This article is sponsored by IntelyCare. This article is based on a Skilled Nursing News presentation with Matthew McGinty, Chief Revenue Officer at IntelyCare. The presentation took place on September 1, 2022 during the Skilled Nursing News RETHINK Conference in Chicago. The article below has been edited for length and clarity.
Matthew McGinty: Who wants to talk about firing agencies? That’s what we’re here to talk about, and it may seem a little odd that IntelyCare is the company up here talking about it but we want to talk about how we can help long-term care move away from an extreme dependency on agency.
I think the entire industry is struggling from a bit of a trust problem across the board. If you look at the government in regulation, the view of the agency, of raising rates, you see nurses often don’t trust the entire industry as well. There’s a bit of a trust challenge going on. Hopefully, by the end of this, you’ll at least trust that IntelyCare is putting their right foot forward here to try to help long-term care.
The amount of revenue being lost this year in long-term care is right around $20 billion. It’s a huge number, but in our mind, it’s not just about revenue. It’s about care. In your mind, everyone in this room is thinking about long-term care because it has the word ‘care’ in it for a reason. That’s $19 billion worth of care, not delivered. That’s a big number. Occupancy rates have not recovered post-COVID, and this is not a surprise to anyone in the room.
Weighing the costs of staffing and flexibility
“There’s this conundrum around how to help them recover because staffing is the biggest way to do it, but staffing costs are so high. How do you get there? In many ways the industry feels frozen. The government has a lot of mandates around staffing coverage, and some are states, some are federal, but the funding isn’t there for it anymore. We’re in a post-COVID world. To the theme of this entire event, this is about ‘rethinking’.
Let’s try to get in that mindset and then higher pay rates. I know some people will look at companies like IntelyCare and say you’re part of the problem. Again, this is about rethinking. Rethink it for a second. What if people like IntelyCare are part of the solution.
IntelyCare is a really big numbers organization, we love data. That’s how it helps us drive our decision making. It seems true for everyone here. If you look at that first data point, 45% of those in skilled nursing are looking to permanently move to a flexible role. Flexible doesn’t mean I want to work an hour longer than my normal shift time, or just shift variability.
Flexibility means a lot of things. This [chart] comes from Oliver Wyman which is a part of Mercer consulting. They put out a huge health care study every year. We partnered with them to try to understand how they could segment a lot of that data they do in healthcare down to long-term care to understand it a little bit more.
If you’re thinking about your full-time hiring or your staffing in general, you’re looking at that first data point, which is pay, the number one thing. We have about 500,000 nurses in our network of which about 10% of them on a given day are taking a shift for us. The things we see are the things that are in blue. They’re actually telling us that work-life balance is the most important thing, as are emotional demand and flexibility.
When they talk about flexibility, they’re talking about a lot more than just flexible shift times. Then let’s go back to the numbers that are under that 45%. 26% of nursing professionals are considering leaving the profession. More than a quarter of an already supply-constrained market is thinking about leaving the market. It’s terrifying to think about. The next piece, there’s a 15% increase on the people that are still in the market.
Put the two of those together and you start to see a perfect storm coming together. 59% of nursing professionals who left cited understaffing. That’s nearly 60% who say the reason they’ve left the market is under staffing. If you look at the news, they’re afraid to go to jail. They’re afraid of how they’re going to pay for their house, how they’re going to pay for their daycare.
Meeting priorities for nursing staff
99% of nursing professionals rank maintaining work-life balance as their top concern. It’s not just pay. I know that at the end of the day, it comes down to the almighty dollar, but we spend a lot of time surveying our workforce. Again, that half a million number on a weekly, quarterly, monthly basis and flexibility is always the thing that comes out. It’s not just different shift times. How do you tackle that problem? Imagine, again, IntelyCare isn’t part of the problem. We’re part of the solution.
