Facing the reality that most new nurses don’t choose to enter geriatrics, senior living and skilled nursing leaders both are going back to the basics and seizing on innovation to expand their direct care staff members and hang on to them.
A panel of long-time female leaders from across the sector embraced those dual themes during an exclusive roundtable conversation at last week’s sixth annual McKnight’s Women of Distinction event.
“We have to empower our existing nurses,” said 2024 Hall of Honor inductee Sharon Roth Maguire (pictured), senior vice president and chief health and wellness/resident experience officer at LCS.
The Iowa-based management firm serves approximately 140 senior living communities, including continuing care retirement / life plan communities, in 35 states, where it is now employing a clinical leadership council that gives current nurses more say in new programming and recruitment and retention efforts.
“Bringing nurses from all over the United States, from within different LCS communities, has really been empowering,” Maguire observed. “We’re giving them the voice to say, ‘What do you guys think will make the difference here? What do you see as a need and how can we attract more nurses, younger nurses?’”
She said she sees major needs for licensed nurses to fill leadership positions and for certified nurse aides.
Others, including 2024 Hall of Honor inductee Rachel Shearer, senior vice president of operations at Ignite Medical Resorts, said that the existing need for registered nurses looms large ahead of a federal staffing mandate for nursing homes. That mandate applies directly only to nursing homes, although the senior living industry expects it also to affect senior living providers because they recruit from the same pool of workers.
“I think we’re doing better than the national average,” said Shearer, whose facilities focus on rapid rehab and advanced clinical programming. “If the staffing mandate happens, we’ll be struggling just like everyone else.”
Shearer called the inclusion of licensed practical nurses in the finalized staffing rule a small win, but she said it remains tough to keep the “rock stars” among the LPNs Ignite’s staffing approach relies on.
“They know they can go down the street to the hospital, have less regulation, less stress, less patients,” Shearer said. “Skilled, in my opinion, is the hardest setting.”
At Principle LTC, recruitment strategies have included RN bonuses as high as $25,000, which still haven’t drawn a rush of new workers. The company was at one point down 10 directors of nursing in a 46-building footprint.
Many nurses today don’t want the overtime hours, which comes with extra pay that used to be enticing to workers. So it’s back to the basics, said Chief Operating Officer Joylin Nation, a 2022 McKnight’s Women of Distinction Hall of Honor inductee.
In rural areas, especially, Principle LTC has had success with new partnerships with local high schools and colleges. The company has offered to pay to develop nurse training programs and offered its own certified staff to teach.
A partnership with Eastern Carolina University has led to the placement of several paid administrators in training, who Principle guarantees job placement. Seven have completed the program and now work for the provider.
Technology’s promise
Although hospitals may be taking much-needed workers, they also may offer a way forward for providers ready to innovate.
Just a few years ago, 2024 Hall of Honor inductee Becky Bodie said, she worked for a skilled nursing company that still was using paper records. That outdated approach not only disadvantages providers when it comes to data collection and insights; it’s just not attractive to today’s workforce.
“I think we’re going to have to start using some of the hospital types of things, like hospital beds [with sensors],” said Bodie, executive vice president and COO at Diversicare Healthcare Services. “It’s cost-prohibitive in some scenarios, but I think we just have to keep looking for all of those types of things that make it just a little simpler for our nurses and our CNAs. Anything that can carve off an hour will help by lightening the burden and help with retention.”
Diversicare recently expanded its presence in the senior living space with the purchase of St. Martin’s in the Pines, an Alabama continuing care retirement / life plan community, last fall.
Ignite recently piloted a falls detection tool from KamiCare that uses a combination of artificial intelligence and human monitoring to predict falls, whereas LCS soon is launching a pilot of a new, updated nurse call system.
And several speakers praised the value of pre-submission payment scrubbers that check for supporting documentation, review care patterns and risks, and offer insights and predictions that can help fuel quality measure improvements.
Claire Stephens, a vice president at roundtable sponsor PointClickCare, said her company is “very much” investing to learn where AI makes the most sense for post-acute care staff, in ways that are both safe and compliant.
The software provider also recently became certified by the Office of the National Coordinator for Health Information Technology, meaning that it is permitted by federal regulators to share more data between hospitals and long-term care providers. That capability should deliver new tools to feed value-based care initiatives, too, Stephens noted.
“We’re doubling down on insights work, as well,” she said. “Analytics is a huge area that I would say [electronic health records systems] have not put a high priority on, just with the nature of all of the work we must do. …[In the future] we want to give you your data and make sure you can easily look at your data in the core tool, without having to go to the marketplace.”
Other avenues for success
Although 2024 Hall of Honor inductee Annie Pineda-Eiland, regional director of clinical service for Illinois-based Legacy Healthcare, also is embracing technology, she sees immigration reform as another key to long-term care’s future.
Her company has reduced its reliance on agency nurses, hired some of them onto its team and built up its own internal pool. But being able to hire more foreign-born nurses would help meet ongoing needs, she said.
She came to the United States a foreign nurse 30 years ago and wants to see such access and programming grow for licensed nurses.
“The recruitment of foreign nurses, that was off limits for a long time, because of a number of legislative and regulatory reasons, but we’re starting to get back into that,” McGuire added. “We have one community that has had great success. We haven’t done it at a large scale, but we’re going to certainly explore that.”
For all of these solutions, the speakers said, providers need more support from a government that is promoting higher staffing and higher quality from the nations’ long-term care providers.
“We have to look at what’s really important to us, and what’s important to us is our people,” Pineda-Eiland said. “The ownership has to make sure we’re taken care of. Our government also has the responsibility to take care of us. If we don’t care of each other, who will take care of the people?”
