As the head of his family-owned nursing home business, Steven Tack, CEO of Pennsylvania-based Quality Life Services, says weathering the ups and downs of the last few years has rested on creating a family-like atmosphere for residents and staff – a message that can be universally applied to improve census and worker retention.
Quality Life has an edge over competitors because family-owned businesses are dwindling, said Tack. And being family-owned ultimately impacts quality of care.
“When we started 50 years ago, most nursing homes were owned and operated by families. And it’s certainly changed. Now, we’re one of three in Pennsylvania, who are multi-generational multi-site family-owned and operated,” Tack told Skilled Nursing News. “So we are embracing the culture of family, and extending it to our employees and residents … Whether it’s staff, who want to be part of something that’s bigger than just themselves, or residents, care is better achieved by people who are local.”
Quality Life runs 10 skilled nursing facilities (SNFs) with seven campuses having assisted living capabilities as part of continuing care retirement communities (CCRCs). All properties are located in mostly rural counties in Western Pennsylvania.
Quality Life has managed to stay afloat amid all the current myriad challenges, including a staffing shortage, reliance on expensive agency labor, high inflation and a tough lending environment.
Tack spoke to SNN about the impact of the federal government’s minimum staffing proposal, challenges to census as well as some wins for Quality Life with financial restructuring and finding stable ground after some lenders pulled out in the first half of the year. He also discussed new work initiatives, which have helped retention and recruitment.
Moreover, as an operator in a state with a staffing mandate in place, the challenges facing Tack’s organization are compounded and give an early glimpse into how the federal mandate would shake out.
Currently, in attempts to meet Pennsylvania’s minimum staffing mandate – which at 3.7 PRPD is stricter than its proposed federal counterpart – Tack’s organization has been grappling with employing expensive agency workers along with licensed practical nurses (LPNs).
A key difference with the federal staffing proposal and Pennsylvania’s is that the state mandate requires a certain level of licensed practical nurses (LPNs) in its staffing ratio, while the role was conspicuously absent from the proposed federal mandate. The federal mandate instead emphasizes hours covered by registered nurses (RNs).
Tack believes that the conditions of the federal and state staffing mandates will need to align so that nursing homes aren’t bearing extra burdens in abiding by the differences in their stipulations. Quality Life has met Pennsylvania’s mandate by using more LPNs but would still be out of compliance with the federal mandate’s RN requirements, Tack explained.
Tack also worries that the government is not attempting to provide funds to support its successful roll out.
“Our state didn’t fund it in its budget this year at all. So, we could be looking at two unfunded staffing mandates, one at the federal level and one at the state level,” said Tack.
The following conversation has been edited for length and clarity.
What is one key goal for your company for the second half of 2023 and why?
Our biggest focus is related to staffing and trying to recruit, retain and build back staffing levels. A couple of our buildings have not fully recovered from Covid in their census, and most of that is due to lack of available staff or in some locations, it’s trying to work out agency use and its costs. We thought we had staffing challenges in 2019. But now we say, “Oh what would it be like to go back to those staffing challenges?”
And we have cost [pressures] to meet these increased staffing ratios here in Pennsylvania. We were already having trouble finding enough staff as it was. Now you’ve got to go out and bring in even more [costly] agency staff … Everyone is trying to outbid one another, [and] higher and higher rates get passed to the providers. [Agencies] kind of hold us over a barrel that way.
Tell us a bit about your company’s history?
About two and a half weeks ago, we reached our 50th anniversary in long-term care as a family, and so I’ve been doing this pretty much my whole life. We have 10 campuses all in Western Pennsylvania, all no more than a two-hour drive from each other. So I am very involved with all of our locations, and four of them are within a half an hour of my house. So we now have the fourth generation involved in the company.
We’ve also gotten into providing some of the ancillary services, pharmacy, therapy, we have our own home health and hospice company, and so in homecare;
In the second half of 2023, how do you plan to resolve the staffing situation, especially in light of the federal minimum staffing proposal?
So one of our big focuses is on training and teaching assistants. We have different locations. We have multiple CNA training programs and we’re very actively recruiting for those. We have been seeing more people willing to go through that training and enter the workforce as the wages keep going up. So we’re being very aggressive at training and getting as many people as we can and then working really hard to make sure they stay on board.
A very big initiative is working closely with some of the different nursing schools. We’ve long had a tuition reimbursement program. And now, we’re actually helping people who want a career path from a nursing assistant to an LPN or an RN in exchange for a commitment of employment with us for a period of time. A rising tide lifts all ships.
And then, of course, we’ve also been looking at international recruiting of nurses. That’s actually one of the things I’m going to talk to our Congressman about, because the State Department has stopped processing visa applications. We’ve been working for several years to bring a group of nurses from overseas and make all those arrangements, but now the process is kind of stalled while we wait for visa applications to be processed.
What is one notable win that your company has notched this year?
Rising inflation and interest rates caused some lenders to move out of long-term care, and so we had to find a new partner this year. And, we were able to put together a short-term and long-term refinancing package that will stabilize things and allow us to continue to move forward as we recover from the pandemic. But that was an enormous challenge in the first part of this year and one that I’m very grateful that we’ve now put behind us.
What is one “miss” or lesson learned the hard way so far for your company in 2023?
I’m not sure there have been any big misses, but there’ve been a lot of little misses. If I had to come up with one, it would be how much slower we have been in understanding the changes in the expectations of the workforce. Some of these changes happened during the pandemic but are permanent. With a lot of those things, we thought, well, it will go back to the way it was and then we realized that, no, there’s a whole lot of things with the expectations of the workforce that just aren’t going back.
With regards to staffing, have staffing pressures eased at all since the start of this year?
Yes, I think we’re starting to see some easing. There was a period of time when even some of the most entry-level positions used to be challenging to fulfill, such as in environmental services and dietary services. We’re starting to see that change a little bit. And our efforts in finding students for our nursing assistant classes, to get them certified and trained, have really been picking up of late.
As we approach the 6-month mark in 2023, what word would you say best describes the year so far for your company and why?
Well, we’ve always described ourselves as, we wanted to be better, different and innovative. Those three words kind of capture what has been the essence of our family and the company for all of its 50 years. And, and I would say 2023 so far has definitely challenged us to be different. It’s been about finding ways to be different, how to set yourself apart as a provider, how to set yourself apart as an employer, how to be different from the competition. When it comes to staffing, we’re competing with all kinds of other employers, so we stress on how we can be different.
How does having a culture based on “family” impact quality of care?
I was just at one of our buildings, which is one within half an hour from where I grew up. I ended up talking to one of our residents, who turned out to be my Sunday School teacher when I was a little kid. So yeah, it’s knowing people personally, it’s having that connection of knowing about somebody, knowing about their family. We’re all in small towns in rural Western Pennsylvania. So it is about building relationships and actually getting to know people, whether they’re staff or residents. That ultimately is what people want. They want to be cared for, work with, and be employed by somebody who they think actually cares about and for them.
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