NIC Chats Podcast On the Road at the 2024 NIC Spring Conference

Lisa McCracken (00:05):

Welcome to the NIC Chat's podcast, and we're happy to be On the Road today live in Dallas at the NIC Spring Conference. My name is Lisa McCracken, I serve as the Head of Research and Analytics with NIC. So excited to be here today with two guests, and I will introduce the two of you, and I'll let you then tell everybody a little bit more about you. But we're excited today because we actually have a repeat guest, Brett Landrum, and he's gonna tell a little bit more about his organization, and what they provide to many of you who may be listening. And then we have a guest, Susie Koenig, who many of you may know, Susie, with SAK Management Services. So before we dive into the conversation, we got about 20 minutes here today to cover a lot of different interesting hot topics that I think many of you'll be interested in learning more about. But for those of you who didn't see us in the fall when we were together at the Fall Conference, Brett, give a little background on you, ProCare,HR, and what would be helpful for those to know about you. And then we'll go to you, Susie.

Brett Landrum (01:07):

Absolutely. When we think about ProCare HR and the vision for our organization, we've built a senior living optimized HR foundation, delivering comprehensive HR services from talent acquisition coaching, etcetera. And we really believe that that foundational kind of HR platform is an opportunity to really build and drive better quality of care, resident satisfaction and financial results for our operators. And so, for ProCare we've been working the last eight years to really refine and understand the industry and build this comprehensive HR services. And now we get to do the fun stuff, which is really to sit back and say, okay, how does this platform we've built enable us to build and buy kind of in industry leading solutions that can really move the needle again in quality care and financial results and resident satisfaction.

Lisa McCracken (02:08):

Right. And we're definitely gonna talk about some of the workforce, obviously that's a hot topic and I appreciate you commenting on workforce being related to resident satisfaction, financial performance. It's all interconnected. So we're gonna come back to that and hit some other topics as well. Susie, do you wanna tell the listeners about you?

Susie Koenig (02:25):

Of course. So I am Susie Koenig and we're with SAK Healthcare. We've rebranded, so we've been in the business as we were talking a little bit earlier for a long time. I've been doing this for over 30 years without giving you exactly my age. However, we come in and we're healthcare turnaround company, and we provide kind of the whole interdisciplinary healthcare group that would come in and almost be like a SWAT team to help providers and to assist landlords, assist REITs, assist lenders to come in and to provide management services or healthcare consulting when needed by many groups as well. We have a third party management arm as well as a consulting arm. And we get very involved in court proceedings, court appointments, receiverships examiners, chapter 11, trustees.

Susie Koenig (03:36):

And I've learned without having the legal degree, a little bit about restructuring. And so been very involved in that probably for about the past 20 years. But started originally as a social service admission director in a facility and learned from the bottom up. And became an administrator and worked through, and now we operate portfolios and all different types of cases that need assistance and providing improvement, mostly, and in quality as well, clinical, financial, and the whole gamut.

Lisa McCracken (04:19):

Your SWAT team depiction, that's an interesting way to put it, right? Because your engagements and management situations, are there with organizations that are in distress. And we're gonna get back to that. because I think that's one of the reasons why we wanted the two of you here today because we are in a situation in the senior housing and care space where there is that element of distress. So, the two of you are often partners in these situations. So, you get the, let's say the mayday call or whatever it may be, and you've got a team and from my perspective that's smart, obviously saying, okay, where do we have expertise? Where do we bring in others that can bring some really solid support? So, Brett, talk to me a little bit about what that partnership looks like and what would be helpful for the listeners to learn about?

Brett Landrum (05:06):

We've been very fortunate. I think we, Susie and I met a couple of years ago and they were contemplating do we build an in-house model for HR. Do we look for a partner? They had kind of, I think looked, and kind of evaluated a handful of different HR partners. And ultimately as we got in there and they got to know us, I think, philosophically we're very similar around pace. When Susie calls, she may have something that's like, Hey, I need you guys in two or three weeks. And you gotta plug your whole HR infrastructure and understand what's happening today.

Susie Koenig (05:43):

Sometimes I say, I need you tomorrow.

Brett Landrum (05:45):

And you never know what you're taking over. Sometimes we have wonderful data and information and access, and time, and there's other scenarios where you have nothing and you're rebuilding everything from scratch, from employee files to how they do pay, and everything else. And I think for us as organizations to partner quite frequently on these, being able to communicate really well and the pace at which both organizations. Operate at is really important to the success of these.

