NIC Chats Podcast On the Road with Jennifer Adams

Lisa McCracken (00:03): 

Hi everyone. It's good to see you. We are in San Diego for the March 2025 NIC Spring Conference. We're so excited to be here today live for our NIC Chats podcast. I'm Lisa McCracken, the Head of Research and Analytics with NIC. Very excited to have our guests Smartlinx, and Jennifer Adams. Welcome. We're excited to have you here with us, and we're going to spend 30 minutes in a really great conversation around workforce and staffing related issues. But before we dive into the conversation, can you tell us a little bit about who Smartlinx is and then we'd love to hear a little bit more about your background and your role in the organization. 

Jennifer Adams (00:41): 

Absolutely. Well, first, thank you Lisa for having us. We appreciate it. So for those who are not familiar with Smartlinx, we are a workforce management technology and partner that is purpose built for the post-acute industry to work around workforce challenges. So we specifically build for post-acute and long-term care, and we've really been focused on this mission for over 25 years. My role personally is centered around being a consultative partner. So every week I have the opportunity to meet with executives in our industry and really gained firsthand insight on the challenges that they have around labor and staffing costs. And in these conversations, my goal is to work with the organizations and really shift the mindset about scheduling and show them how integrating scheduling with time and attendance in a single technology platform can lead to better outcomes for their staff, their residents, and really overall operations. 

Lisa McCracken (01:40): 

I appreciate the history and the legacy of your organization. So 25 years, I think that that contributes greatly on top of the fact that you are especially focused on this industry, which I think makes a big difference as opposed to, Hey, you know, we are a plug and play in a lot of different agency or industries and groups and so forth. So I know we're going to dive into a little bit more of what that value proposition brings to the table, but we definitely want to talk about some of the struggles that facilities have as it relates to staffing, certainly scheduling and where technologies and data and some of these platforms can really help dramatically. Not just from an operational efficiency standpoint, but we're going to talk about some of the expenses and the cost. 

Lisa McCracken (02:23): 

But before we dive into that, I want to take a step back a little bit and really think about the situation that we're in from a labor standpoint. I mean, we know at the height of the pandemic, there was a lot of just labor crisis, but really that was even coming, some of these pressure points were with us even before the pandemic. So, what do you see as we sit here today, some of the key things that are driving the challenges from a workforce standpoint that we see in our industry. 

Jennifer Adams (02:53): 

So we are seeing really like three key areas that are continuing to drive the staffing challenge. And unfortunately, some of them that you're talking about, the pandemic, are still with us. So first something that we are all really familiar with, unfortunately, is that we don't have enough caregivers. Demand for long-term care is skyrocketing and, but the caregiver workforce is really, it's shrinking. And something that keeps many up at night, even in conversations that I have with executives, is that by 2030, the U.S. will need millions more nurses and CNAs to meet the demand. So that's one area. The second area is rising labor costs and compliance pressures. So, you know, new staffing mandates, increased wages and stricter regulations are really pushing a lot of the costs higher. 

Lisa McCracken (03:36): 

Right. 

Jennifer Adams (03:37): 

And then the third is high turnover and burnout, you know, this is a big one. The average CNA turnover rate in our industry is 78%.  

Lisa McCracken (03:46): 

That's crazy.  

Jennifer Adams (03:49): 

Yeah, absolutely. And what that means is that facilities are constantly hiring, they're training and replacing staff, which also is expensive. 

Lisa McCracken (03:57): 

So there's the, you commented on just sort of the shortages issues, but then, there's the retention focus as well. And all of those really escalate the cost pressures. And I know we're going to get a little bit more into some of the compliance stuff too and that sometimes you understand the compliance stuff, but then they can have unintended consequences and so forth. So you do obviously work with direct caregivers and then you're in the post-acute space and so forth. But is this something that's unique to really that caregiver? Or are we seeing this across multiple positions? What's your observations and experiences on that front? 

