Industry leaders looking to boost staffing numbers in 2022 and beyond can no longer sit on the sidelines expecting workers to join the sector simply based on a company’s marketing efforts or increased wages.
Instead, those at the helm of nursing home companies should take an active role in getting young people introduced to the sector as soon as possible — such as setting up summer internships for teenagers.
That’s according to Jennifer Robinson, who ascended to the president role at SanStone Health and Rehabilitation last July.
“As a company we’re making strides to start building those interactions and relationships as early as elementary ages. It’s fundamental, I believe, to help our youth feel comfortable in a skilled nursing setting,” Robinson said recently on an episode of the Skilled Nursing News Rethink podcast.
SanStone has also bolstered its workforce by focusing on internal growth and the creation of succession plans. That planning led Robinson to the role she is in today.
What is accomplished now can shape the workforce for the next 10 to 20 years, she said.
Highlights of Robinson’s podcast, edited for length and clarity, are below. Subscribe to Rethink via Apple Podcasts, Google Podcasts, or SoundCloud.
On SanStone’s succession plans and growing from within:
I think when you grow internally it comes with its advantages and, honestly, it comes with some disadvantages too.
I think the disadvantage is that it’s more work, it’s more work for the leadership team to invest that time and that effort into the growth of their employees. But at the same time, I think the advantage to that is that you are able to continue this culture. I’ll speak a lot to culture because I think ideally that’s what sets SanStone apart from many of the other companies in our industry … Just as an employer in general we develop this culture and as we grow these individuals that’s what continues to contribute to that overall culture.
Many of our administrators … They started out in some other form of leadership, maybe at a department level.
A leader is someone who is very obvious in that they have that kind of compassionate, empathetic personality about them, sometimes they’re easy to spot. So when you are able to recognize that in someone, it’s very important to me and to the other team members here at SanStone that we grow upon that person’s opportunities and give them a chance to really contribute not only to SanStone, but just to the elders and our industry in general.
On what drew Robinson to the health care sector:
I truly believe that I have this innate desire to serve others. I kind of have this sense of purpose in my actions and so when I was in high school, our class volunteered at a local state-owned facility — it was for the developmentally disabled.
In this short period of time that I was doing this volunteer work I became invested in the residents and just in kind of what I was doing and how I felt when I would go home in the afternoons from doing that volunteer work.
I felt like I was able to make a difference in the lives of some of these individuals who were developmentally disabled or just in general some of our population that were … less fortunate.
I think it’s so important that as an industry we work towards introducing our youth to the skilled nursing [industry] as soon as possible. That is how I got into the industry, I was just introduced to health care as just part of a class for a volunteer group, and many people don’t know that this is their calling unless they maybe are exposed to it or just experience that feeling.
I think if we continue to sit back and hope that people will want to join skilled nursing or join our health care industry, because of our marketing efforts or the wages we’re offering, I think we’re really missing an opportunity to attract those types of individuals we all truly want within our organizations.
As a company we’re making strides to start building those interactions and relationships as early as elementary ages. It’s fundamental, I believe, to help our youth feel comfortable in a skilled nursing setting.
It’s not an environment that everyone can just walk into and feel comfortable. So I believe it’s very important that we start opening our doors to more exposure for our youth. We’re opening up to summer internships for teens.
By 2040 in North Carolina, we are projected to have a 116% increase in our population of 85 and older; so I truly believe that what we do today to encourage the youth into our industry as a workforce, it’s shaping that workforce for the next 10 to 20 years from now. And that’s how I feel what someone did for me by introducing me into health care at such a young age. Many years later I’m still here, and it’s because someone opened that door and allowed me to experience what it feels like to be a servant leader and give back.
On SanStone’s relationships with its acute care partners and how the relationship overall has evolved between the two care settings:
We have always tried to be good partners with our hospital systems just through maintaining that ability to provide a higher acuity of payer, whether it be complex wound care, dialysis patients, IV medicines, we’ve always tried to push the envelope and make sure our staff was trained to care for that higher acuity to help the hospital systems.
It was very important to us at SanStone that we were a resource to the hospitals. We wanted to be part of the solution to the hospital capacity issues. Many skilled nursing facilities in our areas stopped taking admissions during the early stages of the pandemic … But we made the decision not to do so. So we continued to take admissions and some of the hospitals became heavily dependent on us to find beds for their residents, whether they’re COVID positive or not throughout the state, in our locations.
So we experienced some of the pain from that decision, we did see Covid in our buildings, but ultimately I think everyone did. As I look back now two-and-a-half years later, I think it was a good business decision. I think ultimately it was the right thing to do to help the health care spectrum during the pandemic, and ultimately I think it truly strengthened our relationships with our hospital systems as partners.
