After virtually exiting Florida, where it dominated the skilled nursing landscape before a series of regulatory and legal challenges, Consulate Healthcare is repositioning itself as a quality provider focused on staff and leadership development.
CEO Jeron Walker and new COO Ashley Winkle last week talked with McKnight’s Long-Term Care News about their vision for attracting and retaining staff, and becoming a go-to resource in the communities where the company remains, as it focuses on future growth.
Much of their strategy relies on staff-first initiatives, especially at the CNA and administrator levels.
“We really have a strong desire for our local leaders to operate their centers as the true owners of their buildings, allowing them to make key decisions that improve quality and help us meet our obligations and achieve outcomes,” said Walker.
He was appointed in December 2021, just as the company was completing a major sell-off that left it operating just 60 facilities — down from more than 200 in the mid-2010s.
Walker talked openly about helping Consulate put its rocky past aside, and he continues to build a team focusing heavily on the initiatives he sees as the way to renewed success. The mission, he said, is to make every staff member he comes in contact with “feel like a million bucks.”
“I try to do that daily. Sometimes I’m successful, sometimes I’m not, but that’s what our goal is,” Walker explained. “I focus on what’s happening today … and I ask my staff, my executive directors, our nursing leadership in our buildings all the way down to the CNAs to have that same type of mentality of, ‘I’m in the moment right now. I’m gonna take care of right now.’”
Reducing the footprint even further has helped bring a new focus to recruitment and retention, and developing new leaders in core markets. Today, Consulate operates 46 buildings mostly in Mississippi, North Carolina, Pennsylvania and Virginia. The company also has one building remaining in Florida.
“It’s allowed us to target key states and markets in which we feel we can provide best-in-class service,” Walker said. “And really that’s the driving decision behind it. It’s allowed for a reallocation of our resources to where we feel we’re better able to support and serve our centers and the leadership in our centers.”
One of the first gains from the intentionally smaller footprint? Consulate has eliminated agency staff from all of its buildings except one, even when faced with some challenging geographic pockets and working to meet increasing state staffing minimums in Pennsylvania.
In-house CNA training push
In 2018, Consulate had to negotiate a careful truce with the state of Florida, which had cited health and safety violations routinely at dozens of buildings and threatened to revoke its Medicare and Medicaid agreements.
Having laid that controversy and a decade-long False Claims case to rest, the company is now focused on investing for the future. Core components are multiple programs to streamline hiring and improve retention, Walker and Winkle said.
Winkle is spearheading an effort to bring certified nurse aide classes to more of the company’s buildings. So far, she has applied to various states to create 23 programs, a “handful” of which are up and running.
The goal is to create a program that folds new workers into the company so seamlessly that they are more likely to stay, improving care consistency and while also reducing expenses associated with turnover.
“It feels like everything comes back to retention,” Walker said. “So this is our pathway forward, similar to our [Administrator-in-Training] situation. If we grow our own, we feel like we have a really large opportunity to get ahead of our CNA challenges. They still represent the largest number of openings within our company.”
Winkle helped establish CNA programs at a previous senior care organization in the Northwest. She views it as a starting point on a career ladder system that Consulate is also eager to expand.
How many CNAs the company can train each year depends on the speed at which individual states grant approvals. It also may be limited in some buildings by the ongoing Centers for Medicare & Medicaid Services nurse-training lockout. That rule keeps providers hit with a certain level of fines from training their own nurses. Legislation to lift the rule has stalled in Congress yet again.
Walker said he favors passage “100%.”
“It’s unfortunate that a situation could occur in a center that has very little or nothing at all to do with CNA training, could have just zero to do with clinical issues for that matter, and yet depending on the scope or severity, can disqualify you from a CNA program,” he said. “It’s almost a step backwards from being able to provide the care and enhance care that our residents deserve.”
Quality from the top down
Behind the local market leadership strategy are “team captains,” a group of hand-selected executive directors with more experience and proven on-site success. They may rove and help other centers within their market deliver on service-oriented goals.
That’s been a key to building up brand recognition, especially in Mississippi, the first market that Walker led new purchases in. Growing their own future leaders will likely be critical to determining whether, when and where to grow in the future.
Another key program falling under Winkle’s watch is the revitalized AIT program. Both she and Walker started their nursing home careers through such a program. But Consulate looks to add to that experience with its Leadership University, a project Walker planned to launch in 2022 but is still being built out.
That program will offer ongoing professional development and career path support to directors of nursing, executive directors and others who want to advance within the company. Each will be recommended by a fellow building leader.
“If that leads to growth and puts us in a position to grow, certainly that could be part of the strategy, but it’s not the ultimate strategy,” Walker said. “It’s really about the center, what’s happening there and making sure that they are achieving.”
Also key to the company’s stability and potential growth are patient referrals. Though it has all-but left Florida, Walker maintains the brand’s reputation is growing in its other states where it has a strong footprint.
“We’re not maybe the largest providers in those states any longer, but we’re well recognized,” he said. “We continue to strive to be well recognized for the culture and for the quality of our care.”
A reputation for quality can also help with recruitment and retention, bringing everything full circle.
Walker and Winkle last week led a training designed to bring more nursing home staff into quality efforts, chiefly by encouraging CNAs, housekeepers and other non-licensed frontline staff to speak up for the patents they may know best.
Quality, Walker said, can’t be an effort left just to a facility’s top leaders. Instead, Consulate has designed more of a per-patient approach, where an all-inclusive small group huddle in some ways replaces large morning stand-ups dominated by a few key voices from the nursing and MDS departments. That is followed by in-depth rounding that occurs with the leadership team.
“We’re working really diligently to engage our team members at every level within our centers in the process of quality,” he said. “Not only do we get key information and share key information with CNAs and nurses and housekeepers, but it’s also our way of connecting with them in a way that can enhance retention.”