Jennifer Adams (04:32): 

Yeah, that's a great question because caregivers, they're not the only ones affected. So picture this, it's, every shift, administrators and schedulers, they're kind of in crisis mode. A CNA calls at 6:00 AM a CNA calls and they call out for the morning shift. So now the scheduler's scrambling with and for what we see without a real time and attendance scheduling, a time and attendance platform, for them to really go and make quick decisions. They're left guessing, they're flipping through spreadsheets or, you know, having to pick up the phone and call to see who's available or using outdated schedules. And they quickly need to know who's available, who's qualified for this shift, who's not approaching overtime, who's not on PTO. So all of these things that they're scrambling to do and the financial impact, it's hitting facilities harder than I think that they realize because many facilities lack that real time visibility to get into staffing. And so the problem just keeps growing. 

Lisa McCracken (05:31): 

And you think about all those things that you mentioned. I mean, if you're on paper and pencil or maybe like Excel spreadsheets, I'll call it old school, that may not be what you call it, but that's what I think about it as. But like to have all of that knowledge in somebody's head, okay, oh, well, you know, Susie worked the night shift last night, we can't call her in or whatever. Like you said there's so many levers to think about and remember that if you don't have, I think the platform to help you do your job, I think you're going to have some natural barriers in that. And the burnout, my goodness. I think that would be a significant barrier to really effectively doing the scheduling and the time and attendance stuff.  

Jennifer Adams (06:11): 

Absolutely.  

Lisa McCracken (06:11): 

So I do want to talk about cost. I love numbers. And with the audiences here today and operators, that can be a very powerful, I think headline and so forth. So, do you have any stats in terms of really how much these inefficiencies and some of these challenges cost a typical facility? I'd be curious to hear what you guys have on that front. 

Jennifer Adams (06:34): 

Yes, absolutely. So we have several, and kind of before I get into that, what I would like to say is that I believe that most facilities really just, they don't realize how much these inefficiencies are costing them until they actually see the numbers. And so when we work with a current client or a prospective client, we provide what we call like a health assessment to really get a clear understanding of their hidden costs around their labor. So like you asked, let's take overtime for example if just one CNA works overtime once a week, that can add up to $11,000 a year per facility. And then if you can't find a caregiver to pick up a shift, then we see the agency overuse. And so in addition to that $11,000 per year, I just mentioned, replacing a full-time W2 CNA with an agency, CNA costs an additional $9,000 per year, and that's just one employee. So you multiply that across your team and you're looking at a major hit to your budget. 

Lisa McCracken (07:32): 

I hate to say use the word bleeding, but like really that's probably what you sometimes see by these inefficiencies with that scheduling and so forth, because that's significant. When you talk about one employee, multiply that by how many staff and so forth they have. A real quick on the agency side of things, how are you seeing the sort of the state of that environment? Is that mitigated a little bit or it completely depends on the facility? 

Jennifer Adams (07:55): 

We're seeing it vary. We're definitely seeing it lessen. We're definitely seeing a lessen from, you know, let's say two or three years ago. Even a year ago, I would say even a year ago, it was still quite bit, and we're starting to see it lessened. And one of the things that I'm noticing, especially when I talk with larger organizations is that a lot of them are creating their own internal staffing. 

Lisa McCracken (08:15): 

I think that's brilliant. 

Jennifer Adams (08:16): 

Or PRN staffs. And so they're being able to lean on that. But even in that case, with our technology, we're able to show them, here's your W2 employees. If these aren't available, here's your, where you can go to your internal or your PRN staff, and then here you go to your outside agency and what that looks like. But still being able to put that in one technology so you can see that, because again, if you don't have a proper technology in place that can manage, it still is difficult to even manage your internal staff. 

