Long Term Care: How Well Are We Recovering?

Much like any illness, a recovery period in a crisis stricken industry requires a number of elements to be successful. To say that the COVID-19 pandemic was an illness not only to patients and residents, but also to an already fragile long term care infrastructure would be an understatement.

So how are things going? How is an industry that was riddled with incredible loss of life, loss of staff and loss of confidence from the public and other stakeholders recovering? In my opinion, there are some bright spots, and there are obviously some once in a lifetime challenges still left to overcome.

I've summarized by category below where I believe our industry is still struggling, where I see light at the end of the tunnel, and what further action needs to occur to help us evolve out of crisis...

Economics: Skilled nursing facilities are still the best "value" in healthcare today. There is no other setting in healthcare that provides as much care and service to high acuity patients at such incredibly low reimbursement. Most skilled nursing facilities today are struggling financially. Factor in inflationary pressure (non labor and labor related) and the slow to recover "non agency" clinical workforce, and we are still in a bind. The good news is (I can't believe this is good news) - CMS had the good sense to not cut our reimbursement this year and most states are providing (albeit not enough) rate increases. The "ripple effects" to the chronic underfunding, however, which btw caused many of the adverse events in long term care during the pandemic, are enormous. Many providers are on the brink of financial ruin unless further financial aid is provided to our industry.

Staffing: Recruiting front line caregivers / nurses aides continues to be a challenge. National data reveals that over 500,000 employees in long term care have left this sector of healthcare. As other better paying positions are offered in communities in non healthcare settings, the open position crisis for nurses aides will persist. I hear anecdotal stories of improvements, but until we fully explore solutions such as a stronger focus on retention (career ladders, improved wages and benefits, etc.), utilizing technology to our advantage to compensate for less staff, limiting agency price gauging, extending TNA 's, starting nursing aide and nursing schools on site in LTC centers and exploring immigration policies that provide staffing relief, we are not going to see the end of this for a couple of years at best.

Occupancy: Occupancy and staffing go hand in hand. McKnight's long term care (industry trade publication) has reported recently that 88% of referrals to skilled nursing facilities have been denied in the first half of 2022. The clients that my company currently represent are averaging over 90% occupancy for the past 6 months due to pent up demand, high quality of care and good relations with clinicians in health care ecosphere. Filling nursing homes beds is easy, ensuring the right payor mix, acuity of patients, and making sure you provide above average (and competent) clinical staffing is hard. Also, a lot of providers I see could benefit from embracing and better understanding of branding and marketing, most don't and as a result suffer with low/stagnant occupancy.

Regulatory: Mandated staffing ratios, isolation protocols, and "the Biden Plan" for nursing home reform will be a challenge in the years to come for operators to comply with. The governmental response to an industry that went above and beyond to protect our nation's most vulnerable seniors, has been to thrust smothering regulations on all ltc providers, with little to no funding to cover the costs of these regulations, further frustrating providers and taking valuable time away from the bedside. Hopefully many of these regulations will be scaled back when providers and advocates for our industry prove that they are suffocating operators from providing high quality of care.

Culture and Leadership: What I believe we need to see more of in long term care are operators who are making an effort to improve culture in their organizations. Providing ongoing education and employee development, quality improvement initiatives, innovations, celebrating and educating team members on diversity, equity and inclusion, developing more impactful human resources policies and strategies and seeking new ways to improve employee loyalty is the great untapped opportunity. People want to know their companies have a sense of purpose and quality focus in exchange for their loyalty and dedication. It may not be obvious in the midst of all the challenges we are juggling today in our industry, but the providers who focus on culture will be the one's who have the most longevity and success in my experience and opinion. Another key concept most newer operators need to improve on is making sure their leaders have the support, resources and tools to be successful. All Administrator's, Director's of Nursing and department heads require coaching, development and routine feedback in order to grow and to help operations evolve - that can easily get lost in a time of crisis. Also, a good blend of new talent along with experience talent in an organization is essential.

The best news is that our industry has no lack of resilient, mission driven employees who seek to make a difference everyday. These employees have more options than ever for employment, the fact that they choose to stay in long term care is a testament to the "calling" individuals have in making an impact in the lives of the elderly.