Take Full Ownership of Your Recruitment

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What's a lot easier to scale

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and what's a lot easier to manage

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is processes, processes and oversight.

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And we are crazy about managing.

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Every last process that we want to roll out and that

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we build out is from start to finish. We want it to have it from

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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.

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It sounds great on paper. We launch it day one. They have a call with

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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.

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Welcome to another live recording of

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The Nursing Home Podcast, the podcast that

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you've learned to turn to to find out real information,

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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

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literally available nowhere else. In today's episode

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on the Nursing Home Podcast, we actually have a very

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interesting episode for you with Avi Richmond.

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Avi has a background in the nursing home administration, is now

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the director of labor and Management and recruiting for Vita Health

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Care Group. And those of you who are following the podcast know that

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we've been focusing on staffing quite a bit recently because

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of the challenges that it imposes on the nursing home industry.

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So I'll be welcome to the nursing home podcast. Thank you.

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Thank you, Shaman. It's been a long time coming.

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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

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know who I am from other episodes, but just a little bit of how you

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got to doing what you're doing right now professionally and then we jump into the

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episode. Sure. So I started off,

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like many in our community, in our industry,

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as an administration, nursing administration, to start off as an assistant

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administrator in a small facility

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in middle of Nowhere,

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Pennsylvania, and it actually

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was a great opportunity.

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My first boss really could have given a master class on how

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to view and share for the next generation

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of healthcare administrators and

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executives. He really understood how to let

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me kind of take the bull by the horns and just kind of do

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my own thing and really grow. It was like kind of the

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perfect petri dish for experimentation,

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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

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was my company was kind of

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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.

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Got it. So you've been doing this ever since in that position?

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Yeah got it. Very interesting.

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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.

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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

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the staffing to support that? For some people became more important.

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The amount that they're spending on agency overtime bonuses,

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the Medicare that they're getting can be completely offset

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by the staffing costs that they have. Yeah, I think that's true. I think there's

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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

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census, that could be awesome. But I think that kind of leads to two

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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

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of mandated staffing levels that they will not allow them to accept

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residents if their staff and levels fall

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dangerously short, whether that's the correct or incorrect thing to do

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morally, there are many states where they will not do that and people

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will staff at dangerously low levels. So you

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definitely have that aspect where it will be mandated.

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Whether you like it or not, they're going to cap your admissions.

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And then there's also the fact that I think we've even

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discussed this in the past. There's the fact of the way that we've

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kind of taken this industry and very

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much was not designed for the way that's

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necessarily being run in certain companies,

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certain groups of homes that are utilizing

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a very antiquated model with staff and a very

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antiquated model with long term care. And the

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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

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use the same nurses that are just not with the same training.

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It's just not a sustainable model at all. Okay,

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so now you bring up something which is very important to discuss.

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There's millions of different ways that people say it, but they say that the community

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hospital of yesterday is today's nursing homes. Yesterday's nursing homes,

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what they call the little old ladies who were pretty much

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stable, and they need a little bit of assistance,

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a little bit TLC, little social life. So mostly medicaid,

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not too much skills. So then the nursing,

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the entire staffing, the skills, the need is completely different

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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

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of America, and any nursing home in the same place, like, the staffing

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levels, the difference is staggering. The example I've

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given before on this show, and I'll give it again now. I know a person

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when my son was in the NICU after he was

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born, and I was going back and forth from the nursing home to

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the NICU Children's Hospital in Boston. So it's one of the top hospitals

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in the world, so it's not a fair comparison. But at the end of the

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day, there was one nurse. Twelve hour shifts with two

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newborn babies. Now, yeah, the babies are there for a reason.

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Thank God the sun is fine, but at

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the end of the day, they're doing very little. They have

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plenty of time to talk to us and show us pictures about their family and

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spend time. And when we were concerned, they were able to

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give us all the time in the world that we needed. And yet there were

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some other emergencies we've seen go on over there.

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But at least from an outside perspective,

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it looks like they're way overstaffed. And it's not just that, it's the equipment,

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it's the actual facility. And as opposed to going back to nursing

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home where we just accepted somebody with a brand new

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trait, respiratory therapist is coming in at night to give

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a crash course to the nurses about what a trick is and how

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to manage it and how to try to get this person decanulated and

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to try to get them not to need the trig anymore. And the therapy team

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is learning on the fly pretty much what to do. This is

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while each nurse is responsible for 20 plus

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patients with CNAs that are not showing up precovid and

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working with extremely antiquated equipment,

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working really hard just to get the basic equipment,

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the basic mess, the basic tubing, like, each thing is a big deal.

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The cart that comes into the room is 25 years

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old. Thank God we were successful

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with that particular patient. But it's just like the resources

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available for taking care of someone

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type of patients, it couldn't be more different.

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And you're right, the staffing levels haven't changed,

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and it hasn't changed. Reimbursement hasn't changed. That's part of

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the root of the problem. We're still getting reimbursed.

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It's interesting actually kind

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of as you were talking, I was making the working mistake and

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I was trying to think of how CMS

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is actually responding to this rather than listening to everything that

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you were saying. But I did hear what you said,

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but I would beg to differ

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on that point. I think that you see the

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whole rehab focus,

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reimbursement is going away and there's a much bigger emphasis on

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skill for nursing. I think that what hasn't caught

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up yet. I think that CMS is actually doing

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the correct thing here. And I think that just to

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back up a little bit, you'll hear about nursing homes. I think the textbook

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case is that the average hundred bed facility

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from ten years ago would have four

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Medicare patients, six managed care if you were lucky,

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for 10% skilled case mix.

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And there was a bunch of old nurses pushing cards like exactly kind of how

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you were saying before. And now you're going to

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have you'll hear stories about facilities that are one of the best operators.

