Assisted living facilities struggle to fill positions as need for option grows

Feb. 8—FLOYDS KNOBS — Born in the midst of German bombing of London during World War II, Theresa McCormack's life journey began in turbulent times, yet she's found tranquility in her later years at the Azalea Hills assisted living facility in Floyds Knobs.

"I've had an incredible life, but to come and spend my last years here, I'm so grateful," said McCormack, 79, who has lived on three continents and retired in Southern Indiana to be close to family.

Cassie McCoun, the long-time administrator of Azalea Hills, pointed out that McCormack's liveliness shouldn't have her thinking about her "last years." And it's McCormack's energy and enthusiasm that pushed her to moving into Azalea Hills eight months ago.

McCormack was spending too much time alone, and her family supported moving her into a facility where she could still enjoy independence while also engaging with others.

McCormack and her family toured Azalea Hills, and it was a perfect match.

"I fell in love with it, and I never looked back," McCormack said.

Without such an option, McCormack, whose movement is restricted by arthritis, said she would probably be "miserable."

But as assisted living facilities struggle to attract and retain employees, McCormack said she's concerned about the future for people in situations similar to hers.

At Azalea Hills, McCoun has been promoted to the top cook by one of the residents. It's somewhat of a joke, as McCoun's primary job isn't to be in the kitchen, but one woman enjoys her breakfast offerings so much that she gave her the new title.

McCoun emphasized she doesn't mind taking on such roles as needed. She credited other employees for stepping up, such as the head nurse, who can often be found washing clothes between her regular duties.

"The beauty of it is, I can see what we're facing and what we need, and I see how hard our employees work," McCoun said.

Azalea Hills, like many assisted living facilities, nursing homes and hospitals, is almost constantly seeking employees.

Nursing shortages have been well-documented in Indiana. Last year, Indiana legislators approved a bill to increase the size of graduating nurse classes to meet anticipated demand. Officials have predicted the state will need another 5,000 nurses by 2031.

According to Southern Indiana Works, registered nurse is the top occupation in Clark and Floyd counties in the healthcare and social assistance field. Employment in the sector has grown rapidly over the past decade. In 2012 there were 262 registered nurses working in the two counties. Last year, that number had risen to 1,215.

An industry snapshot from Southern Indiana Works shows that job demand in Clark and Floyd counties in healthcare and social assistance is almost double the national average.

Assisted living facilities don't require the same level of medical staff as a hospital or nursing home, but they do depend on nurses for overseeing medication and helping residents with health issues.

Hospitals and nursing homes typically pay nurses more than assisted living, which makes recruiting and retention even more difficult. McCoun said Azalea Hills is looking to hire employees for a range of jobs, but there just aren't as many applicants as years past.

While she emphasized the employees are meeting the challenges despite being low in numbers, McCoun added that it does make an administrator pause when it comes to accepting new residents.

"Do you do all of these admissions if you don't know if you'll have enough staff to take care of them?," she said.

Azalea Hills has assisted and independent living, as the campus is home to people ranging in age from their early 50s to over 100. The staff strives to maintain a welcoming environment, as it takes a certain kind of worker to appreciate and embrace working with older residents, McCoun said.

"What separates us from other facilities is our staff," she said.

One recent addition to the staff is Jeff Alexander, who is the activities director at Azalea Hills.

"It's all about just making them smile and enjoy their retirement," Alexander said of his main charge.

The calendar for February was packed with multiple events slated for each day, but Alexander also pulls other duties such as driving residents to medical appointments and helping in the kitchen.

But Alexander said that's become a common theme in assisted living and nursing homes.

Industry-wide, there's concern about what steps may have to be taken to adjust to a lack of workers. There are examples of assisted living facilities scaling back or charging extra for services such as cleaning and laundry, McCoun said. She worries such changes could hamper the overall quality of care in the industry, which she said is paramount.

Indiana's Aged and Disabled Medicaid Waiver provides eligible Hoosiers with funding for assisted living, as opposed to a more institutionalized facility like a nursing home. The waiver takes some pressure off of nursing homes, but that means more staff will be needed at assisted living facilities to meet the demand of an aging population, McCoun said.

The issues are identifiable, but solutions aren't as easy to come by.

"It's a worldwide epidemic right now," she said. "I don't know what the answer is. I really don't."

McCormack has more than fit in at Azalea Hills. She leads the resident council, which provides feedback to staff about issues or complaints. She's racked up a bag of tickets from attending and winning activities, which she can trade in for snacks. She's also become the Azalea Hills backgammon expert.

Such engagement is important for anyone, especially those who are aging, she said. It's why having facilities like Azalea Hills is critical not just for those who now qualify for assisted living, but for future generations who will need such services, McCormack said.

But her concern isn't just for residents, but also for the workers who she credits for making the facility a great place to live.

"I feel so sorry for them," McCormack said. "They all work so hard."