Kent Rodgers, president and CEO for CarDon & Associates, has seen some great challenges in his 17-year career at one of Indiana’s largest nursing home providers, but he’s also excited about being at the forefront of many transformations, some spurred by the Covid-19 pandemic.
In fact, the pandemic was raging when he became the company’s interim president and CFO in November 2020, before he took on his current role in October 2021. But he has been with the company for almost two decades, going back to when the CarDon portfolio consisted of five buildings, most in rural areas, he told Skilled Nursing News during a recent interview at the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) annual conference in Denver.
The company has grown to currently have 19 campuses throughout Indiana that include skilled nursing facilities (SNFs), as well as assisted and independent living units. Rodgers’ main goal now is to improve quality of care rather than addition of more properties, and his tenure has been busy, with innovation a priority.
In fact, he calculates that CarDon has saved about $2 million through its adoption of technology that has helped automate processes. He also looked outside the nursing home industry to make the key hire of a chief human resources officer — and he is blunt about why he took that approach.
When pressed by his team about why he was so adamant about not hiring anyone with nursing home experience, he told them: “Our industry has just given up — it’s got 140% turnover.”
Rodgers also spoke with SNN about other strategic goals and recent changes, including taking a full ownership stake in a pharmacy, plans for an I-SNP [Institutional Special Needs Plan] arrangement, and useful medical interventions aimed at cutting down the use of medicines.
Indeed, he is firmly focused on the future, as reflected in the one question that he would pose if seated at a table with 10 other nursing home executives: “What’s next?”
Overcoming staffing challenges
Covid presented many challenges at CarDon, but perhaps the central one was staffing, Rodgers said. CarDon hadn’t dealt with agency labor in its nearly five decades of existence until the pandemic, and it wasn’t natural for the organization to hire agency workers. CarDon was faced with the dilemma of reducing the number of residents it could care for or hiring agency workers.
“Coming out of Covid – and I was new to the job then – what we said was that we had to fill the buildings again,” Rodgers recalled. “This business has always been census-driven staffing – staff is based on your census, and while [many organizations] decided they would reduce census and admissions because they couldn’t get enough staff, we said, we’re gonna meet the needs of our residents, our communities, and our hospital partners and we’re going to fill the buildings.”
This decision meant hiring agency workers at a great expense.
“From 1977 to April of 2020, the total we had spent on agency staffing was zero dollars,” said Rodgers. “It cost us a lot of money, and it continues to, but we’re 90-plus percent full in our buildings and almost 100% in our residential units. And that was a big step to meet the needs of the residents and our partners.”
The high agency use, however, was always meant as a temporary solution, and CarDon attacked the problem by bringing in a new chief human resources officer, Amy Haug, who was culled from the hospitality sector rather than from the nursing home industry. “I didn’t want someone who accepted ‘that’s the way our industry is’ when it comes to turnover. I wanted to find new and innovative ways to improve our culture and improve our employee retention,” said Rodgers.
The recruitment philosophy ultimately bore fruit, in the form of higher retention. CarDon had gotten a handle on agency use by late 2022, and in 2023 has been focused on establishing a better balance of agency and permanent staff, he said. With only three of 19 campuses currently using agency staff, he believes the company can achieve a goal to be agency-free by the end of this year.
Some of the workforce programs in place that are helping change retention rates – and the wellbeing – of employees are the CarDon Leadership Academy and the Leadership Acceleration Path (LEAP) programs. They teach employees to be better supervisors, including through teaching the use of positive language and the ability to manage difficult conversations.
And Haug is not the only new leader to join CarDon recently. Zach Cattell, formerly the president of the Indiana Health Care Association, joined as chief strategy officer and general counsel.
Diversifying range of services offered
Rodgers also spoke at length about CarDon’s goal to diversify the services it offers.
“We can’t stand still. We can’t just be a facility-based organization. We have to do more than that,” he said, explaining that CarDon has its own therapy and pharmacy company, has “dabbled” in home health, and recently launched a companion care company. “You can either be a product-driven company or a customer-centric company.”
And Rodgers believes that for nursing home operators, it’s imperative to be customer-centric, which also means providing a broader range of services. In fact, it’s his “mantra” to provide as many services as possible, in the interest of serving as many people as possible and for longer periods of time.
As for increasing its commitment to an in-house pharmacy, CarDon took full ownership control of the pharmacy about a year ago, which Rodgers said has improved alignment. “Finally, we’ve got a pharmacy and a nursing staff that has a common goal of best possible patient care,” he said.
CarDon now has pharmacy staff on site full-time in its buildings, and the proximity has made the process of providing medication to residents more efficient, removing redundancies and easing the burden on clinical staff.
Owning the pharmacy was driven by improving quality of care, Rodgers said, and it’s a benefit that is reaping results.
“[The pharmacy ownership] has not really been cost reduction or profit driven. It has been quality driven and staffing driven,” he said. Before, CarDon’s nurses were spending an “inordinate amount of time passing meds.” Now pharmacy techs help with the receipt of the meds, stocking and auditing of med carts as well as overseeing onsite CUBEX machines that automate supply management.
“[The techs] really help the nurses … and now nurses just do what they do best, which is to care for the patients. While the nurses still pass the meds, the audit preparation and making sure everything is in order – the pharmacy tech is helping with that,” explained Rodgers.
Another initiative related to reducing the overuse of medications involves utilizing pharmacogenomics (PGx) with the residents. PGx is the study of how variations in the human genome dictate a person’s response to medications.
CarDon’s ancillary businesses are housed under LifeSpan, which includes Lifespan Pharmacy, Lifespan Therapy, companion care and home health.
Some efficiencies that Rodgers is proud of introducing include Robotic Processing Automation (RPA) and use of bots to automate administrative tasks and ease admissions intake and other tasks.
“[Initially] I thought a bot was a Star Wars character,” joked Rodgers. “And now, we’ve just done so many things with RPA processing to address the labor shortage. Our savings are approaching $2 million and thousands of hours of time, just by using bots.”
Such savings help explain how CarDon is now back at 2019 margin levels, after a “big dip” in 2021. However, the organization is bracing for the potential effects of Indiana transitioning to a managed Medicaid system next year.
And, CarDon is currently in talks to proceed with an I-SNP arrangement, whose details Rodgers couldn’t divulge due to confidentiality agreements. “I’m only going to say we are fully committed to an I-SNP but due to confidentiality reasons, I can’t announce that yet,” he said.