While it might be tempting to spend time and energy making a plan for staffing recruitment, you must be able to stick to that plan no matter what. Avi Richman, Director of Labor Management and Recruiting at Vita Healthcare Group, states that consistency and follow through on planned processes is the only way to ensure that they work at all.
Having served as assistant administrator at a small facility with extensive experience in the senior care industry, Avi Richman understands the extreme challenges facilities face these days in staffing
There is a constant fight over employees and many states cap admissions when a facility is only operating at very low levels of staff.Â
Many facilities attempt to address the problem of staffing through working on their public appearance to prospective employees.
Avi states that this method often won’t work because it's almost impossible for most facilities to scale the idea of what they want their vibe and company culture to feel like.Â
The only situation in which this would work would be if the facility concerned was small, and standalone.
Avi gives an example of such a facility that deepened their company culture by creating an employee counsel that served as a legitimate decision making body.
But is there a sole strategy that will contribute with certainty to the success of staffing endeavors?Â
Avi asserts that facilities need to focus their time and energy on making sure the processes they plan are executed smoothly and to completion from start to finish.Â
It is easy to say that this will happen but very difficult in reality, the only way it will work is if the process is monitored and nurtured 24/7.
Â
FOLLOW AVI AND VITA HEALTHCARE GROUP
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RELATED EPISODES
00:02.637 --> 00:06.417
What's a lot easier to scale
00:06.477 --> 00:10.117
and what's a lot easier to manage
00:10.315 --> 00:13.887
is processes, processes and oversight.
00:14.037 --> 00:17.712
And we are crazy about managing.
00:17.862 --> 00:21.577
Every last process that we want to roll out and that
00:21.595 --> 00:25.222
we build out is from start to finish. We want it to have it from
00:25.255 --> 00:30.372
scratch. We want to have that this process can be implemented properly
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and not just bought up in some war boom somewhere.
00:34.692 --> 00:38.377
It sounds great on paper. We launch it day one. They have a call with
00:38.395 --> 00:40.700
the facilities and then we let it run.
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Welcome to the nursing home podcast. Your goto
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source for professional insights in the long term care industry.
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Hear from leaders and experts as they share current and practical
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insights to help make the most of your day. I'm a longterm care financial
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specialist. What that means is I help people plan for the inevitable.
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Nobody wants to think about getting old, but it's possible that someday we might need
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a little bit of care. Here's your host. Nursing home administrator turn podcaster
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schmoel septimashptimash.
01:21.637 --> 01:25.447
Welcome to another live recording of
01:25.480 --> 01:28.657
The Nursing Home Podcast, the podcast that
01:28.660 --> 01:32.497
you've learned to turn to to find out real information,
01:32.680 --> 01:36.052
things that you cannot Google, real information about what's going on in
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the nursing home industry, best pack practices and inside information
01:40.330 --> 01:43.937
literally available nowhere else. In today's episode
01:44.512 --> 01:48.650
on the Nursing Home Podcast, we actually have a very
01:49.237 --> 01:52.677
interesting episode for you with Avi Richmond.
01:52.782 --> 01:56.047
Avi has a background in the nursing home administration, is now
01:56.155 --> 01:59.722
the director of labor and Management and recruiting for Vita Health
01:59.755 --> 02:02.947
Care Group. And those of you who are following the podcast know that
02:02.980 --> 02:06.367
we've been focusing on staffing quite a bit recently because
02:06.415 --> 02:10.197
of the challenges that it imposes on the nursing home industry.
02:10.242 --> 02:13.177
So I'll be welcome to the nursing home podcast. Thank you.
02:13.195 --> 02:15.425
Thank you, Shaman. It's been a long time coming.
02:17.362 --> 02:20.382
This sure has been. There's been a lot of back and forth and I'm glad
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that we're finally doing this. So before we jump in too far,
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taking just a small bit of time, the listeners
02:28.467 --> 02:31.972
know who I am from other episodes, but just a little bit of how you
02:32.005 --> 02:35.497
got to doing what you're doing right now professionally and then we jump into the
02:35.530 --> 02:38.825
episode. Sure. So I started off,
02:39.262 --> 02:42.912
like many in our community, in our industry,
02:43.062 --> 02:46.977
as an administration, nursing administration, to start off as an assistant
02:47.007 --> 02:50.802
administrator in a small facility
02:50.907 --> 02:53.682
in middle of Nowhere,
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Pennsylvania, and it actually
02:57.520 --> 02:58.550
was a great opportunity.
03:00.937 --> 03:04.372
My first boss really could have given a master class on how
03:04.405 --> 03:08.517
to view and share for the next generation
03:08.577 --> 03:12.067
of healthcare administrators and
03:12.265 --> 03:16.522
executives. He really understood how to let
03:16.630 --> 03:20.152
me kind of take the bull by the horns and just kind of do
03:20.170 --> 03:23.422
my own thing and really grow. It was like kind of the
03:23.455 --> 03:27.087
perfect petri dish for experimentation,
03:27.162 --> 03:31.562
learning, and growth as a nursing administrator.
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Very small facility again, and within four
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or five months. I was very comfortable there and I
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got a call from someone over by the healthcare group they were looking for.
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This is going back a year and a half. This was kind of just as
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operators were trying to adjust to the pandemic and really
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this position that I have director of Labor Management was
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kind of a select few groups
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had this position prior to two years ago. So Vita
04:03.807 --> 04:07.222
was my company was kind of
04:07.405 --> 04:11.150
at the forefront of recognizing the need to
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spin this off of the typical VPO RDO
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portfolio of responsibility
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and create its own department and division.
04:25.237 --> 04:29.000
Got it. So you've been doing this ever since in that position?
04:29.512 --> 04:32.225
Yeah got it. Very interesting.
04:33.712 --> 04:37.025
Just to your point before we jump in too far,
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like we were just saying before we went live, for many operators
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find it. It used to be census, census, census.
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Get up the census, bringing more revenue, getting more
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higher peers and be able to make sure
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that being the revenue so that the business can stay afloat
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now, such as now it's been going up for a while already.
04:59.605 --> 05:03.052
People are saying 1 second, can we actually support the
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census that you're bringing in? Even a census is not an issue. Do we have
05:06.070 --> 05:09.577
the staffing to support that? For some people became more important.
05:09.670 --> 05:13.637
The amount that they're spending on agency overtime bonuses,
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the Medicare that they're getting can be completely offset
05:22.312 --> 05:25.602
by the staffing costs that they have. Yeah, I think that's true. I think there's
05:25.632 --> 05:29.022
the bottom line, the actual PNL
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point of view. I think most of the time if you have a very healthy
05:33.042 --> 05:36.427
census, that could be awesome. But I think that kind of leads to two
05:36.445 --> 05:40.027
other points that it's not just that people are being
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hampered by the cost. For example, in Minnesota and Wisconsin,
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they're going to cap them at they cap the census. There are
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facilities that can only run at 60 70% because
05:51.715 --> 05:55.692
of mandated staffing levels that they will not allow them to accept
05:55.827 --> 05:59.572
residents if their staff and levels fall
05:59.680 --> 06:03.697
dangerously short, whether that's the correct or incorrect thing to do
06:03.730 --> 06:06.922
morally, there are many states where they will not do that and people
06:06.955 --> 06:10.267
will staff at dangerously low levels. So you
06:10.315 --> 06:13.422
definitely have that aspect where it will be mandated.
