When Melissa Powell first joined Genesis HealthCare back in November, she likened it to the “Wild West.”
The skilled nursing operator had more than 5,000 open positions, ranging from frontline staff to leadership level jobs. Genesis was also in the early stages of its shift toward a market-focused model as part of its ongoing restructuring efforts.
By the end of last year Genesis had 250 facilities in 14 skilled nursing markets across 22 states, a far cry from the more than 400 facilities it had operated as recently as 2018.
As part of its path toward financial recovery, which included steps to reduce its debt by $256 million, the longtime player in the skilled nursing space voluntarily delisted from the New York Stock Exchange and significantly downsized its portfolio.
Genesis also obtained a $395 million senior credit facility from White Oak Healthcare Finance back in March, marking “an important step” in the operator’s restructuring.
Several key executives left Genesis last year while others were promoted from within or brought on — including Powell.
Powell is no stranger to the idea of breaking down big corporate structures — it’s ultimately why she was chosen as one of the executives to lead Genesis through its next chapter.
During her 12 years at The Allure Group, which encompasses six facilities throughout Brooklyn and Manhattan in New York City, she and her fellow colleagues put the “ultimate market model” into action.
And she was effectively tasked to do that 14 times over at Genesis.
More than six months later, Genesis is now netting 1,100 hires on a monthly basis, retention has seen slight improvements and census portfolio-wide hovers around 87%.
There is still a long way to go, according to Powell, but her efforts thus far have ensured her confidence in the future of Genesis and its role in the post-acute care sector.
“We talk now about buildings first, the building needs to run the care. They need to be supported by a national structure or market structure,” Powell told Skilled Nursing News in an exclusive interview. “We kind of took down those barriers of almost like how do we support the building, not do it for the building … and that’s the perfect mix.”
Working with, not against, agency staff
Back in November Genesis had 14 recruiters on staff, making it nearly an impossible task to fill open positions — let alone 5,000 of them.
Powell saw the ways in which current employees were already “maxed out” and several buildings were not admitting new residents due to staffing shortages – and knew she had to do something.
One step Powell has taken to help fill some of the open roles Genesis had is to partner with staffing agencies, not work against them.
Genesis, like many other operators in the sector, initially had a mantra that they wanted to eliminate the use of agency due to the costs.
“I believe that the way the workforce has been, as well as the way the workforce is going, that it’s very important to be able to have a partner that when the next pandemic or whatever happens next … that you have someone to rely on,” she said.
Powell has developed a strategic partnership with CareerStaff Unlimited, a Genesis subsidiary, to not only bring on agency staff when needed, but for the agency itself to help with internal recruiting.
“So while the [agency] rates are going down slowly across the country in certain areas, my hiring is going up, I’m able to build census and it’s been a wonderful win-win,” Powell said.
She stressed the importance of treating agency staff like internal employees as early as during the orientation process.
“If you treat them like an other, then they’re going to behave like an other,” Powell said.
Genesis has worked to add staff overall, including in the areas of skin health, infection control, education and additional MDS staff, to “make the center strong.”
On the retention side of things, Powell said they are offering mentoring programs and bonuses for quality care.
“So there’s a lot of fun things that we’re doing to try to say, ‘Hey, this is a great place to work. We’re evolving. We’re changing,’” Powell said.
The ins and outs of the market model
Genesis went through a few iterations of the market model before it settled on what it operates with today, Powell told SNN.
Prior to arriving at Genesis one of the first examples of the new model had 15 high level employees in each market, which effectively just redesigned corporate.
“So we talked about the strategy of letting the buildings lead and going away from this very matrix model where the top was leading, and we kind of turned it upside down,” Powell said during a panel discussion at the LTC 100 conference last month.
The model now features five leadership roles in each market: a market president, clinical lead, human resources, clinical reimbursement/MDS and business development.
“Those people are there to support and guide the center, they are not office jobs,” she said. “They need to be supporting and helping and be an extra set of eyes and hands and make that home-like environment that we’re talking [about] come to life.”
Genesis is temporarily operating under 17 markets, Powell added, as a way to split up a few markets that may need closer guidance and assistance.
Getting back to basics and looking ahead
Powell knows she has work to do to rebuild Genesis HealthCare’s reputation as a quality health care provider, and she plans to do so in many ways by getting back to the basics.
She said a lot of people in the industry have been “stuck in Covid” as it has played a role in nearly every decision that’s been made over the last two years.
Her goal in the next year is to focus on the basics with her staff — anything from med passes to dressing changes for wounds. In doing so, staff will feel more confident and better prepared when surveys come around or issues arise.
“We needed to sharpen our pencils a little bit around the basics,” she said.
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