Lisa McCracken (08:44): 

Right. That is one of the things I've heard is like the internal agency thing, I use the word brilliant, I think they can be incredibly effective, but you’ve got to be smart with how you set it up too. Yeah. because you know, you don't want to cannibalize your own staff too, in terms of what they're getting paid. And often sometimes those agency staff are individuals that want to have more of a, maybe a part-time per diem type of arrangement. That's just sort of where they are. And that employee's always going to exist. So if you can match that up with sort of your internal staffing strategy, I think that's a win-win.  

So we're going to talk about compliance. I mentioned that earlier. We know we are probably one of the most regulated heavily, oversight industries out there and there are rules and regulations and requirements and so forth. And how does that play into some of the challenges? Does all of that compliance stuff put some order to things? Does it complicate it and it sort of create additional issues so I'm curious to know your compliance issues...I don't think we have any like state officials or federal folks from CMS not that I know of here. So go for it. What do you think? 

Jennifer Adams (09:56): 

Well, you're right, you're right. Compliance issues, they can make an already challenging situation even worse. So facilities that miss their PPD staffing ratios or fail to accurately report their PBJ data, they're not just dealing with operational headaches. They're putting their star ratings and reimbursements at risk. And the financial impact it's real. 

A one star rating drop alone can cost a facility $26,000 per year in lost reimbursements. So when we step back and we look at the bigger picture and we're walking an organization through a health assessment, the average post care acute facility could be losing over $140,000 alone per year in preventable labor costs. So going back to your question, compliance is just, it's not about just avoiding penalties. It's about keeping facilities financially strong and ensuring the best possible care for residents. 

Lisa McCracken (10:48): 

How much education do you need to do on that front? Do you find that most facilities are sort of on top of that and understand that, or they don't? Everybody knows if you're in the industry, you understand the five star and you should know the PBJ requirements. But do you think they understand the connection between the financial performance and, all of that with some of these compliance issues? I'm just curious to take in the temperature of the industry, how much education you guys are still needing to do on that front. 

Jennifer Adams (11:17): 

I think there's still quite a bit of education that has to be done. I think from the higher, from maybe a corporate perspective, you do understand PBJ more and what that does. But even there, sometimes you might have one person handling PBJ, but you might also not have somebody that is actually in charge of PBJ and they're pushing it onto the facilities. And the facilities, I believe in their head, understand that PBJ is important, but again 

Lisa McCracken (11:43): 

See the big picture of it.  

Jennifer Adams (11:43): 

They don't have the tools to be able to help manage that. So, you know, one, understanding it's very complex, I mean, it reminds me a little bit of the ACA back with healthcare reform and somebody having to truly understand what ACA means. PBJ is not something easy to understand. So what we try to do is help educate, it's just a very, a high level enough of what you need, but then let our technology and our processes actually be able to solve this for you so that, you know, your facilities aren't having to really be focused on that on top of all their other tasks.  

Lisa McCracken (12:17): 

You're doing the heavy lifting for them. So is most of your work with like the corporate offices and then supporting the individual facilities, or how much do you guys get like boots on the ground in the facilities? I'm just curious how you work with that. 

Jennifer Adams (12:27): 

A little different than maybe sometimes, and this is what we see with scheduling platforms. Scheduling platforms might work directly with the facilities. And you might have one or two facilities using this one and other ones using that one. So the way that we approach it is very similar to anybody approaching their HR, their payroll, their recruitment from a corporate perspective. So we work with corporate and then work to help push that top down because really the successful companies that we're seeing are the ones that are from a top level, they're buying into this and then they're helping push that down into the facilities. And then from there, because our technology is purpose built, we have an adoption program.  

So we then we implement and we work really closely with the facilities even for like the next 12 months to really make sure because we do understand that technology is only as good as it's utilized. So being able to put that time in with the facilities and the schedulers and really understand and make sure that they're utilizing and see, hey, are we, you know, we have metric and scorecard so we can see is this facility, you know, maybe they're still struggling a little bit with their overtime or missing some of this stuff around their PBJ, so let's get them on a call. And let's walk them through that.  