Lisa McCracken (06:21):

Because not all those partnerships work out. And to the whole point, I mean, as you explored, okay, do we build this expertise because HR has gotten a lot more complicated in recent years.

Susie Koenig (06:33):

I can tell you it's the best thing, one of the best decisions I've done in the past year or so. We did explore other groups and we found ProCare to be incredibly responsive, and also having the full boat of services that we needed. And, I'll tell you, I don't hesitate, I used to freak out. We'd walk in with, the first thing we'd have to worry about is employee health insurance. We'd have to worry about payroll, we'd have to worry about all these issues that are big issues coming in, especially with the employee crisis coming up now. And thank goodness for ProCare, they really, we pulled them into one and then we pulled them into a second, and then we said, okay, you are our partner now here on out to come into these facilities. And we're getting more and more all the time.

Lisa McCracken (07:35):

And I do wanna talk about that we were chatting earlier about, what this time period looks like, maybe compared to some other sort of challenging periods that our sector has gone through. But, so I would imagine those first couple days and initial time period pretty critical. So obviously you've got organizations that you work with that are in a degree of financial distress, pretty significant in many instances. But the employee, there's sensitivities with the staffing stuff because it's challenging enough. But that could also really snowball and get even worse in those first couple days. So I would think that there's some really initial things that are really important to do on the employee side. So what do those first couple days look like? Maybe Brett, you can comment and then Susie add on.

Brett Landrum (08:18):

Yeah, to me there's an operational leadership element, which is what Susie's team takes on. And that's reassuring the administrator, the executive director, it's coming in and I guess I won't steal her thunder on some of the operational things they do, but when we're on site with them, we're very familiar with kind of their workflows. But then, on the HR side of things, oftentimes you're coming in and the two major questions, maybe three that everybody has out of the gates is, am I gonna have my job still? Is my pay gonna be right and do I have benefits? And what happened with my benefits? And, I mean, that's it. And those are the three.

Brett Landrum (08:58):

Sometimes there is more distress if there's, they had issues with employee engagement or relations or etcetera. But typically, even despite those types of scenarios, it's generally those three questions. And that's that first week you're trying to get the leadership team comfortable with, at least from an HR perspective, the basics of the technology, to be able to get payroll process for us to get data 'cause again, like a lot of the work that Susie's team needs to do is, they need to have access to information, understand labor costs and staffing and things like that. So it's really, getting that technology infrastructure in place right away, and I think kind of getting that first payroll clean and doing a really good job on benefits is important.

Lisa McCracken (09:44):

How would you respond to that, Susie?

Susie Koenig (09:45):

And it's true, we take over facilities and we have no idea until we walk in the door what the issues are.

Lisa McCracken (09:54):

How much advance notice do you usually have when you need to go in? What does that look like? Is there a typical?

Susie Koenig (09:58):

So there, like right now, I'm supposed to maybe go into a place tomorrow in California. I have no idea yet, because the judge, we have to wait to get the approval if the judge approves the receivership. So we never know.

Lisa McCracken (10:13):

You need to be in the ready position.

Susie Koenig (10:14):

And so I never have an idea of really what is going on. Sometimes I'll have notice where maybe two or three weeks we'll talk about it, we'll work with some of the lawyers. This is all the court appointments, in the regular management engagements that we just come into, it's not, we usually will say a 30 days notice, 60 days notice, and then we can get the information that Brett's team needs. But oftentimes we'll walk in and we have to immediately figure out how payrolls are gonna be met, and then we have to bring Brett's team in to the transfer over. And then some of the previous payroll companies haven't been paid, and they say they don't like, we had an instance over the last few months where we were transitioning a facility in December and January, and the new payroll company didn't wanna do the last payroll, and they didn't wanna do the payroll. What do you call it?Quarterly, the quarterlies and the whole, and I was like, are you kidding me? But then I said, you know what, I don't even want them to touch it. I knew that Brett's team would do it right, and it was more work for them but Brett's team immediately got in there, dug their heels in. The beauty is that they will work with us with whatever we have.

