| How Skilled Nursing Facilities and Assisted Living Communities Can Improve Hiring and Retention | <p>The pandemic revealed the vital necessity of skilled nursing facility and assisted living care workers, yet owners, operators, clinicians, and administrators still struggle to hire and retain staff.<br></p><p>The intense pressure of the industry has caused worker burnout and a high rotation rate, leaving employers scrambling to scale their hiring needs. But with the current U.S. unemployment rate at 3.4 percent, the reality is we're not short of people. We're short of staff. So, where are they and how can we meet the needs of today's job candidates?</p><h3>Walk in Your Candidate's Shoes</h3><p>Put yourself in the mind of your job candidate. What are their wants, needs, and top concerns?</p><p>As inflation skyrockets and a recession looms, most have salary and job security as their top-of-mind concern. They're looking for a job that offers growth and security to counterbalance an unstable economy. If you position your jobs to accommodate these top concerns, you'll attract top talent and end circular hiring processes.</p><h3>Pay Higher Wages</h3><p>The pandemic highlighted the financial challenges faced by care takers, who have historically received a much smaller salary in comparison to workers in hospitals or government health care spaces. While the field has seen a disparity in pay, it's also experiencing a shortage in long term care workers due to peak outbreaks, quarantining, and the growing elderly population. And with high need comes high demand.</p><p>To attract long term care workers at scale, you must fill the wage gap. Your applicants have security and inflation at top of mind; thus, higher wages are far more attractive than promised bonuses or benefits right now. Data from a Talroo Healthcare Report stated that 62 percent of health care job seekers said that higher pay would increase their likelihood of accepting an offer, while 53 percent said that flexibility was their top deciding factor.</p><p>In the same study, 80 percent of job seekers were more likely to apply for a job with a transparent salary range. With workers fearing mass layoffs in an uncertain financial landscape, posting salary range puts their mind at ease. To stay competitive, offer at- or above-market wages and be upfront with your salary offerings.</p><h3>The Cost of Vacancy vs. the Cost to Hire</h3><p>When short-staffed and under stress, hiring can come at a high price. To better understand return on investment when hiring and determining salary, compare these three metrics:</p><blockquote style="margin:0px 0px 0px 40px;border:none;padding:0px;"><p><strong class="ms-rteFontSize-2">1. Cost of vacancy</strong></p></blockquote><p>While it varies by industry, the cost of vacancy can be estimated by dividing company revenue per employee by number of annual workdays. This gives you the average revenue produced by an employee daily.</p><p>Just note that it's difficult to measure the negative impact open roles have on productivity. It adds to burnout by disintegrating team morale, which makes it even harder to tie a monetary value to these metrics.</p><blockquote style="margin:0px 0px 0px 40px;border:none;padding:0px;"><p><strong class="ms-rteFontSize-2">2. Cost of a bad hire</strong></p></blockquote><p>The U.S. Department of Labor puts the cost of a bad hire at <a href="https://www.dol.gov/general/topic/statistics/employment" target="_blank">up to 30 percent</a> of the employee's first year wages. These factors include lost productivity and damage to your reputation as a quality care provider.</p><p></p><blockquote style="margin:0px 0px 0px 40px;border:none;padding:0px;"><p><strong class="ms-rteFontSize-2">3. Cost to hire</strong></p></blockquote>According to the Brandon Hall Group, the average cost to hire an essential worker is $340, and for organizations with 1,000 employees or less, the cost is $670. For the approximately <a href="https://www.ahcancal.org/Assisted-Living/Facts-and-Figures/Pages/default.aspx" target="_blank">28,900 assisted living communities</a> alone in the U.S., there are nearly 1 million licensed beds, with the average size of an assisted living community being 33 licensed beds. Therefore, it costs the majority of these organizations $670 to hire one new worker.<p></p><h3>Recession-Proof Your Recruitment</h3><p>When looking for the right workers, you need to attract a very specific type of employee. They need to have the ability to take on physical tasks as well as exhibit high levels of emotional intelligence to deal with loss and nurturing patients. But they also need to exhibit soft skills such as bedside manner, patience, and the ability to console through grief. In order to attract these specific personalities with strong relational skillsets, you need to look at recruiting through a data lens.