Gary Blake’s nameplate might say CEO, but in some ways, he envisions himself more as chief quality officer of Creative Solutions in Healthcare, the sprawling 159-facility skilled nursing company he founded in 2000.
When Creative Solutions recently replaced every single resident mattress, Blake had a sample sent to his home in the Dallas-Fort Worth area. Then he slept on it. When the company changes its food service vendors or adds new menu items, Blake tests them out. Same for new shampoos or towels being used in the residents’ wash rooms.
“I see that as, oh my gosh, more than 10,000 people in the state of Texas trust me to deliver care to them. … The least I can do is make sure their mattress, where they’re spending maybe 12, 15, 18 hours a day depending on their diagnosis, is a good one. They deserve the most supportive surface,” Blake told McKnight’s Long-Term Care News in an interview Wednesday.
“It’s the culture of the company. It’s unspoken,” he added. “People in the C-suite know that’s Gary’s lane, and they need to let me do that.”
Blake has rapidly grown Creative Solutions from a single managed building to a single-state empire that stretches to most every corner of Texas and includes owned, leased and newly developed sites. The newest Creative Solutions facility opened in College Station in February.
The quality of his facilities, programs and staff have all remained top-of-mind, Blake said, as the brand has expanded its relationships with real estate investment trusts and family investment offices in recent years. The larger the company gets, the more time he spends striving to make it feel like a “smaller, more boutique company.”
“As a company, to grow this fast in over a little over two decades, we’ve had to be very agile and we’ve had to eliminate a lot of the political barriers that some companies layer in,” Blake said. “The chain of command is very important, but I want all of our employees and family members to have my cell phone number. That’s important, too.”
Not attached to ownership numbers
Blake came to the long-term care industry thanks to a career aptitude survey he took in 1992. It suggested he go into mortuary services or skilled nursing. He chose the nursing home administrator route.
In that early career, he worked for Beverly Enterprises, Daybreak Ventures, Integrated Health Services and a regionally based Texas company as a chief operations officer overseeing 18 facilities.
It was a formative experience that gave him insights into two areas that have been essential in scaling the company he later formed: navigating the change-of-ownership process smoothly and controlling turnover and its related expenses and impacts on quality.
“It really shaped the way I run my business now,” Blake said.
Today, Creative Solutions is the largest skilled nursing operator in Texas. Continued growth is likely.
“There is no sweet spot for us,” Blake said. “Some companies say, we’re going to get to 20 buildings or 30 buildings. Well, you say that, and then you get there and you can do more. Some people set a cap on revenue, say, if we get to a quarter of a billion in sales or a billion in sales, we’re going to stop. We’re not attaching ourselves to any numbers like that,” he explained.
“We’re just going to keep on doing what we’re doing,” he added. “We see a lot of opportunity in several markets. We only have three facilities in the Houston market, so we see that as a real opportunity. We see going deeper into the Valley as a real opportunity.”
Like many large regional players, Creative Solutions is leaning into the use of regional leadership teams. It hires additional regional staff before acquiring a new building in a given market to soften the impact when that new SNF comes online. Creative’s regional staff don’t have corporate offices; instead, they each live in their assigned region and work day-to-day from various buildings in their footprint.
White glove service
Those regional teams include a “White Glove” team that routinely visits campuses and looks for everything from dangling tree limbs to broken light bulbs and dingy paint. Their scores of Creative properties help inform a robust maintenance and reinvestment program.
The team also plays a role in ensuring the right technology is in place to support a partnership with the company Maintenance Care, through which residents and family members can scan a QR code to immediately report maintenance issues. Those are then prioritized daily by the on-site team.
The company also keeps to a long-term remodeling program, and reviews quarterly smaller needs such as updated paintings, common room furniture, resident room upgrades and more. The typical full-building renovation for Creative runs to about $750,000 but those investments have led to increased business and some other strategic gains, Blake said.
“We do so much business with REITs and private family offices outside of our own properties that we just let them know what we’ve got going into their properties,” he said. “Let me tell you, that has spurred a lot of business because they see us not depleting their asset, but actually adding to and enhancing their asset and extending the natural life of the asset. Of course they want to do business with you at that point.”
Other reasons to commit to physical plant when others insist their margins are too squeezed to do so? Blake said referrals increase and staff tend to stay on longer.
“When your facilities are clean, your food is great and then you’re planning your remodels, we have noticed a pretty strong trend of that lowering our turnover to some degree,” Blake said. “When your turnover is high, your quality is low. And that’s a hill we’re prepared to die on. We’re going to continue to work to get our turnover down; we’re going to work to continue to improve our quality because it’s the right thing to do. You never have to apologize for high quality.”
One-state way
Blake has intentionally kept his business a one-state enterprise as he scaled up, and that is starting to pay dividends. Texas last spring passed its first permanent Medicaid rate increase in a decade.
While lawmakers are in an off year between biennial budgets, there’s more good news coming: The state is switching from a RUGS-based payment system to a PDPM-related one and officials are also hammering out final details for new metrics to be used in a state quality improvement program. It is set to expand payments by 60% this year, presenting opportunity for those who can meet the benchmarks.
“For the right operators in Texas, the operators that I know very closely, we don’t have a problem with producing quality,” Blake said. “We actually want reimbursement tied to quality. Then nothing matters beside the management’s attention to delivering quality, whether it be management under the roof driving that quality on a minute-to-minute basis or the corporate office driving it from a 30,000-foot view, making sure that everyone understands the assignments and becomes mission critical on delivering results. That’s what the patient deserves.”