Lisa McCracken (11:40):

And that's hard because a lot of organizations can't pivot and respond. I mean, knowing tomorrow that you may or may not go into a place that that's, can operationally be a little challenging to execute. So, often there's the term, the low hanging fruit. So, when you think around about some of the fixes that need to be made, I would suspect above and beyond keeping the wheels turning, you gotta get people paid and so forth. And maybe some of your answers to this might be around accessing data and so forth, but are there some initial, like, these are the three common things we see and maybe you can comment on some of the HR workforce stuff and maybe operationally above and beyond that, Susie. So are there some just general common mistakes that people are making that really they're just maybe are keeping their eyes off the wheel or taking their eyes off the wheel?

Brett Landrum (12:26):

So if you start with labor, right? That's the big one. And it's generally two things. There's the talent acquisition, so how are we getting folks in, and particularly how are we getting our frontline team members into the community? And then the second is, how are we actually, what are we doing with the team that we have? How are we staffing, how are we thinking about staffing? And oftentimes I'd say what we see is there's no system or discipline around talent acquisition. So, it's great that we post on Indeed, but what are our expectations. What are the cis tools we're using to measure how quickly people are responding. Our team, as do we have supervisors that are actually scheduling interviews or applicants waiting for two weeks and whatnot.

Brett Landrum (13:13):

There's a lot of, I think, low hanging fruit around the talent acquisition process and execution. And then on the labor side, it's making sure we have the right systems in place that the data's credible 'cause we can be looking at a lot of the labor management data, but if it's not good, we're kind of, we're falling in the dark. Those are two kind of immediate things that we typically see as opportunities.

Lisa McCracken (13:44):

You're probably getting into the forensic HR stuff sometimes too, trying to figure out, alright, unravel some of these things, not knowing certain things you're getting into. What do you observe? Are there, your situations are obviously complex and you said there's variability, but are there common things? Like these are the top.

Susie Koenig (13:59):

Every situation is different, but there's staffing issues and every, every building. And listen, you wanna do the best thing, you wanna give orientation, right? You wanna do all those things, right? But sometimes you just can't do that. So we talk to facilities, we say get them in the door. Do we'll do a mentoring program where we'll do buddy systems where we will have a new CNA. We won't wait a week until they get into the orientation pool and sit down with a group. We will have them immediately go to the floor, work with some mentors on the floor, try to understand what's going on. Especially if you're hiring people that have experience. Right now, if you're hiring people without experience, that's a little bit different. But we see, I think the most part, facilities just don't take their time to teach and to train the employees to do the right thing.

Susie Koenig (14:55):

And I'm not just talking about CNAs and nurses. I mean, I am talking about the whole workforce and when we come in, we teach and we train and we even go into the dietary department and show them how to do portion control, show them how to cook, how to make things from scratch instead of going in and using all this frozen food, types of things and the recipes to really look at it and not have, and the CRCs and in the LFS numerous different, like four or five different health. You can't do that. You can have the always available, right? You can have, a substitute and then maybe a special. But you just, maybe years ago that was okay, but now , times that you've got to watch your food costs. You've got to watch your staffing, you've got to watch everything. I pulled the medical supplies while I was here yesterday from buildings, and I said, why are we using these expensive incontinence supplies when this facility, I can compare across the board.

Lisa McCracken (16:05):

And that's where you've got that perspective too, right? You can go in and say, well, that is not normal. That's outta whack. Or you're, it's, you have a low spend here, but a really high spend here.

Susie Koenig (16:14):

We had one group that was buying all these pull ups in extra large sizes that are more expensive and they didn't even fit the residents. So of course they had skin issues. Of course, there's all because of the lack of true knowledge and training. And the problem is you can't even get good managers nowadays. Forget about the people to work the floor. You can't get DLN's, executive directors, administrators. After Covid, even during Covid, we had good people. People were there, but I think Covid shot something in people's brain where they said, you know what? We don't need to do this anymore. And there's a lot of healthcare burnout.

Lisa McCracken (17:01):

So you live in the world of distress from any of that. That's the nature of your business. You see obviously a lot of that. And you have perspective over different cycles and we've been through different cycles in senior housing. The great financial crisis was the last one we had the pandemic and so forth. How is this time different? Maybe? I mean, what you're seeing?

