As COVID-19 maintains a hold in significant portions of the U.S., it’s poised to shake up some key aspects of how care is provided in the skilled nursing setting.
Consulate Health Care’s new chief operating officer, Tim Lehner, joined the Maitland, Fla.-based operator in June, amid a major pandemic that’s reshaping the skilled nursing landscape in ways both drastic and lasting. That includes the rise of telehealth and the increase of technology in the SNF setting.
But more broadly, the pandemic could reshape how operators go about their work with both residents and staff, he believes.
Lehner previously served as COO for Windsor Health Care in California, and his family has worked in long-term care since 1948, which has shaped his outlook on the sector.
Skilled Nursing News caught up with Lehner on June 25 to talk about his priorities heading into the new position, and how he’s looking to shape the future for skilled nursing.
This interview reflects the COVID-19 situation at the time. It has been edited for length and clarity.
This is an interesting time to take on a new role, so what has COVID-19 done in terms of changing the COO position and what you’ll be working on with Consulate?
Today’s my ninth day on the job here at Consulate, and candidly — I don’t know if you remember that movie “Independence Day” with Will Smith, as they’re fighting the aliens taking over the planet and with the whole world working together. That’s what it feels like to be to be in this role.
But in “Independence Day,” they all came together to save the planet, right? That that hasn’t necessarily been the case. One of my most important roles is to make sure that people don’t necessarily buy into the negatives. And there’s been all kinds of negatives about nursing homes and the work we do related to COVID, largely related to the political environment. My big question is: Wouldn’t it be amazing if every single agency and every single group in this country asked one simple question: How can we help our frontline workers in skilled nursing facilities?
I think how much less fear would be out there, not only for my staff and the staff here and the residents and the families — but how much more we could accomplish. So one of the things I’ll be doing and one of the most important things that I’ll be just fitting into with Consulate is saying “thank you” to our frontline caregivers, making sure they know they’re appreciated. And the other piece I’ll be asked on this, and frankly, I’ve had it on every single phone call and every conversation I’ve had with somebody, is: How can I help you?
Much of the focus is on how we can help keep our residents and staff safe and be a good partner to our communities. I’m really proud that the Consulate team in Florida, led under the division president, Mikki Meer, in just 10 days reopened a building that was empty to meet the community needs for just COVID-only patients. This was an example of how we can help.
One of the important things I think also, coming into the COO role in the time of COVID, is it allows me to focus on the future and where we want to go — and assemble a team of leaders to think about life after COVID.
What are we going to do? You know, even though we’re still in crisis, we we’ve already begun that process here, even on my first nine days. We have an executive director counsel — that’s a group of administrators that advise Chris Bryson, the CEO, and myself related to policies and procedures and a new program implementation and the things we want to do. They’re helping us look at things like workforce, business development, emergency preparedness, and telehealth. Those are all things that are being implemented in COVID, some of it, and some of it will be implemented after.
When it comes to workforce, frontline skilled nursing staff are facing a lot of danger and stresses than usual, and it was a job that was stressful even before COVID-19. What initiatives are you thinking about related to staff engagement during this time, and are any of them related to the pandemic?
There’s nothing in my day that is more important than making sure that my staff have the tools to be successful, and that the patients are getting what they need and safe in this environment. One of the things that COVID-19 has really reinforced for me, is that our frontline caregivers — number one, they’re heroes. But the well-being of our patients and supporting those frontline caregivers, that’s paramount to what our duty is. Consulate really believes in listening to our customers, both our patients and our staff.
So I define our staff as customers. My job is to make sure our staff is successful, and to create an environment that they can each achieve their best and highest goals.
I am too soon to have any new initiatives that we’re rolling out. I can tell you we have an employee engagement survey that that is soon going to be be implemented. I can tell you that we’re listening to our people and when they need us, we are there for them.
