Good Samaritan CEO: ‘We’ve Still Got a Long Way to Go’ With Thousands of Open Positions

With roughly 2,000 job openings to fill, Evangelical Lutheran Good Samaritan Society CEO Nate Schema has had to attack the issue from all sides.

Most recently Good Samaritan launched a director of nursing (DON) in training program in hopes of developing a “very defined pathway to grow high potential people.”

The not-for-profit senior care giant has also gotten off the ground a national certified nursing assistant (CNA) online program for the 22 states where it operates. Six or seven states have signed off on their curriculum so far, resulting in being able to more quickly and efficiently train CNAs, according to Schema.

“We’re not reliant on one building teaching all of these programs or trying to rely so much on one local leader in one form or the other. So I think we’re doing some different things on that front end,” he told Skilled Nursing News during a one-on-one interview at the AHCA/NCAL Conference in Nashville.

Persistent staffing issues have also forced Good Samaritan to have some difficult conversations and make some tough decisions — including closing 10 buildings over the last 10 months.

Schema told SNN that those sometimes difficult conversations about the future will continue as the operator better defines what its strengths are and where it has the most density and, as a result, influence.

“Where we have a huge hospital presence, where we have a lot of density within our own organization, we have more influence. We’re absolutely looking at where the future lies within the Good Samaritan Society and where we continue to grow our mission,” he said.

In spite of these challenges, Schema remains generally positive about the future of the sector.

“As I look at where we’re at today, and we’ve got a long ways to go to recover to pre-pandemic levels, but I think it’s created some new innovations in this space,” he said.

The interview has been edited for length and clarity.

SNN: I figured we could start with what you’ve been working on just this past week. I’m curious how things have been going with the cleanup and the aftermath of the hurricane, and if you could share some of those thoughts that you had while being down there.

Nate: It’s one thing when you have something unprecedented and devastating happen, but when you see it in person it’s pretty sobering. 

We have a 400-acre campus there and it serves about 125 skilled nursing residents, 25 assisted living and then over 1,000 independent living seniors.

Right now we have upwards of 1,000 or more independent living seniors that are displaced. Their homes have water anywhere from three to eight feet. It was a lake; It literally looked like a lake in some places and so it was really tough to see that.

And yet when you only talk to the staff there, the spirits were unbelievable. Everybody’s pretty optimistic but they’re ready to get home. We have our skilled residents and AL residents about 70 miles away up in DeLand, and while that’s been great, it’s been a nice alternative … they’re ready to go home.

We’re working with local authorities right now to make that happen as soon as possible and get things figured out. But to see that level of devastation and some of our seniors, some of these independent living residents lose a lot of their personal effects and items — you can’t put it into words.

Remind me what part of Florida we’re talking about here.

So we have three communities but this is in Kissimmee, Central Florida. While we had 75 mile an hour winds, it was the rain. We have a creek that runs right behind us and the creek hit two and a half feet above the highest flood level it’s ever reached. So while the authorities were trying to drain the water levels prior to the storm, it wasn’t enough with all the rain and all the water that rolled through with Hurricane Ian.

During the opening general session of the AHCA conference, AHCA/NCAL President and CEO Mark Parkinson predicted that the industry will recover if providers don’t quit, commit to those who already are or become a top performer and fight against upcoming hurdles. What will it take for Good Samaritan to recover?

I’m pretty bullish and optimistic as well. As I look at where we’re at today, and we’ve got a long ways to go to recover to pre-pandemic levels, but I think it’s created some new innovations in this space.

We just launched this whole virtual hospital, virtual care center that ‘s a game changer, not only for our acute care partner … It allows us to bring specialty care and some of these services to some of these rural areas that just don’t have access to those things. So being able to do that in a new creative way, I think that’s huge.

I think the other reason is that the workforce is going to recover. We are trying to figure out a way to expand that pipeline, all providers are, but I think for us in rural America it’s how do we recalibrate and how do we figure out what that identity is going to look like?

It’s rolling out the red carpet, it’s showing folks that yes we’re a 24/7 business, we don’t maybe have the same flexibility that a lot of businesses and entities have but we have heart, we have family, we have culture and those things are unparalleled.

Where is Good Samaritan at with staffing and what are some of the wins and challenges you are still seeing at this point?

We still have roughly 2,000 open positions so by no means are we in the clear. But what we have done and what we continue to build upon is what are those things that we can control, what are those pipelines that we can work with, whether it’s local nursing programs — we just started a new director of nursing (DON) in training program.