</p><p>Much like caretaking, recruitment is a relationship-oriented science. Dig into the metrics to take a quantitative approach that extrapolates your hiring costs and the return of quality hires when budget pressure is applied in a recession.</p><p>In many cases, data helps the search process. Start by looking at where you have had success in attracting workers. Not only will you find those who already exist in the field, but you will also attract new people into your workforce. Plus, these talent analytics help identify where your ideal candidates are to properly target your advertisements for open positions.</p><p>After determining who to target, focus on leveraging key words for ideal candidates to fill your open positions. Ultimately, job titles are what turn heads and spark intrigue, landing that initial click for candidates to read your description. Once you have their attention, then you can help lead nurturing and capable candidates through the doors.</p><h3>Invest in Your Candidate's Future</h3><p>If you want great hires, don't simply set candidates' sights on the “now," but instill a vision for their future. Staff training is a powerful retention tool in health care fields. For positions that don't require certifications, offer in-house training or sponsor higher education. By positioning your care center as a place of learning, you'll ease burnout while filling the skills gap. If you can offer the ability to move vertically and linearly, your culture will instill hope—reminding staff why they dedicated their lives to caretaking in the first place.</p><h3>Encourage Self-Care</h3><p>According to research done at John Hopkins University, during the periods of high COVID-19 deaths, researchers found a paralleled statistic of lowered caretaker employment.</p><p>This is due to a myriad of factors: emergency demand and availability, risked exposure while tending to patients, increased protection protocols, and the reality of end-of-life care taking a toll on mental health. Long term care workers witnessed a massive loss of life while still needing to tend to their families. Unfortunately, this type of work carries an emotional weight home.</p><p>For this reason, workers in these facilities are prone to disregard their own self-care for work priorities. The lack of staff may also lead to long hours. This can have a damaging effect not only with burnout, but the trajectory of their career.</p><p>Encouraging your staff to implement self-care boundaries helps ensure their emotional, physical, and mental health needs are being met. It's important to highlight this prime difference in your workplace culture—showing prospective job applicants that your workplace prioritizes wellness. Because a job intended to care for others means caring for themselves in return.</p><p><em>Thad Price is CEO of Austin-based Talroo.</em></p><p style="text-align:center;"><em><strong>Learn More:</strong></em></p><p style="text-align:center;"><em><a href="https://ahcapublications.org/products/2020-2021-assisted-living-salary-benefits-report"><img src="/Articles/PublishingImages/2023/ALSalary.png" alt="Assisted Living Salary & Benefits Report" style="margin:5px;width:250px;height:323px;" /></a>       <a href="https://ahcapublications.org/products/nursing-home-salary-benefits-report-2020-2021"><img src="/Articles/PublishingImages/2023/NHSalary.jpg" alt="" style="margin:5px;width:250px;height:324px;" /></a><br></em></p> | 2023-03-30T04:00:00Z | <img alt="" src="/Issues/2023/Spring/PublishingImages/CIC.jpg" style="BORDER:0px solid;" /> | Workforce | Thad Price | The intense pressure of the industry has caused worker burnout and a high rotation rate, leaving employers scrambling to scale their hiring needs. |
| Indiana’s Long Term Care Leaders Bring Attention to Workforce Crisis and Needed State Reforms | <p>Clif Porter, senior vice president of government affairs for the American Health Care Association (AHCA), and Julie Simpkins, National Center for Assisted Living (NCAL) board member, joined 60 long term and post-acute care leaders at the Indiana Statehouse in March 2023 for the annual <a href="https://www.ihca.org/events/ltcday/" target="_blank">Long-Term Care Professionals Day</a>. Hosted by the Indiana Health Care Association (IHCA/INCAL), the event offered an excellent platform for long term care (LTC) leaders to advocate for needed health care reforms that will strengthen the state's workforce and increase access to care for more aged and disabled Hoosiers.</p><p><img src="/Articles/PublishingImages/2023/clif%20et%20al.jpg" alt="Clif Porter, Mike Gerig, Daryl Jones, Rick Banas" class="ms-rtePosition-2" style="margin:5px;width:450px;height:338px;" />“The pandemic has been very hard on our profession. It is critical that policymakers hear how our ongoing struggles have a direct impact on access to care for our seniors," said Porter. “I'm delighted to see Indiana's LTC leaders come together as a solid force, leverage the momentum and this incredible platform to advocate for better polices on behalf of our residents and staff, and seek stronger support and viable solutions from policymakers," he added.