A Radical Idea: Residents Hiring Staff

by, Beth Baker, ChangingAging Contributor

Would you allow residents to hire your staff? Most nursing homes would likely find that idea unimaginable, if not outright crazy. But at Sunny Hill Nursing Home of Will County, in Joliet, Illinois, residents play a critical role in the hiring process. Indeed, no employee is hired without resident approval.

On the homepage of its website, Sunny Hill proudly proclaims it is on the culture change journey. The home, licensed for 238 residents, is among the dwindling number of county-owned skilled nursing facilities in the nation.

As part of its culture change, Sunny Hill decided in 2007 to include a trained committee of residents in the final stage of its hiring process. “Our residents are the boss and remain in control of their lives,” said Becky Haldorson, assistant administrator, at a workshop at the 2014 Pioneer Network conference. “This shows that management has respect for their opinions.”

She acknowledges the process has not been an easy one. She began by speaking with the Director of Nursing and the heads of the social services, dietary, and housekeeping departments. “I said if we’re going to do this, we have to have 110 percent buy-in from all of you,” she said. “And there was.” Sunny Hill employees are also union members, adding an additional layer of complexity to the decision to include residents in the hiring process.   (Because applicants are not yet union members, that became a non-issue after much discussion.)

Department heads review the applications and conduct the initial interviews. Once they have made their final choice, the preferred applicant must meet with the resident committee. The committee then votes to accept or reject the applicant.  The residents have interviewed more than 300 potential employees since 2007. Of those, the committee gave a thumbs down to 36. On at least two occasions, the DON was enthusiastic about a proposed CNA, “but the residents couldn’t stand her,” and the applicants did not get the job. Others failed background checks or physicals. That leaves 228 employees who have been hired using the resident-approval process.

To serve on the hiring committee, a resident must commit to being available every Monday and Friday at 1:30, in case an interview needs to be scheduled. Haldorson aims for four to six committee members—or a minimum of three– participating in each interview. They all undergo training, to ensure the interviews are conducted professionally—and legally.

“We knew they had to understand the legalities of doing an interview,” she explained. “We are accountable. We had a lot of conversations about what they can and cannot ask. They can’t ask how old you are, your sexual preference, or the number of children you have.” Residents tend to not want to hurt people’s feelings, said Haldorson, and she cautions the committee to not be swayed by an applicant’s sad personal story. The average age of the residents on the committee is 87; one committee member was 104 years old.

Haldorson looks for residents to serve on the committee who had some hiring and firing experience during their careers. Residents are instructed to introduce themselves based on their identities as retired professionals, whatever that may be, rather than as “a resident of 10 years.” Before the interview, Haldorson briefly explains to the committee the applicant’s work history.

Residents helped her develop the questions, and that process alone took nearly three months. Among the questions:

Could you tell us what position you are applying for and what experience you have in this capacity?

What would your past employers say about your work performance?

Describe your work ethic.

What path led you to working with elders in long term care?

If you are not sure what is expected of you, what would you do?

Describe what you know about person-centered care.

If you witnessed something inappropriate what would you do?

If you are not able to keep a promise to me, how would you explain your actions?

If I ask for something special would you get it for me (e.g. a cup of coffee at 10:00 at night)?

What will we talk about while you are caring for me?

What would you like to share with us about yourself that would influence our decision to approve your being hired here at Sunny Hill?

In addition, those working in the nursing department are asked other questions related to resident care.

The residents then go around the table and tell potential employees what they would expect of them if they are hired. After the applicant leaves, Haldorson returns and one by one, residents share their comments, which she writes down.

Haldorson says the process sends a message to all applicants about Sunny Hill’s commitment to culture change. “Potential employees establish a relationship with residents before they even meet their coworkers,” she says. As a result, “the staff respect residents as decision-making adults.”

This article first appeared in the January-April 2015 PADONA Journal of the Pennsylvania Directors of Nursing Association.