06:13.542 --> 06:17.322
Whether you like it or not, they're going to cap your admissions.
06:17.517 --> 06:21.262
And then there's also the fact that I think we've even
06:21.325 --> 06:25.017
discussed this in the past. There's the fact of the way that we've
06:25.077 --> 06:29.167
kind of taken this industry and very
06:29.290 --> 06:33.477
much was not designed for the way that's
06:33.507 --> 06:37.192
necessarily being run in certain companies,
06:37.315 --> 06:41.397
certain groups of homes that are utilizing
06:41.442 --> 06:44.977
a very antiquated model with staff and a very
06:44.995 --> 06:49.597
antiquated model with long term care. And the
06:49.630 --> 06:52.707
Acuity is going up dramatically and everything's going up dramatically
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and we're still trying to use the same staffing parts, the same staffing models and
06:56.680 --> 06:59.587
use the same nurses that are just not with the same training.
06:59.650 --> 07:03.187
It's just not a sustainable model at all. Okay,
07:03.250 --> 07:06.725
so now you bring up something which is very important to discuss.
07:08.812 --> 07:12.052
There's millions of different ways that people say it, but they say that the community
07:12.145 --> 07:16.152
hospital of yesterday is today's nursing homes. Yesterday's nursing homes,
07:16.182 --> 07:19.972
what they call the little old ladies who were pretty much
07:20.080 --> 07:23.442
stable, and they need a little bit of assistance,
07:23.502 --> 07:27.807
a little bit TLC, little social life. So mostly medicaid,
07:27.972 --> 07:31.407
not too much skills. So then the nursing,
07:31.497 --> 07:35.767
the entire staffing, the skills, the need is completely different
07:35.965 --> 07:38.975
now that we have these little mini hospitals. You're right.
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If you take a regular hospital in any town, United States
07:43.615 --> 07:47.202
of America, and any nursing home in the same place, like, the staffing
07:47.232 --> 07:50.577
levels, the difference is staggering. The example I've
07:50.607 --> 07:53.767
given before on this show, and I'll give it again now. I know a person
07:53.815 --> 07:57.397
when my son was in the NICU after he was
07:57.430 --> 08:01.072
born, and I was going back and forth from the nursing home to
08:01.105 --> 08:04.332
the NICU Children's Hospital in Boston. So it's one of the top hospitals
08:04.347 --> 08:07.432
in the world, so it's not a fair comparison. But at the end of the
08:07.435 --> 08:10.897
day, there was one nurse. Twelve hour shifts with two
08:10.930 --> 08:13.987
newborn babies. Now, yeah, the babies are there for a reason.
08:14.125 --> 08:18.052
Thank God the sun is fine, but at
08:18.070 --> 08:21.727
the end of the day, they're doing very little. They have
08:21.745 --> 08:24.997
plenty of time to talk to us and show us pictures about their family and
08:25.030 --> 08:28.177
spend time. And when we were concerned, they were able to
08:28.270 --> 08:31.747
give us all the time in the world that we needed. And yet there were
08:31.780 --> 08:35.107
some other emergencies we've seen go on over there.
08:35.185 --> 08:38.877
But at least from an outside perspective,
08:38.907 --> 08:42.597
it looks like they're way overstaffed. And it's not just that, it's the equipment,
08:42.642 --> 08:45.882
it's the actual facility. And as opposed to going back to nursing
08:45.897 --> 08:49.597
home where we just accepted somebody with a brand new
08:49.630 --> 08:52.777
trait, respiratory therapist is coming in at night to give
08:52.795 --> 08:55.852
a crash course to the nurses about what a trick is and how
08:55.870 --> 08:59.377
to manage it and how to try to get this person decanulated and
08:59.395 --> 09:03.277
to try to get them not to need the trig anymore. And the therapy team
09:03.295 --> 09:07.327
is learning on the fly pretty much what to do. This is
09:07.345 --> 09:11.062
while each nurse is responsible for 20 plus
09:11.125 --> 09:15.097
patients with CNAs that are not showing up precovid and
09:15.130 --> 09:18.252
working with extremely antiquated equipment,
09:18.357 --> 09:21.597
working really hard just to get the basic equipment,
09:21.642 --> 09:25.567
the basic mess, the basic tubing, like, each thing is a big deal.
09:25.765 --> 09:29.617
The cart that comes into the room is 25 years
09:29.665 --> 09:33.357
old. Thank God we were successful
09:33.447 --> 09:37.422
with that particular patient. But it's just like the resources
09:37.467 --> 09:41.362
available for taking care of someone
09:41.425 --> 09:44.122
type of patients, it couldn't be more different.
09:44.230 --> 09:46.992
And you're right, the staffing levels haven't changed,
09:47.127 --> 09:51.052
and it hasn't changed. Reimbursement hasn't changed. That's part of
09:51.070 --> 09:53.387
the root of the problem. We're still getting reimbursed.
09:54.637 --> 09:57.982
It's interesting actually kind
09:57.985 --> 10:01.702
of as you were talking, I was making the working mistake and
10:01.795 --> 10:05.762
I was trying to think of how CMS
10:08.212 --> 10:12.082
is actually responding to this rather than listening to everything that
10:12.085 --> 10:14.975
you were saying. But I did hear what you said,
10:15.487 --> 10:18.922
but I would beg to differ
10:18.955 --> 10:22.567
on that point. I think that you see the
10:22.690 --> 10:25.775
whole rehab focus,
10:26.137 --> 10:29.797
reimbursement is going away and there's a much bigger emphasis on
10:29.980 --> 10:33.252
skill for nursing. I think that what hasn't caught
10:33.282 --> 10:36.502
up yet. I think that CMS is actually doing
10:36.520 --> 10:40.552
the correct thing here. And I think that just to
10:40.570 --> 10:44.892
back up a little bit, you'll hear about nursing homes. I think the textbook
10:45.027 --> 10:48.587
case is that the average hundred bed facility
10:49.687 --> 10:54.922
from ten years ago would have four
10:54.955 --> 10:58.602
Medicare patients, six managed care if you were lucky,
10:58.632 --> 11:01.767
for 10% skilled case mix.
11:01.902 --> 11:05.152
And there was a bunch of old nurses pushing cards like exactly kind of how
11:05.170 --> 11:08.557
you were saying before. And now you're going to
11:08.560 --> 11:12.132
have you'll hear stories about facilities that are one of the best operators.
11:12.147 --> 11:15.732
They know exactly what they're doing. They're running 37 skills,
11:15.822 --> 11:20.017
29 Medicare, 17 management. They're doing a great job.
11:20.140 --> 11:24.137
And that's where the kind of the high risk
11:26.587 --> 11:30.472
is coming from, where you have this massive workload and
11:30.655 --> 11:34.597
the patients that they're getting from Medicare are
11:34.630 --> 11:38.352
a lot sicker and that point will often be countered and you'll
11:38.382 --> 11:41.697
have people will say, well listen, we're still having a hard time staffing our facility
11:41.817 --> 11:45.887
and we're 85% medicaid.
11:46.312 --> 11:49.267
So I think it's a little more nuanced. I think both points are true.