I can definitely understand it being too soon for distinct initiatives, but do you have areas that you’d be looking at? Anything related to specific things, like compensation or time off or changes in terms of issues that have come up with COVID-19 — maybe related to home things like child care? Mostly I’m curious whether there’s things you’ve heard as things to think about.
Honestly, I probably won’t be bringing a whole lot of initiatives related to the COVID and what we’re going to be doing, because Chris Bryson, the CEO of the company; Andi Clark, CNO [chief nursing officer]; and the rest of the Consulate team, they have done such an outstanding job already in those areas. I’m just fitting in. This company’s exceeded the sector averages related to COVID-19 and the management of COVID-19. They’ve started some really, really wonderful communication, some special training and incentive programs for our employees to take on this challenge of COVID.
So for me, I wouldn’t mess with something that’s beating the standards —and by a long ways, beating the standards. It’s how I fit into what’s already established and working very, very well here.
If not related to COVID, are there initiatives you’d be thinking about drawing from previous work or issues you’d want to bring to the table that would have been a priority even outside a pandemic?
Post-acute care prior to COVID-19 was already just a rapidly changing environment, like on a daily basis: How care is provided … the growth of technology and how you engage that in providing care. It’s changing the entire landscape of our sector. When my family started, we didn’t accept patients in wheelchairs, that was too heavy a care [level]. That was 1948, so it’s been a while — I wasn’t alive in 1948, by the way. Let the record show that.
I want to continue to expand — we already have principles of quality and people. Chris Bryson, the CEO, prior to COVID actually challenged the leadership team here at the beginning of the pandemic: We need to leave this pandemic stronger than we entered it. And there’s a full commitment to doing that.
Some of the things we’re already committed to, and in the process of doing, is full electronic health records in every building, We’ve already got 50% of the buildings, and we’ll want to take it to 100%. Implementing telehealth and telemedicine for physician access to our clients — we’ll look to capitalize on those initiatives and others.
I want to fully leverage this team, and the assets on this team, to partner in our communities. This means creating programs that are really specific to the local needs, like respiratory programs, specialty wound programs that go beyond the normal SNF programs, and many, many others.
You have to remember prior to COVID, telehealth was hit and miss in different states. But technology is really moving rapidly. For example, there’s now blood pressure cuffs; you can take a blood pressure and it directly loads into the electronic medical medical record. There’s all kinds of those types of things happening. I think you’re going to see a lot more velocity around that area, post-COVID.
Given that variation in states, that actually leads to something else I’m curious about — what are some of the things you’re thinking about given Consulate’s multi-state presence?
The one thing I’d say, and this is something my grandparents and my parents both have instilled in me: Health care is a people business. It was about people yesterday, it will be today, and it will be tomorrow. The state regulations are minimum standards, and it’s our job to make sure that that our buildings and the people that work in our buildings have all the tools that they need to be successful and meet those standards.
Consulate established a concept of “big company, local market.” In this philosophy, what we’re hoping to do is leverage our big company resources and expertise that being a company our size and the programs allows us to have — but allowing local operators leeway to create a vision and a future for their unique market.
That includes regulatory compliance and relationships. That includes things related to even COVID, where you have local county health departments that are really running the show. And it’s not a state-by-state thing when it comes to COVID. It’s a county-by-county thing when it comes to COVID.
In addition, one of the things that I’m really hoping to focus on when we come out of COVID — I’m sure you remember the shooting in El Paso, Texas at the Walmart there, and that it affected me in the most terrible ways. So one of the things I also will be looking at that, that I think we have to look at as a sector — and our company has already started looking at it — the workforce diversity and creating places of love, not hate.
In my past job, I actually engaged with the Museum of Tolerance in Los Angeles, and had started an entire program of acceptance. This is all part of the new world, especially with Black Lives Matter, and this is a time as as humans that we have to seek to understand. Consulate Health Care is going to actively be engaging on how we can come overcome issues of race, LGBTQ, religion, the mental capability of people. One of the things I think is most important is seeking people with a common heart and a love for wellbeing and care. And we will do a better job, and we will teach acceptance to our people.
