Foundations Health Sees Direct Connection Between Skilled Nursing Growth, Employee Retention

Staffing struggles are nothing new for skilled nursing operators, but one provider in Ohio specifically credits investments in staffing and culture for its recent growth.

Foundations Health Solutions, a skilled nursing and physical therapy company that operates 57 properties across Ohio, has boosted margins and expanded its footprint by streamlining the relationships between corporate, clinical, and administrative staff — while showing appreciation along the way.

In October, Levi Lunsford, director of operations of the North Olmsted, Ohio-based company, spoke to SNN about three skilled nursing construction projects in Ohio totaling $20 million — promising to bring 80 jobs and $2.5 million in annual payroll to each community. A minimum of 284 skilled nursing beds will be added through these new projects in Marietta, Belpre, and Westerville.


Lunsford pointed to employee retention as Foundations Health Solutions’ key weapon to drive new projects in what he called a “challenging market,” recently noting an “improvement to overall retention and negative labor dollars like overtime without relying on staffing agencies.”

This month, SNN spoke to Bob Speelman, Jr., Foundations’ vice president of culture, to take a look behind the scenes and learn just how the company’s culture is the backdrop for its economic health — such as its average 93% occupancy rate across 5,128 dual-certified Medicare and Medicaid beds.

Speelman’s experience isn’t just confined to culture. Prior to accepting his current role, he served as Foundations’ regional director of operation, but decided to explore a job on the front lines in order to connect with residents — and pass along lessons to the rest of the executive team.


What are some of the origins for your focus on employee retention?

Founder Brian Colleran has been investing in our employees, and we wanted to do this strategically because of the general nurse and CNA shortage in this sector. We wanted to have the best employees to get our culture right — with great love and respect for our caregiver teams. As a nursing home management company, we had to ask: Why are we doing this work? And go back to our mission. As soon as we started asking that question, a lot came together for us.

We came up with the Culture of Care concept, meaning having people that wanted to be in it for the same reasons we did, to make a difference. In our Culture of Care, we have to help each other, and we need to do this every day. It’s not about the role, and it’s always about the goal, which is our number-one core value.

Years ago someone from the front office came into the dining room and a resident said, “Who the hell is that?” So I wondered, what kind of message does that send to our staff? So if we’re going to do it and be out there, we need to do it every day. That’s the message to our management.

Before I became the vice president of culture, I was the regional director of operations, and spent most of my time with administrators, mainly focused on surveys and financials — with minimal staff interaction.

For me the interesting thing was when I first started as an administrator, I knew the residents and staff day-to-day. I started to lose that connection when I got involved on the corporate side, where everything became a spreadsheet and financials.

I used to work with two sisters who were owners of a facility called Avon Place, now in Avon, Ohio. They worked in the front office and from my understanding, one was the administrator and the other was the business office manager. They used to wear high heels to work and carry gym shoes so that they could jump in and help staff — including housekeeping tasks like making beds. This memory stuck with me.

I wanted to feel more connected to staff and continue to find meaning in my work, so I went to get my STNA — which in Ohio is a State Tested Nurse Aide — to work alongside other STNAs. I worked with them, followed along with them, and took notes. I was showering, toileting, and feeding patients. The unexpected thing for me was working with patients brought love, passion, and joy back to what we do. This is something I still do. It’s the get-up-and-help-when-you-can attitude that we enact here, which is ‘the why’ we do what we do.

Was there an adjustment period when you began working in the field with clinical staff from the corporate side?

In a lot of buildings, the aides were a bit nervous at first to have me with them. But then they would realize that I’m really a nursing assistant, and they started to feel more comfortable to open up about things. I would take the discussion back to the corporate team and management, which is something that was mostly happening only once a year as part of our annual survey. Now we all chip in and help every day.

What are some new initiatives in better highlighting staff relationships and work?

I asked the STNAs how we could become better, and they began giving us feedback. What they wanted wasn’t always more pay, but more involvement and recognition, so I began a years of service program. I noticed that we worked with a group of people in one facility, for example, who had been STNAs for 45 years and 35 years, and we weren’t recognizing them.

I also created a weekly blog to tell stories of who I was meeting — and I wanted to tell their stories. The blog has allowed us to highlight those people and create a quarterly newsletter. Stories about some of our residents and others are truly inspiring.

We had our first annual STNA summit this past summer to teach corporate how to make systematic changes. We brought every STNA together from every facility, and held a listening session for our corporate staff. The STNAs offered feedback — based on a variety of topics — and the corporate team took suggestions back, and made changes based on what they’d learned from the STNAs to improve overall care.

Focusing on food service, we also initiated a “Last Tray Standing” competition, where each facility competed regionally to see who had the best meal from our menu. The winners were from all six regions in the Ohio Health Care Association. We had a party for the last tray standing, and highlighted the winning facilities. This competition elevated everyone to want to improve quality meals and dining experience.

How does compensation affect employee satisfaction across the board?

I told founder Brian Colleran that our STNAs and nurses were being paid decently, but then I started hearing many stories about dedicated housekeeping and laundry team members. We decided to raise the base pay for every employee across the board to at least $10 per hour, where in some facilities they were being paid $9. It was the right thing to do for everyone. Some staff have come in to work for us without any experience, and some make more than $10 per hour and are paid above and beyond for their experience.

What is one patient-focused initiative you would like to share?

On December 23, a group of 10 of our STNAs will review the products we ordered for resident care to get feedback about good purchasing including razors, shaving cream, soap, personal care items, hair brushes, and toothpaste, for example. A lot of times you order things and think that it’s the best bargain, and then the product is terrible. We’ve been in the field asking caregivers what products residents like and changed our purchase approach. You’d think it would be simple, but when you make decisions at a higher level without input from your people, something has to change.

Are there any case studies that come to mind while working outside of corporate?

I met with one STNA named Mary Francis with two daughters who are RNs. She told me, “My daughters are always telling me to go back to school and get my RN. I tell my daughters, ‘You guys do what you love, and I love what I love.’” She looked at me and said, “You know every day I leave work, I ask myself, did I do the best I could? If ever the answer is no, I turn back.” She feels she’s following her calling.

Another story from an STNA came out of working with dialysis facilities. For these patients, you have to get a weight to see how much fluid was taken off during dialysis. Patients are wiped out afterwards, and they have to be put on a Hoyer [lift], lifted up to be weighed, and then put back in bed. Hospitals have beds with scales to get a patient’s weight. We called a procurement person and looked into prices for updating our beds. Our normal beds are $1,500, and the bed with the scale is $2200. We purchased 10 of them and started standardizing these beds across the company.

If the STNA hadn’t given us that feedback, we would not have known about it. We thanked and rewarded her for telling us, and being part of a team to help ensure the quality of life for our residents.

In addition to corporate and nursing, I started working in other departments — including housekeeping and laundry. I learned about a gentleman from Cincinnati who has been working in the dietary department for eight years. He takes the bus until the end of a line and then walks a mile each way to work, and he’s here all the time. I never knew his story until I was working at that facility as a nursing assistant about six months ago, and we recognized him.

Would you comment on how staff development pays off in terms of financials for the company?

Even though we’re spending more, we haven’t seen a loss. The beautiful thing is that our profits have been better since we’ve been doing the right thing. Our census has never been better, which is a direct result of our employees feeling part of a team.

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