11:49.315 --> 11:54.037
I think that there are folks that are taking much
11:54.100 --> 11:57.702
higher level of acuity and like you said, the respiratory therapist soon becoming
11:57.732 --> 12:00.877
a night giving a crash course. I think it's much more than that. I think
12:00.895 --> 12:05.037
that the hospitals are discharging patients, not necessarily
12:05.112 --> 12:08.902
skilled patients, they're just discharging patients. They're incentivized themselves to have
12:08.920 --> 12:12.442
a much shorter length of stay and they're discharging patients that
12:12.490 --> 12:15.627
could be going directly to long term care, to longterm care units,
12:15.657 --> 12:19.177
to longterm term care floors that are much, much sicker than
12:19.195 --> 12:21.350
they were 510 years ago.
12:21.712 --> 12:25.267
And I think overall it's a good thing for the industry. I think it's getting
12:25.315 --> 12:28.377
people out of hospitals faster and I think we should get people out of nursing
12:28.407 --> 12:32.422
homes faster and into home health. People should be going to nursing homes less.
12:32.530 --> 12:36.200
My grandfather, my grandparents, they're doing very well,
12:38.062 --> 12:41.377
their ninety s and eighty s, and they're living at home and they had
12:41.395 --> 12:44.727
this very old school, longterm health plan benefit
12:44.757 --> 12:47.827
and they were picking up what nursing home they wanted to go to and I
12:47.845 --> 12:50.032
had to sit them down and say, you don't ever want to go to a
12:50.035 --> 12:53.122
nursing home. You want to build your
12:53.155 --> 12:56.225
whole care plan that you should be at home as long as possible.
12:56.962 --> 13:00.502
So I think we're just kind of seeing a downstream effect from
13:00.520 --> 13:04.032
the hospitals where the acuities growing tremendously,
13:04.122 --> 13:07.627
not just in the skilled patients, but even in what we would typically call a
13:07.645 --> 13:11.452
long term care unit. And we would say that
13:11.620 --> 13:15.217
one to 30 for nurses and one to 15 for
13:15.265 --> 13:18.682
CNAs. And we'll staff the rehab unit we'll give a
13:18.685 --> 13:22.812
little extra care to. But I just think it's
13:22.962 --> 13:27.007
just the overall sickness and
13:27.085 --> 13:31.147
infirmity of patients. It used to be we were kind of high
13:31.180 --> 13:34.437
level assisted living for a lot of the residents.
13:34.512 --> 13:38.977
You're seeing less and less of that. So just
13:38.995 --> 13:44.827
to kind of get both of those right.
13:44.920 --> 13:48.142
No, I definitely hear that loud and clear.
13:48.190 --> 13:51.892
And the whole PDP model definitely is
13:51.940 --> 13:55.632
making that. You can't just take the little old ladies and put them into therapy
13:55.647 --> 13:59.457
and take advantage of that in order to maximize reimbursement.
13:59.547 --> 14:02.932
But at the end of the day, nursing homes still cannot afford to pay
14:03.010 --> 14:06.442
the prices that hospitals are paying. They can't afford even
14:06.490 --> 14:09.837
with the shift, they're not paying more dollars to nursing homes,
14:09.912 --> 14:13.302
they're just choosing how the dollars are spent on nursing homes.
14:13.332 --> 14:16.937
So I agree with you. And we actually have a couple of great episodes
14:17.587 --> 14:20.977
about this particular change. We had Mark Zimmer on the show, we had
14:20.995 --> 14:24.922
Stephen Little Hill on the show, maybe a couple of others talking about this specific
14:25.030 --> 14:27.957
change and maybe a link up to that in the show notes.
14:28.047 --> 14:31.327
But they still don't have the same level of
14:31.345 --> 14:34.452
resources unless, like you said, they're maximizing.
14:34.482 --> 14:38.387
Instead of the four 5610 skilled
14:38.737 --> 14:41.767
residents, they have more 30, 40. So you're right,
14:41.815 --> 14:45.472
then the revenue is going to be that much higher, but then you still run
14:45.580 --> 14:49.447
the chances, the risks. But maybe I
14:49.480 --> 14:53.347
want to just turn the conversation a little bit. There are
14:53.380 --> 14:57.067
many people listening to the show and
14:57.115 --> 15:00.697
in the industry, whether they're listening right now, which we have people
15:00.730 --> 15:04.327
listening right now live on LinkedIn, and people are going on
15:04.345 --> 15:07.942
Facebook as well. But the real
15:07.990 --> 15:10.752
question is staffing is such a terrible,
15:10.857 --> 15:15.247
painful problem. And in
15:15.280 --> 15:18.997
my opinion, I think there's two parts of the problem. One parts of the
15:19.030 --> 15:22.447
problem is people just getting people to want to work and getting people
15:22.480 --> 15:25.387
to want to work for you. The other part of the problem is the actual
15:25.450 --> 15:28.947
process, the recruitment process, where even if you have people in the pipeline,
15:28.992 --> 15:31.737
like, are you really managing the process properly?
15:31.887 --> 15:35.462
So what would you say if someone wants something practical?
15:35.812 --> 15:39.627
This is what you're doing for your company and I'm
15:39.657 --> 15:43.282
working. We have a company as well cloud a recruit, and we're doing this in
15:43.285 --> 15:46.762
our own way. What would you say? Some practical things that
15:46.825 --> 15:50.332
an opera is really struggling with, staffing can implement today
15:50.485 --> 15:54.202
to start dealing with the problem and alleviates some of
15:54.220 --> 15:55.337
the pressure.
15:57.112 --> 16:02.137
So that's definitely
16:02.200 --> 16:06.127
something that this is why I came on and
16:06.220 --> 16:10.475
I'm very happy to talk about this. I think when you ask about
16:11.887 --> 16:16.402
a specific hiring tool.
16:16.570 --> 16:20.377
How can we get folks to work for us? How can we get folks to
16:20.395 --> 16:23.527
want to stay with us? I think you're going to hear a lot
16:23.545 --> 16:27.102
of gimmicks. I think you're going to hear lots of, you know, party lines.
16:27.132 --> 16:30.062
I think you're going to hear all kinds of great ideas.
16:30.487 --> 16:33.757
It reminds me of guys sitting around changing the world in
16:33.760 --> 16:37.377
yeshiva and, and the herb, some dorm room somewhere.
16:37.557 --> 16:41.587
Guys have the best plan on paper. The problem
16:41.650 --> 16:45.337
is, especially as you grow out, the company
16:45.475 --> 16:48.212
I work for is 50 plus centers.
16:48.712 --> 16:53.087
It's almost impossible to try to scale
16:53.812 --> 16:57.052
your feelings and your vibe and what you think
16:57.070 --> 17:00.800
that you want your cultural company to be. That's extremely difficult.
17:04.687 --> 17:09.247
That's extremely difficult. But what
17:09.280 --> 17:12.667
we see is what's a lot
17:12.790 --> 17:16.182
easier to scale and what's
17:16.197 --> 17:20.377
a lot easier to manage is
17:20.545 --> 17:23.872
processes. Processes and oversight. And we
17:23.905 --> 17:27.012
are crazy about managing.
17:27.162 --> 17:30.402
Every last process that we want to roll
17:30.432 --> 17:33.592
out and that we build out is from start to finish.
17:33.640 --> 17:36.877
We want it to have from scratch. We want to have that this process can
17:36.895 --> 17:40.147
be implemented properly and not
17:40.180 --> 17:43.797
just thought up in some boardroom somewhere.