On one new development in the sector that excites Robinson:
I think what we’ve seen definitely here in North Carolina, but I would say that I also saw this on [Capitol Hill] when we went there, was improved awareness amongst our governmental constituents and legislators about our sector, about nursing homes in general and what we do.
In North Carolina we’ve been so fortunate to have a collaborative relationship throughout the entire pandemic and I truly believe that’s been instrumental in getting the skilled nursing industry in North Carolina the resources we’ve needed to survive over the past two-and-a-half years.
As our state of emergency here in North Carolina is coming to an end, I’m excited to see this collaboration continue as we all continue with our associations, with our members within the association, the providers, government officials, as we continue to work together to kind of determine what’s the new normal, what support does our industry need to be financially viable to attract workforce and to continue to serve our elder population.
So I think that out of everything from this pandemic it has definitely brought a bigger awareness of nursing homes, skilled nursing, what we do, resources we need, to our government officials at state levels as well as national levels.
On SanStone’s short-and long-term staffing solutions:
As a company we made the decision that we were not going to utilize agency staffing in our buildings just for many reasons, but cost definitely is not the most important reason. The most important reason to us is that culture that I talk about, and we just felt if we have agency staffing in our buildings, then we deteriorate that culture that we’ve worked so hard to develop.
So we chose to try to manage our labor challenges through supplementing with some of our leadership. There were days, there were weeks actually that I myself worked on a Covid unit as a CNA, but those are the challenges and that is the intimate kind of relationship that our company has amongst our team and our family. A lot of our leadership has adopted the all hands on deck approach and so we’ve supplemented [staffing] with that.
We’ve [also] supplemented [our staffing] with some personal care assistants across the facilities and we know that that’s coming to an end based upon CMS’s decision to end that [waiver] back in June.
We took the opportunity to grow some of our staff, whether it be taking our certified nursing assistants and putting them through training to become medication aides or whether some of our certified nursing assistants went to school to become an LPN. We’ve promoted that professional growth.
We also took a lot of the money that people would spend on agency staffing … to make sure that our staff knew that they were appreciated. We invested in some marketing strategies across the state with a uniform platform of getting the word out that SanStone is a great place to work. We promote within, you can grow personally and professionally.
I think all of those strategies have helped us, and to this day, we still do not have agency in our buildings. I think that’s helped us maintain that overall quality of care and culture that we strive to provide.
On PDPM’s greatest challenges and opportunities:
I think it was Tim Fields with Ignite who recently said on one of your podcasts that he believes PDPM is a step in the right direction, and I fully agree. I think PDPM is a step in the right direction towards a more appropriate payment model.
Unfortunately, I think using the past two-and-a-half years as a benchmark is just not accurate data. Those rates reflect the extreme level of care, including isolation and Covid-related respiratory complications that we were caring for, and as we see those complications related to the virus kind of lessen we’re seeing these weights decline already.
To base our parity adjustment on data and the height of a pandemic, I truly believe it’s not comparing apples to apples. PDPM it’s a complex payment model, it takes many aspects of the care under consideration … What we’ve seen as a company, and I think as an industry, is that our nursing component of those buckets is truly where those increases have come from but that’s to be expected in the middle of a pandemic.
So we’re now as nursing homes being reimbursed based on acuity and complexity, comorbidity, and in the past two and a half years, we’ve seen the highest acuity and complexity ever so it only makes sense that our reimbursement has been a lot higher over the past couple years.
As a company we’ve always made it kind of our business to understand the payment models and ensure that we’re getting reimbursed for that high acuity care and those extensive rehab services we’re providing. Our average PDPM rate in Q4 2021 was 16% higher than the state average and 14% higher than the national average.
But late 2021, we decided to improve upon that even better and strengthen our outcomes and make sure we were managing quality not only in the facility, but after the resident [was] discharged home. So we added a partnership with … Comprehensive Rehab Consultants.
They provide physiatry care in our facilities, nurse practitioners, they help us with managing these residents and these rehab residents’ complexities, but the great thing is they follow them after they go home. We’ve seen just huge improvements in our hospital readmission rates, but most importantly our overall customer service has improved because our residents are getting that on-site care daily.
These practitioners are in our buildings assisting with PDPM, assisting with the residents daily. So when a resident comes to the skilled nursing facility for rehab, if they see somebody in a white coat, you know to them, it’s a doctor and so just seeing that person in that white coat every day has really helped improve our customer service and ultimately our quality outcomes by utilizing this group.
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