As president and CEO of Saint Therese Senior Living for the last two years, Craig Abbott has been on a mission to change the idea of wellbeing by strengthening his organization’s workforce and making an urgent case for long-term care and accessibility to nursing homes as a community issue.

“We set out a 10-year vision to impact 25,000 lives. So as we look at 2025, we continue to incrementally set targets for ourselves, and not just for growth for growth’s sake, but in looking at the social issues that we think are important, such as affordability and accessibility,” he told Skilled Nursing News. “We’ve spent a lot of time on a strategic plan, and we have a lot of different goals.”

The long-term care industry is facing a “perfect storm” with threats to access, according to Abbott, and advocacy needs to be ramped up, with providers across the health care continuum lending their voices in support.

“We are at a pivotal crossroads in senior services,” said Abbott. “[We have] to take some action and do some things that are maybe a little bit unprecedented.”

Moreover, the federal government needs to have policies that help, not hinder progress, he said.

“You need the workforce, and the dynamics are challenging,” Abbott said. “More and more people are in need of our care and services. [This does] create a perfect storm for the industry, for those who are in need of service with accessibility, affordability.”

In his interview with SNN, Abbott also shared details of his organization’s expansion into Michigan and Ohio, and the difficult decision to close its flagship campus.

Minnesota-based Saint Therese, founded in 1964, has four senior living communities in Minnesota as well as one each in Michigan and Ohio. Most communities provide the full continuum of care from independent living, assisted living, memory care, skilled nursing and transitional care.

The following conversation has been edited for length and clarity.

SNN: What have been some of your organization’s biggest challenges?

Abbott: First, it’s our workforce for the industry as a whole, although at Saint Therese, we feel pretty good about that. 

Second, the expansion of our ministry. Over 50 years, we’ve done a good job, and we’re proud of the fact we’ve been able to take what’s been really a Minnesota-based mission and spread it to other parts of the country. Probably the biggest challenge we faced was that while we’re expanding our footprint and looking to provide more accessibility, we’ve also taken a hard look internally at those things that are working and not working. So we actually sold our flagship campus because it was an aging campus and we did it during a more challenging market after almost two years of exploration and looking at different possible solutions … The decision to [sell our original campus], weighed heavily on the organization. 

SNN: Where have you expanded to and what are your future plans?

Abbott: We just opened a new campus in a suburb of Minnesota in September. In the last year, we’ve spread our mission to Michigan and Ohio, and our hope is that it’s easier to operate here and you could have more presence regionally.

For now, we don’t necessarily have states targeted, but we want to be able to have the efficiencies and economies of scale by operating in those two communities [in Ohio and Michigan], which are within two hours of each other. In other words, we’re looking for complimentary fits around that geographic area. And since we’re a faith-based nonprofit, we want like-mindedness anywhere we look to expand our footprint.

SNN: What factors do you pay close attention to when evaluating whether or not to enter a state?

Abbott: I’m not going to speak about the states we wouldn’t go into, but aside from what I mentioned, we look at regulatory reimbursement environments, amongst other things.

SNN: As you expand, would you consider acquiring freestanding skilled nursing facilities (SNFs)?

Abbott: Probably not, unless it was strategically located, but we very much value the continuum of care, particularly an approach where people can have access and affordability, different services and an experience to live well on our campuses. And, once they’re with us, they could be with us through their life journey.

SNN: Can you speak to the influence of Medicare Advantage on Saint Therese?

Abbott: Minnesota has been in the managed Medicare environment for a long time. So it is not a new pain point for us. However, there are opportunities within that value-based reimbursement system. Minnesota was one of the states that had a lot of experience with [MA], and it’s become, in a lot of ways, the fabric of what our staff has become used to and countering with value-based care.

SNN: What are ways that the industry can overcome its current challenges?

Abbott: We’ve taken a deep, internal, hard look over the last three years, and said access and affordability of care is a big deal, not just for those that have means, but for those that don’t. We want people to live well, and provide service to even our caregivers, our volunteers, our donors, and really focus socially and have people live their best lives. If we don’t have the workforce and a lot of innovative solutions in place, we won’t be able to do things the right way.

We call it the Saint Therese Way. From the time people think about coming to live or be served within Saint Therese through their journey, we want to ask, how are we really fundamentally looking to evolve and change some of the care and service dynamics the same things for our workforce? Are we attracting people that might not think of our industry? What’s their experience when they first reach out to an organization like ours? Are they onboarded? Are they oriented? Are they trained? Are they developed all the way through their journey? We hope they stay with us for a long time, but in their Saint Therese experience, we want them to experience something different and live well. And, we’re trying to mesh the resident and employee experience together as a way to position ourselves for what we see as some of the top social issues of our time.

SNN: Can you share any metrics on your success with retaining workers?

Abbott: We have about 1,000 employees, and our retention rates are now at 75% to 80%, which we feel pretty good about. However, this still means that there are about 150 to 200 people that are moving through our system every year. That said, during the pandemic, those numbers were monumentally higher. So we’re not perfect, but we’ve done a lot of employee-focused work to really curb that departure and increase the retention rate.

SNN: Any workforce initiatives that you’re particularly excited about?

Abbott: In the state of Minnesota, we’re part of a consortium with Presbyterian Homes, Cassia, Volunteers of America. It’s called Empera, and it was put in place several years ago as a way to bring like-minded organizations together for quality care and service. We apply for state grants and performance projects.

On our ability to show measurable change, we get some [added funds] to our Medicaid rates. 

The CEOs from those organizations said a couple years ago that the workforce was a big deal.  This specific program that we’ve done in the state of Minnesota is called OARS, or onboarding and retention specialists. The program is state supported, although we don’t get the full cost absorbed. It allows an employee ambassador to be on site. They really latch on to new staff members from the first time they start an orientation and on through their journey.

Where we really where we lose so many of our staff is in those first three months. And by six months to a year, they start to get disillusioned. So [the state-based program] has been a big, intense focus on that front end onboarding experience to help with retention.

SNN: How has Minnesota state been helpful?

Abbott: The state grant allows us to bring adult learning experts, leadership experts. When you get state funding, you have to report what it is that you’re doing in terms of hiring initiatives, retention initiatives, and turnover being decreased. We just completed satisfaction surveys that have to go to the state of Minnesota to show that it’s having an impact. And it’s early, but so far, the signs are positive.

SNN: What does the future look like for long-term care and skilled nursing?

Abbott: I remain excited about our opportunity as an industry to provide care and services, but there’s going to have to be more aggressive steps that we take from an advocacy standpoint and positioning than we’ve seen in the past. That’s because providers can only be stretched so far and be pushed so far. We’re at a crossroads right now and you can only put so much tension in the rod and provide that high level of care and service.

For skilled nursing, more providers are choosing to not do skilled nursing. There’s already been some downsizing of [SNFs] through closures and so organizations are focusing on less labor intensive, less regulation-intensive environments.

Well, then where do the seniors go? When health systems get backlogged and payers see that residents get served for days, weeks, and months in hospital settings, that’s not realistic. Then you get up and you get a whole different voice at the table. We don’t have a voice as a senior care industry, but you start to layer in hospitals, health systems, payers [speaking up]. I see that in the positive light. Frankly, if you have their voice more in partnership with us, it really becomes a social community issue.