As Principle LTC maintains a focus on staff retention and recruitment, the company is developing new programs to ensure staff have meaningful relationships to their roles.
Lynn Hood, CEO of Principle LTC, which manages 45 facilities across North Carolina, Kentucky and Virginia, said that over her lengthy career in health care, she has learned that employees really value when management shows up for them during times of crisis.
In a former nursing home leadership role, Hood raised money for Haitian employee’s families affected by the earthquake. She said she carries the philosophy of helping employees in times of crises in her current role at Principle.
“For those employees who we helped their families during that horrible event, 80% of them were still with the company five years later,” Hood said during SNN’s RETHINK podcast. “That’s a big story.”
Besides advocacy work, Hood spoke about specific staff training and education programs that have succeeded at Principle, as well as her philosophy on developing leaders.
Highlights of the podcast, edited for length and clarity, are below. Subscribe to RETHINK via Apple Podcasts, Google Podcasts, or SoundCloud.
Could you share a story from your career that you would tell an aspiring nurse something to get them excited about a possible career in the post acute sector?
So, I actually started in this industry when I was 16 years old, working in the kitchen of a nursing home, and, through the years, continued to work in nursing homes while I was getting my nursing degree. And I guess I’m a little bit of a different nurse because I actually never went into nursing practice. By the time I had finished my nursing degree, with a focus in biology and psychology, I had already been enrolled in long-term care administration programs. So, I immediately, at the age of 24, became a nursing home administrator.
So, for other nurses, it’s a wonderful career. For nurses, not everyone has the drive to go into leadership and administration; it was kind of always my drive. But I believe if you’re a nurse, then you know the world is your oyster; you can really go in any direction you want.
Long-term care is such a fantastic career because it’s such a generalist career. You get to touch everything from housekeeping to laundry, finances, clinical care, and customer relations. So, it’s a wonderful career for nurses.
I highly encourage them, before they even consider going into administration, to actually consider coming to work in a long-term care facility. Right now, three of my leadership team members who are in the C-suite are nurses. One went from being an LPN all the way up to being my chief operating officer, and another one went from being an RN to an RN consultant in our chief process and our sort of people and Employee Relations Department and marketing and sales. So, it’s a great career.
Has Principle been able to implement any initiatives to improve recruitment?
Recruitment is so tightly wound into retention. We have actually netted 1,000 new hires this year, and we’ve reduced our agency dependency by 70%.
We did start our own recruiting department during the course of the pandemic. It was not a department we had before, but we knew we needed all hands on deck. We also created some tools for the administrator to use – visual tools to discuss with their team the number of openings and who’s coming in for interviews and making sure that we are at the front desk, making sure potential applicants are treated well. It’s been kind of an all hands on deck approach.
Could you talk a little bit more about retention?
From the beginning of my career, going back to when I was an administrator at 24, I always believed that if you take care of the people that take care of the patients, a lot of things take care of themselves. And, that’s simplifying the industry. But I’ve always found in my career that if the people that are taking care of the patients feel like they are respected, they have clear guidelines and systems and they have the tools available to do their jobs, that is a key point.
So at Principle, some of the things we’ve done with retention have been, I think, very fundamental to our success. So, the first is we created our guiding principles when I got here in 2018. And those guiding principles were built by a group of leaders in the company. And the areas that we address under the word principle, which is our company name, are people’s respect, integrity, nurturing, care, inclusivity, purpose, leadership and excellence. So on the retention front, you start with a fundamental approach to caring for people. And that approach allows a lot of things to fall into place.
We start in principle with care. Principle Cares is a not for profit arm of our company that provides an employee with an income level under $50,000 a year to fill out an application for financial support. [This covers] things like personal crises, divorces, fires, having issues with paying rent and food. We’re available to our employees on the front line to help with that.
We also have another program that’s in the process of being developed called Cardinal Closet. It’s a room in a building area designed for our frontline staff to access items like bread and food. The program has been piloted successfully, and family members can also contribute by dropping off a few loaves of bread.
Additionally, we have Payactiv, a program that helps with retention. It allows employees to access their daily earnings at little or no cost. If they sign up for a Payactiv credit card, they can receive their pay immediately at no cost to the company.
We’ve also built a robust orientation program. With over 1,000 new hires this year, we asked them to rate the success of the orientation program from their perspective. On a five-star scale, our new hires have given us a 4.75 rating.
Could share some success stories or examples of employees who have benefited from some of these programs?