</p><p><span style="font-size:14px;"><em><span style="line-height:17.12px;font-family:calibri, sans-serif;">From left to right: Clif Porter, AHCA/NCAL senior vice president of government affairs; Mike Gerig, administrator at Century Villa Health Care; Daryl Jones, COO of the Integral Group; and Rick Banas, vice president of development and positioning for Gardant Management Solutions</span></em><br></span></p><p><span style="color:#000000;font-size:medium;"></span></p><p>During the event, the IHCA/INCAL hosted numerous legislative events, notably a legislator luncheon that was attended by Lt. Governor Suzanne Crouch and many representatives and senators to discuss these pieces of legislation.<br></p><p>Gardant Management Solution, an IHCA/INCAL member with assisted living communities in Indiana and Illinois, catered the lunch for the event. It was a perfect opportunity to shine a spotlight on the high-quality meals that our seniors enjoy in Indiana's LTC communities on a daily basis.<br></p><p>IHCA/INCAL President Paul Peaper offered remarks during the day's events, acknowledging the unprecedented challenges that the sector faces as it continues to recover from the pandemic, including the ongoing workforce crisis. He also appreciated the relentless dedication of our LTC leaders to improve quality outcomes for Hoosier seniors.</p><p><img src="/Articles/PublishingImages/2023/LtGovernorCrouch%20et%20al.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:450px;height:338px;" />“Our association is always unwavering in how we approach our advocacy," said Peaper. “We're more successful when our voices are united. This event offered a valuable opportunity for LTC providers from across the state to share their unique stories of triumphs and challenges of our sector, have face-to-face discussions with legislators, build meaningful connections, and most importantly seek their support for legislation that will strategically enhance the delivery of care our providers offer to thousands of Hoosiers. This is one of the most important actions we can take to advocate for a brighter future of our profession."</p><p><em class="ms-rteFontFace-5">Lt. Governor Suzanne Crouch along with several LTC leaders from Indiana.</em></p><p>IHCA/INCAL activities focused on supporting <a href="https://iga.in.gov/legislative/2023/bills/house/1461" target="_blank">House Bill 1461</a>, which is the focal point of the sector's advocacy efforts in Indiana. The bill would correct overburdensome occupational licensure regulations, provide more transparency on Medicaid expenditures, increase access to care for aged and disabled Hoosiers, and enhance the safety and well-being of residents in assisted living communities. The state's biennial budget also includes language that the IHCA/INCAL advocated for, requiring the state's Medicaid program to regularly update Medicaid reimbursement rates for home and community-based providers, such as assisted living, and other health care providers. These providers have not had any type of rate schedule with some provider groups going decades between reimbursement updates.<br></p><p><img src="/Articles/PublishingImages/2023/DeekshaKapoor.jpg" alt="Deeksha Kapoor" class="ms-rtePosition-1" style="margin:5px;width:130px;" /><img src="/Articles/PublishingImages/2023/NickGoodwin.jpg" alt="Nick Goodwin" class="ms-rtePosition-2" style="margin:5px;width:165px;height:200px;" />HB 1461, which is authored by former emergency room surgeon State Representative Brad Barrett (R-Richmond) and is now being sponsored in the Senate by Senators Liz Brown (R-Fort Wayne) and Ed Charbonneau (R-Valparaiso), passed unanimously out of the House of Representatives and has been assigned to the Senate Health and Provider Services Committee for additional deliberation. All bills must pass out of the House and Senate before the General Assembly adjourns for the year on April 27.<br></p><p>Visit <a href="https://www.ihca.org/advocacy/" target="_blank">IHCA.org/advocacy</a> to learn more about IHCA/INCAL's legislative priorities.<br></p><p><em>Deeksha Kapoor is director of communications for the</em><em><strong> </strong></em><em>Indiana Health Care Association (IHCA) and the Indiana Center for Assisted Living (INCAL). <em><span style="font-size:11pt;line-height:1.2;">Nick Goodwin is director of government affairs for IHCA/INCAL.</span></em></em></p><p><em></em></p> | 2023-03-28T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/clif%20et%20al.jpg" style="BORDER:0px solid;" /> | Management | Deeksha Kapoor and Nick Goodwin | Hosted by the Indiana Health Care Association, the event offered an excellent platform for long term care leaders to advocate for needed health care reforms that will strengthen the state’s workforce and increase access to care for more aged and disabled Hoosiers. |
