Nursing home operators have already started to turn inward to stabilize their staffing, while federal and state efforts lag behind or come with an expiration date.
Doing so is a must in order for operators to move on from pandemic-era stop-gap solutions as stimulus funds dry up and waivers sunset, according to Eitan Zeffren, founder and CEO of Chicago-based Pearl Healthcare.
Pearl’s efforts to stabilize staffing has borne fruit, notably with its certified nursing assistant (CNA) school. The in-house training program has earned Pearl an agency-free status, while offering more long-term solutions.
While the temporary nurse aide (TNA) program was helpful short-term, the Pearl team discontinued their involvement prior to when the waiver was expected to sunset, Zeffren said during a recent appearance on the Skilled Nursing News RETHINK podcast.
Zeffren also shared what he felt were crucial steps to building relationships as a new operator in the skilled nursing sector, having been founded in 2018. He also described his vision for what the nursing home of the future will look like. Continued steps toward higher acuity and added ancillary services increasingly make the futuristic SNF a “mini hospital,” he said.
Zeffren feels Pearl is a “diamond in the rough” in terms of untapped potential. Involvement in clinical trials has strengthened the operator’s relationship with nearby hospital systems, while also helping boost census.
Highlights of the podcast, edited for length and clarity, are below. Subscribe to Rethink via Apple Podcasts, Google Podcasts, or SoundCloud.
On CMS’ plans for a minimum staffing ratio:
We all know that staffing plays an extremely important role in the quality of care provided at the facility level. My concern with the minimum staffing standards for facilities is the next step … becoming more punitive in nature. We’re looking to work collaboratively with the government agencies to come up with creative ways to improve staffing levels at the facilities, as well as get more people and more volume out in the workforce.
There are a lot of other people at the facility site that do play a major [role] in patient care, between therapy, activity [coordinators], resident assistants, that should be factored into the equation, in terms of level of care that’s being provided to our residents.
Facilities should be looked at from a broader view of patient care being delivered, and who contributes to that, which I think does expand beyond our nurses and CNAs.
On Pearl’s CNA school:
The program has been really exciting. We have loved the opportunity to bring new people who are excited and passionate about health care and about long-term care into our work environment and entire facilities. It’s really proven to be a beneficial program both for the students and for our residents.
I think that we’ve seen a lot of excitement and enthusiasm from those folks that are just joining this industry. It allows us to set our expectations very early on with our students – to work together to ensure that they are understanding the level of care that we want to provide both from the care standpoint but also from a customer service standpoint.
When you’re part of that training process, you are able to make a more significant impact on how they are going to conduct themselves within our facility. We really just love that opportunity. We’ve seen some really positive impacts in terms of helping our general staffing and increasing our staffing levels throughout the facility.
It’s been a great program thus far; we’re looking forward to expanding it to the rest of the portfolio in the next year or so.
On the impact of being agency free:
[Our CNA school] has allowed us to remain agency free, which has been our ultimate goal. In that way, we’re able to really have a much stronger impact on the quality of care that we’re delivering the facilities.
Not only does it help the morale of the facility and the rest of the staff, the continuity of care is huge. Taking care of the same patients day in and day out is a huge benefit. They’re able to understand what [the residents’] baselines are, and it allows them to better assess if there are changes with them. If there’s any sort of altered mental status, or anything that’s going on with them that seems out of the ordinary, their ability to pick up on that is so much better and quicker.
On anticipating the TNA sunset, the end of waivers:
We were looking ahead at this program being discontinued. We had already essentially planned for that. We’re kind at a point now where we’ve essentially discontinued it, with the understanding that this was going to eventually be removed.
Had we known that it was going to continue longer, it would have probably been something that we would have looked to continue. At the end of the day, this was always rolled out as a temporary program. We were looking not only for temporary solutions, but for more long-term fixes. We refocused our energy and attention on how we can get people to join our CNA schools, [finding] other ways to incentivize and attract staff into our buildings outside of the TNA program.
On building trust as a new operator:
Long before we enter into the market, I identify key individual players in those markets, between the hospitals, and the community itself. [They] understand the history of the facility, the reputation, whether it’s positive or negative. If it is negative, [I try to figure out] why that is and what we can do to give it a fresh start and improve upon it.
We try to do less talking and more listening in the beginning. From there, we look to develop programs that cater to the needs that they’re expressing; there are sometimes specific clinical programs, or in some markets … the hospital was having difficulty placing a certain type of patient population that didn’t have strong financial capabilities to pay for services. We worked with the hospitals and to be able to care for those patients.
It’s proven to be a great way to start. [Hospitals and the surrounding community] appreciate knowing that you’re actually listening. The second part is obviously implementing it and putting those [intentions] into action.
On Covid adjustments, plans for 2022 and beyond:
It’s been an adjustment across the board, learning to operate in a Covid environment that hasn’t truly gone away – although it has diminished, it still very much exists. [We are] adjusting to that new normal, regrouping and going back to the old days where you couldn’t rely on stimulus and other sorts of financial aid to help during those downtimes or low census trends.
Staffing challenges this year have been, at least from our standpoint, the most challenging since we’ve been in the market. We’re finally seeing over the last couple of months a significant rebound in the staffing levels in our buildings and interest from applicants, and other people, to join this industry.
The second quarter of this year, speaking to other operators, was a challenging quarter. The third quarter has already seemed to rebound a lot census wise; staffing is getting healthier and facilities are relying less on agency than they did earlier in the year. We’re undoubtedly seeing a tremendous upward trend. It’s something that we knew would level out.
On the SNF of the future:
We’ve become mini-hospitals compared to what nursing homes and long-term care facilities were dealing with, from a clinical standpoint and patient acuity standpoint, 10 to 15 years ago.
It’s going to push our industry to be more self-sufficient within the four walls of the facility. A futuristic facility is able to run all of its ancillaries … between X-ray capabilities, pharmacies, lab work, those are things that, in today’s market, we have to work with third parties to provide those services.
Financial constraints that exist right now make it somewhat impossible to be able to do all of those things internally. If we continue to see the industry shift, taking higher acuity patients and avoiding unnecessary hospitalizations, to me, the natural next step is to be able to do more at the facility level and to be able to do it quicker.
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