17:43.992 --> 17:47.497
It sounds great on paper. We launch it day one. We have a call
17:47.530 --> 17:51.050
with the facilities, and then we let it run. There's no process,
17:51.637 --> 17:57.037
especially with the
17:57.100 --> 18:00.287
spread out nature, the disconnected nature
18:00.787 --> 18:04.187
of this industry. It's usually a central corporate
18:05.512 --> 18:09.102
headquarters, and then facilities and centers spread
18:09.132 --> 18:15.222
out across multiple states. And the decentralized nature
18:15.267 --> 18:19.192
of this business makes that the only way to
18:19.240 --> 18:22.852
really have the procedures and processes that are put in place.
18:22.870 --> 18:27.592
I think most of the people that are listening to this call are probably very
18:27.640 --> 18:30.817
smart and very articulate, and they themselves can
18:30.865 --> 18:35.202
explain a process. If they're in staffing, whatever executive
18:35.307 --> 18:39.127
position that they're in the nursing home industry, they can most
18:39.295 --> 18:42.622
certainly come up with a pretty good idea how to solve certain
18:42.655 --> 18:46.372
staffing challenges, or how to solve any challenges and explain it to their
18:46.405 --> 18:50.007
friends in the boardroom. Put together a nice workflow
18:50.022 --> 18:53.377
and a nice email, send out a zoom link, and, you know,
18:53.470 --> 18:57.172
have a great meeting with your 13 centers. And then
18:57.280 --> 19:01.177
six weeks later, get mad and call up your administrator and
19:01.195 --> 19:04.597
say, hey, we have this great process. Why isn't everyone doing
19:04.630 --> 19:07.822
it right? And I think that's really where the focal point
19:07.855 --> 19:12.997
is that it's very difficult to
19:13.105 --> 19:16.702
follow up. And you'll hear, this is just business 101.
19:16.720 --> 19:20.392
It's all about execution, and it's very, very difficult to
19:20.440 --> 19:23.347
do that. But that's the only way that we've ever found success,
19:23.530 --> 19:27.397
is with incessant follow up. And if you
19:27.430 --> 19:31.332
have a program that you want to run, and again, there's hundreds and hundreds
19:31.347 --> 19:35.217
of different programs and nuances and tracking software
19:35.277 --> 19:38.452
and all kinds of things that you as an operator can come
19:38.470 --> 19:41.902
up with and plan and try to execute. The only way
19:41.920 --> 19:45.667
that it will ever work is if you baby it and mother it and
19:45.715 --> 19:48.982
troubleshoot and be there. 24/7 answering the dumb questions
19:49.060 --> 19:52.882
and getting on calls. Just to give a
19:52.960 --> 19:56.502
concrete example, we track our daily labor
19:56.682 --> 20:00.132
in a very, very comprehensive spreadsheet.
20:00.147 --> 20:03.622
We get all kinds of information on there. We can pull
20:03.655 --> 20:07.372
information from our reporting systems and our time clock, but we have them do
20:07.405 --> 20:11.300
manual entry, all the schedulers in our facilities to track
20:11.962 --> 20:15.277
our labor. And when I started this a
20:15.295 --> 20:18.607
year and a half, two years ago, the idea was we're going
20:18.610 --> 20:22.257
to have some calls to roll it out, the schedulers
20:22.272 --> 20:26.017
are going to put it in, and then I'll move on to
20:26.065 --> 20:29.077
the next project. And this is going to be just a one daily call with
20:29.095 --> 20:32.932
the facilities to ensure that this is happening. And then I'll be on to
20:33.010 --> 20:36.397
bigger and better. It's two years later and I'm still
20:36.430 --> 20:39.697
having the same daily calls with my facilities to make
20:39.730 --> 20:43.507
sure I'm answering a lot of the same questions over and over again.
20:43.660 --> 20:47.167
But at the end of the day, we get real hard data
20:47.365 --> 20:50.952
from our facilities. And I know one of the biggest issues that operators are struggling
20:50.982 --> 20:54.652
with right now is the agency management piece. There are
20:54.670 --> 20:58.947
facilities that feel that there's
20:59.142 --> 21:02.937
five up to 10% cushion
21:03.012 --> 21:06.562
and what they're actually being billed as to the hours
21:06.700 --> 21:09.275
that the agency contractors are working.
21:09.937 --> 21:13.072
So whether our agency numbers are where
21:13.105 --> 21:17.602
we want them to be, they never will be. That's not the nature of this
21:17.620 --> 21:21.697
beast of this industry. I think that we're very competitive. I think that
21:21.805 --> 21:24.937
many markets were well above the market
21:25.000 --> 21:28.377
standard. But we definitely know what's
21:28.407 --> 21:31.792
going on is that we're not waiting for our invoices to come in
21:31.915 --> 21:35.722
to see what the damage was six weeks ago.
21:35.830 --> 21:39.277
We know where we are. We know what the usage is on a
21:39.295 --> 21:43.257
day to day basis. And it's only because the execution
21:43.422 --> 21:46.747
goes and follows the process all
21:46.780 --> 21:49.942
the way. There's no let up, there's no stop. It's never
21:49.990 --> 21:53.075
fire and forget with us. You got to follow it all the way through.
21:53.737 --> 21:57.125
Okay? So having a clear process,
21:57.487 --> 22:01.250
following the process, there's no set it and forget it
22:01.987 --> 22:07.042
being hands on 24/7 being
22:07.090 --> 22:10.852
there, holding their hands through the process, supporting them and holding them
22:10.870 --> 22:15.067
accountable, these are
22:15.190 --> 22:18.800
practical things that people can suggest. Are there any
22:19.462 --> 22:23.542
just let's get a little bit more specific. So really
22:23.665 --> 22:27.462
there's a couple of ways of looking at this is the operational
22:27.537 --> 22:30.382
way of looking at this, which is you want to make sure that financially you're
22:30.385 --> 22:33.812
not spending too much money on agency over time and bonuses.
22:34.162 --> 22:37.562
And at the same time, obviously you need the facility to be well staffed.
22:37.912 --> 22:41.452
And then there's the operational side of this for
22:41.470 --> 22:45.222
the administrator or the do, and they just want to make sure that their patients
22:45.267 --> 22:48.727
are cared for. They prefer not to use agency because they know
22:48.745 --> 22:52.102
that agency is bad. Prefer not to use overtime or bonuses because those
22:52.120 --> 22:55.475
are also bad, but then they're looking for people.
22:56.362 --> 23:00.052
What would you say to a facility? I'm not
23:00.070 --> 23:02.842
holding you accountable here to know, because this is what everyone is trying to figure
23:02.890 --> 23:06.417
out. But let's say the issue is applicant flow.
23:06.477 --> 23:09.702
We just are not getting people. We got three CNAs
23:09.807 --> 23:13.512
who applied over the last month. Two of them were not certified,
23:13.587 --> 23:19.625
and the other one do not hire. Or maybe it was hired right?
23:23.287 --> 23:27.027
There's obviously 101 different components.
23:27.057 --> 23:30.547
And if there was one thing that anybody could
23:30.580 --> 23:32.825
say, then we all would have figured it out by now.
23:34.237 --> 23:37.550
It's the devils and the details, as they say.
23:37.987 --> 23:42.062
First of all, if my administrator said I'm like enough applicants,
23:43.987 --> 23:47.052
I usually am not so sympathetic.
