After 55 years, Foulkeways Persists Through COVID and Industry Staff Shortages

Financial incentives and staff's commitment to residents has helped the community continue to thrive.

While the healthcare industry struggled with a shortage of workers that persisted through the pandemic, nursing homes and long-term care facilities were hit the hardest.

"In healthcare when you’re talking about licensed staff—RNs in particular—long-term care has never been the preferred site for care for nurses," Mary Knapp, director of health services for Foulkeways at Gwynedd, told HealthLeaders.

Foulkeways has offered continuing care for more than five decades, with a licensed nursing facility and pharmacy, assisted living capabilities, Medicare certified hospice agency, and outpatient rehabilitation center included on its campus.

The community has affiliated physicians that come on site occasionally, but has its own staff of certified nurse practitioners (CNAs), licensed practical nurses (LPNs), RNs,and nursing assistants that provide primary care to residents.

Now in its 55^th year of operation, Foulkeways has never used an outside nursing agency to supplement its staff, which already sees a minimal amount of turnover, Knapp said.

"We have staff who are CNAs that retire at age 70 from Foulkeways," she said. "However, with COVID, we experienced a lot of staff retiring because we had a lot of nurses and LPNs who were working past age 65. Because of the positive work environment and very little turnover they continued to work, but COVID puts a strain on people."

Like most CNAs, those who worked at Foulkeways also worked at other nursing facilities to supplement their income. Those CNAs, Knapp said, struggled with the long hours, carrying out their responsibilities while wearing heavy personal protective equipment, and bearing the risk of contracting the virus or bringing it home to their family.

“For organizations like ours, there was a commitment to their residents. So many of the nurses’ aides, that are really professional nursing assistants, have been doing the care for a long time. When you talk to them about how good they are about providing care they often say, ‘It’s like taking care of my grandmother; of course I’m going to give them good care,’ Knapp said.

Staff who had been with Foulkeways for a long time consider the residents like family, where, with other organizations the commitment can vary, she said.

In the early days of the pandemic, nursing homes and communities such as Foulkeways were hot spots for the virus. Hired companions for residents stopped coming in. Staff who’d been planning on retiring in a few years decided to retire early.

"The people who didn’t exit, who remained, most got salary increases and possibly bonuses along the way during the pandemic," Knapp said, adding that financial incentives like these were common throughout the industry.

Similar incentives such as sign-on bonuses, according to Knapp, are improving and helping with staff retention. However, because of the competition in less-stressful environments, like food service or even retail Knapp said, facilities such as Foulkeways are just managing to keep up with the market.

Knapp added that because CNAs could potentially make just as much, if not more, working in those industries, in addition to their diminishing role in acute care and being pushed into long-term care, the temptation to make the switch is strong.

Supporting staff with educational benefits, such as programs that enable them to pursue higher industry certification, or a degree also help with staff retention. To supplement its staff, Foulkeways works with 17 schools, allowing their students to come to the facility for clinical training.

"I have talked to other organizations about doing the same because your colleges and universities, your community colleges, your technical schools, they have a really hard time finding clinical sites," Knapp said. "If you can get a school or university to come into your nursing home, providing an instructor with the students, then that can really lift some of the workload for the staff—particularly the CNAs."