Nursing home providers have long suffered from a worse public image than their peers along the senior housing and care continuum, with just the phrase itself conjuring images of a place that few people would ever choose to call home.
It’s a problem that leaders with decades of experience in the space acknowledge could become an even larger issue as the baby-boom generation gradually ages into the need for institutional skilled care.
“They will do everything humanly possible not to come into a nursing home,” Robert Hartman, founder of Symphony Post Acute Network, said of baby boomers during a recent industry event. “I’m getting to the age where I could be a mystery shopper in one of my own buildings, so I’m thinking about this, too — would I go to one of my buildings? Would I try to do everything possible not to?”
But after working with skilled nursing operators for nearly a decade, Kelli Luneborg-Stern — the founder and managing partner of Trifecta Public Strategies — thinks there’s too much good in the industry that providers allow to go unnoticed.
“I would take an operator of a skilled facility with me in a dark alley, a war-ridden zone,” Luneborg-Stern said on the most recent episode of SNN’s “Rethink” podcast. “These people act on the fly. They make critical decisions. They’re responsible for keeping people healthy and well and alive, and rehabbing them and getting them back home.”
Prior to entering the post-acute and long-term care space, Luneborg-Stern helped tech startups and cybersecurity firms craft their messages — and though those spaces don’t necessarily have the same public baggage as nursing homes, she insists that skilled nursing operators can apply many of the same lessons she’s learned from her work in other industries.
Excerpts from Luneborg-Stern’s appearance on “Rethink” are presented below, but make sure to download the full episode on the podcast service of your choice. And if you like what you hear, subscribe to Skilled Nursing News on SoundCloud, Apple Podcasts, or Google Play so you never miss one of our twice-per-month episodes.
What are the biggest changes you’ve seen in the skilled space since you got into the niche?
Coming from a very aggressive startup environment where we dealt with a lot of mergers and acquisitions, generating a lot of news, launching products — and then switching over to skilled, it was an interesting transition, because there was this culture to have no comment. And I think that is one of the worst positions that any company can really have — is no comment. So quickly, we identified a need to train people on what it looks like to talk to the media, be okay with telling your story, and understand that there are difficult situations that happen in any industry.
You look at the cybersecurity space — which we we’ve worked in that area — and there are breaches all the time. Companies are constantly having to communicate about those situations. There are simply unfortunate events and difficult situations that happen when you’re in a person-to-person, service kind of environment. As you said, these providers are taking care of our most vulnerable population, and there are a lot of situations and circumstances that happen there — and they’re not all bad.
I found, over the years, that there was this cloud that hovered over the skilled nursing industry for negativity and negative press. But when I was in the buildings, when I’m meeting with the administrators, when I’m talking to CEOs, when I’m interacting with the people and the clinicians — all the way from the committed maintenance directors, to the CNA and everyone in between that cycle of care — I just thought, you know, there’s a lot of really good stories to tell here. We really, as an industry, need to do a much better job of telling the story.
I always tell people: We’re not going to change the bad. We’re just not, in any industry. But what we can control is our ability to talk about what we are doing well, what is working well, and some of the wins and the positive things that happen.
What are some of the strategies you use to convince operators and other players in the space to open up, and maybe promote some of the good things they do?
We talk a lot at Trifecta about the whole ecosystem, in terms of who we’re communicating with. On any given day, these administrators, clinicians, they’re interfacing with 15 to 20 different audiences to do their job day in and day out. So I tell people: Everything that I’m going to teach you, you actually already do — when you’re talking to your referral sources, when you’re talking to someone at the hospital or a physician, or you’re talking to a family member that might be very scared and uncomfortable. Everything that I’m going to teach you or help you message, you already do because you deal with difficult situations all day long.
The media just has a habit of coming at you, and they go right for the jugular sometimes, and no one blames you for being concerned or wary or scared to take an interview. But you don’t have to be concerned about that.
I ask people: Walk me through your QAPI, walk me through your clinical care … talk to me about your attrition and your employee and your culture status that happens in your building. Talk to me about how much training you do, because regulatory guidelines dictate that you do — and are required to do — a lot of really good things. So let’s talk about those issues.
Then the other piece that I like to share with people, and specifically to the media, is: Let’s spend time talking to the media and educating them on what we do. A perfect example of that is I used to get in 2012 and ’13, and even ’14, a lot of reporters from some smaller communities, and they would be on a bender about: Why do you have all these one-star buildings — Or two stars, or three stars, or why is this a five-star and right next door, or across the street, there’s a three-star, or one-star?
So I would say: “Well, let’s just take a step back. How much time have you spent on Nursing Home Compare? What do you understand about CMS and the five-star rating system? Are you aware of all of the metrics that go into those calculations?” And a lot of times, they would say, “Well, no, I just went on Nursing Home Compare and saw these one-star buildings.”
So what I encourage people to do is educate the media. Stop and take a minute to explain to them your business, walk them through some of the technicalities of what we do day in and day out, and then have the conversation from there. A lot of times, what we’ve been able to do is to turn those conversations around into something positive, so that they say: “Oh, I didn’t realize ABC or XYZ. Thank you for taking the time to explain that to me.”
There’s a lot of different nuances because it is such a complex and highly regulated environment. I think sometimes providers — they’re very busy people, right? Extraordinarily busy. But I just think we would do ourselves a favor if we would just take the time to educate the reporters, and if the reporters would reciprocate, and take the time to invest in us and to ask questions and learn more about the industry.