23:47.232 --> 23:50.872
Obviously, if you go in there and you see that they're really
23:50.905 --> 23:54.812
worth three applicants in the month of March or the month of April,
23:55.687 --> 23:59.517
and two of them lived in Weehawken,
23:59.577 --> 24:03.952
then that's a real issue. So I
24:03.970 --> 24:07.777
think that's not really at the
24:07.795 --> 24:10.992
facility level. That's not something that the facility
24:11.052 --> 24:14.000
can manage. How many applicants that they get?
24:15.187 --> 24:18.592
I think a strong corporate recruiting team,
24:18.640 --> 24:22.342
a strong corporate sense of how to drive,
24:22.465 --> 24:26.542
how to properly manage. There's no secrets. It's not like I have
24:26.665 --> 24:30.277
any industry secrets. It's just having a really good, you know,
24:30.445 --> 24:34.047
understanding of the different advertising and network
24:34.092 --> 24:37.707
modalities and use them properly.
24:37.797 --> 24:41.127
Be willing to spend a lot of money on, indeed, on ZipRecruiter,
24:41.232 --> 24:45.062
Facebook, LinkedIn,
24:45.487 --> 24:48.847
while LinkedIn is not as relevant for the
24:48.955 --> 24:52.447
frontline staff, but on Instagram, is a big one.
24:52.555 --> 24:56.692
Facebook is huge spotify. It's just
24:56.890 --> 25:00.127
properly managing your campaigns and spending a lot of money will
25:00.145 --> 25:02.987
get the applicants. We get a lot of applicants.
25:04.312 --> 25:08.000
I think the biggest issue,
25:08.962 --> 25:12.297
the thing that you can't teach and what gets lost
25:12.492 --> 25:15.772
is just the hunger and the follow up
25:15.805 --> 25:18.937
and the ownership at the facility level that you can't teach,
25:19.075 --> 25:22.642
you could support, you can train, you can get all of the tools possible.
25:22.765 --> 25:26.392
And we have corporate recruiters that are nonstop just
25:26.440 --> 25:29.907
scheduling interviews for folks, putting it on their calendar.
25:30.072 --> 25:33.397
Like our administrators are living the
25:33.430 --> 25:36.697
dream. Well, no one is right now in our
25:36.730 --> 25:40.717
industry, but as good as it gets as far as in
25:40.915 --> 25:43.167
this field where there's a dearth of applicants,
25:43.302 --> 25:47.157
we're really head and shoulders
25:47.322 --> 25:51.097
above what I've seen a lot of our peers in the industry going.
25:51.280 --> 25:54.682
But with all that, we're still using agency. I had a
25:54.685 --> 25:58.147
guy come in and actually eventually hired him, but he was
25:58.180 --> 26:01.477
working for a competitor, and he came in to take a look at what we
26:01.495 --> 26:04.927
were doing, and he saw just a
26:04.945 --> 26:08.142
list of interviews that we had scheduled, the people that showed up for interviews
26:08.202 --> 26:10.807
in one facility. And he said, how's it possible that you use the agency in
26:10.810 --> 26:14.300
this facility? He said, I would kill for this
26:16.162 --> 26:19.792
level of Apple and flow and
26:19.990 --> 26:24.062
at the end of the day it really still needs high level facility
26:24.412 --> 26:27.757
execution and you really need that administrator to really be bought in.
26:27.835 --> 26:31.550
And they have a million other regionals that are all telling them that they
26:32.287 --> 26:36.087
prioritize and their department is the most important. Census collections,
26:36.162 --> 26:39.157
whatever it is, nursing all the most important.
26:39.310 --> 26:42.657
And I'm a staffing guy. We have to fight for what's
26:42.672 --> 26:46.422
ours. If you're a staffing guy out there and you're
26:46.467 --> 26:49.712
listening and this is your department, you got to go to ownership,
26:50.137 --> 26:53.602
you got to go to the facility, you have to go
26:53.620 --> 26:57.097
to your peers and you have to fight for priority because there's only a
26:57.130 --> 27:00.575
very limited bandwidth that these people can take in. Not these people.
27:01.012 --> 27:03.972
I don't mean to say that in a demeaning way. There's only a very limited
27:04.017 --> 27:07.252
bandwidth that we often take in. I have
27:07.270 --> 27:10.927
myself, I'm the director of labor management and recruiting for
27:11.095 --> 27:15.402
a nursing home group. And there's a director of accounts,
27:15.432 --> 27:19.242
received one, there's a director of business development.
27:19.302 --> 27:22.702
But we expect the facility, the administrator to take in
27:22.795 --> 27:26.527
all of our priorities from all these different seats around the table to
27:26.545 --> 27:30.127
all be channeled through one seat. It's very difficult to
27:30.145 --> 27:33.292
do that. So it just really takes the only
27:33.340 --> 27:36.937
facilities I've seen reliably to turn themselves around and go from using.
27:37.000 --> 27:39.442
When we started. Let's say we have facility that I was using. Let's say 30
27:39.490 --> 27:42.592
agency shifts a day, half million dollars a month,
27:42.640 --> 27:46.257
$40,000 a month agency in some of our worst centers.
27:46.347 --> 27:49.602
And really turning that around to using minimal
27:49.632 --> 27:52.972
agency. $50,000 a month have
27:53.005 --> 27:56.975
been the administrators that are grinding it out, gutting it out,
27:57.937 --> 28:01.792
answering emails on the weekend, doing whatever it takes to
28:01.840 --> 28:05.302
really get their buildings fully staff. They have to really want to get
28:05.320 --> 28:09.247
their facilities out of agency. But I think from
28:09.280 --> 28:12.650
a corporate perspective, if your facilities are not getting
28:14.212 --> 28:17.427
the applicants that you feel like they should be getting, if you have facilities
28:17.457 --> 28:20.600
they're still getting three applications for a nursing job
28:21.712 --> 28:25.132
per month. I think you have to really spend a little more money and
28:25.210 --> 28:28.325
take a really good hard look at how you are
28:28.687 --> 28:32.675
allocating your dollars. Got it?
28:33.562 --> 28:37.102
Basically you're saying that at least in depending on the size of the
28:37.120 --> 28:41.182
company, but let's say company or size there's including a strong corporate support
28:41.260 --> 28:45.127
in place so then applicant flow doesn't fall on
28:45.145 --> 28:48.667
the facility at all and it's a matter of
28:48.790 --> 28:52.937
spending the right money with the right channels
28:54.937 --> 28:58.522
and then the recruiters are setting up. Really in your case, they are living
28:58.555 --> 29:01.402
the dream. All they got to do is interview the people that walk in the
29:01.420 --> 29:04.437
door and hire them. That's how they get out of agency.
29:04.512 --> 29:06.887
Pretty much from the facility standpoint,
29:08.212 --> 29:12.102
I wouldn't say that the set up you're describing
29:12.207 --> 29:15.502
is the norm. I would say there's probably the exception as I'm sure you
29:15.520 --> 29:19.177
know, this is where you come in and this is the value that
29:19.195 --> 29:22.372
you bring to the company to have such a result.
29:22.555 --> 29:26.047
My question still is if someone
29:26.080 --> 29:29.332
is a standalone facility, somebody does not have a
29:29.335 --> 29:33.447
big marketing budget. I'm not talking about someone who lives in rural town
29:33.567 --> 29:36.650
in the US where it is literally four people.
29:37.837 --> 29:40.187
That can be a whole different type of conversation.
