Despite good occupancy levels, low reimbursements amid high inflation pushed Accura Healthcare into survival mode over the last year or so, according to CEO Ted LeNeave.
And successfully navigating through tough times had Accura leaning on strong partnerships — with vendors, lenders, landlords and even employees, LeNeave told Skilled Nursing News.
Emerging out of this struggle, LeNeave is relieved to see higher reimbursement rates approved on the state level, and feels gratitude for all the partnerships that allowed the organization to stay afloat. Now, Accura’s attention for the remainder of this year will be on paying back, he said.
Iowa-based Accura operates 34 senior living communities, including independent living, assisted living, memory care and skilled nursing facilities across Iowa, Minnesota, Nebraska and South Dakota.
LeNeave said he is hopeful for the future of the nursing home industry.
“I’m hopeful because we have great talent in the sector,” he said. “We’re willing to be very strategic, focus on relationships to work with Congress and to work with CMS and our state healthcare agencies to solve the challenges.”
LeNeave said he is focused on strategic loan repayment plans for the “significant debt” held by Accura, with a continued emphasis on quality.
LeNeave also discussed his company’s culture that is built upon close relationships with not just financial partners but also employees — an effort that has helped with retention and recruitment, he said.
For Accura and other nursing homes, especially those operating in rural states, keeping the doors open has been a labor of love that stems from a sense of responsibility towards serving the community, said LeNeave.
As we approach the six month mark in 2023, what word would you say best describes this year so far for Acura?
I would say gratitude. This has been a very difficult year — the last six months of last year and the first six months or five months of this year for us here in Iowa, and actually all the states we operate in.
It was touch and go for a long time because of the financial reimbursement of the sector. And we were really struggling because we had some good census, but our rates just did not keep up with the inflation that we have over the past year. And so the reason I would say gratitude is because there’s a lot of partners – vendor partners, landlord partners, and banking institutions. If it wasn’t for them, we wouldn’t still be here today. And they stepped up and helped us make it to where we are right now where we have received significant rate increases, which we’re grateful for. Those rate increases and how our legislators and our governor have come together made that possible. They recognized that our sector was in trouble, that the reimbursement mechanism that was out there wasn’t going to kick in until mid-year.
We had to figure out ways to survive, and the relationships we had with banks and lenders and landlords and also with our employees. We stuck it out and worked hard and did what we could do operationally to be efficient. And so I would say gratitude because we made it. It was a big sigh of relief when we finally made it to this time. Now, it’s time to pay all of those people back. And so even though we made it, we do have significant debt, but we have a way out and we have a payback plan that will allow us to continue to provide great care and services.
What is your goal for the rest of the year?
It’s hard to answer that without saying quality. I mean, quality should always be a given. You know, giving great care to our residents and tenants is always a key goal, along with providing great benefits and culture to our staff. But in addition to those two items, I would say beginning our payback plan with the partners that helped us make it this past year. Our big goal for the second half of this year is to begin those payback plans and let our partners know that we truly are committed to a long-term partnership.
What is one notable win that you know you feel like you have accomplished in the past year?
Keeping our doors open. Yeah. I mean that is notable when building on our culture. You know, when times get tough, and we’ve seen this throughout history, you really find out if your organization is strong enough as a family to come together. And I think we realize that our team and every employee we have in the company just has great character and great resolve to our culture, to our mission, and our vision that they all came together. We supported each other. We hugged each other and gave words of encouragement. There were times where we cried together, as everyone has struggled, struggled with inflation, even employees that just struggle with what’s going on in their own lives. And we just really all came together as a united family. So I would say the one great thing that we learned was that we are a united family. And that when we’re tested, we stick together.
Have you noticed staffing pressures easing at all since the start of the year, and have you had any specific initiatives for recruitment and retention that have worked?
Staffing has gotten better. We utilized a lot of agency staff in the past year. We have reduced agency staffing by 60%. At the same time, our census has come up. And so our hiring has gotten better. And I would attribute that to recruitment bonuses, with sign-on bonuses, retention bonuses, all those types of things. That’s no different than anyone else.
But I think where we’ve been extremely successful is we really double down on our culture… The people that are going to win are the people that are going to provide a culture that the employees fill. [They] trust the leadership team, they trust the owner, they know the owner. As the owner, I am in the facilities. I’m being very transparent with them. I’m not hiding our challenges and our struggles. And I’m also listening to their challenges and struggles. And so I would say the thing that has set us apart is that culture is our focus on a relationship. And so we’ve had people leave us in the past year, only to call us back and say can I come back? Because they love the relationships and they feel empowered when they can talk to the owner and senior leaders about what their challenges are and actually be heard.
Have you seen any benefit from Medicaid boosts in any of your markets?
So for the past year until April 1, it was very tough. Our rates just did not keep up with inflation. But that’s the way the system here in Iowa was set up. Your rates only increase every couple of years, and we were coming up on the end of a two year cycle. We received significant rate increases that took into account what was going on with inflation. We saw that it was a game changer for us. In Iowa, I think 25 nursing home facilities have closed down in the past year.
Still, we have facilities that are completely full. So it wasn’t a volume problem. The facilities were completely full. The issue truly was the rates were just not keeping up with the inflation. As of April 1, we were able to fix that problem. And we will have another rate increase that is greatly needed here in July. So that’s what we’ve seen and without our governor, our legislators and, and the support of our health care association in Iowa, we wouldn’t have survived.
If there was one CMS policy you could change, what would it be and why?
In the next month, we should see some sort of staffing minimum mandate from CMS. That is the one that I think has the entire sector throughout the country worried, you know – what will that number be and who will be included and counted towards the minimum staffing number.
We are a sector where none of us can find the employees, we need to make sure that there is a waiver in place if you’re not able to get there right away. It has to be funded for us, especially those that are majority Medicaid providers, and even those that are private pay providers. The funds are not there to have a very high staffing ratio and we are trying to determine what the right number is. I think the system that we have right now, that just bases the quality in your facility on your surveys, will tell you whether you’re meeting the quality expectations or not with the staffing ratio you already have in place. I don’t see why that wouldn’t be the standard that we continue with going forward.
If you were sitting at a table with CEOs of 10 other skilled nursing operations, and you could only ask them one question, what would it be?
I was sitting at a table just two weeks ago with a number of prominent CEOs from around the country. We were at the American Health Care Association’s Regional Monitoring Facility CEO Leadership Group. I am a chair of that organization and of that council. We talked about a number of challenges within our sector. As we talked about all those challenges, I watched the pain and the frustrations that many of them were experiencing. And this is across the entire country.
The question would be why do you keep fighting the good fight? And we talked about that, you know, why do you keep going? Why don’t you give up? You know, some people might say, well, they’re not going to give up because they’re personally guaranteeing millions of dollars of debt. I personally guarantee millions of dollars of debt every single day, but that’s not why I keep going. It would be a lot easier to sell my company and walk away and go do something different.
What I am finding when that question is asked to my colleagues, they do it because of the love that they have for not only the residents and the family members, but their employees. They do it because if they don’t do it, who will do it because they’ve gone through these challenges and experiences and they have built these relationships. They don’t want to walk away from these employees and these residents for fear of not knowing what would happen to them if they weren’t there. It’s not about money, because none of us are making money right now. It is truly about a labor of love and a responsibility we feel to take care of lives to care for other people.
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