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They know exactly what they're doing. They're running 37 skills,

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29 Medicare, 17 management. They're doing a great job.

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And that's where the kind of the high risk

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is coming from, where you have this massive workload and

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the patients that they're getting from Medicare are

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a lot sicker and that point will often be countered and you'll

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have people will say, well listen, we're still having a hard time staffing our facility

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and we're 85% medicaid.

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So I think it's a little more nuanced. I think both points are true.

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I think that there are folks that are taking much

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higher level of acuity and like you said, the respiratory therapist soon becoming

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a night giving a crash course. I think it's much more than that. I think

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that the hospitals are discharging patients, not necessarily

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skilled patients, they're just discharging patients. They're incentivized themselves to have

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a much shorter length of stay and they're discharging patients that

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could be going directly to long term care, to longterm care units,

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to longterm term care floors that are much, much sicker than

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they were 510 years ago.

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And I think overall it's a good thing for the industry. I think it's getting

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people out of hospitals faster and I think we should get people out of nursing

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homes faster and into home health. People should be going to nursing homes less.

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My grandfather, my grandparents, they're doing very well,

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their ninety s and eighty s, and they're living at home and they had

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this very old school, longterm health plan benefit

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and they were picking up what nursing home they wanted to go to and I

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had to sit them down and say, you don't ever want to go to a

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nursing home. You want to build your

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whole care plan that you should be at home as long as possible.

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So I think we're just kind of seeing a downstream effect from

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the hospitals where the acuities growing tremendously,

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not just in the skilled patients, but even in what we would typically call a

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long term care unit. And we would say that

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one to 30 for nurses and one to 15 for

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CNAs. And we'll staff the rehab unit we'll give a

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little extra care to. But I just think it's

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just the overall sickness and

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infirmity of patients. It used to be we were kind of high

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level assisted living for a lot of the residents.

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You're seeing less and less of that. So just

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to kind of get both of those right.

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No, I definitely hear that loud and clear.

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And the whole PDP model definitely is

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making that. You can't just take the little old ladies and put them into therapy

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and take advantage of that in order to maximize reimbursement.

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But at the end of the day, nursing homes still cannot afford to pay

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the prices that hospitals are paying. They can't afford even

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with the shift, they're not paying more dollars to nursing homes,

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they're just choosing how the dollars are spent on nursing homes.

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So I agree with you. And we actually have a couple of great episodes

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about this particular change. We had Mark Zimmer on the show, we had

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Stephen Little Hill on the show, maybe a couple of others talking about this specific

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change and maybe a link up to that in the show notes.

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But they still don't have the same level of

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resources unless, like you said, they're maximizing.

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Instead of the four 5610 skilled

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residents, they have more 30, 40. So you're right,

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then the revenue is going to be that much higher, but then you still run

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the chances, the risks. But maybe I

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want to just turn the conversation a little bit. There are

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many people listening to the show and

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in the industry, whether they're listening right now, which we have people

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listening right now live on LinkedIn, and people are going on

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Facebook as well. But the real

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question is staffing is such a terrible,

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painful problem. And in

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my opinion, I think there's two parts of the problem. One parts of the

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problem is people just getting people to want to work and getting people

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to want to work for you. The other part of the problem is the actual

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process, the recruitment process, where even if you have people in the pipeline,

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like, are you really managing the process properly?

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So what would you say if someone wants something practical?

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This is what you're doing for your company and I'm

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working. We have a company as well cloud a recruit, and we're doing this in

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our own way. What would you say? Some practical things that

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an opera is really struggling with, staffing can implement today

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to start dealing with the problem and alleviates some of

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the pressure.

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So that's definitely

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something that this is why I came on and

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I'm very happy to talk about this. I think when you ask about

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a specific hiring tool.

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How can we get folks to work for us? How can we get folks to

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want to stay with us? I think you're going to hear a lot

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of gimmicks. I think you're going to hear lots of, you know, party lines.

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I think you're going to hear all kinds of great ideas.

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It reminds me of guys sitting around changing the world in

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yeshiva and, and the herb, some dorm room somewhere.

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Guys have the best plan on paper. The problem

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is, especially as you grow out, the company

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I work for is 50 plus centers.

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It's almost impossible to try to scale

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your feelings and your vibe and what you think

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that you want your cultural company to be. That's extremely difficult.

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That's extremely difficult. But what

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we see is what's a lot

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easier to scale and what's

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a lot easier to manage is

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processes. Processes and oversight. And we

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are crazy about managing.

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Every last process that we want to roll

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out and that we build out is from start to finish.

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We want it to have from scratch. We want to have that this process can

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be implemented properly and not

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just thought up in some boardroom somewhere.

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It sounds great on paper. We launch it day one. We have a call

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with the facilities, and then we let it run. There's no process,

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especially with the

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spread out nature, the disconnected nature

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of this industry. It's usually a central corporate

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headquarters, and then facilities and centers spread

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out across multiple states. And the decentralized nature

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of this business makes that the only way to

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really have the procedures and processes that are put in place.

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I think most of the people that are listening to this call are probably very

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smart and very articulate, and they themselves can

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explain a process. If they're in staffing, whatever executive

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position that they're in the nursing home industry, they can most

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certainly come up with a pretty good idea how to solve certain

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staffing challenges, or how to solve any challenges and explain it to their

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friends in the boardroom. Put together a nice workflow

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and a nice email, send out a zoom link, and, you know,

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have a great meeting with your 13 centers. And then

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six weeks later, get mad and call up your administrator and

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say, hey, we have this great process. Why isn't everyone doing

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it right? And I think that's really where the focal point

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is that it's very difficult to

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follow up. And you'll hear, this is just business 101.

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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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47:10.780 --> 47:15.502
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