We created this platform to recruit credential and engage and match nurses across 30 plus states. What if we gave that to owners and operators to build their own float pools? We do not think the solution is just to be dependent on agency forever, which is ironic because we consider ourselves a technology company. We don’t consider ourselves an agency. I’m sure there’s people in the room that question my credibility about that. That would be a fair question for you to have. At the end of the day, we only focus on long-term care because we actually care about long-term care.
My dad died in a long-term care facility. That’s why I’m here. The reason he died is my mom was sitting in the hallway with a plate of food. My mom couldn’t get in to see him because of a staffing shortage, because he was in a dementia unit.
That’s why most of the people in IntelyCare are here because we care about long-term care. What if we can help you hire and retain those folks without you having to go out and try to figure that out on your own. We figure that out at scale with technology. How can you really quickly and easily deploy and manage that float pool?
It’s not just as easy as saying I’m going to start an agency. You have to think, “How do you then keep those nurses engaged?” “How do you understand what the flexibility is that they’re actually looking for?” Then how do you use algorithms, just like you use every single day? How many people used Uber here today or this week? Imagine for a second that you’re managing your own float pool, you’re opening it up and you know with a high degree of probability that that nurse is going to show up and not call off. That’s what we’ve built.
Imagine that that’s in your hands. You don’t have to do that. Your schedule doesn’t have to be on the phone. Your admin doesn’t have to be on the phone. What if you could increase your census in order to do this?
Finding a balance
“We notice that there was a massive imbalance in how people were using staffing. 60% made up the full-time staff. As much as 40, 50, 60%, in some cases, in some cases lower, some folks didn’t use any or very little that you had no control over that. That’s going to feel awful, feeling like you’re writing a check and you have no control over half of it.
You have tools to engage that full-time staff and then you are managing your own float pool. You’re giving them that flexibility to go across locations, to work when they want to work and you don’t bug them when they don’t.
That’s why they want to go work somewhere else. They want to seek that release valve to go somewhere else. What if you had the tools to do that and knew that, and then you could always target those people and then you’re really controlling 93% of your staffing mix. I know everyone’s going to say you really want the top of that pyramid to be zero. The reality is that it’s probably not reasonable across the industry to get down to zero.
We think the balance is somewhere between 7% and 10% where you’re flexing out in order to use that. You need to have the tooling in place to do this. We’ve invested millions as a company to do it. We only focus on long-term care. If you want to get to that mix, technology is an enabler to do it. Half a million nurses across the country engaged on a regular basis at IntelyCare. You can do the same thing in your local neighborhoods. You could take back control.
You can get to the point where you’re controlling 93% of your workforce instead of just 40 or 60, somewhere between there. We’ve got some great people here.
What if we really are the solution, we’re not the problem, we can help you. We can give you those tools to do it yourself, to manage it yourself and take control.
Flexibility changed that during COVID I’d say about 50 times and even this year, it’s changed about 50 times. I guess the first piece is having a tool and a platform to be able to define flexibility as. They engage with us and they give us their preferences. We survey them on a regular basis, and understand what those definitions are. In the beginning, flexibility was, “I have childcare and therefore, I have to drop them off two hours later or earlier.”
I’m sure that’s what a lot of you associate with flexibility. Over time that became, “I need the flexibility to not work in this facility. I want to be able to work overtime and work somewhere else.” That’s the reality.
Those are all interesting ideas that we need to consider because if you’re listening to the nurse, they feel indebted almost to the resident. It’s really good care but they also want to sometimes just be able to, we hear them saying they want to work home health shifts. SNF at home. If you have a sniff-at-home offering, that’s a definition of flexibility.
They want to work at a hospice shift somewhere.
If you don’t have those services, I get that’s a challenge but the key is to have technology, to first listen, so then you can react and match people to what that flexibility is so that you don’t burn them out and then just turn them. Where are they going to go? They’re going to call people like us. Then you’re going to say, “IntelyCare stole my staff.” No, they just were looking for flexibility and we as an industry weren’t listening, and we weren’t constantly re-listening every month to what they defined that as.”
IntelyCare is a workforce management partner that can help you attract and retain more internal nursing staff. To learn more, visit: https://www.intelycare.com/.
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