When Fortune magazine publishes its first “Best Workplaces in Aging Services” list on Sept. 27, it might include some skilled nursing facilities.

That wasn’t what Jacquelyn Kung, CEO of Activated Insights, expected when her firm began leading the effort to compile the “Best Workplaces in Aging Services.” Activated Insights is based on the San Francisco corporate campus of Great Place to Work, a research and consulting firm that creates the “Great Workplaces” lists published in Fortune every year.

Employers had to submit an application and have at least 55% of their workers complete a survey by June 18 in order to earn certification that would let them try for a spot on the “Best Workplaces in Aging Services” list. To be certified as a Great Place to Work, an organization would usually have to score at least 70 out of 100 based on the employee survey, but the threshold was lowered to 50 for the first year of the aging services list. It will rise to 60 in 2019 and to 70 in 2020.

Kung said she expected 100,000 surveys to be surveyed in the first year; there were just below 150,000.

And the SNFs that applied was a surprise as well. Though Kung declined to provide specific SNF numbers to preserve applicant confidentiality, she said SNFs had a much stronger showing than she expected, both in terms of numbers and in terms of employee engagement.

“I just thought SNFs would not apply,” she told Skilled Nursing News. “It just goes to show you that you have ingrained ideas, but data shows a different story, and there’s a lot to learn from it.”

SNFs surprise in early data

The certification process revealed some surprising things about the SNFs that applied to the program. For one thing, a significant portion of the organizations that applied were single sites, rather than regional or national providers. Over the entire aging services spectrum, which included senior living, skilled nursing home care and a category for communities like those targeted at 55+ year-olds, 25% of entries were single-site.

For SNF entries, the number was even higher; about half of both applicants and certified SNF organizations were single-sites, Kung told SNN. Many of those were also from unexpected places. Though there were a fair number of applicants from “the usual suspects” such as California, New York and Florida, West Virginia had a notably good showing for skilled nursing. Other states that surprised Kung included Nebraska and Missouri.

Another place where SNFs threw a curveball was in employee engagement, where many did better than expected, she added.

“We’ve done some visits to really high-performing SNFs and they’re not any different, they’re 35% to 45% Medicaid with the rest in Medicare and private-pay,” she said. “It’s not like there’s anything different there. When you look at their star rating, not really anything different there, must be something else accounting for the magic. We’re doing resident surveys too and [high employee engagement] is translating into better resident experiences on the SNF side. I want to dig into that more.”

In fact, some of the highest-scoring organizations in aging were skilled nursing. One of the top three organizations in terms of raw score was a single-site SNF, though Kung noted that a single-site SNF also accounted for one of the lowest scores. But the fact that SNFs were able to score highly is a pleasant surprise, Kung stressed.

“As you know, the sector has been on a census decline, and it’s been really battered,” she said. “There hasn’t been has much time or resources to be investing in people — or that was the hypothesis. But there are, and that’s the good news.”

Innovations in the works

The SNF sector has indeed been hit with a barrage of headwinds in recent months, including declining occupancy and fights over low reimbursement. But many providers are taking steps to try to improve their position. Many of Activated Insights’ SNF customers are looking to sustain their future, and getting listed as a Great Place to Work is just one step, Kung said.

“Many of them have gone outside [skilled nursing] and they’re offering home and health the usual suspects,” she explained. “And some of them are exploring different strategies to diversify beyond SNFs.”

Great Place to Work’s data team will now take the results of certified providers and use the same algorithm that generates the other Fortune “Best Workplaces” lists to crunch the numbers. Company size, complexity and consistency are factored into the algorithm, and that analysis will determine the final list.

Kung, for her part, is already happy with what she’s seen from SNFs in the first year of the list.

“All of this is for better patient care and quality of life,” she told SNN. “We’re really excited by that, and we’re really excited we can spotlight some of the great work happening in SNFs, despite all the problems happening to the SNFs as a whole.”

Tim Mullaney contributed reporting.

Written by Maggie Flynn