Diversity is a huge deal. We’ll be forming a group that looks at our diversity. We’re going to look at everything, and this includes for our patients. I am a firm believer that we need to be accepting of anybody that wants to come into our facilities, that they should be comfortable getting that care from people that love them, and that love each other. That’s the environment I want our facilities to have, and Consulate very much already has as a team. So it’s pretty exciting to me, that that’s the direction we’re going.
The other piece is I think we’re going to also have to really look at things like how we deliver care and and you know, the specialties that we get into. I think that’s going to be a big deal.
I don’t want to press if this is something painful, but why did the shooting in El Paso spark your interest on this issue?
I don’t mind at all; I’m banging on this drum as as hard as I can, both in my professional life and in my personal life. So I’m in a mixed-race marriage. I have an LGBTQ child. It is extremely personal to me.
I don’t understand how we can’t look for the good in each other, and how we can’t find love. The world would be so much better if we had that in our hearts when we met with people, and we look for the good in people and we didn’t judge people on who they pray to, who they kiss, what level they are on the spectrum for autism — to instead looking at every person’s possibility. Think about the power that would give us. Can you tell I’m a little passionate about this?
I can. These are things focused on the future, and given the upheaval we’re seeing now both societally and clinically, I’m curious about how you think the skilled nursing world will look because of this pandemic. How are SNFs going to change because of this, and are there specific areas you see for improvement?
Here’s what I think for SNFs — and frankly it’s not just SNFs, it’s every medical setting that there is — I think you’re going to see huge changes in how we look at infectious disease management. I’m hopeful that finally, in addition to that, that the state and the federal government will finally recognize that SNFs are a vital cog, and they’re going to fund the sector appropriately, so we can begin to see changes in equipment like PPE, even the physical structure of the building.
An example of that is like a negative air pressure room; that would seem to be something you would want to see in an infectious disease environment. I think you’re going to see them start to fund it, and actually in some states they are funding those right now.
I think you’re going to see changes and how we look at universal precautions. Universal precautions used to be: Wash your hands and wear gloves. There was already some changes started, but you’re going to see a lot more change there in and how we do that. And by the way, that’s not defined by the sector, that’s defined by the CDC, largely.
I think you’re going see big improvements on the computerization on contact tracing on a micro level in facilities. What I mean by that is: You have an infection in a building. These caregivers touched it. These caregivers touched these people, these people touched these people. You’re going to see that as that area starts to evolve in our general society. That’s not even fully evolved for all of us yet, and I think you’re going to really see that evolve for us [in long-term care facilities].
Related to diversity, I believe that it’s time that we start start asking questions like — when we admit patients, I’m going to be specific to patients — “What pronouns would you like to be called?” Something as simple as that. I think that’s really important. We should recognize people for who they want to be and who they are.
There’s a lot of training that goes into that, though; we have so many unconscious biases. We just have to get better about it. It’s like anything else: It’s muscle memory. You keep doing the right thing and it eventually happens for you.
Related to PDPM [the Patient-Driven Payment Model], I think that was the right thing, and I applaud it. I applaud that we’re actually going to have a payment for the entire care of the patient, and not just therapy. And frankly, it was about time we did something like that. So I think that was very important.
I think you’re going to see a whole bunch of focus on payment for safety of residents and additional PPE [personal protective equipment]. How do we get stores of PPE? How do we fund capital in SNFs so we can update them to meet the most modern standards? I think those are going to be some big, big deals.
Is there anything else you’d want to add?
This is really important to get out there, that this sector is full of heroes. And it is time to not only embrace those heroes, it is time to celebrate those heroes. The politicizing of COVID, and what’s going on and what’s not going on, is absolutely offensive to me, because I see what our nursing assistants and our nurses and my partners here at Consulate are doing every single day. And it’s time to celebrate them. It’s not time to say you’re doing a bad job.