29:40.837 --> 29:44.467
But there are people to work with and
29:44.665 --> 29:48.222
they're on their own pretty much. There might be some sort of weak corporate structure,
29:48.342 --> 29:51.367
maybe two, three facilities. Administrators talk to each other,
29:51.490 --> 29:54.787
meet up every six months or whatever it is. They don't have that strong.
29:54.850 --> 29:58.302
So again, this is not going to be specific by your company, but it applied
29:58.332 --> 30:02.487
to other companies. What have you learned in your experience and your role?
30:02.637 --> 30:05.497
That these people who kind of are on their own,
30:05.530 --> 30:09.117
they really are on their own, that they can implement in addition
30:09.177 --> 30:13.192
to just like what you said, really grinding and hustling and
30:13.390 --> 30:15.050
making the most of every opportunity.
30:22.912 --> 30:26.197
I'll add to that. Okay, but I'll let you go. I can name
30:26.230 --> 30:29.907
a few tools, but I would really be lying
30:29.997 --> 30:33.922
if I said that it was anything other than letting something else
30:33.955 --> 30:37.252
slide, let something else go, push something else off your
30:37.270 --> 30:40.732
plate. And you have to really want, you have to be there on
30:40.735 --> 30:44.217
the weekends. You have to treat each applicant. If you're in a standalone facility,
30:44.277 --> 30:47.122
then the whole first half of this podcast is out the window. If you have
30:47.155 --> 30:51.437
one facility, then you could improve your vibe.
30:52.162 --> 30:55.822
If you have the smallest level of charisma and
30:55.855 --> 30:59.682
you can convince people that what you're selling, that the service that you're
30:59.697 --> 31:03.322
providing to the community is worthwhile and that they as employees will
31:03.355 --> 31:06.652
have a voice and that they can make
31:06.670 --> 31:10.452
a difference in your facility. And that's all you do. We are piloting
31:10.482 --> 31:14.617
in one facility. You're digging for something,
31:14.665 --> 31:18.477
so I'll give you something. We just started in one of our facilities,
31:18.657 --> 31:21.650
very tough facility in a pretty rural area.
31:23.662 --> 31:27.742
It's a border facility, so it's cross state and that makes all
31:27.790 --> 31:32.032
sorts of licensure issues. And what we just
31:32.110 --> 31:35.352
began there is we have a very charismatic
31:35.532 --> 31:40.400
young administrator and we instituted an
31:41.287 --> 31:42.737
employee council.
31:44.137 --> 31:49.102
And it's an employee council that is not like the resident council in
31:49.120 --> 31:52.552
name only. It's a really meaningful council. We have a
31:52.570 --> 31:57.007
very large employee retention budget that we
31:57.085 --> 32:01.042
decided as a company that we will never
32:01.090 --> 32:04.327
skimp. We have food trucks, we have all kinds of fun things that we do
32:04.345 --> 32:08.037
as a company. But in this case we turn that over to employees
32:08.112 --> 32:11.947
and they meet biweek week and they have full control of that
32:11.980 --> 32:15.007
budget. They own that budget. They can spend it how they like.
32:15.160 --> 32:19.175
They can address concerns if there's the most common
32:20.062 --> 32:25.677
complaints besides for pay, there's never enough supplies
32:25.782 --> 32:28.927
on the unit. But now instead of. Just grumbling about it and
32:28.945 --> 32:32.752
yelling at the nurse or your patient. Now you
32:32.770 --> 32:36.132
have somebody that can actually affect change without having to go to the scary administrator
32:36.147 --> 32:39.277
who you have a connection to. You can go talk to a
32:39.295 --> 32:43.222
peer, to a GNA, a CNA, a nurse who
32:43.255 --> 32:47.427
can now actually who you feel like can not just grumble
32:47.457 --> 32:51.067
with you, but can do something about it. And that's something that we feel
32:51.115 --> 32:56.450
will have a tremendous impact, that is having a tremendous impact because
32:58.837 --> 33:02.842
it's an amazing marketing tool. Imagine your indeed Ad
33:02.890 --> 33:05.975
said, have a voice on the table. You know,
33:06.487 --> 33:10.550
come work here, and you could determine what you
33:11.887 --> 33:15.275
what working in conditions you will
33:15.637 --> 33:18.800
be under. This is something that,
33:20.062 --> 33:23.277
besides for just being a good marketing
33:23.307 --> 33:26.422
tool, which could be very gimmicky, this is something that really
33:26.455 --> 33:29.237
talks to people. So if you have one facility,
33:31.087 --> 33:34.477
have a town hall that you weren't forced to
33:34.495 --> 33:38.697
have because five of your staff members left, have a town hall and nominate
33:38.742 --> 33:43.287
some folks that will not just foment
33:43.362 --> 33:46.777
drama in your facility. And just you
33:46.795 --> 33:54.502
have to use a little bit of you
33:54.520 --> 33:56.387
want somebody that's a little level headed.
34:00.487 --> 34:03.847
Let me kind of hear a couple of points here. First of all,
34:04.030 --> 34:07.507
it's such a simple concept, but I think that's the thing in the
34:07.510 --> 34:11.232
comments that this is that's
34:11.247 --> 34:15.067
an amazing idea. It's so simple and
34:15.190 --> 34:18.507
but I think even more important than the specific idea and you're
34:18.522 --> 34:21.627
right, I am digging that's. My job as a podcaster is to dig for gold,
34:21.657 --> 34:26.000
and I smell blood here, I'm going for it.
34:26.737 --> 34:28.325
But besides for that,
34:29.737 --> 34:33.702
it's getting to the root of what's
34:33.732 --> 34:37.227
going on here. For example, I'm a manager company called Recruit,
34:37.257 --> 34:40.402
as you know, and one of the things we do in the onboarding call is
34:40.420 --> 34:44.407
I ask every single client, why should somebody
34:44.485 --> 34:48.112
work for you over the nursing home down the block? I can't tell you that
34:48.175 --> 34:51.757
nine out of ten times the administrator at the on,
34:51.835 --> 34:55.072
sometimes someone from the regional team is on the call. Whatever, we're just
34:55.105 --> 34:57.757
another nursing home. Yeah, raise or this or that. But at the end of the
34:57.760 --> 35:01.447
day, they admit right away they're not sold, that someone should work
35:01.480 --> 35:04.627
for them. It's a problem. I need somebody to work for me to fill my
35:04.645 --> 35:07.327
shift. I don't really have a good reason why they should work for me over
35:07.345 --> 35:10.102
the person down the block, but that's my job, and I have to make it
35:10.120 --> 35:13.432
happen. That's like an impossible situation. It's like, what are
35:13.435 --> 35:17.332
you supposed to do if you're not sold on your own building? You don't have
35:17.335 --> 35:20.827
a good reason. Then what should I do? I push tired of the rates and
35:20.845 --> 35:23.917
we can't afford it, or we're going to do it soon, or it's a process.
35:24.040 --> 35:26.450
We tried this, we tried that, we tried the other thing,
35:27.712 --> 35:31.002
and it's a risk to the bottom. Even when you are hiring
35:31.032 --> 35:34.177
the rates and reimbursement is not being adjusted currently. Here are all the
35:34.195 --> 35:37.747
excuses but we are touching on. Here is a very
35:37.780 --> 35:41.107
good point. It's not just about the money. What is a huge,
35:41.185 --> 35:44.962
huge amount of disloyalty, if that's the word between
35:45.025 --> 35:48.362
employees and employers, that's because there's a real disconnect.
