Hurlbut Care President: With Nursing Home Sector In Limbo, It’s Time to Think Differently

Robert W. Hurlbut, president of Hurlbut Care Communities, knows a thing or two about battling burnout among his workers.

Paying staff well along with flexibility of work schedules and retaining a family atmosphere has proven to be sure shot strategies to beat turnover.

And the proof of this strategy’s success is in the results. Hurlbut Care, which operates 11 facilities in the New York area, has had zero agency use since the 1990s, while its turnover rate is below the rest of the state’s 85% turnover rate.


Hurlbut, who has held this position since 1993, sat down with Skilled Nursing News to discuss successes on the staffing front, including better wages and centralization of administrative tasks to reduce burnout. He is also among nursing home leaders who are calling for reforms to New York state’s nursing home Medicaid reimbursement policies, partly in order to pay his staff better.

“We are offering what we can offer. Hurlbut Care Communities does not use agencies for our staffing and we need to attract more people with a passion to work in senior healthcare,” Hurlbut told SNN, adding that continued success to retain workers at current rates hinges on better reimbursement from the state. “It all depends on the budget decision for the Medicaid reimbursement rate … There is tremendous growth potential for those looking to move up the career ladder.”

Part of the issue relates to disparities between downstate nursing homes – particularly those in the New York City metro area – and those in upstate markets. Given their higher current reimbursement rates, an across-the-board rate increase would benefit the NYC facilities more than others; for example, a 10% rate increase on $300 a day means an extra $30, while a 10% increase on a $200 a day rate is only an additional $20. For this reason, Hurlbut is among those pushing for a methodology that would narrow the disparity that exists among markets.


Furthermore, he sees the need for more funding specifically related to workforce.

“In the past, New York State offered financial incentives to nursing homes for vocational training. If we are to have robust nursing home care in the future, we need to think differently about how we care for our seniors,” he said.

The following interview is edited for length and clarity.

What is one key goal for your company for 2024 and why?

Post-pandemic, our key goal is to continue normalizing operations which will positively impact our residents, families, and employees. We have given greater autonomy to our 11 facility administrators. We have centralized their paperwork at our main office to free up their direct work with employees, residents and families.

We’ve been filling out [a mandated survey related to Covid protocols] for four years, every day. And it’s due by one o’clock, and you get fined if we don’t do it. Now, a lot of it we have a template for, so they can do it on their own instead of taking three hours like it used to … Now it takes about a half-hour to 20 minutes, but we have to do it, and it makes no sense.

With our staff, depending upon their family life, what they’re doing with kids, spouses, are they going to work? Are they working remotely? You know, we’re just trying to be really flexible with staffing because we don’t use agency.

We’re also discharging a lot of rehab residents – that’s gone really well. But the backup in hospitals is still prevalent in Rochester …So at this point, we are just getting even patients in really worse conditions.

What’s one notable win that your company has notched in the last year?

Fortunately, we do not have the turnover that is typical in our industry. Each of our nursing homes has a different personality, but we treat everyone like family. To that end, we have peer reviews and hold cross-administrative meetings.

We are also seeing great success following the hiring of two new administrators. So when we hired this administrator, after about three months, she called me and just said, “I can’t tell you what a relief it is working for Hurlbut Care Communities because you let us run our facilities. You don’t get into the weeds. You understand that each form is different, and you pay your bills.”

What is one “miss” or lesson learned the hard way for your company?

Considering Governor Hochul’s Buffalo roots, we were expecting more Medicaid reimbursement support for upstate New York seniors. Medicaid reimbursement pressures will ease only if the Governor’s budget includes the increases that we have requested. 

What has helped with turnover?

I learned this [principle] from my father … that you work as a team and you work together. That’s why we do the peer reviews, where our administrators act like New York State Health Department officials, and they go in twice a year. They do a survey and if they find something wrong, they write it up. But it’s not punitive.

Other department heads also do this. So I bring in people from housekeeping, laundry, dietary, nursing, because sometimes there’s more than one way to do things. And we learn from some of our other employees as well.

Nursing home administrators in New York don’t last very long [but] … a lot of my administrators have been with me for 15 to 20 years. So [consistency of leadership] helps with staffing, training and resident care. Everything else seems to fall into place. It makes life a lot easier.

Can you share your statistics on turnover?

CNAs at nursing homes in NewYork have the highest turnover rate at about 85% turnover. Ours is probably closer to 50% to 45%. A lot of that has to do with wage competition among nursing homes and their jumping ship because [other] nursing homes might be paying $3 more … And they realize that the grass isn’t greener on the other side, so I get a lot of them back. I hire them back if they leave on good terms.

I’m also very flexible with our schedules – we’ve even got some nurses and nurses aides that work maybe five shifts a month. And they’re working other places, but they come and work with us because we treat them better.

How important is flexibility on work schedules?

We understand that because we’re dealing with 90% women [staff], and if you’re a single mom, and you’ve got kids, daycare is a problem. [Daycare] costs too much. So, I even tried, at one time, starting my own daycare for my employees, but the cost was astronomical and it just wasn’t going to work. So I didn’t do it.

But we work with people’s schedules, and if they can only work, let’s say, five hours out of an eight hour shift, then that’s fine as long as they divide the shift up, depending upon days, evenings and nights. Also, if they’re a couple hours late because of a situation with their kids, then if they work a couple hours later, I’m fine with it.

I also have older nurses – some in their 70s – and they work because we treat them well. And they may only work maybe five times a month and I’m fine with that. I mean, it’s still consistent.

How has centralizing administrative work helped?

I learned about centralization from my dad. So we have centralized accounts, purchasing and payables. So we try to take all the nonsense paperwork away from the administrators so that they can actually run the nursing home like they’re supposed to.

My son [Vice President Robert G. Hurbut] has taken over the daily operations. We have a regional director who is an RN and has been an administrator with me for about 12 years. So she’s like the area director and works with staffing at the homes. And then I have another nurse who is in charge of clinical and is overseeing MDS for reimbursement. This is all my office centralized.

So you have been free of agency use for a decade? Tell us how you achieved that? Has this always been the case, or is there a certain strategy that you’ve put in place to achieve this?

Well, when I was the administrator of Hurlbut Care back in the mid-80s, we had the same sort of shortages going on, so we started using agency personnel. And I convinced my father to give a $5 an hour raise to all the nurse aides. And, I promised him I would get rid of like 90% of agency nurses aides. Well, I kept my promise.

And then, when I became vice president of the company in 1990…. I made an edict by 1992, saying that I’d never use agency labor again, because it’s like becoming a heroin addict. It really messes up your current staff [and culture], because they don’t work. I threw out four or five nurse aides and a couple of nurses for causing trouble sitting around doing nothing. And then I started thinking about the agency staff saying, well, how would you feel if you had to work for 10 different nursing homes? You’d have to face 10 different ways of doing things. And, you’re not really treated well.

So, what I did is that I started hiring agency personnel. We treated them well. And even though we couldn’t pay them exactly what they were making, they felt more comfortable because they got benefits. The pay difference really wasn’t that much, but more importantly, they liked that they had a home to come to. And resident care went up.

In entering the first quarter of 2024, what word would you say best describes the year so far for your company and why?

Fortitude! We are always moving forward and remain optimistic.

Would you choose the same word to describe the year for the sector as a whole so far?

For our sector, I would say we are “in limbo.”

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