So we’ve always talked about administrator in training (AIT) programs, but we want to take that to our nurses and our nurse leaders so we can develop a very defined pathway to grow high potential people … Building out a national CNA online program. Right now it’s so segmented and governed by each state and so we’ve been trying to take our curriculum and get it approved by each of the 22 states that we’ve served in.

While we’re about six or seven states in, that’s been huge for us. We’re not reliant on one building teaching all of these programs or trying to rely so much on one local leader in one form or the other. So I think we’re doing some different things on that front end.

Rural America is challenging. We have to continue to ensure that we have the resources in place, the technology in place, because demographics are changing and so we have to change with it.

Could you talk a little bit more about that CNA training program? 

Some of these states have been really receptive and go, ‘Gosh you check every box and it makes sense.’ For example in Iowa we have roughly 15 locations and so instead of having each individual location hold that curriculum, we’re able to take a centralized program and a centralized instructor to work through that across all of the locations.

There’s a heavier emphasis on the online component … Today, we’ve had over 600 CNAs go through the program and our pass rate is over 90%. So we’re pretty proud of the early success, but know there’s a long way to go.

So looking at the end of this year into 2023, what are two goals you have for Good Samaritan?

I think number one is how do we continue to build upon the faith and tradition that we’ve been a part of for the last 100 years? Very few, I think it’s less than 1% of organizations, ever hit that century mark.

So one of my goals is to continue to build upon that culture and ensure that we have all of the infrastructure in place, all of the programs in place so that our leaders can do what they do best and that’s care for people day in and day out.

I think our other goal for this next 12 to 18 months is really looking at how we best leverage that virtual care center as a part of our integrated health system. We’re a very large integrated system with over 1,500 physicians on our team that, at a moment’s notice, we can call up and have some of the best doctors in the world weigh in.

COVID was so disruptive; So now I feel like we have the ability to turn the page, bring all these disparate systems and make them work seamlessly. That’s what we see as our differentiator as a combined organization as an integrated health system.

How are you thinking about the proposed staffing minimum with the reality that you’re still trying to fill positions now and may not meet whatever requirement that comes down the pike?

For us, 70% of where we serve and who we serve is rural. Our message has been and will continue to be that we can’t have a one size fits all approach. If we’re going to move forward with a minimum staffing mandate, which clearly appears to be the path we’re heading down, what are the curbs and gutters or what are those waivers that might be available to a provider?

Quite frankly, I couldn’t find people today in some of these small locations. So moving forward with this type of black and white approach, it’ll devastate the skilled nursing industry if there isn’t something else in place. I’ve got towns of 1,000 people, I’ve got buildings where we serve roughly 25 to 30 residents.

So I think it all comes down to this: as a country are we OK with people going 40, 50 miles or more for care? We’ve obviously had to make some really tough decisions over the last year and I’ve been pretty open about those tough decisions. We’ve closed 10 buildings in 10 months.

While it’s always a last resort it won’t be the last time we have to do that if CMS comes out with a very stringent and a plan that is just black and white.

Have there been conversations, are you thinking about the realities of maybe Good Samaritan getting considerably smaller given the challenges that are coming with staffing? 

I think you always learn something when you go through something like Covid. You’re constantly reevaluating what makes sense for your organization, and I think what we’ve learned is as a combined organization with Sanford Health we’re stronger together, we’re stronger where we can concentrate our resources … I think we’re looking at everything.

When you’re working with 22 different states who think they all can manage Covid a little differently and better than the next state, that becomes really challenging.

Where we have a huge hospital presence, where we have a lot of density within our own organization, we have more influence. We’re absolutely looking at where does the future lie within the Good Samaritan Society and where do we continue to grow our mission?

So I think you’re going to continue to see us have conversations on what the future holds, and I think the future is bright, it’s just going to look different than it does today.

You mentioned operating in 22 different states — I’m sure that Good Samaritan is having to navigate all of the different regulations with the CDC now with unmasking.

It’s been fascinating. We’re still learning exactly how this is going to play out in all of our states.

Being in Florida last week it still felt a little unsettling walking up to a building and not seeing masks and being able to see smiles again and interact with people. It was incredible and it really took me back.

I try to get out to locations almost every month and it was the first time in three years that you get to interact and engage people in a different way. So that’s been really cool.