35:48.862 --> 35:52.582
The voice not being heard is a big deal.
35:52.735 --> 35:56.617
Knowing that when there's an issue, I can go to someone
35:56.740 --> 36:00.642
at first of all and just be heard, really heard and understood,
36:00.777 --> 36:04.747
and then maybe actually implement change and we can change the way we run
36:04.780 --> 36:07.722
the facility. Based on my feedback,
36:07.917 --> 36:11.272
I might not be looking down the block for actually a dollar an hour or
36:11.305 --> 36:13.747
because I could go to the agency who's going to pay me a little bit
36:13.780 --> 36:18.442
more, and they're going to explain. To me why? Financially, I'm crazy for
36:18.640 --> 36:21.847
staying with the facility if the only thing we
36:21.880 --> 36:25.867
discussed in this episode was just this one point that don't just
36:25.915 --> 36:29.362
fight for attention. Don't just fight for the rates and the benefits,
36:29.500 --> 36:32.977
but get to the root of the reason. What makes an employee want to stay
36:32.995 --> 36:36.402
at a certain place? We could also we could talk about the pandemic.
36:36.582 --> 36:39.772
Unemployment is over, the pandemic benefits are over.
36:39.880 --> 36:42.952
So therefore where is everybody? I don't know the answers to
36:42.970 --> 36:46.192
that question. I don't think anybody knows the answer to that question and
36:46.240 --> 36:48.200
there's no point in discussing that here.
36:50.812 --> 36:54.547
It's a great resignation. Exactly. So everyone's starting all their
36:54.655 --> 36:58.917
unicorn startups. They're all in their infancy
36:58.977 --> 37:02.272
right now. In two years from now we have all these billion dollar companies.
37:02.380 --> 37:06.052
Highly doubtful, but whatever it is, people are doing jobs that
37:06.070 --> 37:09.547
fit with their passion, it doesn't matter. Right now there are people that are looking
37:09.580 --> 37:13.027
for nursing home jobs and there are not enough people in the
37:13.045 --> 37:16.042
industry. And me and you are not solving that problem.
37:16.090 --> 37:19.642
Maybe a government's going to solve the problem, maybe they won't solve the problem.
37:19.765 --> 37:23.452
But most people are responsible not for the industry as a whole, but for their
37:23.545 --> 37:27.127
buildings, their company specifically. And you have to give them a
37:27.145 --> 37:30.592
good, strong reason to want to work for you other
37:30.640 --> 37:33.432
than just dollars and cents. Because dollars and cents,
37:33.522 --> 37:36.650
it's the same currency. So right now you make more sense.
37:37.462 --> 37:40.777
It makes more sense for them to come and work for you. They might make
37:40.795 --> 37:44.047
more sense in 5 minutes to work down the block. But if they actually have
37:44.080 --> 37:47.122
a reason to want to work for you and they feel connected, they feel heard,
37:47.155 --> 37:49.775
they feel understood and maybe a lot of other things,
37:50.287 --> 37:53.547
then not only can you help your facilities succeed,
37:53.667 --> 37:56.752
you can also maybe even help change the trend in the
37:56.770 --> 38:00.502
industry in general. It'll give people reasons to want to actually be
38:00.520 --> 38:03.817
there. Yeah, and I couldn't agree with you more.
38:03.865 --> 38:08.452
Like I said, if we're talking on a one off basis or
38:08.620 --> 38:11.872
out of cap at six or seven homes where
38:11.905 --> 38:17.162
you really feel like you can impart your personality and your brand,
38:18.262 --> 38:21.267
for lack of a better word, upon your facilities,
38:21.402 --> 38:26.302
then there's a lot of work there for really
38:26.470 --> 38:30.352
adjusting. The way I look
38:30.370 --> 38:34.147
at it. And I guess the question that I always ask is what is the
38:34.180 --> 38:38.007
nurse or the CNA or one of my unit managers,
38:38.022 --> 38:41.750
what's she feeling? What's he feeling when he sees the sign for
38:42.787 --> 38:45.952
one of the centers? When they pull in the morning, what's the
38:46.045 --> 38:49.897
first thing that they feel? Is it a sense
38:49.930 --> 38:52.977
of, like a pit in their stomach, a sense of dread,
38:53.082 --> 38:56.302
a sense of another day here?
38:56.470 --> 39:00.067
Or is it something that like, oh, wow, part of something.
39:00.115 --> 39:03.657
This is something that there are people here I can rely
39:03.672 --> 39:06.082
on. There are people here that I like. There are people here that want to
39:06.085 --> 39:09.650
work with me, and I'm doing a good thing here. I'm not just getting
39:11.137 --> 39:14.712
chewed up and spit out by a crazy fast paced environment
39:14.787 --> 39:18.472
that I didn't sign up to when I went to nursing school 15 years
39:18.505 --> 39:19.100
ago.
39:21.862 --> 39:25.377
Well, you're really getting to the root
39:25.482 --> 39:29.202
of what makes people tick. This is definitely not limited
39:29.232 --> 39:32.677
to nursing homes. But what does
39:32.695 --> 39:35.302
it feel like? And I can tell you as you're saying those words, what does
39:35.320 --> 39:38.452
it feel like? I'm thinking about the different sons that I used to pull up
39:38.470 --> 39:42.267
to, and you're not my therapist
39:42.327 --> 39:45.577
yet, but I can tell you that some buildings I feel that not
39:45.595 --> 39:48.472
in the stomach, and some of them are like, wow, we really do good work
39:48.505 --> 39:52.162
there. And it's true. And if I feel that way,
39:52.300 --> 39:56.227
the administrator or even different roles I've been in, obviously the
39:56.245 --> 40:00.142
staff feels a similar way too. And it could
40:00.190 --> 40:04.287
be neutral, like whatever. I have no connection here. They pay my paycheck.
40:04.437 --> 40:07.167
I try to do my best. I take care of some patients.
40:07.302 --> 40:10.700
Maybe tomorrow I'll work sell on Amazon or something.
40:11.662 --> 40:14.722
And that obviously is not going to help.
40:14.755 --> 40:18.247
And I know that we're going a little bit over time
40:18.280 --> 40:21.922
here, but I'm going to try my luck. If you don't mind, one more
40:21.955 --> 40:25.497
point, this conversation, and we could do another whole podcast
40:25.542 --> 40:28.807
about this. Maybe we will, if you're open to it. But one point I
40:28.810 --> 40:32.227
can tell you that I see personally from the work that we do is
40:32.245 --> 40:36.052
that we work really hard. We're pretty much just to say it
40:36.070 --> 40:39.622
out there, what we're doing in quality. What you're doing in house is very
40:39.655 --> 40:43.627
similar, right? You're doing all the process. Many companies are
40:43.645 --> 40:48.502
not the size, and they're not as strong as your
40:48.520 --> 40:51.952
company. So they can't do that. We come
40:51.970 --> 40:55.507
in, we do it for them. But the frustrating part, and I'm curious to know
40:55.510 --> 40:58.582
if you see this, is that you finally bring the person in.
40:58.660 --> 41:02.142
They're finally on board. They're working. They picked up a few shifts
41:02.277 --> 41:05.697
and then 30, 60, 90 days later, they jump ship.
41:05.817 --> 41:09.637
You spent thousands of dollars, tens of hours
41:09.700 --> 41:13.327
getting these people finally on board and getting them to mix with
41:13.345 --> 41:17.137
everybody else, and then they're gone. The retention piece
41:17.275 --> 41:21.712
is huge, especially when you work so hard on anything
41:21.775 --> 41:26.075
to say about that so very quickly.
