WASHINGTON — The workforce shortage in long-term care is not simply an issue of recruitment, but perhaps more importantly it is an issue of retention, according to Robyn Stone, Dr.P.H. “We are facing significant shortages, so we want to worry about recruitment, but—as providers—our focus should be [on] retention,” she said. The executive director and CEO of the International Longevity Center in Washington spoke recently during the kickoff of the Quality Summit, the national campaign to advance excellence in America's nursing homes. AMDA is one of the organizations to help lead this campaign. “Many people have been spending the past decade working on staffing issues,” Dr. Stone said. However, “I believe there is a disconnect between recognizing the need to invest in our workforce—nursing, physicians, medical directors, therapists, and administrators—and actually doing something.” Dr. Stone said the fact that “we don't have a comprehensive strategy at a policy level or practice level” poses a significant problem. She added that many people in the provider sector think they are investing in staff by holding ‘in services’ and spending money on training. However, she noted that “your entire infrastructure has to be about the people who work there—how information flows, how the organization is structured, how people get clinical, administrative, and leadership [skills] training, and what they do with this information when they come back to the facility.” While there is no panacea to solve staffing shortages and turnover in long-term care, Dr. Stone emphasized that there are answers and they aren't as complicated as people might think. “It is about what you do every day. You need to go back and look at the infrastructure and supports you have in place. You need to address how training is used and spread throughout the organization,” she observed. “It's not rocket science. It's what every good employer needs to do.” The “Advancing Excellence” campaign hopes to unveil and share best practices in staff retention and recruitment. Dr. Stone noted that there already are some useful models in existence. For example, she pointed to Better Jobs Better Care, a 4-year, $15.5 million research and demonstration program that seeks to achieve changes in long-term care policy and practice to reduce high vacancy and turnover rates among direct-care staff. The project will test new approaches to providing a more stable and qualified staff and will systematically evaluate what works best to achieve this objective. “We need to look at models that are most successful and how they involve staff, including front-line caregivers,” said Dr. Stone. She added that these models need to employ evidence-based practices that staff use because they are “empowered to do so.” While Quality Improvement Organizations (QIOs) can be effective partners in improving staff quality, Dr. Stone emphasized that the facilities themselves need to make the changes. “QIOs can't do this. Instead, things happen because people do it. Staff have to observe and document better, catch things earlier, communicate more effectively, and so on.” Providers play a key role in improving staffing in long-term care, Dr. Stone observed. She said, “good providers recognize caregivers, listen to them, and treat them with respect. Teamwork is a common concept, and most facilities aim for this; but it is really hard to get people working together effectively as a team and to keep this momentum going.”