Donna Kelsey considers herself an optimistic realist.
As the head of American Senior Communities (ASC), Kelsey remains hopeful about the opportunity to boost census across the company’s 102 facilities.
She also recognizes the realities of continuing to operate in a pandemic where federal and state regulations for nursing homes remain tight as the rest of the country lessens its grip on such guidelines.
As of earlier this month, Indiana-based American Senior Communities had 55 buildings with a staff member or resident who tested positive for Covid.
“Now with that said our deaths have been almost nothing and they’re not going back to the hospital … But I have to tell my stakeholders that we’re still in the pandemic and I’m still required to bring people in and isolate them. I’m still required to use a lot of PPE that’s very expensive and our staffing is still a challenge,” Kelsey told Skilled Nursing News.
ASC has 90 skilled nursing service sites, some of which are on campuses with assisted living facilities or garden homes, and 12 standalone facilities, in addition to “growing” hospice and home health companies and a recent addition of palliative care services — all exclusively in the state of Indiana.
Kelsey doesn’t expect ASC to take “big strides” between now and the end of the year. Until nursing homes can eliminate Covid from its buildings, or the government loosens its testing requirements, she expects things to be stable.
And she is perfectly content with that.
“Right now stable is fine — stable would actually be good for a little bit,” Kelsey told SNN.
In the meantime, Kelsey has set her sights on recruiting staff, reducing turnover, getting stable leadership in every building and, in turn, boosting census.
Building relationships builds trained, committed staff
While ASC has seen an increase to its flow of overall applicants, Kelsey recognizes the realities of a limited pool of skilled nursing applicants.
While the nursing home employee count has ticked up modestly since the beginning of the year, the number is still nowhere close to what the industry saw 10 years ago – about 21% of the sector’s workforce has not returned.
“When you have limited resources out there, everybody is competing against each other, and that does make it difficult because some of the providers do offer outrageous amounts of money,” Kelsey said.
One of the benefits of operating across different avenues of the care continuum is the ability to hire for each of the service lines under one umbrella. For example, if someone doesn’t want to work in one care setting in particular, ASC can offer alternative options that could still place a worker within the company, she said.
However, one challenge of operating in Indiana alone has been the reality that sometimes two ASC buildings are across the street from one another and end up occasionally competing for staff or residents.
One of ASC’s biggest successes has been its floating nurses. Somewhat of an internal agency staff, the nurse will go wherever they are needed — whether that’s to support the DNS or another position on the floor.
ASC has also worked to expedite its “touch points” — cutting down the time it takes for an applicant to express initial interest to a hiring manager reaching out.
The Indiana operator has also revamped its orientation program, including adding a requirement that the executive director or director of nursing services (DNS) spends the first day with all new employees.
In addition to developing bonds among coworkers, ASC is also working to establish relationships between employees and the residents in their buildings. Through the care companion commitment, ASC employees share information about themselves with the residents in hopes of creating a greater sense of community, Kelsey said.
“We know that if we can keep our staff … A trained, committed staff makes a difference all the time, particularly in quality care and in our five-star ratings,” she added.
Since the beginning of the year ASC has reduced its turnover by roughly 10 percentage points – going from 85% to 74%.
But turnover by building continues to vary greatly. Some buildings are “outrageously horrible” while others maintain a turnover rate of under 30%, according to Kelsey. Those buildings with much lower turnover rates often have a solid executive director or DNS, she added, resulting in a good building culture and staff who want to stay in their jobs.
‘We have to do better by Medicaid’
As new regulations and oversights continue to come down the pipeline, Kelsey hopes the federal government gives nursing home operators a chance.
What is currently required of providers, according to Medicaid regulations, is not what nursing homes are actually getting paid for.
“Everybody should have rights with dignity and kindness and great care, but we have some regulations in here that just simply aren’t attainable and they’re certainly not being monetized,” she said.
A federal staffing minimum, for example, is a regulation that many nursing home providers would like to comply with but fear they will be unable to do so given the enduring staffing challenges facing the industry.
American Health Care Association President and CEO Mark Parkinson has warned that an unfunded daily minimum standard of 4.1 hours would put essentially every nursing home building in the country out of compliance.
If federal regulators were to think through these decisions and make them “operational” things could potentially be different, Kelsey said.
“Most of the people in this field want to do well, we want to provide great care to our residents and have a great enriching experience while they’re there with us and we’d like to think that the government is our partner,” she said.