Lisa McCracken (13:37): 

That makes sense. because I can't even imagine you know, a multi-site organization like it just being different things being implemented in different communities so I can understand the top down approach. So we've used tech enabled and talked about technology platforms a good bit. So how does your platform specifically address some of these pressure points at the end of the day? And at the end of the day, it's about reducing the labor costs. 

Jennifer Adams (14:03): 

Exactly. In post-acute it's really common to see one platform for time and attendance, and then another separate one for scheduling, or maybe it might be a scheduling platform, it might be paper, it might be Excel. The problem is that these disconnected systems create gaps in your staffing visibility. At Smartlinx, because again, we are industry specific. I will continue to say that because I do think it's key. We build our technology and it offers a single platform with scheduling and time and attendance. Scheduling drives time and attendance. Separate systems that don't communicate and are not built for post-acute challenges, they just drive up the cost and they put, push budgets off track. And so with the right technology, like Smartlinx, scheduling drives time and attendance not the other way around. 

Lisa McCracken (14:49): 

Right. I think that that is so smart. I'm all about like metrics and have research. I like data information. So I'm curious to know how you track and measure the ROI of your platforms and I think obviously that's an important part of the implementation. So how do you guys look at that? 

Jennifer Adams (15:07): 

When we walk through a health assessment so like I explained to the health assessment 

Lisa McCracken (15:12): 

I love, by the way  

Jennifer Adams (15:13): 

Thank you. Thank you. So when we walk through a health assessment with an organization, we are really unable because we understand where these hidden costs are. And so we're able to uncover them around their scheduling and labor tracking purposes. And then we put a clear plan around how integrating this technology and our partnership can save them money. So a couple key areas to your ask that we do that is around real time visibility into open shifts available staff and overtime risk before they happen. 

Lisa McCracken (15:42): 

Is this like a dashboard? 

Jennifer Adams (15:44): 

So it does, we have dashboards, but the first step is putting these together, right. And being able to actually have the system provide this proactive information, which today is separated. You can't be proactive, you're reactive, you know, so accurate payroll data is another area that we can help with. Because it reflects now actual hours worked, reducing time theft and payroll leakage. PPD staffing ratios are met in real time, so that helps avoid penalties, which on top of it also wage PPD stays under control because now you're optimizing your shift coverage with the right mix of full-time, part-time, you know, agency if you need to at per diem. Another big thing that we uncover and solve for is that overtime is flagged before it happens. So that's gonna reduce those excess labor costs. And then the big one is agency. Agency reliance is minimalized. So by filling open shifts with internal staff first and then lowering the need for costly labor. So really all of these, they're just, they're difficult to achieve if scheduling is over here on an island or it's manual and not integrated with time.  

Lisa McCracken (16:51): 

I love hearing success stories and sort of vignettes about, hey, you know, this is what things look like when we initially partnered and here's how we were able to move the needle. Do you have any sort of little examples of where you've partnered with different facilities or organizations and say, we got from here to here and, and you know, it's a great success story. 

Jennifer Adams (17:11): 

Facilities that use our workforce management they usually actually see pretty quick measurable results in some areas. So 27% savings and overtime costs, and that sometimes happens within the first few months. 56% reduction in agency dependency which we're talking about. One of our clients even eliminated two years of agency reliance in just 90 days after implementing. We also see faster air proof, like PBJ reporting, so that helps protect five star ratings, which also affects your bottom line, which is sometimes not everybody realizes. And then what we've always talked about is the big one, it's higher staff satisfaction and lower turnover. Because again, now you're giving somebody an integrated solution to be able to do their job, which leads to a more stable workforce. 

Lisa McCracken (17:57): 

Right. So there is a cost to doing nothing. Any adoption of a technology, there's an upfront investment, there's a commitment, but there is a price to pay for doing nothing. What is your take on that? I mean, obviously that talks about the value proposition from all of you, but that's a reality. If you continue to do what you're doing , I hate to say you'll be out of business, but I mean the consequences are significant. So I'd love your reaction to that. 