| Where Do Providers Fit in to the CMS 2030 Accountable Care Goal? | <p>In 2021, the Centers for Medicare & Medicaid Services (CMS) set a goal of having 100 percent of Medicare beneficiaries in an accountable care relationship by 2030. Since then, CMS has been enthusiastically pursuing systemwide health care reform for whole-person centered, equitable, accountable care. This means that an increasing number of beneficiaries will be attributed to or enrolled with a payor whose payment is tied to quality and health outcomes.<br></p><p>Primary care has been and continues to be the foundation for achieving CMS' goal. However, CMS has noted the importance of an accompanying specialty care strategy to ensure the goal is met and participants get the best care possible that best aligns with their needs. In executing its vision, CMS is choosing to focus on a few models, in order to strengthen and enhance these models to create a longitudinal interplay of coordinated primary and specialty care in which the provider is responsible for improved outcomes and total cost of care.</p><h3>What Does This Mean for Long Term Care Providers?</h3><p>Accountable care organizations (ACOs) and managed care are here to stay. The question is whether long term care (LTC) providers will take the initiative and lead in this evolving landscape or continue to be managed. Despite all the headwinds, including unprecedented workforce challenges, LTC providers need to pay attention, learn, assess their organization's current status in today's value based environment, identify their short and long term goals, and start exploring paths forward that align with these goals. They need to consider what role they want to play in this health care ecosystem in which the vast number of payments are no longer coming directly from CMS but rather through a “broker."</p><p>Providers are keenly aware of the very real challenges of this structure where prior authorizations delay care, utilization management strategies such as pre-payment and post-payment audits serve to trap providers in administrative wormholes.</p><p>“Providers need a comprehensive strategy that will mitigate risks and assess their readiness and ability to engage in these models," said Ted LeNeave, CEO and founder of Accura Healthcare of Iowa. Accura currently participates in Iowa's provider-owned integrated care network and is partnering with other local providers on an Institutional Special Needs Plan (I-SNP). If expanded opportunities arise within CMS' complementary specialist strategy, whether short or long term, LTC providers with some experience in value-based care and population health are positioned well to take a leadership role. “In the end, we risk being left behind if we do nothing," he said.</p><p><img src="/Articles/PublishingImages/2023/NishaHammel.jpg" alt="Nisha Hammel" class="ms-rtePosition-2" style="margin:5px;width:150px;height:150px;" />It behooves providers to take note and look at avenues through which they can lead and/or meaningfully participate in this evolving landscape. Forward-thinking providers are tackling these challenges head on by establishing I-SNPs or participating in ACOs or other care management models enabling them to strengthen their future position. The first step is learning more about these value based care models and the risks and opportunities that each present. The time is now.<br></p><p><em>Nisha Hammel is associate vice president, Population Health Management at the American Health Care Association.</em></p><p style="text-align:center;"><em><br></em></p><div style="text-align:center;"><strong>Learn More:<br class="ms-rteForeColor-2"><a href="https://www.springerpub.com/population-health-management-9780826144263.html" title="Population Health Managment" target="_blank"><img src="/Articles/PublishingImages/2023/Population-Health-Management-Pub-2021.jpg" alt="Population Health Management" style="margin:5px;width:209px;height:305px;" /></a><br></strong></div><br> | 2023-03-28T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/0820_News2.jpg" style="BORDER:0px solid;" /> | CMS | Nisha Hammel | Providers are keenly aware of the very real challenges of this structure where prior authorizations delay care, utilization management strategies such as pre-payment and post-payment audits serve to trap providers in administrative wormholes. |