41:26.437 --> 41:30.367
I can say about that. It's kind of a little bit of what I had
41:30.565 --> 41:33.937
originally, the first kind of the
41:34.000 --> 41:37.522
tagline that I sent over, that brief little
41:37.705 --> 41:40.297
blurb that you wanted me to kind of put out,
41:40.480 --> 41:44.092
and it was about tying in the global oversight piece
41:44.140 --> 41:47.677
to the facility level, to what happens at the facility. And I
41:47.695 --> 41:51.652
think that they're both very important, I think, especially once you go above the one
41:51.670 --> 41:54.922
or two facilities and even really five, six or eight,
41:54.955 --> 41:58.567
but it doesn't even have to be that many, is the ability to
41:58.615 --> 42:02.002
react quickly to good data, because you
42:02.020 --> 42:05.692
can't be everywhere. And there is a sweet spot where I think,
42:05.740 --> 42:09.062
where a lot of operators can outgrow their initial,
42:09.562 --> 42:13.702
where they can have an immediate impact on every one of the facilities that
42:13.720 --> 42:17.667
they own and where they can impart themselves on every facility
42:17.727 --> 42:20.802
at the same time. And their stretch are a little too thin. And then it's
42:20.907 --> 42:23.827
kind of just like a game of whack and mole. It's exhausting. And you could
42:23.845 --> 42:27.592
never, ever get down to the root cause of things,
42:27.640 --> 42:29.612
because you're just putting up fires.
42:30.712 --> 42:34.550
I think that really, really good data that's coming in in real time
42:35.587 --> 42:39.142
is the way that you can effectively solve this. And you could get
42:39.190 --> 42:42.247
out, you know, you're not coming in and
42:42.280 --> 42:46.447
hitting a trend 60 days in or even 45
42:46.480 --> 42:49.527
days in. You could really see what's going on a week by week basis,
42:49.632 --> 42:53.317
and you could go down, and you could spend some
42:53.365 --> 42:56.827
time where it has to be spent before things get out of control. And you
42:56.845 --> 43:00.202
asked me about retention, about the culture of a facility. That's really what it
43:00.220 --> 43:03.877
comes down to. It comes down to, and this is kind of the hardest part,
43:03.970 --> 43:08.157
facilities all start with nursing
43:08.172 --> 43:11.387
retention starts with the people that are running the nurse.
43:12.562 --> 43:16.162
It's not the owners, it's not the regionals, it's not me. It's the
43:16.225 --> 43:19.402
administrators and the dons that are the bosses of
43:19.420 --> 43:22.497
these people that are in the buildings every day. They're the ones that are promoting
43:22.542 --> 43:26.427
their work environment. And it's a very tough time to say hire good administrators
43:26.457 --> 43:29.422
and hire good deals. But that's what you got to do. You have to have
43:29.455 --> 43:32.827
good nursing leadership. I know let's not talk
43:32.845 --> 43:36.052
about unit managers and supervisors, and they're also all
43:36.070 --> 43:39.397
very important. But to have to
43:39.430 --> 43:43.417
support, to give as a regional, if you're a regional on this call,
43:43.540 --> 43:46.987
the goal is really, really and it took me a while to believe in myself.
43:47.050 --> 43:50.302
I said it a lot before I believed it. Our job is not to
43:50.320 --> 43:53.827
fix things. Our job is not to be the big hero that
43:53.845 --> 43:57.262
saves the day. Our job is to really
43:57.325 --> 44:00.852
support and free up as much as the administrator's
44:00.882 --> 44:04.342
time so we can see what he has to see quickly
44:04.465 --> 44:08.127
and he can spend his time not being reactive
44:08.157 --> 44:11.767
himself or herself and really impart their
44:11.815 --> 44:15.577
brand and their because these people are not they got to
44:15.595 --> 44:18.777
that point in life and they believe in something. If you've
44:18.807 --> 44:21.652
been that miniature for a long time,
44:21.745 --> 44:25.072
the one common denominator about a lot of that miniature is they really
44:25.105 --> 44:29.952
like what they do, at least before coping. And they really and they'll
44:29.982 --> 44:32.675
keep you in their office talking and talking and talking.
44:33.412 --> 44:36.727
There's no one more talking about a nursing administrator and talking to
44:36.745 --> 44:40.057
people are people that have a lot to share. And these people, they have a
44:40.060 --> 44:43.700
lot to share. People like to work for somebody that has
44:44.062 --> 44:47.975
a brand and has a vision and has their own unique flavor and
44:48.862 --> 44:52.597
they can be very tough people, it could be very regimented, but they have
44:52.630 --> 44:55.822
something that they believe in and that you're showing up to fit into their
44:55.855 --> 44:59.062
system. And if you like it great, and if not, not. But that is
44:59.125 --> 45:02.992
very attractive to a lot of people. So our goal is
45:03.040 --> 45:06.327
really to make sure that we're empowering the leaders
45:06.357 --> 45:10.137
on the ground with the quickest data, the best data, the best processes,
45:10.212 --> 45:13.297
that they can just spend time doing their job,
45:13.330 --> 45:16.432
which is running facilities and not
45:16.585 --> 45:20.422
being on calls with corporate all the time and getting yelled at for census numbers.
45:20.530 --> 45:23.827
And then no wonder that they're losing other people. The people are not working for
45:23.845 --> 45:28.177
anybody. It's leaderless the
45:28.195 --> 45:32.367
inmates are running that we have to let our administrators
45:32.427 --> 45:35.247
lead. Amen.
45:35.367 --> 45:38.977
I can tell you that because all
45:38.995 --> 45:42.337
too often does not know what's happening. It's been amazing. Have you
45:42.400 --> 45:46.850
on the podcast. I know when significantly past
45:47.287 --> 45:50.572
what we usually do on the show, but just
45:50.605 --> 45:54.172
because there's so much real world experience that you sharing with
45:54.205 --> 45:57.472
our listeners and followers of the show, I really
45:57.505 --> 46:01.117
appreciate your time and it's definitely worth,
46:01.240 --> 46:04.302
definitely worth the wait to be able to have this separate
46:04.332 --> 46:08.097
conversation. We really appreciate you sharing generously
46:08.142 --> 46:11.600
and openly of your real world experience.
46:12.637 --> 46:15.772
Before we let you go, any final thoughts that you would want to leave with
46:15.805 --> 46:19.177
the listeners before we
46:19.195 --> 46:23.347
close out this episode? No. It's just been
46:23.455 --> 46:26.602
good chatting with you over the last few months. I think that you're doing a
46:26.620 --> 46:29.452
great thing here and I really hope that your audience grows. I think a lot
46:29.470 --> 46:32.537
of people could benefit from these kinds of conversations.
46:33.712 --> 46:37.192
We're all in this together. Absolutely.
46:37.390 --> 46:40.692
Thank you so much Object, for coming on the show, really appreciate
46:40.752 --> 46:41.375
that.
46:55.687 --> 46:59.257
Now that you've enjoyed this episode of the nursing home
46:59.335 --> 47:03.237
podcast, I'd really appreciate if you'd rate this podcast
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and let everyone else know what an amazing resource this
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is. For those wanting to learn anything and everything about the nursing home
47:10.780 --> 47:15.502
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