Having the right staff is key for skilled nursing providers to remain financially viable in a volatile market, and with recent regulatory changes, planning for higher acuity patients takes priority.

These are some of the takeaways leaders from Journey Skilled Nursing and Ocean Healthcare shared during a panel discussion at the recent Skilled Nursing News’ RETHINK Conference in Chicago.

Indiana-based Journey has 22 facilities in six states, while Ocean operates 12 facilities in New Jersey.

Positioning your company to attract new staff

Attracting new staff and retaining existing workers remains a struggle for the nursing home industry. However, providers who want to maintain profitability should focus on building a solid staffing plan.

“You want to build the base of our skilled nursing staff,” said Matt Trammel, COO at Journey Skilled Nursing. “This is what helps us open up revenue generation.”

Trammel said Journey has been attacking their staffing issues in a similar way in which they build their census. Whether it’s in sales or administration, the company looks to set itself apart from others in the market.

“What’s going to make us different? To attract staff here and really model it that way,” he said. “As we’ve gotten buildings out of agency and then built the base of their staff, it’s provided a level of, I would say, just breathing room in the buildings.”

Journey has had buildings go from 82% occupancy to 92% by “aggressively eliminating agency” in its facilities, Trammel explained.

Joe Kiernan, chief strategy officer and SVP of network development at Ocean Healthcare, said his organization’s biggest challenge has been competing with other acute care partners, such as hospitals, for staff.

“Their salaries are better, their benefit packages are stronger,” he said. “The opportunities within the health system are a bit more vast than when you look at skilled nursing.”

Ocean partners with the local health system for staffing, so many of the nurses in their facilities also work within the hospital. This shared staff, Kiernan said, provides a better continuity for care and efficiency.

“And then, because of the continuum of care that we have within our organization, there’s crossover opportunities as well between hospice, home care, skilled nursing, assisted living, even to a certain extent, our behavioral health side,” Kiernan said. “Leveraging what we have together as an organization and as an integrated network and an integrated health system ourselves, we can maximize our strengths, minimize those weaknesses.”

Ocean’s diversified health care also allows the company to attract people with more specialized backgrounds, which can increase the census.

“As you are looking for that right nurse, do they have the cardiac background? Do they have the pulmonary background? Do they have the neuro-psych background in order to attract them for the programs that you have and better care for those patients?” he said.

Regulatory signals

The One Big Beautiful Bill Act (OBBBA) has been closely watched in the skilled nursing industry, as early drafts of the bill included major cuts to provider taxes and Medicaid. The provider tax cuts didn’t materialize in the final version, which Trammel said was a “win for skilled nursing.”

Trammel added that Journey is keeping an eye on potential Medicaid cuts across its service areas for skilled nursing, as some states are applying cuts to other health care sectors.

“We have to be regional experts that are involved at the association level and at the state level,” he said. “Whether it’s going to be home health that’s taken a hit in that state, or maybe it’s Planned Parenthood. Where is that and is it going to be spread long term through Medicaid hits for our state? It can be looked at very differently in Georgia [than in] Indiana. We’re looking to keep our hand on the pulse long term and hopefully influence those conversations in the future.”

Kiernan said Ocean is working with leaders in New Jersey to evaluate the bill’s impact, but for now is waiting for answers and planning ahead.

“I just haven’t heard anybody with those answers as of yet for us to have anything really solid to go on so we continue to just focus on the job at hand,” he said.

Kiernan explained that Ocean is trying to “follow the breadcrumbs” from the Centers for Medicare & Medicaid Services (CMS) and the CMS Innovation Center (CMMI) to shape their strategy. Currently, that means shaping the company to provide solutions for higher acuity patients and their health system partners.

“You’ve got to be able to come to the table with an option,” Kiernan said. “And if the hospital, if your health systems, or your partners where you get your referrals from, do not own and operate skilled nursing facilities, they’re going to look to you to be that, to be that arm, that extension of what they need.”

Providers can build focused care programs, such as a cardiac care program, to help those patients transition from the hospital and avoid readmissions, Kiernan explained.

Trammel said that it feels like there’s a pivot in priorities from CMS and CMMI nearly every quarter. He said Journey is specifically watching changes with the Patient Driven Payment Model driving more quality nursing and therapy outcomes.

“CMS is telling us that you need to take higher [acuity] residents, and so we’re gearing up for that,” Trammel said. “I think that that’s a message that’s coming across us to say, ‘let’s look at these breakdowns and where we are going to get paid more. Are we [already] taking those type of patients today?’ And in some of our homes, I think the answer is yes. In particular, in some of our rural homes, we are really pushing to slowly integrate a higher level of acuity or clinical capabilities into those homes so that when the time comes, we’re sitting in a good position.”