a week to pursue professional
fulfillment (continuing education, research or
mentorship).
A large pilot, involving 3 district health
authorities, in Nova Scotia also applied the
80/20 staffing model to a challenge that is
comparable to the one facing private and not-
for-profit residential care employers in BC: that
is, the retention of late-career nurses and
transition of next-generation nurses. Pat
Bellafontaine, the project coordinator for the
Late Career Nurse and New Grad Transition
Project, points towards a body of evidence on
professional transitions for new nurses that
indicates 33% to 61% change their place of
employment or leave the occupation within
their first year of practice.29 The Nova Scotia
project aimed to retain late-career nurses and
improve professional outcomes for new nurse
graduates. The Nova Scotia Mentorship
Program was delivered with the following
resources:
� Program Design and Coordination: The
Nova Scotia Mentorship Program
engaged project partners in the design
of the program through a Steering
29
Overview of Mentorship Program and Mentorship
Guidelines.
http://www.cdha.nshealth.ca/default.aspx?page=Docume
ntRender&doc.Id=7442
Committee. Provisions for the Late-
Career Nurse Strategy were also
included in the Collective Agreement.30
� Mentor and Mentee Matching: Leads
at each employer (often those in Clinical
Nurse Educator roles, requiring
approximately a 0.2 FTE) recruit late
career nurses as mentors and match
them with new grads, using established
tools for matching mentors and
mentees.
� Mentor and Mentee Preparation: Both
received required reading material and
a full-day workshop delivered by the
project’s nurse educator (0.5 FTE) for
mentors and mentees. The materials
also included a checklist of common
areas where new nurses need
additional support, such as contacting
physicians or handling the death of a
resident.
Other retention programs, such as the Late-
Career Nurse Initiative by the Ontario Ministry
of Health and Long-Term Care, are also
organized using the 80/20 concept.31
30
Originally, only nurses within 3 years of retirement with
an unreduced pension were eligible for the 80/20 positions
(as noted on Page 150 of the Collective Agreement at:
http://www.nsnu.ns.ca/AbsPage.aspx?siteid=1&lang=1&id
=1175). The Nova Scotia Late Career Nurse and New Grad
Transition Project developed a Memorandum of
Understanding with the Nova Scotia Nurses Union to open
up eligibility for greater participation from nurses. 31
Late Career Nurse Initiative FAQs.
http://www.health.gov.on.ca/english/providers/program/
nursing_sec/docs/late_nurse_faq_01_20070523.pdf
48
Recommended Partners: � Ministry of Health Services (please see
resources required for program
coordination and mentor/mentee
preparation as above)
� Employers (please see cost to
employers below)
� Unions (please see program design
above)
Impact to Employer: While the Nova Scotia Mentorship Program
project was conducted within public sector care
settings, the project coordinator noted that
private and not-for-profit sector employers
have expressed interest in the program.
Speaking from her observations in
implementing the Mentorship Program in
multiple care settings, Pat Bellafontaine
recommends piloting the project at sites with
leads that are passionate about and have
demonstrated innovation with respect to
recruitment and retention. Employers
interested in participating consider several costs
and benefits:
� Cost of temporarily backfilling LPN
Mentor position(s)
� Improved readiness of LPNs for and
productivity within residential care
roles.
� Cost of lead (estimated at <0.2FTE) for
coordinating the program at the
employer site
� Increased employer attractiveness and
recruitment success
� Reduced cost of LPN turnover
Improved resident outcomes and resident
family experience
Impact to Employee: While a formal evaluation of the Nova Scotia
Mentorship Program will not be complete until
Spring 2011, Pat Bellafontaine has spoken with
nurses that say they were planning to retire but
have stayed for another year because of the
80/20 mentorship program. Late-career
participants comment that they have always
wanted to mentor new graduates but couldn’t
do so with their current workload. The 80/20
position gave them the opportunity to do so.
The program promises to positively impact LPN
retention by:
� Decreasing ‘transition shock’ (stress and
anxiety) frustration and job dissatisfaction
for new LPNs when dealing with high
workload, new leadership roles, and
complex clinical issues.
� Increasing professional fulfillment for late-
career LPNs.
� Providing an opportunity for late-career
LPNs to continue to work in a less physically
demanding role.
Impact to Patient-Client: Residents and their families stand to benefit
when turnover is reduced and next-generation
LPNs are better prepared to provide leadership
in residential care facilities and respond to
complex clinical issues and family situations.
49
Home Care Best Practice: Fixed Hour Pilots
Brief Description: Several regions throughout the province of BC
have conducted fixed hour pilots – providing
schedules of fixed hours of time for Community
Health Workers (CHWs). Instead of CHWs being
available for a 10-hour window of time and not
being sure when they will be required for work,
a regular schedule offers more consistency of
hours for employees, as well as consistency of
care for clients.
