CHICAGO — Facing the reality that most new nurses don’t choose to enter geriatrics, skilled nursing and senior living leaders are both going back to the basics and seizing on innovation to grow their direct care staff and hang on to them.

A panel of long-time female leaders from across the sector embraced those dual themes during an exclusive roundtable conversation at last week’s 6th annual McKnight’s Women of Distinction event.

“We have to empower our existing nurses,” said 2024 Hall of Honor inductee Sharon Roth Maguire, senior vice president and chief health and wellness/resident experience officer at LCS.

The Iowa-based management firm serves about 140 life plan and senior living communities in 35 states, where it is now employing a clinical leadership council that gives current nurses more say in new programming and recruitment and retention efforts.

Sharon Roth Maguire. Credit: Tori Soper Photography.

“Bringing nurses from all over the United States, from within different LCS communities, has really been empowering,” explained Maguire. We’re giving them the voice to say, ‘What do you guys think will make the difference here? What do you see as a need and how can we attract more nurses, younger nurses?’”

Maguire sees major needs for licensed nurses to fill leadership positions and for certified nurse aides.

Others, including 2024 Hall of Honor inductee Rachel Shearer (pictured top), senior vice president of operations at Ignite Medical Resorts, say the existing need for registered nurses looms large ahead of a federal staffing mandate for nursing homes.

“I think we’re doing better than the national average,” said Shearer, whose facilities focus on rapid rehab and advanced clinical programming. “If the staffing mandate happens, we’ll be struggling just like everyone else.”

Shearer called the inclusion of licensed practical nurses in the finalized staffing rule a small win, but added that it remains tough to keep the “rock stars” among the LPNs Ignite’s staffing approach relies upon.

“They know they can go down the street to the hospital, have less regulation, less stress, less patients,” Shearer said. “Skilled, in my opinion, is the hardest setting.” 

At Principle LTC, recruitment strategies have included RN bonuses as high as $25,000 — but they still haven’t drawn a rush of new workers. The company was at one point down 10 directors of nursing in a 46-building footprint.

Many nurses today don’t want the overtime, which comes with extra pay that used to be enticing to workers. So it’s back to the basics, said COO Joylin Nation, a 2022 Hall of Honor inductee.

In rural areas, especially, Principle LTC has had success with new partnerships with local high schools and colleges. The company has offered to pay to develop nurse training programs and offered its own certified staff to teach.

A partnership with Eastern Carolina University has led to the placement of several paid administrators in training, who Principle guarantees job placement. Seven have completed the program and now work for the provider.

Technology’s promise

While hospitals may be taking much-needed workers, they may also offer a way forward for providers ready to innovate.

Just a few years ago, 2024 Hall of Honor inductee Becky Bodie was with a skilled nursing company that was still using paper records. That outdated approach not only disadvantages providers when it comes to data collection and insights; it’s just not attractive to today’s workforce.

“I think we’re going to have to start using some of the hospital types of things, like hospital beds [with sensors],” said Bodie, executive vice president and COO at Diversicare Healthcare Services. “It’s cost-prohibitive in some scenarios, but I think we just have to keep looking for all of those types of things that make it just a little simpler for our nurses and our CNAs. Anything that can carve off an hour will help by lightening the burden and help with retention.”

Ignite recently piloted a fall detection tool from KamiCare that uses a combination of AI and human monitoring to predict falls, while LCS is soon launching a pilot of a new, updated nurse call system.

And several speakers praised the value of pre-submission payment scrubbers that check for supporting documentation, review care patterns and risks, and offer insights and predictions that can help fuel quality measure improvements.

Claire Stephens, a vice president at PointClickCare, said her company is “very much investing to learn where AI makes the most sense for post-acute care staff, in ways that are both safe and compliant.

The leading software provider also recently became ONC Health IT certified, meaning it is permitted by federal regulators to share more data between hospitals and post-acute providers. That should deliver new tools to feed value-based care initiatives, too, Stephens noted.

“We’re doubling down on insights work, as well,” she said. “Analytics is a huge area that I would say EHRs have not put a high priority on, just with the nature of all of the work we must do. … [In the future] we want to give you your data and make sure you can easily look at your data in the core tool, without having to go to the marketplace.”

Other avenues for success

While 2024 Hall of Honor inductee Annie Pineda-Eiland, regional director of clinical service for Illinois-based Legacy Healthcare, is also embracing technology, she sees immigration reform as another key to LTC’s future.

Her company has reduced its reliance on agency nurses, hired some of them onto its team and built up its own internal pool. But being able to hire more foreign-borne nurses would help meet ongoing needs.

She came to the US a foreign nurse 30 years ago and wants to see such access and programming grow for licensed nurses.

“The recruitment of foreign nurses, that was off limits for a long time, because of a number of legislative and regulatory reasons, but we’re starting to get back into that,” added Maguire. “We have one community that has had great success. We haven’t done it on a large scale, but we’re going to certainly explore that.”

For all of these solutions, the speakers said, providers need more support from a government that is promoting higher staffing and higher quality from the nation’s long-term care providers.

“We have to look at what’s really important to us, and what’s important to us is our people,” Pineda-Eiland said. “The ownership has to make sure we’re taken care of. Our government also has the responsibility to take care of us. If we don’t care of each other, who will take care of the people?”