To meet some of the most daunting challenges facing nursing home providers today – including in the realms of workforce and regulations – leaders must shift their mindsets.

This was one major takeaway from a recent webinar that Skilled Nursing News hosted, featuring a panel of nursing home executives.

With regard to public policy and regulations, a reactive mindset must be replaced by proactive advocacy. Focused Post Acute Care Partners CEO Lori Strubbe established a team dedicated to monitoring policy changes on a daily basis.

Strubbe discussed policy strategies, workforce sustainability tactics and how it all fits together along with Deke Cateau, CEO of Georgia nonprofit A.G. Rhodes and Matthew Maurano, CEO of Maryland-based Transitions Healthcare.

This article, along with two others focused on innovative care models and subtleties around access to capital, are all based on a webinar that covered topics which will be under discussion during our RETHINK conference happening in Chicago this week, Aug. 18-20.

“Certainly all of the regulatory activity, specifically in the state of Texas, has been something of a challenge. It has been something that we’ve had to push to correct as necessary and navigate our reactionary moments to make them much more responsive,” said Stubbe.

Transitions is doing something similar, Maurano said, with scheduled calls every month to review new regulations coming down the pike.

“CMS went from not changing anything for like 20 years to now rewriting final rules every year and putting a lot of strain on what we have to do,” Maurano said. “That’s putting a lot of pressure on the time it takes for our staff to deliver care.”

Advocacy state of mind

For A.G. Rhodes, proactive advocacy all comes down to understanding what’s coming down the pipeline and spending a lot of time on efforts in Washington D.C.

“My entire congressional delegation, they know who I am. They know who A.G. Rhodes is. From time to time, they call to get someone into one of our homes, and I use that as an opportunity as well, to let them know how their policies affect us, or can affect us,” said Cateau. “Nursing homes in general do not do enough of that.”

Encourage policymakers to visit facilities, he said, to show them how policies are affecting folks at the ground level.

Maurano echoed Cateau’s sentiments on advocacy, adding that lawmakers often are in their own “bubble” and need to see what operators are up to on a daily basis.

“The more we can get that story out, I think the better we are,” he said.

Both Cateau and Maurano said this kind of transparency goes against how the sector has historically been more closed off from the public, wary of criticism and negative feedback. But keeping lawmakers and the public out of facilities has only hurt the sector, they said.

Workforce sustainability, advocacy and career ladders

In terms of specific advocacy objectives, the leaders zeroed in on workforce issues.

“We cannot be in competition with fast food places or with Walmart. We have got to be something that is a little better and strive for a little bit more of a path for people to make a career out of caregiving,” said Maurano.

Policy advocacy has helped here through the creation of a career ladder for CNAs in Pennsylvania, he said. The addition of certified medicine aide after CNA certification fills a gap between CNAs, LPNs and RNs.

“Hopefully we’ll have those regulations in October, because there has to be a way for somebody to join our ranks, work hard, have us pay for the certifications and what it takes for them to go to the next step, and the next step, and the next step,” Maurano said of the career ladder initiative.

Right now, CNAs would be lucky to get a 2% raise over 5 years working in skilled nursing. Putting staff on a path to make a very good, higher than livable wage is the long term solution to competing with big box stores or the gas station down the street, Maurano added.

Perhaps not everyone will take that path but it needs to be available. Cateau agreed that career ladders need to be more readily available, acknowledging that the industry has done a bad job with leadership development.

Leadership mindset needs to shift

Strubbe said the search for workforce sustainability is nothing new to the industry – it’s a problem that has been in the making for at least 40 years, she said. Of course, Covid-19 heightened the issue, which Strubbe believes ultimately is a good thing, to get the right people paying attention.

Giving recognition and respect to CNAs is imperative, she said, and culturally, every role has to be crucial to overall care delivery.

“No one is ‘just’ anything in our world,” Stubbe said. A big part of her company’s culture stresses that every role has a place and is important.

Equally important is changing the mindset of industry leaders to align more with this culture shift, she said.

“The industry has been conditioned to think in terms of, ‘If we pay a little less we’ll get a little bit more.’ I personally have spent a lot of time with our leadership explaining to them exactly how wrong that mindset is,” said Strubbe. “That doesn’t do anything for the frontline staff, who ultimately are carrying the weight.”

Cateau said pay is the obvious link to achieving high retention and low turnover, but listening and knowing the staff –understanding their needs and their families’ needs – is crucial too.

“I do quarterly town hall meetings with all our staff and all our homes … this industry has grown up with the mantra that the resident’s always right, and by virtue we’ve made the staff always wrong,” said Cateau. “The reality is no one’s always right in life, and we need to stop stratifying our staff in what they do.”

Click here to view the webinar in its entirety.