by Jennifer Murtoff

The CEO of Good Samaritan, the nation’s largest nonprofit skilled nursing provider, is bullish on wins related to staffing – perennially one of the most daunting challenges in the sector. 

More specifically, Good Samaritan’s own workforce initiatives have driven positive results, including improvement in the organization’s 90-day retention rate for new hires. And CEO Nate Schema is celebrating the judicial and legislative victories in the battle against the federal nursing home staffing mandate.

However, the passage of the One Big Beautiful Bill Act (OBBBA) has opened up sharp concerns that Schema now is focused on addressing. Namely, the effect that deep Medicaid funding cuts could have on the nursing home sector, especially rural facilities.

Meanwhile, coming up on three years since announcing a significant move to consolidate its footprint, Good Samaritan is also focused on growth – including the development of a $200 million continuing care retirement community.

Good Samaritan is part of Sanford Health, a nonprofit health system headquartered in Sioux Falls, South Dakota. It serves 10,000 seniors across the upper Midwest, 70% of whom reside in rural areas, offering rehabilitation and skilled nursing centers as well as other types of senior living, and home health and hospice agencies. 

Good Samaritan also provides integrated, coordinated care through a Medicare Advantage Institutional Special Needs Plan (ISNP), with teams in Sioux Falls conferring with medical professionals at Sanford. 

Workforce wins

To meet the challenge of labor shortages, Good Samaritan has invested in various programs to improve staff experience; as a result, overall worker retention increased by two percentage points in 2024.

“We’ve created more flexible roles, raised wages, launched new hiring incentives, and expanded scholarship programs,” Schema told Skilled Nursing News. One program has improved 90-day retention by 2% to 5%. The organization has also implemented successful training programs that focus on peer support for young leaders.

Another area of focus for Schema has been directors of nursing (DONs), who often cover extra shifts when facilities are short staffed, leading to increased risk of burnout. Good Samaritan has created programs to support DONs and certified nurse assistants, reducing turnover and the number of open positions.

Staff also participate in regular safety briefings. Through the Sanford Accountability for Excellence (SAFE) program, staff feel empowered to raise issues and see positive results of doing so.

“Ultimately, our residents benefit the most from these hardwired processes, and better survey results are a secondary benefit. We receive two fewer deficiencies per survey than the national average,” Schema said.

Bigger-picture, Schema is relieved that the federal staffing mandate will not take effect as originally planned.

“This … was a win for the residents and families we serve, especially in rural communities,” said Schema. “It will ensure seniors continue to have access to the high-quality care they rely on close to home. This victory is a reminder that advocacy matters — and that the voices of providers, staff and families make a difference.”

Now, Schema is clear that advocacy must pivot to the future of Medicaid and preserving the viability of rural nursing homes.

‘Urgency and focus’ needed to shape Medicaid policy

Schema, like other nursing home leaders across the United States, is deeply concerned about how Medicaid provisions of OBBBA will affect providers, particularly the possibility that deep funding cuts could lead to widespread closures and staffing reductions.

“[This is] one of the most significant shifts in federal health policy in over a decade, with wide-reaching implications — especially for rural America,” Schema said.

In some of Good Samaritan’s rural locations, 70% of the organization’s patients and residents rely on Medicaid. Schema noted that now is the time to collaborate with leaders at the state level to influence how provisions of OBBBA will be enacted and the impact on nursing homes.

“We have an important opportunity to shape the implementation process to reduce friction with new Medicaid rules and ensure continuity of care for those we serve,” he said.

Good Samaritan is engaging in dialogue with state leaders to secure funding that would ensure the sustainability of its programs and services. 

“Now is the time for state and rural health care leaders to come together — with urgency and focus — to strengthen sustainable access to care,” he said.

Moving toward the future

While the new legislation looms large, Good Samaritan is moving forward through long-term investments. The most significant is a $200 million continuing care retirement community called Founder’s Crossing. 

Set to open in 2026 in Sioux Falls, the community will offer a full continuum of care and various amenities. “We see it as a blueprint for future senior living communities across the Midwest,” Schema shared.

In addition to the investment in the new community, the organization recently added new services, including a memory care facility in Rapid City, South Dakota; an onsite dialysis den within a skilled nursing facility in Bismarck, North Dakota; and expanded home health services in Nebraska and Minnesota.

In 2025, Schema plans to expand virtual care by applying new technologies to offset staffing shortages and geographic challenges. AI and other technology tools will decrease demand on staff — for example, a new EMR that reduces by two hours the amount of time it takes to admit a patient.

In other words, being a largely rural provider means that Good Samaritan has to be on the cutting edge of innovation in order to overcome obstacles to accessing care and to meet a dynamic market.

“As the nation’s largest nonprofit provider of skilled nursing care, we’re deeply committed to preserving access to care in rural communities — and doing so in a way that meets the evolving needs of seniors and their families,” said Schema.