The Centralized recruitment model is gaining momentum across long-term care communities and nursing homes, and more operators amid consolidation in the sector, are attesting to its success.

Operators like Covenant Living Communities and Services understand well, however, that success is only as good as the region and setting.

“I don’t necessarily think there’s a magic bullet,” said Elizabeth McLaren, senior vice president of revenue-cycle, reimbursement and home and community-based services (HCBS) at Covenant Living. “We still have some communities in our portfolio that are really, really struggling with retention. They get people in, they get them onboarded, and they leave in three weeks.”

That said, she credits the centralized recruiting model for maintaining the urgency on recruitment efforts and it’s helping a lot. Certainly, the model seems to be bearing fruit for other nursing home providers as well.

“We’ve been fortunate enough where we have not needed to necessarily limit positions or eliminate census because of staffing,” she said.

Covenant Living has 20 long-term care communities, including those featuring skilled nursing, in 11 states.

And aside from the centralized recruitment model, employee well-being is what has really been the heart of efforts to improve staffing for Covenant.

“We are really invested in our employees. We are looking at their benefits, looking at comps, raising minimums – doing a lot of those things to make sure that we’re an employer of choice. It’s been a significant investment for us,” she said. “Our board is 100% behind it.”

Elizabeth McLaren, who joined the Covenant Living leadership team in August 2009, has also served as a member of the LeadingAge Illinois’ skilled nursing facility cabinet and the American Healthcare Association’s (AHCA) not-for-profit provider council and the healthcare provider billing advocate committee.

McLaren sat down with Skilled Nursing News to discuss some wins and challenges at Covenant, including staffing solutions and reimbursement strategies, and how her organization is staying on top of mounting administrative burdens from new regulation. She also talked about her role over the last two years as the chair of the board of directors for LeadingAge, illinois.

The following interview has been edited for length and clarity.

SNN: How is the staffing situation at Covenant?

McLaren: The centralized recruitment model that we have has really helped because that recruitment group can really focus on what they do well with the sole focus on recruitment. And then, it becomes the community staff’s responsibility, depending on where they are, to onboard and train.

SNN: Do you recommend the centralized recruitment model for larger providers?

McLaren: It depends on what their infrastructure looks like. [Our scale] is one thing that we’re really fortunate to have. So if you’re looking for training staff, whether you’re looking in Connecticut or California, there’s definitely benefits from scale with that. But I think staffing is still challenging overall for the sector.

My mom is a health care administrator for a for-profit [provider], so I listen to her challenges, and they’re struggling. They’re struggling with agency. They’re struggling with the challenges that [agency staff] brings.

So, I don’t think there’s necessarily a magic bullet, because we still have some communities in our portfolio that are really, really struggling with retention. They get people in, they get them onboarded, and they leave in three weeks.

SNN: Are the staffing challenges based on the urban versus rural setting?

McLaren: I would say it’s interesting because some of our communities are [struggling with staffing] even in a city setting. We haven’t quite figured it out. Some of our communities are struggling a little bit more with retention than others.

What I’m hearing from our executive team and our chief human resources officer is that the priority is to solve the retention piece for the most part, or solve the recruitment piece with our model.

SNN: What are some interesting workforce strategies at Covenant?

McLaren: Our biggest strategy is focused on retention because the more you retain, the more you keep your people happy. I think onboarding and training are two huge parts of [our retention strategy]. I think as an industry, sometimes we kind of forgot how to train and work because our house was on fire for two years during the pandemic. And now we’re kind of coming out of that fog, and still in it a little bit. But we’ve go to get back to the basics, which is to train our people, to make them feel supported, to make them feel well-equipped to do their jobs.

I think that’s where everyone probably has a little bit more opportunity.

SNN: Are employees still wearing multiple hats?

McLaren: Nurses are still being pulled to the floor but an important component of our being able to continue providing care is to get paid for the services that we’re rendering, to make sure we’re coding at MDS and capturing all of those care and services. So it’s inevitable relying on agency staff – you have to do whatever it takes to be able to care for the people.

It’s gotten better at Covenant, but I hope we can get away from [agency and staff shortages] as an industry at some point.

SNN: What about changing the work environment at facilities, and will that take a long time?

McLaren: We are really trying to be intentional about being more of an employee-centered organization. Our former CEO, Terri Cunliffe, who just retired, and David [Erickson] both agreed with this message that employees are the backbone of everything we do. If we have happy employees and employees who feel supported, fulfilled and feel like they’re doing good work and they feel valued, that’s going to reflect in the level of service they provide to residents. And so, we make sure people feel supported and are well trained.

SNN: Can you describe one challenge that Covenant has faced over the last several months?

McLaren: We’ve seen the managed care days kind of inching up more. So May was the first month where the percentage of managed care was higher than the percentage of Medicare, and that’s a significant change because you have to manage that completely differently [and] we are having to be more intentional about our case management.

About three years ago, Covenant had a huge problem with admissions related to managed care. So we would admit someone, we provide the care, we go to billing and we’d get a denial. So we decided to centralize that intake function so that for all our admissions, across all of our communities, there’s a uniform process. We have a 30-minute turnaround time. We have a staff that works 365 days a year.

The next phase is really looking at how well we are case managing residents after their initial admissions. Some of our contracts are a flat amount per day. Some are based on PDPM scores, and then some are based on levels of care.

SNN: How has occupancy been for Covenant? What about Illinois operators, who were confronting problems with occupancy last year, with many operators reporting empty beds? Has that situation changed?

McLaren: It depends on the area. From Covenant’s perspective, nationwide, our occupancy in skilled nursing is really strong. We have had a really nice bounce back this year. But I’d say around the state, there are some providers in the city struggling, some doing well, some rural ones struggling, some doing well. So, it’s very regional, and I do think it’s tied to staffing as well.

SNN: What advocacy efforts has LeadingAge focused on in Illinois?

McLAren: So in Illinois, you’re advocating for the several different sub sectors here, assisted living, independent as well as skilled nursing.

We had some pretty significant Illinois legislation related to the Medicaid rate in the last couple of years. LeadingAge actually had four bills that we supported and helped get passed in the last couple of years.