This article is sponsored by Reverence. It is based on a Skilled Nursing News virtual discussion with Emily Vazquez, Vice President of Special Operations at CareOne, Lee Hudson Teslik, CEO of Reverence, and Scott Erwin, leader of workforce optimization and automated scheduling at Reverence. The discussion took place virtually on November 29, 2022 during the SNN Staffing Summit. The article below has been edited for length and clarity.
Skilled Nursing News: Our focus topic today is staffing challenges, and some of the steps that can be taken to shore up skilled nursing businesses in the midst of a staffing crisis. Lee, can you tell us how you are seeing the market right now?
Lee Hudson Teslik: Yes, absolutely. If you are a healthcare provider group and you are confronting a staffing challenge, at the most basic level there are two things you can do. You can get more people, or you can make more use and better use of your existing people. Clearly, this isn’t an either/or. You need to do both things well. But what we have seen in the market over the last few years is an overwhelming focus on option one, on getting more people. Over the last 12 months, we started to see diminishing returns, either because there simply weren’t more people to get, or because the cost of getting them was so high that it was becoming a big problem.
At Reverence, we have really dug into number two. That is, how can we help folks within the space get the most out of their existing workforce and frankly, how can we help do that in a way that feels good both for the patients and families who are being served, and also for the workforce. Your workforce is one of the most precious assets you have as a company, and being really thoughtful about how best to make the experience of the day to day a good experience for them is really important.
SNN: Emily, how is this playing out at CareOne?
Emily Vazquez: It’s a multi-part answer. I know a lot of companies, hospitals, home cares, etc., that are dipping very deep into the agency pool. We’re not. That’s not our issue, but CareOne is a really large organization, and what we have a hard time with is properly utilizing our staff. You’ll have one facility with a low census and there aren’t enough hours to give everybody, but still maintain their budgeted staffing ratios. Those staff now are out of hours. Could they be used somewhere else that’s struggling to find staffing? That’s where we’re having a little bit of a harder issue.
Like I said, we have hospitals. I had someone that went out for an emergency FMLA at one of our hospitals and, very easily, we filled with a manager from one of our SNIPs, but it took a few bumps in the road to get there. Our struggles are not that we don’t have the staff. Our struggles are sometimes because we’re such a large organization, just making sure that we’re using them efficiently.
I have worn many hats on my way to this role, but I was a staffing coordinator at one point in my career. I loved it. It was like playing people Tetris – I called it the people puzzle – and it feels really good when you have everybody in the right place. We aren’t doing that super well right now, so where someone’s struggling and someone isn’t struggling, kind of meeting in the middle. So I think everyone is feeling staffing challenges that would be ours.
SNN: How big of an issue is retention?
Vazquez: Retention has been difficult in different places. Each individual business line and then each location where the services are provided, so whether it’s a facility or out a pharmacy office or something is run by its own CEO. There’s a lot of autonomy there and some are better than others. CareOne as a whole pays very well at a baseline, so we haven’t had to resort to bonuses and almost being hijacked for raises. We haven’t had to respond with those tools in our toolkit, but there has been a lot to it.
SNN: Scott, I’m assuming some of the issues that Emily just highlighted are relevant to a lot of people on this call. If I’m an operator, where do I start? Are there best practices you can share?
Scott Erwin: A lot of the best practices are what Emily said that CareOne is doing now. How they have been able to attract and retain a good number and not have to be overly reliant on external and often expensive third-party staffing agencies. When you’re trying to answer the question which I suspect our operators might be – how can I continue to deliver the service levels that I desire with what are a number of staffing challenges and potentially an over-usage of external temp agencies – is to begin by looking at your own workforce.
As Emily was mentioning, a closer look will actually reveal that quite often within locations or within groups of people, there actually are hours. There actually is the ability to utilize, a desire to actually to work more shifts, a desire to have a more flexible work opportunity. I think almost going back to what Lee was saying, the first instinct can be to go straight to recruitment, but our view is always the first answer is to talk to the existing workforce and ask, what more do you want?
I can’t count on one hand the number of times when I’ve talked to a provider group that is really bending over backwards and using far too many temp agencies, but equally losing people because they’re not offering their own internal workforce enough opportunities for flexible work. This is the worst of both worlds, obviously.
