This article is sponsored by Health Dimensions Group. In this Voices interview, Senior Housing News sits down with Darrin Hull, SVP, Consulting Services, Health Dimensions Group® to talk about senior living solutions for stand-alone and rural communities including centralized recruiting, interim leadership, repositioning and centralized billing, among others. He discusses the unique challenges facing rural and standalone communities in today’s operating environment, providing insight into the innovative solutions HDG has developed to help tackle staffing challenges, regulatory compliance and financial constraints.
Senior Housing News: What life and career experiences do you most draw from, in your role today?
Darrin Hull: I’ve operated skilled nursing and assisted living facilities in thirteen different states over the last thirty years, the last ten of which I’ve also served as a consultant. In my consulting role, I have worked in twice the number of states that I’ve actually operated in, so our organization has worked across the entire United States. We have a national footprint encompassing both urban and rural communities, so I, along with the rest of the team at Health Dimensions Group, bring a unique perspective when working with all types of senior living and care communities.
What unique challenges do rural and standalone senior living and care communities face?
In the rural standalone environment, three things come to mind: staffing, reimbursement and rapid industry changes.
Rural providers struggle to find sufficient care staff for the number of residents in each of their communities, and more of these residents rely on the Medicaid waiver to pay for services. The reliance on Medicaid makes it difficult to operate an expense profile consistent with the waiver reimbursements, which have been historically lower than private pay residents. And finally, the big challenge facing rural communities is responding to rapid industry changes. The regulatory compliance arena is very dynamic, and some rural providers are struggling to stay ahead of program development and training to care for higher acuity patients as they work to enhance their clinical capabilities. All of these factors put a major strain on growth, efficiency, and the bottom line.
What solutions has HDG deployed to help clients navigate the challenging staffing environment in senior living?
One of our big successes for our organization and its clients is leveraging centralized recruiting services. Many of the standalones and rural providers just don’t have the time or resources to build a robust talent pool for growing their teams. We have the ability to deliver a higher volume of qualified candidates with greater velocity to fill vacant positions. For those communities that have a need to fill open leadership roles, our interim leadership and executive search services can supplement our centralized recruitment services for standalones.
In the rural environment, operators often need to wear multiple hats. An assisted living administrator may take an active role in the business operations. The social work responsibilities may be shared with the recreational services. We’re seeing a lot more creativity in the combination and consolidation of roles and responsibilities in a rural standalone environment, but we’re also seeing a lot of success with implementing staffing ladders and career pathing opportunities in our communities and with our consulting clients.
Giving employees a way to achieve their professional goals is critical to success with recruitment and retention. Many employers just look at annual performance evaluations when deciding who to promote. Instead, they should focus on creating a professional environment that allows each staff member to grow in their own ways.
How can rural and standalone communities ensure they remain financially viable?
There are essentially two levers that can be pulled from an operations perspective — one being revenue and the other being cost management. Assisted living operators need to make sure they are capturing all services. With more seniors aging in place and new services being costly, this has been a challenge that can affect revenue.
Next is understanding where the community may have unmet needs and finding ways to address those needs. Successful providers will stay agile and adapt to the increasing needs of the residents in their communities. The same goes for the use of space. Providers experiencing lower resident occupancies can leverage their extra square footage to create additional revenue streams by looking into the community for other local organizations that may be interested in leasing that space.
On the cost side, a lot of effort has been focused on eliminating the reliance on agency or temporary staff, which typically comes at a very high expense – that’s where centralized recruiting can make a dent in reducing expenses. In the big picture, providers should be recalibrating operating expenses in relation to their revenue streams. This requires more than just annual budgeting — it is an ongoing process where, on a weekly basis, operators are making sure their cost structures align with the revenues entering the operation.
With limited access to regulatory expertise, how can rural and standalone communities ensure they stay in regulatory compliance?
It all ties back to the pre-admission assessment and the initial comprehensive assessment completed on new residents. Sometimes providers cover the basics, but they don’t dive deep enough into the history and the nuances of each individual’s experiences and needs. This can create challenges from a regulatory perspective, on top of demonstrating a lack of sensitivity to all of the patients’ needs and desires. The senior living environment needs to adopt a skilled nursing QAPI-type approach to their quality improvement initiatives and outcomes data analysis. This will help to continually improve the quality of each facility.
Next, staff training and education is critical. Sometimes it’s difficult to stay on top of all the changes in the regulations. I see successful providers leaning heavily into staff training and development, and making sure there’s a comprehensive process in place so staff are equipped with the latest knowledge on how to best care for the senior population.
And lastly, it’s always wise to have a third party do quality and regulatory testing of the clinical compliance for any senior living environment. We offer these services and will complete an annual or semi-annual mock survey process for our clients. It gives providers an early chance to course correct if there are any areas of deficiency they may not be aware of.
What makes HDG uniquely qualified to help rural and standalone communities overcome these challenges in today’s operating landscape?
Health Dimensions Group is a unique organization as we are both operators and consultants. Our knowledge is born from our hands-on experience in the field. We leverage the knowledge gained from the communities we managed to improve our consulting services. In addition, we’re an organization focusing on senior care and post-acute care exclusively. This expertise tells providers that we can give the best possible support for their organization.
We’ve earned our reputation as a values-driven partner with our clients. We have a proven track record of getting results in all areas where we apply our expertise.
Finish this sentence: “In the senior living industry: 2024 will be defined by…”
… continued change in the regulatory landscape.
These changes should be in resident expectations and desires, and payments on the waiver side. States are moving towards a more home-like environment for their residents under waiver programs. Overall, the future looks bullish for providers that are willing to exercise agility, embrace change, and recraft their strategic plans to accommodate the realities of the future.
Editor’s note: This article has been edited for length and clarity.
To discover how Health Dimensions Group can help your organization overcome the difficulties of today’s challenging senior living and care environment, visit healthdimensionsgroup.com or contact us at [email protected].
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].
