Idaho-based operator Cascadia Healthcare plans to “grow intentionally” in existing states — the predominantly post-acute skilled nursing operator has 25 facilities across six states, with plans to add four more facilities by the end of the year.
Three of its new SNFs will be in Washington and the fourth will be in a state Cascadia operates in; the operator is not at liberty to say where that is yet. Cascadia currently has facilities in Idaho, Washington, Montana, Oregon, Arizona and New Mexico.
In addition to skilled nursing, Cascadia offers home health, hospice and home care to its residents. The company was established in March 2015.
Skilled Nursing News sat down with Cascadia CEO Owen Hammond, and Steve LaForte, director of corporate affairs and general counsel, to discuss the company’s growth trajectory, juggling vaccine mandates, internal staff vaccination efforts and leadership training programs.
The executives also touched on what Cascadia is doing to aid COVID-embattled Idaho, working with the state to open a 40-bed surge hospital outside of Boise.
These interviews, conducted before and after the Biden administration expanded its vaccine mandate, have been edited for length and clarity.
So Cascadia sees an opportunity to grow right now, at this point in the pandemic?
LaForte: We’re trying to grow in the states that we have less of a presence in and diversify, diversify ourselves on a geographic basis.
We got to a point … we’re big in Idaho, and so 18 of our 25 eggs are in one basket. We’re looking at growth opportunities in other states, we have great leaders on the ground in so many other states; we’re trying to expand their presence.
We have four buildings that will transition before the end of the year so definitely by the end of the year we’ll be 29 and looking to grow.
What about growth in the care continuum, service and insurance offerings?
LaForte: We have one assisted living [building], that’s a service that we’ll eventually build out. Starting in January, we’ll have an I-SNP with American Health Partners.
In the Boise area, we are in home health, hospice and home care; we’re looking to expand to other markets and create opportunity in that space.
Explain a little bit about your growth strategy, how have you chosen to grow?
LaForte: I don’t think we grow, to grow, we grow intentionally — is there an opportunity to improve the care, is there an opportunity to give back to the community? We’ve taken a lot of distressed buildings from operators who maybe weren’t doing as much as they could.
The other piece is, do we have the leadership to put into the building because we’re field driven, and we’ve developed a really robust leadership training program.
We have people in it, they get our vision … we want to find them a building.
How did you cultivate the company’s leadership training program?
Hammond: I grew up very much with an entrepreneurial mindset. I would say a regional mindset too, so that we can be very active in the communities that we serve, very militant and attentive to our employees and our residents.
We’re a flat organization. We’re not looking for somebody that can just fill this little small box and say, go play in this small box. We need somebody who can play in this very, very big box, and mitigate risk that way. And so we look for entrepreneurial people, people that care about people and care about business, care about creating jobs, care about creating benefits and structures where families can be enhanced and communities can be enhanced.
We really feel that’s the best way to mitigate risk in the industry, instead of piling on senior [vice presidents] and clinicals, we have resources that they can utilize and they’re helpful. Best way I can put it is that the peer-to-peer accountability is our safety net, as opposed to other companies, their safety net is their corporate structure.
So, we really look for that type of CEO mentality. They’re not always there yet but that’s what we aspire them to be.
How does that peer-to-peer, flat organization structure help with carrying out the vaccine mandate?
Hammond: We’ve actually allowed each of the facilities to generally make a determination on how they’d like to handle the mandate, and how they want to deliver the messaging of that. Now obviously, we’re going to be helpful in crafting that. Steve’s very helpful in crafting that language, or actually allowing every community to really have a discussion with their staff because in different parts, some people are very much anti-vaxxers. We have some very small markets that we’re in, and some are very pro [vaccine]. It’s allowed there to be stakeholder involvement in those discussions.
How has the mandate expansion to other areas of the care continuum changed that?
LaForte: We’re continuing to work on education, we’re continuing to work with our employees, and we’re continuing to take some faith that the culture that we have is going to, to the greatest extent possible, preserve our employee relationships.
That said, we’re not unrealistic and we know what the numbers are showing and we hear it from some of our employees; people were not happy.
It doesn’t affect us to the maximum degree it possibly could, ie, health care professionals having other places to go in the market. Health care professionals leaving us, leaving hospitals, leaving hospice and leaving other providers along the continuum to go work for Amazon and Walmart is still a tangible fear.
How does this fear break down in different regional markets?
LaForte: For us, especially in Idaho, which is our largest market, and in some of our other rural markets, the real concern … I am not intending to pick on anybody here but it truly is Walmart. In the greater Boise area it’s Amazon … in our Twin Falls market it’s Chobani and it’s Clif Bar.
Unless there’s a locational aspect, most of those employers obviously have more than 100 employees. That aspect does help us.
LaForte refers to President Joe Biden’s mandate expansion to include employers with 100 or more employees.
What is Cascadia doing to help hospitals overwhelmed with COVID-19 cases right now?
LaForte: We hope to have [a SNF facility] open next week and under an emergency license sanction from one of our other Boise buildings; we’re going to be able to create 40 COVID beds. The guidance I got from the state is this is temporary, probably for another six months.
[The temporary facility] will likely end up taking over discharges from around the state, so I don’t know that it will be limited to the greater discharges coming from hospitals solely in the greater Boise area. It might encompass where the biggest need is right now, in northern Idaho.
Nobody wants to do this but now we’re at a place where they have to do it … we’ve been sort of careening to this point. I have to say, the state is being really responsive. They’re working on enhanced reimbursement for skilled facilities taking COVID discharges. They’ve been really good at working with us and getting this building open.
Do you plan on doing anything similar in Idaho, or other states you operate in?
LaForte: There has been some discussion, right now there’s nothing tangible happening, but I think it’s something we’re going to continue to explore.
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