I think our answer is to first understand where you are either having an opportunity to engage your internal workforce more effectively, or equally on the less exciting side where you may be seeing an overuse of external third-party temp agencies. Then ask, is there a way in which we could share or pool together staff from multiple locations, multiple pools of labor and together perhaps become a first line of defense in the case of needing extra shift support, and engage your own internal workforce, build your own internal flexible pool of labor and then try to, in some ways, meet the desires that are often reasons people leave?
A desire to have more and extra work opportunities and have it be a bit of a win-win by engaging your staff productively and, all things considered, reducing the cost of labor by engaging people internally as opposed to again relying on external third party labor.
SNN: I know technology can play a role in addressing some of these problems. Where do you see technology fitting in when you are advising facilities on staffing?
Erwin: Ultimately, the name of the game is flexibility, but I think the challenge can be flexibility can mean different things to an organization and also to a workforce. Flexibility to an organization typically means the ability to associate staffing levels with the amount of demand, the census, the requirements, and flex up and flex down as needed. Flexibility to a workforce, to an individual, often means the ability to secure work that fits around the many other commitments that one may have in his or her life.
Speaking of caregivers, we know how many are also caregivers professionally but also caregivers personally. Flexibility for them is making that work. These are two different definitions of flexibility, and an organization needs technology to take both of those definitions and create a system that can honor both, to take a wide variety of different and fluctuating staff availability, and make that meet the needs of a schedule that ultimately meets the needs of the patient which is why we’re all here.
As Emily was talking about, with staff Tetris, there’s a limit to how much a human mind can do. And this is where technology can play a very powerful role, and in some ways can obtain that almost impossible win-win situation of providing the flexibility an organization needs, and the flexibility that their workforce desires as well.
SNN: Lee, when you are talking to the C-suite of skilled nursing and assisted living facilities, what trends are you seeing in how they are thinking about workforce and staffing, and how is this evolving compared to 6 or 12 months ago?
Teslik: I’m seeing a few things happening all at once. First and foremost, we’re definitely seeing more focus even in the last six months on workforce optimization – on how we are getting smart around use of our existing workforce. It’s not just, How can I find more people to bring into a staffing pool? It’s also, How am I deploying the talent that I have? How am I providing work opportunities for the people that we have? How we’re providing flexibility in a way that’s both helpful for our workers but also helps us fill more shifts.
Scott has actually been directly consulting with a number of skilled nursing facilities and assisted living facilities, specifically looking at retention. So this has been a big theme. What are the low-hanging fruit steps they can take to better retain their existing workforce. I think that all together, that focus on workforce optimization and existing workforce is a big one for sure that has really come into focus in the last 6 months, maybe 6 to 12 months.
Secondly, definitely a renewed focus on technology. I’m definitely seeing a lot more automated scheduling-focused RFPs than a year ago. Basically, are there ways to get creative? Are there ways that we can better share staff across facilities? Are there ways that we can in that vein create shared staffing pools that are helpful given the goals we have in terms of staffing?
Also, are there better ways to fill last-minute shifts? When we have dropped shifts, or no-shows, or shifts that need to be filled on a moment’s notice, getting smart in how technology can supplement a physical schedule, a person who is your scheduler to help them do their job more effectively. Just in the last couple years, we’ve seen some really interesting examples where for particularly difficult shifts, if the fill rate on really challenging last-minute requests, in steady state might be 50%, tech options that are enabling provider groups to get more like 90%, 95% of those shifts filled because there are essentially ways to automate doing that that are quite effective. I think that getting smart on technology is probably the second one.
The third one, I would say, is an interesting one. Particularly amongst the bigger players in the market, folks are starting to get smart and really get thoughtful on new and adjacent ways of making money. I’ve had more conversations in the last six months than ever before with, for instance, skilled nursing facilities that are keen to explore new payment models.
Perhaps considering strategically, are there pathways towards taking risk-based payment. They haven’t worked in that way in the past, but they’re actively exploring. Given a challenging business environment, are there ways that we can leverage the things that we’re quite good at in order to monetize the work that we’re doing in new and interesting ways? That’s one, I think, that I would expect to see more of as well going forward, and it’s a pretty interesting one, folks exploring new revenue streams and new reimbursement models.
This excerpt has been edited for length and clarity. To watch the full discussion on video, please visit:
Reverence is a technology company partnering with provider groups to set a new standard for clinically effective and financially sustainable at-home care models, starting with a powerful approach to automated scheduling. To learn more, visit: https://www.reverencecare.com/.
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