Jennifer Adams (18:26): 

Yeah, I mean, it's huge. Again, when we look at our Smartlinx data, just over three years, a facility could lose hundreds of thousands of dollars due to staffing inefficiencies. And here's the reality, like anything, the cost of inaction is far greater than the implementation cost of Smartlinx. So, as I mentioned, a lot of facilities typically see a quick ROI within months, often just from reducing overtime and agency use alone. And that's even before factoring in like the time saved around scheduling or PBJ reporting. One of the areas that we often see really quick is around just schedule punch restrictions for early arrivals. Because now again, you have a system that if they're scheduled, that they actually should be punching in and they don't have to actually, instead of people just punching into the clock. So we have a larger client that we actually helped save over $1.1 million annually just in this area alone by being able to do that. So these numbers at the end of the day, the question isn't really whether you can afford to invest in this, into automating your workforce management, it's whether you can't afford to do it. 

Lisa McCracken (19:33): 

So if I'm an organization, and I am still, again, Lisa's term old school, I won't put that on you. You're marketing people are like, we're not using old school, but anyway, old school, for least there's a label. But I need to take that initial step and sometimes like that, that either decision or just like we, something's got to change. But they may have a long way to go. So do you have any thoughts in terms of like, what are some initial baby steps? Like how do I get started? How does old school Lisa get started if I'm in this position?  

Jennifer Adams (20:08): 

So old school, Lisa, let's start with a common challenge in post-acute.  

Lisa McCracken (20:14): 

Okay. 

Jennifer Adams (20:15): 

This one I get a little passionate about, so bear with me. But many organizations believe scheduling is too complex to automate, but in reality, it's not a technology limitation, it's a change management challenge. So the first step that I really try to encourage people to do is be open to learning how scheduling truly drives your labor costs and workforce efficiencies. In our industry, again, we put scheduling on its own island because traditional HCM systems that aren't industry, HCM human capital management. So HR, payroll, those traditional system that a lot of our industry uses for HR and payroll they're not built to handle the unique challenges and staffing that we have for post-acute scheduling.  

So as a result, organizations then they use these, they rely on these traditional HCMS and say, okay, let's also plug our time and attendance in it to manage it when in reality time and attendance in our industry is driven by scheduling, not payroll. So why is scheduling being left out here on this, on the, again, on this island. So it's really time to shift our thinking and recognize that scheduling is the foundation of labor management. And now without integrating it, we're missing controlling costs of the labor, optimizing the staffing and the compliance.  

Lisa McCracken (21:33): 

Staff buy-in is a big thing here. I've seen organizations they adopt this great technology or this platform and like people don't use it because there's either resistance, a lack of understanding. What's in it for me? What is your take on the staff buy-in piece, educating it for the what's in it for me? I'm sure you guys have to deal with that often. 

Jennifer Adams (21:55): 

One of the biggest concerns we hear is our schedulers won't adopt a scheduling platform. We've tried, they want to adopt it, but the issue isn't resistance, it's disparate systems and processes that they're being asked to do, you know, around scheduling. So a standalone scheduling system here, a spreadsheets or something over here to be able to manage that. And then they're tracking time and attendance labor over there, and it forces them to work in silos. Which leads to double the work it inefficiencies to proactively manage the costs that they're being asked to handle. And so frustration. So of course they give up, you know, imagine I got to create a schedule over here in one system, but then I have to go manually double check the hours over here into another one just that, you know, one simple task of that.  

So the initial steps again that I, you know, that I mentioned before is, first we must shift the mindset that scheduling is just an operational task. It really is a strategic function. And then back into that is the second thing of, you know, kind of going back to your initial questions of these baby steps on top of it is that you really have to truly understand your hidden costs.  