In 2004-2005, negotiations of the Community
Health Collective Agreement resulted in support
of fixed hour pilots32. Fixed hour pilots
implemented by employers, with union support,
are highlighted from the Interior Health and
Northern Health regions of BC. The impetus for
fixed hour pilots in both regions was to deal
with the challenges scheduling presented
primarily to CHWs, and schedulers. For CHWs,
they are expected to be available – sometimes
for 10-hr windows, with no guarantee of hours
and frequently split shifts (especially for
casuals). This makes for a disruptive day with
inconsistent income. Schedulers often spend a
great deal of time rearranging CHWs schedules
due to sick time (which may be heightened due
to less than favourable working conditions). The
ultimate desire for change is to create a
workplace that supports satisfied workers as
well as clients.
Interior Health
In 2006, 7.5 hour positions were created in the
Interior Health region. One quarter of
approximately 250 CHWs held full time fixed
hour positions during the pilot. Additionally,
Team Leader positions (also referred to as
32
See MOA #20, corresponding with Article 15 of the
Collective Agreement, BCGEU:
http://www.health.gov.bc.ca/library/publications/year/20
07/conversation_on_health/media/BCGEU_Conversation_
on_Health_Submission.pdf
Workflow Leaders) were created to coordinate
and provide support to CHWs. Team Leaders
were CHWs (who received an increase in pay for
this role). CHWs met as a team, organized by
geographic area, at the beginning of their shift.
This enabled the team of CHWs and the Team
Leader to discuss care plans and talk about
changes for client needs. The Team Leader
coordinated this effort. CHWs enjoyed the team
environment combined with the fixed work
hours. During periods of ‘downtime’ (often
early afternoons), CHWs would take this time to
update client records and discuss changes in
clients and needed care plan changes, as well as
to provide care for clients in other geographic
areas.
The outcomes of better schedules for CHWs
includes improved communication between
CHWs about client needs and improved quality
and continuity of care. Most relevant to the HR
Strategy, an evaluation of this pilot found that
85% of CHWs who responded to a survey felt
valued, fewer workers moved on to other
employers, there was less sick time and less
reliance on casual staff.33
While the fixed hour pilot continued in 2009,
due to budget constraints, the team leader
positions were discontinued. Geographic offices
are still in existence and provide a place for
CHWs to begin their day. Most fixed hour
positions are now part time (0.75-0.8 FTE).
Northern Health
33
Innovations in Community Care: From Pilot Project to
System Change, p.35:
http://www.policyalternatives.ca/sites/default/files/uploa
ds/publications/BC_Office_Pubs/bc_2009/CCPA_bc_innov
ations_web.pdf
50
Similar to the Interior Health pilot but without
the team leaders, Dawson Creek in Northern
Health offered approximately 25 CHWs
schedules of 6 to 8 hours of work per day. The
most senior CHWs had their days planned first,
working ‘down’ the list to the casual CHWs.
Those CHWs with 6 fixed hours could be topped
up with additional hours, based on seniority. In
an effort to offer the best client care and
desirable schedules, CHWs and nurses met to
review and client needs and adjust time period
for specific care needs (i.e. bathing) to a
‘harder to fill’ time during the day. This
ultimately gave clients a choice in their care
hours and helped to promote a more appealing
schedule for community health workers. This
pilot emphasizes the fact that part time as well
as fixed hour positions are valuable for both
employers and workers.
When it comes to determining client needs a
CHW states, “Client needs don’t change on a
daily basis. You know how many clients you
have and how many are on the waiting list”. The
fixed hour pilot in Dawson Creek enabled
continuity and consistency for the clients as well
as for CHWs. For the more junior CHWs, fixed
hours made the more difficult to fill hours
easier to staff. “As long as workers know when
they will be working, they are much happier to
work some evening and weekend shifts”, states
a CHW.
While the pilot was viewed as positive,
Northern Health is moving to rotation positions
instead. Next steps include further discussions
between Northern Health and union leaders.
Recommended Partners: � Employers
� Unions
� Ministry of Health Services
Impact to Employer: � Improves scheduling efficiencies
(including scheduler time backfilling
positions)
� Reduces over-time and sick time
� Client and staff satisfaction
Impact to Employees: � Consistent hours of work (more
balanced life)
� Fewer disruptions in relationships with
clients
� Income security
Impact to Patients/Clients: � Consistency of care provider
� Better communication of client needs
51
Home Care Best Practice: Clustering of Home Visits
Brief Description: Most home support services consist of a
Community Health Worker (CHW) providing
one-on-one support to clients. Traditionally, this
care is provided in pre-determined blocks of
time in the client’s home. An alternate
approach, known as Cluster Care, is emerging as
an efficient and effective model of providing
care to multiple seniors living within close
proximity (often in the same building). This
approach to home care service delivery
‘clusters’ visits and tasks for clients living in a
specific geographic location. Care is tailored to
meet the client’s needs throughout the day and
is, therefore, not restricted to specific blocks of
time. In effect, clients receive more frequent
monitoring. The CHW is assigned to a group of
clients who reside in close proximity and moves
freely among the clients in the building,
focusing on the care or task needed. The
“shared aide” concept has not only gained
recognition in population-dense New York City;
cluster care has been implemented in and
proven beneficial for BC’s North Shore and
Sunshine Coast regions (Vancouver Coastal
Health).
