How Lorien Health Services Has Remained a Steady Force to Survive Ever-Changing, Turbulent Sector

Nearly half of the for-profit nursing homes in the state of Maryland have changed hands in the last five years, putting operators like Lorien Health Services in a unique position.

Lorien, which offers a range of services from skilled nursing to assisted living across its 15 facilities, was founded in 1977 by the same family that leads the company today.

“Lorien has been owned by only one company for the whole entire time, hasn’t done any acquisitions … [The founder] built his own buildings, so we are, I would say, basically the way the industry used to be versus what’s happening today,” CEO Lou Grimmel told Skilled Nursing News.

The continued rush of deals is not an unfamiliar trend for the industry. The Centers for Medicare & Medicaid Services (CMS) released data back in April that found more than 3,000 skilled nursing facilities experienced a change in ownership between 2016 and 2021.

Despite its long-term leadership, Grimmel said Lorien has seen its efforts to bridge the gap between home-and community-based services and nursing homes as a way for the company to prepare for the future of post-acute and long-term care.

“What excites me is what’s not being done in nursing homes today, and if you have longevity in the marketplace and the hospitals and physicians know about you, I think that the role going forward is a much less traditional nursing home,” Grimmel said.

This interview has been condensed and edited.

What do you see as Lorien’s role in the senior care space?

It’s a steady, stable and ever-changing environment.

What do you mean by that? Can you elaborate a little bit on that?

Look, the pandemic and especially in Maryland — all the change and ownerships and everything — is an absolutely changing environment. Lorien has been owned by only one company for the whole entire time, hasn’t done any acquisitions … [The founder] built his own buildings, so we are, I would say, basically the way the industry used to be versus what’s happening today.

I know that’s happening in other states as well. But are you seeing [change of ownership] a lot in the state of Maryland?

Since 2017, 41% of the for-profit nursing homes have changed hands.

Why do you think that is? What do you see is the driving force for that?

Maryland has a better than average Medicaid reimbursement for nursing homes, and it has one of the lowest managed Medicare penetration in the country. So you take those two factors, it makes Maryland very inviting to outside investors.

Have you seen that be pretty consistent since 2017? Or has Covid ignited that even further?

It’s been consistent or even accelerated. I think some of the big companies, for example Genesis, had a stronghold in Maryland … So that certainly added to it.

What keeps you up at night as a senior care operator?

Right now in my mind it’s only one thing and that’s labor. It’s called a nursing home for a reason, because you have nurses. If you don’t have nurses I don’t see how you have a business. So that’s my number one issue is staffing, nursing, all staffing.

Is that something you guys are seeing both on the clinical side and the non-clinical side?

Absolutely across the board. I mean you tell me an industry that’s not experiencing it. So you add … The difficult job that you have in a nursing home and that just adds to it.

Lorien created a career ladder program back in 2021. Where is that program at this point and what are some of the other ways you are recruiting and retaining staff?

Well the career ladder program is very effective because … We pay the tuition upfront because there are companies that say, ‘Well you take the course and if you get a certain grade on it we’ll reimburse you.’ Well when you have people working in nursing homes, and a lot of times they have children at home and stuff like that, they don’t have the money to put out up front. We put the tuition out upfront.

You want to go to school, you want to do your career ladder, here we’re gonna give you the money and we’re going to work your schedule around your school because … It’s just a common sense approach. I don’t know of too many other facilities, companies that do that.

Has that helped with retention? Obviously you’re bringing people in the door, you’re taking care of their tuition. Have you seen that pay off in terms of the people that have been in this program so far?

Yes, we have successes that started off as nursing assistants and are up to RNs and will go in for their bachelor degree. So that pays off. But also we’re recruiting in high schools. I think that high schools are a big opportunity because when you wind up in your senior year in high school not everybody knows what they want to do. I would say a good number of people do, but not everybody knows whether they want to be an accountant or an architect.

So we offer that opportunity — of course we have our own CNA class and we can train them and they can, right after high school, they can get trained and go to work, at least have a job bringing in an income and probably getting their parents off their back.

How has the TNA training been going?

That process is actually going very well. We have an association in the state of Maryland, Lifespan [Network], and they just got approved for their CNA course where the students can do their classroom online at any time. They have a certain time they have to complete each chapter but they can do it at their leisure, they don’t have to be in front of the computer at set times. They take the class whenever it’s convenient for them, and if they have questions and stuff, they can take the questions into work the next day and talk to their supervisor or the nursing supervisor about the issues. That program is working.

This is going to be a key to the success and training of individuals going through this class. It’s very innovative.

What is the state of agency right now at Lorien? How much agency are you using?

We’re using much more than we would want to, I mean, before the pandemic we were agency free for years and then all hell broke loose.

What percentage of staff is [made up of] agency?

The majority of our staff are our employees but we need to backfill them with agency, and then there’s a whole new hybrid of agencies out there … You take somebody like me who’s been around for a long time, this is pretty radical, some of this stuff that is happening today with staffing and the innovative different programs that different companies have come out with to try to address and tackle the issue.

I think there are factors that come into play: Is your facility in a safe area? Is it a safe place to work? Is it a clean place to work? Are there enough supplies for the patients? I mean all of these factors come into play, but there’s no one knockout punch. That’s how I think as the staff, employees of nursing homes mature in this market, I think those things that I just mentioned will start caring more and more of a weight. Right now I think we’re still almost in that highest bidder race.

What excites you about the future of the industry?

So what excites me is that I believe that nursing homes can be so much more than what the perception [is] and what they’ve been. I think they can be so much more, and we’re entering into an era where we have growth in the population that utilizes nursing homes and I think they can be a very important cog in home-and community-based services (HCBS) that use the nursing home as a home base. What excites me is what’s not being done in nursing homes today, and if you have longevity in the marketplace and the hospitals and physicians know about you, I think that the role going forward is a much less traditional nursing home. I think there’s chapters to be written about what nursing homes can do well going forward.