So this isn't always easy to do for organizations on their own and because we're post-acute focus when we work with that organization and create a health assessment of their hidden costs, it really allows them to understand what these disparate systems and staffing challenges are costing them. So we believe that the successful organizations that we see are the ones again, that I talk about that drive this top down corporate, top down. And so, you know, we encourage people, give us a call, let us do a health assessment for your organization. And that's a good step to just get a clear understanding of what this is actually costing your organization. 

Lisa McCracken (23:36): 

And I know we've talked a lot about the cost piece, which is huge. But we haven't spent a lot of time on the staff satisfaction piece because what you described as disparate systems is maddening, I think for the staff. So at the end of the day when you've got the integrated platforms that Smartlinx has, you're going to have staff that are just happier and less frustrated I think with their day-to-day job. 

Jennifer Adams (24:02): 

Well, listen, Lisa, the crazy thing is we do that for HR payroll, recruitment, they have a team, they have, you know, or you have a leader in there, you have a team in that, but our scheduling. And our time that drive our labor, our number one challenge is not. The successful ones we've see are the teams that have created either somebody that is a leader and over their workforce management or have created a team of their workforce management because they understand the value and how much that actually drives labor and how much it's actually costing the organization. Right, 

Lisa McCracken (24:32): 

Right. Yeah, I agree. I think sometimes it's an afterthought and not given the level of priority it needs to. So I'd just love to hear about what's on the horizon? What are you looking at next the year ahead? What's up for Smartlinx in the year ahead? 

Jennifer Adams (24:47): 

So like everybody, I think, we believe that AI is really going to create a significant opportunity. Kind of three areas that we're focusing on, around AI is the first to reimagine the user experience and workflow. The second is around reporting and insights. And then the third is around interoperability. So interoperability is crucial for scaling AI across our industry to improve collaboration and to make AI adoption more flexible and efficient. We work internally with our partners and our customers to explore all three of these areas. And it's great being post-acute focus. We love that. We also seek regular feedback through our customers, through our customer advisory board we have that's and also our product advisory board. And in those conversations, we highlight what's working, you know, what's needed, and then we take that and actively take it into consideration when building out our technology for the future. So, I mean, we're really excited for the future and continuing to work within our industry and continue to develop that and solve these challenges.  

Lisa McCracken (25:50): 

I love that sort of the, what you call the advisory groups or user groups. But because the reality is one of the things I do hear sometimes with certain platforms, it's like, it was developed, you know, 10 years ago and it looks the same as it did 10 years ago. I think as much as things are changing on the workforce side of things, the constant evolution is important in listening to your customer, I think is important.  

Jennifer Adams (26:11): 

And we learn so much. I mean, I call my customers all the time and I learn, I mean, I have customers who know our technology better than, you know, and just learn and learn and be able to take that and use those in conversations and continue to help our own product and our own company be able to develop and really solve for these challenges.  

Lisa McCracken (26:27): 

So before we tell people where they can go for more information on Smartlinx, are there any other hot topics like that we didn't cover? We got one minute left that you're like, I'd love to just share this with folks and I think it's important, you know, for them to think about. 

Jennifer Adams (26:42): 

No, again, I just think I can't say it enough, just really shifting our mindset. I think that we, in this industry we really need to shift our mindset about technology and how we handle that with labor and whether that's Smartlinx or it's somebody else, but really truly understanding how you've got to be able, able to bring time and attendance and scheduling together, and figure out how to be able to make that adopt. 

Lisa McCracken (27:04): 

Right. So you're here at the conference. Yep. Obviously a few of you. So if people do want to learn more about Smartlinx, where do you suggest they go? 

Jennifer Adams (27:12): 

Yeah, you can just go to smartlinx.com. S-M-A-R-T-L-I-N-X. I do like to, yeah, I like to throw out that at and you can reach out and again, we can do a free health assessment and help you understand some of those costs. 

Lisa McCracken (27:24): 

Perfect. Thanks for being here, Jennifer.  

We appreciate you listening to us. If you're interested in more NIC Chats podcast, you can find them onnic.org. Thanks everyone.