In thinking about why after nearly 50 years in the long term and post-acute care profession he still gets up every morning excited to go to work, Robert Siebel says it’s because his professional life has meaning. Pure and simple. Meaning.
“I started as a 22-year-old and am still doing it at 70,” the chief executive officer (CEO) of Carriage Healthcare Companies says. “For me, personally, it has been an amazingly fulfilling life.”
Despite the CEO title, Siebel spends a fair amount of time in Carriage facilities where he is happiest with staff and residents. “We providers all over the country do an amazing job of working with people who really need us when they are most vulnerable. And, we do it very well and in a very caring way, even when facing unbelievable obstacles,” he says.
This leaves him gratified at the end of each day to be a veteran leader in the field, helping to really make a difference in people’s lives. “I have to say it is a pretty cool way to wake up every morning, and I have not changed my opinion on that over these many years. I still feel the same way,” he says.
Learning to Make it in a Tough Profession
The start for Siebel came as an administrator 48 years ago in February 1971 for a Good Samaritan facility, which led to heading the operations for a small chain of eight skilled nursing facilities (SNFs), which were later sold to a larger chain.
By 1981, having worked for 10 years in the business, he started his own company and “did the requisite starving to death for a while,” Siebel says with a laugh. “From then, I started developing a management company in the late 1980s and early 1990s and have been doing that ever since,” he says. “It was an evolution, not one huge event.”
Initially, with all of his experience in the SNF universe, Siebel attempted to consult to nursing facilities. But that was a mistake.
“I learned consulting directly to nursing homes is not a real profitable business because most of us have no money. We want to use them [consultants], but don’t want to pay a lot of money for them,” Siebel says.
This knowledge led him to instead start consulting for banks and bond firms that had troubled facilities because they needed help with their foreclosed properties and were willing to pay for that help. “That is better, when you have clients who pay you,” he says.
Eventually, the evolution he spoke of resulted in his business clients asking if he could provide temporary management services and even run SNFs for a while until buildings were in good enough shape to sell to someone or take out of bankruptcy.
“These facilities needed some kind of help, they were distressed for pure financial or regulatory problems or some combination of the both. The business started to grow after that, and we began managing for nonprofits, and some of those groups grew substantially over the years,” Siebel says.
Now, Carriage Healthcare claims 22 facilities, split right down the middle with 11 SNFs and 11 assisted living communities. There are also two home health agencies and an outpatient rehab entity. While most of the properties are in the Upper Midwest in Wisconsin, the Carriage home base is in Lakewood, Colo.
Plotting for the Future, One Year at a Time
With all of these years in the business of caring for seniors, Siebel seems to be a logical choice to ask “crystal ball” questions on what the future holds for owners and operators. But, not so fast.
“You used to be able to do a five-year plan with some certainty, but not as much now,” he says.
On the positive side there are the projections showing that within around five years baby boomers will be reaching the age that requires professional care. “These are good numbers [for providers’ business prospects] if you believe all the charts. Five years is kind of when that cliff happens of people who may need your service,” Siebel says.
While he notes that the percent of people from the coming wave who wind up in a SNF will likely continue to go down, “the raw numbers are so enormous” that census numbers should stay steady or increase.
“I am fairly optimistic that good SNFs that can adapt long term will do well. The next four to five years are going to be extraordinarily difficult, however, and the only caveat to that whole assumption on the baby boomer cliff is the staffing thing,” he says.
The “staffing thing” is on the lips of nearly all providers along the entire senior care continuum. “If you look at our facilities, they are in rural and very small towns, in some cases with 700 to 1,000 people. And then you look at the labor market, and it is frightening, because there is no labor market,” Siebel says. To balance the work done by Carriage to find and keep workers is the Wisconsin Department of Workforce Development, which aids in the cause.
“So that is my one caveat to my optimism about five years down the road. If we can find people literally to care for our people. And, I don’t have an answer to that one,” he says.
Quality Improvements Spurred by Many Sources
While the battle is being waged to keep staffing levels adequate, Siebel says the way in which the industry has advanced in quality is impressive. Saying that the overall level of quality has increased dramatically over the past 10 or 15 years, he points to a number of reasons why.
“It is partially because providers have become more in tune with the need to do so, and a lot of that has to do with the work of the American Health Care Association. They have developed highly sophisticated programs around quality, and I think the regulatory process is part of it,” he says.
Even though he calls himself a “frequent critic” of regulation, the emphasis by the federal government on improving outcomes across the entire health care spectrum has “worked to raise the bar in a positive way.” Another reason is third-party payers. “The Medicaid managed care and insurance companies have helped by putting pressure on providers, saying ‘we are only going to deal with facilities that meet certain quality metrics,’” Siebel says.
What Comes Next?
Although he has tracked the changes in how reimbursement policies have changed over the previous decades, the push to value-based payment has surprised him in the ferocity in which it has occurred.
“I have been surprised though over the last five years in how really quickly it has happened. I was most surprised that the federal government has moved as fast as it has,” he says. “It used to be that you put in the back of your brain that it would take five to six or seven years to hear about changes actually taking place, but it has come much faster now—the new Medicare payment models, bundles, Medicare Advantage, etc.”
While Carriage has adjusted to the changes, and Siebel laments the way in which Medicare has planned to phase out the role of SNFs in bundled payment programs, the march of time continues for the company, as it meets the goals set by its tightly knit 11-member corporate team.
“We have former administrators comprise our senior management team, and I think that helps make us special,” Siebel says. Spoken like a former administrator himself, all these years later.