Trilogy Health Services, one of the largest skilled nursing and senior living providers in the United States, is aiming to recover 90% of pre-pandemic occupancy by the end of the year.
The Louisville-based company also is pursuing selective new developments and is seeking to grow through its ancillary services business, while addressing workforce challenges through its continued investment in education and other professional development and support programs, President and CEO Leigh Ann Barney recently told Skilled Housing News.
Trilogy operates a portfolio of over 110 senior living communities. The company was one of the largest SNF market share growth leaders in Indiana, Kentucky, Michigan and Ohio between Q2 2020 and Q3 2020.
This interview has been edited for length and clarity.
How will Trilogy Health look to grow post-COVID?
One way that we’re looking to grow is through our ancillary company lines. We have a therapy company and pharmacy, under the name of Synchrony Health Services, and we’re starting a lab company.
Earlier this year we brought our employee pharmacy in-house so they can get their medications mail-ordered from us.
We started all of these business lines to provide great service to our campuses and to be able to control the service. If some type of unique service came along or there were advancements with technology, then we could control that through our ownership of those companies.
All of our entities that we currently have serve as third parties and have been able to build a base of business outside of Trilogy. Our pharmacy is only about 30% Trilogy business, the rest of their business is outside of Trilogy. It’s a great way for us to grow our revenue, it’s less expensive than the development model of building new facilities, which we still will be doing, but this is really more of a sales approach to go out and build business and get contracts
What other trends are you seeing in the industry right now?
We’ll all be challenged to offer more in the way of private rooms versus semi-private rooms. I think those that have older facilities with mostly semi-privates will struggle a little bit more.
We’ve spent time over the last however many years we’ve been growing to change our design to have more private rooms.
I think post-COVID will see a lot more desire for private rooms.
Higher clinical acuity [is another trend we’ll see from SNFs].
We have the ability as an industry to take care of higher-acuity patients; that was something that was really proven during COVID.
The Patient-Driven Payment Model (PDPM) really focuses on payments for more acuity in the SNF setting, so I think you will be challenged to adapt and change and to be a resource for hospitals and other providers.
Home care now takes that lower-acuity client, so we’ll need to adapt to take the higher-acuity patients from the hospitals.
The American Health Care Association (AHCA) is currently pushing for legislation to help the industry, as a drop of 19,500 nursing and residential care jobs was reported in May’s labor report. How is Trilogy Health handling staffing shortages?
I think that everybody is dealing with staffing shortages right now. I would say that I feel that our turnover, even during the most difficult period — which was our fourth quarter of last year — is probably lower than a lot of the rest of the industry. I’ve seen numbers of 100% turnover, and we went from low 40s up to high 40s in our turnover.
We did see an increase but not to the significance of 100-plus percent.
What are you doing that’s working to attract new staff and keep staff on?
Our biggest focus, and this was the case before the pandemic and certainly is now, is our education programs for employees. We run one of the largest apprenticeship programs in the country and it’s a way for our employees to improve themselves professionally as well as financially.
We have a foundation of very strong scholarships, we offer student loan repayments and we have our program with Purdue Global for college education. We utilize that as a tool versus something like a sign-on bonus or something that would be a short-term attraction. We try to look at the longer-term that we’re investing in these folks.
Any other programs you want to mention?
We have a lot of other great programs, we have a homeownership plan and employees can save money and have it matched by buying their first home.
I think those kinds of things show that we care about them and take an interest in them long-term. We hope that attracts employees and has them stay with us longer because they see those advantages.
Will you look toward training a universal direct-care workforce that can work across multiple settings?
I wouldn’t say that we’re necessarily looking for a universal worker, but we do have opportunities through our apprenticeship program for employees to take different courses.
Customer service is one of our programs, so everyone can be involved in that. Around hospitality, our housekeeping staff can take the dementia apprenticeship course so that they’re versed in that because they’re in the rooms dealing with the residents.
And so it’s all a way for them to, again, educate themselves but they get paid more for every class that they take.
What does post-pandemic occupancy success look like to you?
We’re expecting to be back to pre-pandemic levels by the end of the year. We’re seeing growth month-to-month.
We did open some campuses last year during COVID and I’d say that it was a mixed bag. Some still saw very good occupancy levels and growth as we would expect of a startup, while others were a little bit slower.
Now that we’re past having COVID in our buildings and recovering, we’re seeing those that were lagging, picking up. If you looked at our same-store, our target would be back to 90% occupancy [by the end of the year].
Right now we’re continuing to see growth, but we’ll be conservative with our thoughts of what the summer will be like.
How will you look to bring in more high-acuity patients?
I think that more reliance on technology and telehealth [is key].
We have some partnerships in place now but we’re looking at others and what they offer as far as nurse practitioners on staff.
A lot of our physicians already provide us, in our more urban markets, with nurse practitioner access 24/7. But in our more rural markets where we don’t have that, we’re looking to the telehealth model more for that.
And again, as I mentioned, education for our staff [is essential].
We’re trying to get more of our LPNs to become RNs, more of our caregivers to go into maybe an LPN program.
We have one certified nurse at all of our locations and need infection control certifications, coming out of COVID. So again, that investment in education helps us to improve our level of clinical competency among our staff.
Are you expecting regional consolidation of SNFs once federal relief dries up?
I think it’s probably safe to say that there will be consolidation. We’ve never been a very acquisitive company. If you look at our history, our acquisitions have been small and very planned to fit our model.
We are a development company mostly and still have development plans for the next couple of years, but it hasn’t been our history to make a large acquisition.
We like doing management contracts, so you might see us do more of those as long as they strategically fit with what we’re doing.
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