Now, we don’t have that situation with folks like yourselves and some of the other publications. We can have a little bit higher, elevated, technical conversation, but especially in these grassroots communities — or even a Dallas Morning News or a Wall Street Journal or a Sacramento Bee, any of these papers — they don’t have the resources to have someone, a reporter, exclusively dedicated to health care and understanding all the nuances within health care.
I certainly have sympathy for that — I’ve worked in local journalism, and I just didn’t have that much time to become an expert on some of the topics I covered. And I also understand the urge to highlight stories of abuse and other problems, since that is their job as journalists. But I also know I have a different perspective on the space given my current job, where all I do is read and write about skilled nursing issues.
It’s a hard industry to cover … I read probably two hours a day and I will tell you, I’m constantly feeling like I’m behind — because there is just so much to keep up with. As a PR person, I try to deliver the best value and the best strategy for my clients.
So I really feel like it’s important that I stay on top of certain trends, and plugged in with key media, and maintain those relationships, so that if I’ve got something, I will flat-out tell a reporter: “I would love to have this conversation with you, but we’re in the middle of an investigation. We have to partner and we will continue to partner with the local police department. We’re also juggling HIPAA as well as this, and we don’t want to set alarm bells off for other patients and residents, or the industry at large, because we just simply don’t have all the facts yet. It’s not that we don’t want to say something. It’s that we’re not able to right now. If you’re interested in following up later, we would be happy to have a conversation, explain to you what went wrong, let you know what we’re doing for correction, tell you how we’re working with the state, et cetera.”
Sadly, sometimes reporters are just interested in what happened today, right now, this instant, and it just doesn’t work that way in our environment. I think that’s a really big thing that PR practitioners, communicators, and even providers really need to [consider] when they’re looking for someone to tell their story and advocate — is to find someone that’s willing to have those conversations with reporters. I don’t apologize at all for what I can and can’t say or when I can say it, because at the end of the day, I sleep very well knowing that I have tried to do the best for the provider, and also make sure that the truth is presented and the information is out there to the best of my ability and to the best of my provider.
I think a lot of the providers, in general, really do want to tell their story. They’re just scared because they’ve gotten a bad shake, or they’ve gotten a couple of [instances of] bad press. This morning, one of the things that they were talking about in an investment publication I read is all the negative press for several years now — that’s in the opening line, that on the skilled nursing side, there has been a lot of negative press or have been a lot of stories that haven’t been reported accurately or entirely.
As providers, they have to always balance: “Well, what do we say that’s not going to ignite fear, uncertainty, doubt, and have a deluge of families calling and other residents concerned. We’ve got to communicate to the ombudsman; there’s a lot of people that have to be communicated to when you have any kind of critical event. I just think it’s important to be cognizant of all those audiences, try to communicate fairly, accurately, consistently. And also never, ever, ever underestimate the importance of communicating to your employees and your staff, because they deserve to know what’s going on, and they’re probably proud of where they work.
I used to say, when I worked at a large national provider, if you don’t believe that pigs fly, you just need to sit in my office for a day, and I’ll show you what crazy stuff happens in the skilled nursing environment — and again, not all bad, but just stuff you wouldn’t believe that can happen when you’re taking care of a vulnerable, critically ill person.
What are some of the most common misconceptions about nursing homes that you see in your work? Just from reading a lot of local news stories about the industry, I know one of the most common I see is the frequent conflation of skilled nursing facilities with other senior housing sites — a memory care facility described as a “nursing home,” for instance.
That’s a big one, because skilled is also enormously regulated, and not so much with assisted [living] — although I do think we’re going to see more regulations on the assisted side of the house coming through.
But I think one of the biggest misconceptions is people don’t understand the day in the life of an executive director, an administrator, an operator — the ones in the building, so your ED and your director of nursing services, your DNS, and then also the CNA population.
To take care of this critical population takes a really extraordinary human being. I had someone early on say, “Kelli, if you make it two years in this industry, then you will make it a lifetime.” Because if you can really support the operators and the administrators — and that’s really what I think is my role, is to support them and help them do their job and take this one thing off their plate so that they can get back to doing the hard work that they do.
These are some of the hardest-working people I’ve ever met — and I’ve worked with startups, going through mergers and acquisitions and people trying to build their dreams and create their rocket ship.
But this particular industry — nobody does this for the money. They do it because they genuinely care, and there is a compassion there. We have to remember that these people are human beings, and they get fatigued and they get tired. So we have to really make sure that we look after them in that way too, and equip them with training and physical equipment that they need to really do their jobs.
That, by and large, above everything else stands out — is that these workers, these clinicians, these administrators, they simply do not get the credit that they deserve for what they deal with on a day-to-day basis.
I would take an operator of a skilled facility with me in a dark alley, a war-ridden zone. These people act on the fly. They make critical decisions. They’re responsible for keeping people healthy and well and alive, and rehabbing them and getting them back home. It’s just a lot of moving parts — and then, oh, by the way, in the middle of that, you’re in a blizzard, and your sprinkler system explodes in the middle of the night, so you’ve got to relocate patients and residents.
There’s a lot that goes on behind the scenes and a lot of issues that, thank god, never make it to the press — because I don’t think the general public would necessarily be able to comprehend everything that these people are dealing with on a day-to-day basis. But I have an enormous amount of respect, obviously, for these people, and I’m just thankful that more of them aren’t running from the industry.