| Iowa Legislature Passes Medical Malpractice Reform Bill Capping Non-Economic Damages for Iowa Nursing Homes | <p><img src="/Articles/PublishingImages/740%20x%20740/gavel_steth.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:200px;height:200px;" />The financial stability of the long term care sector requires sufficient revenue and managed costs, and legal liability is one of the largest cost threats facing long term care providers. The Iowa Legislature tackled this threat head-on when it passed <a href="https://www.legis.iowa.gov/legislation/BillBook?ga=90&ba=HF161" target="_blank">HF 161</a>, a bill that caps non-economic damages for health care providers, including nursing homes. Iowa Governor Kim Reynolds signed the bill into law Feb. 16, 2023.</p><p>"Everyone agrees that when mistakes happen Iowans deserve their compensation," said Governor Reynolds when signing the bill into law. “But arbitrary multimillion-dollar rewards do more than that. They act as a tax on all Iowans by raising the cost of care. Protecting our health care system from out-of-control verdicts promotes access to care in communities across our state and better positions us to recruit the best and brightest physicians to Iowa."</p><p>The new law caps non-economic damages—intangible damages such as pain, suffering, or inconvenience—at $1 million for Iowa nursing homes and other health care providers and $2 million for hospitals. Starting in 2028, the caps will increase by 2.1 percent to account for inflation.</p><p>The law became effective immediately upon the governor's signature, and the new limits will apply to any new medical error incidents. Existing lawsuits will be excluded. The law does not limit economic damages, such as money awarded for financial losses, or punitive damages in cases of "willful and wanton disregard" for a patient's safety.</p><p>“This has been a long-time coming," said Iowa Health Care Association's (IHCA) President and CEO Brent Willett. “Significant reform related to legal liability limits has been part of Iowa Health Care Association's legislative platform since 1998. This is a highly important victory for the long-term stability of the nursing home, assisted living, and home health care sectors in our state."</p><p><strong>Medical Malpractice Threats</strong><br>“The threat of legal action from aggressive trial attorneys seeking exorbitant malpractice judgements exacerbates other problems facing Iowa nursing homes—negative operating margins due to astronomical cost inflation, compounded by Medicaid funding shortfalls," added Willett. “Irresponsible claims by trial attorneys often result in exorbitant malpractice judgments, which until now has promoted a negative litigious environment that makes it difficult for providers to maintain operations and plan for the future."</p><p>“I'm grateful to the legislature for passing reasonable medical malpractice reform, allowing Iowa's health care industry to become stronger and more accessible," said Governor Reynolds.</p><p><strong>Difficult Road to Passage</strong><br>“Medical malpractice reform, while critical to the stability of the health care continuum, is a difficult topic to navigate politically, and is a highly sensitive and contentious issue," said Willett.</p><p>Over the past three years, IHCA and the Iowa health care provider community have worked on legislation that would set a hard cap on non-economic damages in medical malpractice suits. In 2021, bills were proposed in the Iowa House and Iowa Senate to set the cap at $1 million. Each year the proposed legislation fell short of the necessary 51 votes in the Iowa House of Representatives.</p><p>This year, Governor Reynolds called for medical malpractice reform to be a priority in her Condition of the State address to the Iowa Legislature upon opening for session in January 2023. After a long and heated debate, the Iowa House passed the bill 54-46 on Feb. 8, and the Iowa Senate passed the bill by a vote of 29-20.<br><strong> </strong><br><strong>Liability Insurance Among Cost Savings</strong><br>From a cost-containment perspective, not only does the new cap protect providers from the threat of aggressive trial attorneys seeing exorbitant malpractice judgements, it also provides savings in the form of liability insurance rates.</p><p>“Data shows the costs for liability insurance was approximately $12.7 million in 2019, and approximately $15.2 million in 2021," said Jeff Steggerda of Brighton Consulting Group.</p><p><img src="/Articles/PublishingImages/2023/RyanHanser.jpg" alt="Ryan Hanser" class="ms-rtePosition-2" style="margin:5px;" />During the early 2000s, nursing homes saw a wave of liability insurance increases that tripled the cost of insurance. IHCA joined the American Health Care Association to study the impact extraordinary claims and settlements were having on the sector's liability insurance rates.</p><p>“The data found liability insurance costs approaching $2,000 per bed or more. The limit of $1 million set by the new law today may seem high, but it should stop or possibly reverse the trajectory of liability insurance premiums and possibly encourage additional companies to enter the market," added Steggerda.<br><strong> </strong><br><em>Ryan Hanser is president at Hanser & Associates, </em><em>a public relations firm.</em></p> | 2023-03-23T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/gavel_steth.jpg" style="BORDER:0px solid;" /> | Finance;Legal | Ryan Hanser | Over the past three years, IHCA and the Iowa health care provider community have worked on legislation that would set a hard cap on non-economic damages in medical malpractice suits. |