ProMedica Senior Care President: Nursing Home Operators Need to ‘Embrace the Disruption’

ProMedica’s Angela Brandt is fairly upbeat about the year ahead, despite the fact that the not-for-profit health system’s senior care division is facing rough waters and headwinds continue to pound the industry as a whole.

ProMedica Senior Care reported a $124.3 million loss during the first quarter of 2022, pointing to lagging occupancy recovery and high labor costs as the biggest factors.

Shortly thereafter, ProMedica also made major changes to its leadership lineup — promoting Arturo Polizzi to serve as president and Louis E. Robichaux as interim CFO among them.

At the same time, the nursing home industry is waiting with bated breath as the Centers for Medicare & Medicaid Services (CMS) contemplates $320 million in cuts, and the implementation of a federal staffing minimum in the next year.

Nevertheless Brandt does see some light at the end of the tunnel.

She’s seen some incremental improvement on the hiring side and has helped ProMedica Senior Care create new, less “contentious” relationships with the staffing agencies they work with.

“While we haven’t arrived yet, that has been something foundational where you feel like you have a little wind in your sails after facing so many challenges,” she told Skilled Nursing News during the recent 2022 LTC 100 Conference in Florida last month.

And while Brandt understands the importance of focusing on the core business, she also recognizes the need to be agile and to “embrace the disruption” that stands before the skilled nursing industry.

“When things are challenging there’s no better time for disruption and so that will be an exciting byproduct of how we change and how we leverage some of these challenges,” she said.

Last year ProMedica announced partnerships with Emory Healthcare in Atlanta and The MetroHealth System in Ohio to build three skilled nursing facilities. The nonprofit health system also acquired facilities from Genesis HealthCare’s portfolio over the course of Covid.

And Brandt told SNN that the company is in talks with three to five other health systems about further partnerships or joint ventures.

Taking the helm as president nearly one year ago, Brandt continues to use her past experience on the acute care side to her advantage.

Staffing wins

One of the most impactful things ProMedica Senior Care did when it came to revamping its hiring system was to break down some of the administrative burdens that existed, according to Brandt.

The skilled nursing operator decided to outsource portions of its human resources department as a way to complement its own team and “get that muscle up a bit faster.”

Brandt’s team also developed a more simplified application process so the prospective employee was not bogged down by submitting a laundry list of information to show interest in a particular job.

She said the company has also embedded the larger health system’s focus on the social determinants of health into its workforce strategies — making sure meals are available to employees while on the job or providing Uber rides when transportation is hard to come by.

But also first and foremost, “getting out of our own way.”

ProMedica Senior Care has gotten rid of the traditionally structured eight to 12 hour shifts and is taking a page from the staffing agencies in providing more flexible scheduling — in addition to increasing pay.

Brandt also stressed the importance of getting employees back to doing the jobs they were hired for, as many in the industry wore several hats over the course of Covid. This, in a lot of ways, contributed to the burnout of longtime, experienced staff who ultimately left the industry altogether, according to Brandt.

“Now we’ve got to shift to continuing to be more proactive, I still feel like we’re still in a bit of a reactive state, but with the progress we’ve had with hiring my hope is that we can start to build on some of this foundation,” she said.

While the operator has seen some notable improvements on staffing, Brandt said they, like many others in the industry, had to make the difficult decision to suspend admissions in several of their markets.

Prioritizing the workforce therefore remains the highest priority, according to Brandt, as it’s not possible to grow patient census without it.

ProMedica Senior Care operates 157 skilled nursing facilities across 26 states.

“First quarter we had to hold our census while we managed agency and got those new hires onboarded so we deliberately had to suspend some of that so we could convert, and now we’re starting to see some of those admissions start to tick up,” Brandt said.

‘The headwinds aren’t getting easier for us’

While there are some bright spots for both ProMedica and the industry ahead, Brandt remains concerned over the ways in which the industry has and will continue to be challenged in the next several years.

Whether it’s cuts to Medicare funding or unfunded staffing mandates, the current operating environment presents obstacles at a time when the need for the industry has become more significant as the population continues to age.

“I think it’s a challenge and it should make all of us nervous, it really should,” Brandt said.

In general Brandt worries there will be more closures and operators will be forced to go back to the drawing board in many ways, but she also recognizes the ways in which being part of a large health system has its benefits.

“Certainly being a large organization we can weather some of these financial challenges differently and that is the privilege of being part of a large diversified health system that we’ve been able to weather just a little bit more so than others,” she said.

Even so, Brandt believes there’s room for both giants like ProMedica Senior Care and small mom and pop operations in the nursing home industry.

“Given the number of referrals, there’s a place for each of those models in each of the markets,” she said. “I think that’s appropriate and good for all of us because I worry that there are still patients who are lingering in hospitals too long or going home before they’re actually ready and not safe to do so.”