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

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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.

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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

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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

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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.

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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

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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.

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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.

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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

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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).

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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

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• 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.

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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