Marjorie Dorrow, COO of Cascade Health Services, which operates two facilities in Boerne and Castroville, Texas, said that the company’s status as a smaller operator has afforded it many advantages, and quick adaptability is one of them.
With the ever changing regulatory environment, the end of Public Health Emergency reimbursements, and other uncertainties and staffing challenges, the company has had to become increasingly resilient — and has lived up to the challenge.
Darrow sat down with Skilled Nursing News to share how her team has developed enhanced ways to train, recruit, retain team members, among other initiatives during tough times. And being a smaller operator means her team can get new training on their feet quickly at both of their facilities.
This interview has been edited for length and clarity.
Have you seen staffing pressures ease at all since the start of the year?
Since the beginning of this year, we have seen the pressures ease quite a bit. Whenever it comes to the volume of overall applicants and the quality of those applicants, that has definitely improved. Most of the time, whenever we have new employee orientation sessions, those groups are much larger than they were at any point during 2022. And so we have seen some gains – a lot of that has to do with what has happened globally in our markets. We’ve seen the economy continue to improve and people wanting to find jobs and being more willing to work.
Could you tell me about any particular challenges or strengths you have at Cascade as a small operator?
Being a small company has some huge advantages. We’re able to revamp policies or change the way that we do something very, very quickly. We don’t have a lot of layers of people to go through or a board that is required to approve anything. It’s a very small group of us, and we are able to talk through what we think needs to be changed or revamped and put that into practice immediately. It also allows us the ability to interact on a one-on-one level with employees throughout the organization. I think it gives them a sense of purpose and knowing who we are. I think the one disadvantage is we don’t have a ton of resources. So when things like the Covid pandemic happened, there weren’t a lot of people to pull together to help rewrite policies or revamp best practices. It’s a very small group of us, often learning from our friends and partners at much larger organizations.
Are there any specific examples you could share of times you were able to get new changes in place quickly?
Pulling from most recent experiences, early on in the pandemic, we had a lot of CMS regulations that came out and would hit us one day and then often change a couple of days later. Because we are small and there’s not the group of regionals or higher-ups that have to approve and review every policy, it was often us just sitting down in a room talking through all of the steps related to what our new guidance needed to look like, and then doing the training simultaneously.
Because we only have two locations, it’s very easy for us to be in both locations on the same day. So we’re able to develop the policy and then immediately implement it by doing one-on-one teachings and training and small groups. It doesn’t take us two or three days or two or three weeks to react to it, we can do it almost immediately.
If you could change one CMS policy, what would it be?
If I could change anything, it would probably be related to the survey process. The way it is now, a lot of times it provides inconsistency. So, similar situations might be handled very, very differently based upon the survey team or the survey region, or maybe even just an individual surveyor’s experience in that facility previously. I don’t really have a good idea on how to go about revamping it. But I think it’s definitely the one thing I would snap my fingers to change.
How are your margins doing and have you seen any benefit from Medicaid boosts in Texas?
Our margins are tight at best with the increased demands on labor wages in our markets and the overall cost of doing business increasing from start to finish. It really just doesn’t allow any room for error. When the PHE ended on May 11, Texas operators lost the 1963 Medicaid add-on. Still, it looks very promising, and I think we’re gonna get some bridge funding to help us get through the next fiscal year. But without the 1963 add-on, I think in all honesty, I think that was the only thing keeping operators in Texas above water. It makes it really tough if we don’t have that on our budget. We haven’t seen any kind of adjustments with managed care rates. Those have remained flat.
If you were sitting at a table with the CEOs of 10 other skilled nursing companies, and you could only ask them one question, what would it be?
I think I would ask them what they envision for skilled nursing homes in the next 10 years. I think it might be interesting to hear their ideas on how our industry will shift and mold into something completely different in the future. So, it might be pretty interesting to just hear their differing opinions on what that looks like for us.
