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Stabilizing the Direct Care Workforce: Best Practices from Massachusetts

By Emily Dieppa Colo (she/her) | December 10, 2019

Massachusetts, like much of the country, is feeling the weight of the direct care workforce shortage as long-term care providers across the state try to find and keep the workers they need to support older adults and people living with disabilities. With a low unemployment rate and companies like Amazon and Wayfair offering starting wages well above the minimum wage, direct care workers have more options for employment than ever, and long-term care providers are struggling to compete.

In response, the Massachusetts Senior Care Foundation (MSCF), along with the Massachusetts Senior Care Association (MSCA), partnered with PHI to identify practical strategies for recruiting and retaining a strong direct care workforce. PHI conducted deep assessments—which included leadership interviews, focus groups, and quantitative analyses—at three Massachusetts long-term care communities: Broad Reach Health Care, Kimball Farms Nursing Care Center, and Seacoast Nursing and Rehabilitation Center.

Steered by PHI’s publication Growing a Strong Direct Care Workforce: A Recruitment and Retention Guide for Employers, PHI consultants identified opportunities for strengthening recruitment and retention practices while unearthing inspirational examples of how these communities are already striving to make a difference in their workplace. At the annual MSCA conference in November, 2019, PHI had the opportunity to highlight lessons learned from this work, along with best practices from the three communities. Here are a few general lessons we shared.

Recruit the Right Staff

“The key to retaining a committed and well-qualified direct care workforce is to recruit the right individuals from the start—those who are most likely to succeed in the caregiving role.” – Growing a Strong Direct Care Workforce: A Recruitment and Retention Guide for Employers, PHI

Broad Reach Healthcare is a family-owned organization based in Chatham, MA offering long-term skilled nursing care, post-acute rehabilitation, assisted living and hospice care. To creatively expand its recruitment strategy, Broad Reach created partnerships in Puerto Rico that allowed them to successfully recruit nurses to live and work in Chatham. Because their nurse licensure wasn’t transferable from Puerto Rico, the nurses are working as CNAs at Broad Reach while they continue their education in Massachusetts. Broad Reach also connected recruits with affordable housing options in Chatham, because local accommodation has historically been a significant barrier for people interested in working at Broad Reach.

Recognize and Reward Staff

“A living wage and better benefits are two essential elements for boosting recruitment and retention in direct care. However, wages are just one important piece of the puzzle. Even when operating on tight margins, you can show appreciation for your workers in a variety of ways—and these gestures make a difference.”Growing a Strong Direct Care Workforce: A Recruitment and Retention Guide for Employers, PHI

Kimball Farms Nursing Care Center (Kimball Farms) is a member of a continuing care retirement community based in Lenox, MA. Kimball Farms offers a suite of value-added benefits to their staff, thereby increasing their employees’ overall compensation package even when they’re unable to give hourly wage increases. For example, Kimball Farms offers free soup to all staff, 24 hours a day, seven days a week. Employees are understandably appreciative of a guaranteed warm, free meal every shift, but it was clear in our assessment that the soup also serves as a symbol. For staff, the soup is a tangible expression of Kimball Farms’ gratitude, deepening feelings of mutual respect and trust between them and their employer.

Develop Advancement Opportunities

“As with all employees, direct care staff need opportunities to learn and grow in their jobs; otherwise, they will start looking elsewhere for new challenges. By offering specialty training and advancement opportunities, you can maximize a worker’s contribution, reward their dedication, and improve retention in the long run.” Growing a Strong Direct Care Workforce: A Recruitment and Retention Guide for Employers, PHI

Seacoast Nursing and Rehabilitation Center is based in Gloucester, MA. To attract promising candidates and support existing staff, Seacoast created a career advancement track for direct care workers. Through this program, Seacoast hires non-certified staff as Hospitality Aides and then sponsors them to become certified (CNAs), allowing them to “earn and learn.” This program was applauded by current CNAs who deeply appreciated the supportffered by Hospitality Aides, particularly when working short-staffed. Because Hospitality Aides can assist with non-clinical tasks, they’re able to make a bed or answer a call bell, freeing up time and energy for CNAs to focus on providing quality care for residents.

For more information on PHI’s recruitment and retention services, please visit our website or contact Emily Dieppa at

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