Inside a More ‘Holistic’ Approach at Nursing Homes: Attracting New Nurses, Countering CMS Regulations Effectively

As the skilled nursing industry continues to evolve, efforts towards collaboration, innovation and advocacy will be paramount in addressing the challenges and opportunities ahead – along with making the industry “sexier” to potential nurses and healthcare professionals.

This is according to Lana Blagg, Senior VP of Clinical Services at Touchstone Communities, who spoke at Skilled Nursing New’s CLINICAL conference in Tampa last week. Blagg said the industry can help address staffing crises by creating training programs similar to those at hospitals.

To that end, initiatives at Touchstone Communities are aimed at attracting and retaining skilled nursing professionals, including tuition reimbursement and implementation of comprehensive preceptorship programs that allow for experienced nurses to support new nurses in their transition, Blagg said.


There’s a great need to make the skilled nursing industry more appealing to new nurses, Blagg said, and SNFs need to draw lessons from other health care settings by providing opportunities for hands-on training and mentorship.

“We really have to make our industry sexy,” she said. “I think that [we can] by starting out by mimicking the acute care setting and implementing preceptor programs,” adding that as an industry, skilled nursing usually just sticks with three to seven days of orientation for new nurses and CNAs.

“I’m talking about true preceptor work, where you are with a nurse, working as a nurse on a schedule,” she said, adding that the educational component makes nursing home care feel like a viable career, instead of a box to check in a nurse’s training.


Blagg was joined by Joel VanEaton, Executive VP of PAC Regulatory Affairs and Education at Broad River Rehab, and Jim Polaski, Senior VP of Operations at Westminster Communities of Florida, in sharing their perspectives on various aspects of skilled nursing care, ranging from staffing shortages to regulatory compliance and technological advancements.

Navigating regulatory changes: compliance and documentation

VanEaton discussed the impact of implementing PDPM and the shift it brought in the perception of facility needs and various departments working in silos. He emphasized the importance of synergy among facilities, which he said leads to a more holistic approach to care and enhances satisfaction and communication.

“One thing that we excel at in our communities is our ability to engage in conversations, leveraging what we bring to the table from both the nursing and regulatory compliance perspectives,” he said. “We utilize our synergy to ensure that we are all aligned in our goals.”

VanEaton also said that employing registered nurses (RNs) and nursing staff from the broader community to assist with MDS, especially in states transitioning away from Medicaid and Case Mix Index (CMI) reimbursements, has led to Broad River exploring various ways to incorporate RNs into facility staff, such as directly hiring them or contracting with them through pharmacy services, to better adapt to the changing landscape of healthcare reimbursement models like PDPM.

He added that the value-based purchasing side, health equity bonus adjustments have started to come into play and will impact reimbursement adjustments.

“If you’re not already familiar with it, accessing and downloading your Health Equity Confidential Feedback Reports is crucial,” he said. “Quality Reporting is essential, especially considering CMS’ direction in that regard, which is becoming increasingly important.”

Addressing staffing shortages

Blagg underscored the critical need for specialized training and education tailored to the unique demands of post-acute care settings, and urged industry stakeholders to engage with local nursing schools to promote skilled nursing as a viable career path.

“We need to get those good nurses that don’t have bad habits that we can really mold into the type of clinician that we need for them to be a true specialist,” she said.

Moreover, Blagg stressed the importance of advocacy efforts to address staffing shortages, urging collaboration with local and national politicians to secure increased staffing and reimbursement. In response to the challenges posed by the COVID-19 pandemic, Blagg highlighted the importance of flexibility and innovation in adapting clinical education opportunities for nursing students, and current employees.

She also said it is important for operators to offer continuing education opportunities to all staff, from administrators to housekeepers.

“We can’t forget about those people because they’re the ones who will lead to creative positions,” she said. “So, those are some of the little things that we put in place, and hopefully, they will improve.”

Jim Polaski echoed Blagg’s sentiments regarding staffing challenges, highlighting the financial strain faced by nursing homes due to a negative net operating income.

Speaking to the operating environment in Florida, Polaski emphasized the need for additional reimbursement to support quality care delivery. He said it is important for operators to engage with policymakers and advocate for policy changes to alleviate staffing shortages and ensure sustainable funding for skilled nursing facilities.

“We’re getting involved with our politicians,” he said. “I’m going with LeadingAge to Washington. We’ve been politicking with our local politicians and we’re heading to Washington to tell the story.”

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