So one of the first things when I arrived here in 2018, is we started a certification program for nurses. The certification is called a RAC certification. And it specializes nurses in managing the MDS, the minimum data set of our business. And so today, we’ve put 72 nurses through that program.
The other piece of it is just offering educational opportunities with support so that people can improve their overall life circumstances by getting educated.
And if you think about what that industry has been through in the last three years, the retention of those nurses is about 65%, which might not sound great, but it really is good considering the turnover. We also have been training with East Carolina University [for new administrators]. And through that program, we’ve been able to retain quite a few administrators, and some of them have actually moved up in the company.
Besides staffing and retention, what else are you really focused on right now?
My first and foremost priority, besides ensuring that employees are treated fairly and we have good systems in place, is developing my leadership team. My leadership team comprises more than 50% women. I have a strong dedication to helping women succeed in their careers. In fact, I was fortunate to work with Direct Supply, one of our outstanding partners in this industry, through a group called Win. I had the opportunity to talk to them about the glass ceiling that I believe my generation has somewhat cracked.
So, definitely, developing leaders is a top priority. Additionally, I like to focus on innovation. We’ve developed what I would call very effective internal tools to manage the day-to-day operations of the nursing home. These tools are easy to use and provide quick feedback to the administrators on their actions.
Another significant area I would say is advocacy. Our industry is not known for creating an environment where we speak up when something is about to be pushed down to us on the regulatory or legal side. We often accept challenges along the way. Therefore, we’ve established an advocacy program that engages all our employees to speak up and write letters to their senators, congressmen, CMS, or any relevant authority when issues arise.
In the last two issues we addressed, one was the PDPM changes. With those changes, 40% of the letters came from Principle … We hope more people will start speaking up on advocacy issues. PDPM, as it was proposed before the advocacy, involved a cut, but we ended up getting an increase.
The second issue was related to mandated staffing minimums. We initiated the first letter-writing campaign before the rule came out, and we were able to secure about 26% of the total letters from the industry. So a significant amount of my time has been spent talking to other CEOs and other leadership figures about the importance of advocacy. During our advocacy efforts, one of the most astonishing things, though it shouldn’t have surprised me, was that 80% of our letters came from nurses and aides. They are familiar with the issues, understand the reasons behind regulatory recommendations, and know how to address them, stating what will work and what won’t.
The name of this podcast is RETHINK – Is there a common practice or maybe a piece of industry conventional wisdom that you think nursing home operators need to rethink?
If organizations and companies believe they will be successful without their staff having a voice, being respected, and treated equally, that’s not going to happen. One of my stories related to this was in my last organization. About 25% of my workforce was impacted by the 2010 earthquakes in Haiti … I was actually involved in leading an effort to raise money, funds, clothing, food, and ultimately tents because many of my employees’ families were homeless. I connected with a group called the Haitian American Nursing organization in South Florida, which is now national. They’re an amazing group of women, just absolutely amazing. They agreed to get our supplies over there, but said I had to go. I’m now a board member or executive member of their organization. It’s a not-for-profit organization. It’s not a paid position. But once we engaged with those employees, we then partnered with one of the universities in South Florida and measured retention. For those employees whose families we helped during that horrible event, 80% of them were still with the company five years later. That’s a big story. So when we’re thinking as an industry about the bottom line, finances, and ways to do things, those are all important. But if people aren’t put first, I think the success of the organization is going to fail.
I think the other thing is we have to advocate for ourselves, and it’s that we can’t keep taking beating after beating. Nursing homes are not a popular business; no one really wants to go to a nursing home. I don’t want to go to a nursing home. However, we play a really important role in the health care spectrum. It’s our job to let everyone know that our industry is a needed industry. When we look at our residents, we think how many of them could go home if the nursing homes were closed or something catastrophic happened. Very few, even with family members living in the house, could handle being home because of their needs. So you have to speak up for the industry.
Surround yourself with the best people, both as partners and in your work team. I am definitely never the most educated or smartest person on my leadership team, even today. But I know how to find them, and I know how to motivate them. I don’t always do it well, but I try to let them know that they’re an important and integral part of the company. I think it’s all about people, your partners, and just the way you advocate for the industry. It’s time for this industry to start realizing that we are needed.
If you remember, during the early parts of the pandemic, when many nursing homes couldn’t take patients, the hospitals collapsed. So we have to remember that, because anything the government does to the organizations that causes a financial collapse or an operational collapse is going to back up the hospitals, which is going to back up the health system. We are an integral part, and we have to keep reminding ourselves that we play a key role in speaking to the health care community, be it hospitals, home health, doctors, that we are an integral part and we want a voice at the table.
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