Susie Koenig (17:26):

So I think from my perspective, I'm older, which gives me a little bit more perspective and more experience. And I can look at things now and really get it where, when I was working with older guys, because when I originally started in this industry, I was working with people that were 30 years my senior because I was moving up the trajectory. And I was like, how do you know that? How do they. And you know what? Age, experience. But it is so different. People don't talk to people.

Lisa McCracken (18:04):

So it's largely the staffing and people part of it, you think, I mean the regulatory environment, all that stuff's different. Obviously economics.

Susie Koenig (18:10):

I think social media has really made it so crazy in a good way and in a bad way. In a good way. We can go out there and post jobs and go on Facebook and do tiktoks and do all this fun stuff to get staff. And there's a lot of facilities that are doing that kind of thing. But then, you also have people in there talking about negative things that are going on with my mother, my father, my this, my that. And some of these people are doing it because, there's no tort reform in certain states. And to sue, they know if they're gonna sue, they're gonna get an insurance company to settle no matter what. So they're just, so they'll go on social media, and say things that are not even true. And how do you control that?

Lisa McCracken (18:58):

Your brand is being defined by other people in many respects too. And I think we would all agree that it is a more complicated business these days. You gotta understand and have that expertise.

Susie Koenig (19:08):

The supply chain. Who would've thought we'd have things sitting in the ocean on pallets not being able to get in? 'cause we don't have enough people to unpack. That never happened. People used to love getting jobs, but we don't have people that wanna work. People don't. I don't understand it. When I was young, had to have my family, I I had to be out there working, but now people wanna work from home. How do you take care of people from home?

Lisa McCracken (19:35):

That's tough in our business unless you're at the back office. So we've even talking a lot about some of the headwinds and the stress and you do noble work really for stepping in those difficult situations to really rightsize and turn the ship around. I wanna end on a positive note. Okay, let's dig deep here. So what are you most optimistic about? I mean, so there's headwinds, but there's some really significant tailwinds and opportunities. What are you optimistic about, Brett?

Brett Landrum (20:02):

When I think about the staffing shortage and crisis right now, it's not gonna end, it's gonna continue. But I think it's gonna force us to change how we think about the work that our frontline, our frontline team members do. I think we're gonna have to get more creative. I think we're gonna have to find ways to make it for them to perform more of the fulfilling, resident interaction and engagement. I think that the crunch is going to, while painful in the short term, like I think it's gonna provide some really good innovation, make us better and evolution of the industry. And I think it's gonna, there are solutions. I don't think we've figured out exactly what they are yet. But if we keep trying and failing at some point, I think we'll get the bullseye and I think the industry will be better off for it.

Lisa McCracken (20:58):

Okay. Put on your rose colored glasses, Susie. Let's hear it.

Susie Koenig (21:00):

Well, I think those, that's a great comment that you have to say because honestly, we've taken over now in the past three weeks, several large facilities and communities that are beloved in the community. And they just can't make a go at it. So what I've done is I've gotten out there and done a bunch of town meetings with the community and with families and with residents, and I never would've gotten people together. And I said, I need your help. And I made residents in charge, I mean, they love it. They want to belong. And it's gotten them more involved and it's gotten them to become more of a part of the community. And I would've never done that 10 years ago. But now we're trying to save them and I tell them, I need your help.

Susie Koenig (21:53):

And families, people are saying, what can we do? We just had this burger night at the Moose Lodge and they sold more. It was a not-for-profit that I just came, they sold more burgers than they've ever sold because there's also kids, this facility had an orphanage. And now there's a kids program there and everybody wants to help. Charity is important. And, and coming close to home is what's important. So we're seeing that we're looking at different ways to get people involved and bring in more of a community type of a thing. And getting our employees to be more vested too.

Lisa McCracken (22:36):

Right, right. I think at the end of the day, particularly in these difficult situations, the residents want to see the community succeed. The family certainly does, and the staff. So I think if you can harness that and maybe the next time we do this, we'll have, we'll meet at Burger Night at the Moose Lodge, NIC Chat's podcast On the Road at the Moose Lodge. So, we appreciate everyone tuning in. Thank you so much. This was a really good conversation. I'm glad we did this tag team. Thank you.

Susie Koenig (23:00):

There's so much more we could talk.

Lisa McCracken (23:00):

We could keep going, but we're limited. So thank you so much. You can check out this podcast on nic.org and enjoy the rest of the conference and thank you again very much. Thank you.