North Shore Home Support
Maureen Oliver, Manager, North Shore Home
Support, and her team have implemented
cluster care in the Twin Towers buildings, high
density seniors’ residences. A team of nine
CHWs meet at the beginning of their shift in a
little office that the Twin Towers has made
available to provide care for 30 seniors each
day. The CHWs work as a team, collaborating
and talking about their clients. Maureen states,
“They have amazing flexibility. For example, if
Mrs. Smith isn’t looking so well, 2 CHWs will go
together and check in on her later on in the
day.” When Maureen speaks of the support
from the LPNs in the success of the cluster care
model, she’s passionate, “I’ve never worked
with such a talented group. The LPNs have the
leadership skills to enable the CHWs to work
together as a team, encouraging them to use
their discretion. The LPNs have taught the
CHWs how to make decisions within their
scope.” Maureen also speaks of the benefits of
cluster care in terms of continuing education.
CHWs have the opportunity to take part in
ongoing education as well as training for
specific clients in teams, learning together and
teaching each other. The North Shore has also
implemented fixed hour schedules for almost
half of the CHWs. “Right now, 44% of CHWs
have fixed schedules, working in clusters. 13
workers stay in a specific local driving area. I
would like to go as high as 70% of workers being
in cluster care because it saves a lot of wear and
tear on driving and it saves rushing so CHWs are
more relaxed to do their work, and therefore,
are less likely to make errors.”
Sechelt
On the sunshine coast, cluster care is also
emerging as part of home care redesign. Mona
Groves, Manager, Home Care Services, shared
that the traditional model was no longer
meeting the increasingly complex home support
needs in Sechelt. The current success of home
care services delivered in Sechelt is attributed
to the implementation of cluster care, with the
addition of workflow lead positions and
increased communication supports (i.e. daily
meetings with workflow leads, client-specific
training, and tools such as cell phones). The
project required a lead time of about six months
to set up and to create a well functioning team.
Recommended Partners: � Employers
� Unions
� Ministry of Health
� Senior’s Residences
52
Impact to Employer: The outcomes associated with the Sechelt home
care redesign project (that cost $285,000 to
implement) so far include a:
� Reduction in CHW injuries and WCB
claims ($28,000 savings have been
realized so far)
� Increase in client satisfaction
� Decrease in overtime (by as much as
79%)
� Reduction in client hours (by 7%)
Impact to Employees: Both North Shore and Sechelt have seen an
increase in CHW satisfaction. Specifically,
Sechelt has realized:
� A 30% increase in CHWs satisfaction
with respect to communication
� A significant reduction in CHW injuries
One CHW says, “In Gibsons, we meet every day
as a team to share information and plan for our
clients’ needs. On Tuesday, a client may require
a one-hour visit, but the next day only 30
minutes. It makes so much sense to work this
way, and it is very satisfying to feel like an
important part of the team.34
Impact to Patients-Clients: A national study comparing cluster care model
with traditional one-to-one fixed-period visits
and at Fraser Health sites and other areas
across Canada (Waterloo and Kamloops in the
Interior Health region) indicated that cluster
care was suitable for most clients and most
appropriate for those who live in high-density
residential buildings and receive considerable
home support hours. 35 The evaluation found
that the pilot was suitable for clients, and that
34
Submission to the Conversation on Health. September
27, 2007, BCGEU.
http://www.health.gov.bc.ca/library/publications/year/20
07/conversation_on_health/media/BCGEU_Conversation_
on_Health_Submission.pdf 35
Sharing the Learning: Health Transition Fund: Synthesis
Series: Primary Health Care. http://www.hc-sc.gc.ca/hcs-
sss/pubs/acces/2002-htf-fass-prim/index-eng.php
while clients in fact used 74% of the maximum
hours authorized by the home care program,
care levels required by clients increased during
the life of the project. The average cost per
client was $422.50 per month, $20.50 more
than it was the year before the pilot was
implemented. Survey results from clients and
CHWs indicated a high level of satisfaction with
the pilot. CHWs specifically highlighted that
flexible time allocations permitted them to
respond quickly to client needs
53