Skilled Nursing
Articles
Q& A with Joshua Segal, SNF Exec Director & Administrator
March 12, 2024
In our Q&A series, we sit down with facility leadership at our partners in long-term care to get their insights on their top challenges, solutions, and successes in today’s environment.
What regulatory concerns keep you up at night?
While we await a final rule on the federal staffing mandate, it’s the Rhode Island staffing mandate that keeps me up at night. Rhode Island nursing homes are mandated to provide 3.8 hours of nursing care per resident. The state staffing mandate is essentially unfunded, and the mechanism by which it would be regulated is daily fines. It is estimated that it could result in some $60 million
annually in fines. Despite our best efforts to attract and retain the best and brightest, staffing is a finite resource; and highly qualified staff is a subset of that.
What strategies is your facility using to contain costs?
Labor is a big expense, but we are fortunate not to rely on pool or agency staff, which is a big cost for many organizations. We focus on recruitment and retention and having dedicated staff for our facility. Costs for office supplies and other things that get used on a daily basis add up as well, so we have made an effort to become more paperless and focus on those efficiencies.
We also leverage the relationships with our partners like PharMerica, who we lean on to reduce pharmacy spend through efforts like global authorization, split billing on resident discharge, and constant review of medication regimens to eliminate the use of unnecessary medications.
What specific initiatives or best practices have you implemented to enhance care quality? What are other opportunities to improve quality ratings?
In the past year, we have pursued and achieved several facility-wide certifications. We received National Certification Council for Activity Professionals (NCCAP) certification, and we now are a certified person-centered care community, which ensures our staff have the knowledge and skills to deliver physical, mental, and psychosocial support to residents. Additionally, through the Alzheimer’s Association, we have facility-wide dementia certification.
Beyond these things, we have a strong QAPI process. We have monthly meetings to identify and
stay on top of issues early on and come up with creative solutions. We go above and beyond what is required. We also have successful initiatives around falls and altered diets. More and more, we have people coming in with special dietary needs and preferences, and we work as a team to come up with solutions and ways to satisfy everyone.
How is technology playing a role in nursing homes, and what innovative advancements do you see on the horizon? What technology has your facility adopted and why?
There are a lot of exciting things happening around technology, especially Artificial Intelligence (AI). We have AI software that integrates with our EMR system and extracts metrics such as vital signs and key data from medical notes. This provides an additional set of eyes to support nursing staff. We also are seeing incredible innovations such as robotics that patrol halls and spot fall risks/
hazards. And we are seeing some wireless devices on the wall like a thermostat that monitors residents’ vitals via a bracelet they’re wearing.
What key lessons did COVID-19 teach nursing homes about infection prevention, and how do you envision these lessons shaping the future of the industry?
At the beginning of pandemic, we had a lack of supplies and resources. We have come a long way,
and there has been so much growth in that area. At the same time, we have demonstrated the ability to adapt when there is an outbreak of some kind. When COVID happened, we saw one infection and, before you knew it, there were dozens more. Now we are at a point where we can mitigate and contain outbreaks; and that speaks to our commitment to education and constant reinforcement and support for our nursing staff.
What are your strategies to retain staff and leadership?
There isn’t any substitute for competitive benefits and wages, which I think comprise the foundation to attract and retain good staff. We also encourage staff’s growth through professional development. As a nonprofit, mission-driven community, we find that an environment like ours, where people dedicate their lives to caring for others, makes a difference in employee satisfaction.
Lastly, we have partnered with some community education centers so we host students, and that has been a successful track to help us secure employees. As they graduate and obtain their licenses, they often will come back to us for positions.
How would you describe your leadership style?
I believe in management by walking around. You can’t effectively run a nursing home from behind a desk. I interact with staff, residents, and families every day. It’s important that they see that they’re supported from all levels in the facility. I’m also a big proponent of customer service. I consider this to be the 6th star in the 5-star rating system. I always tell staff that we fill a very important role in the community because no one chooses to come to a nursing home. They come to us because they can’t care for themselves and have no one to care for them; so it’s up to us to step up and make a positive impact in the lives of those we serve.
What tips do you have for other administrators based on what’s been successful in your organization?
Be visible in the facility. Let staff know they have your support and focus on customer service. It is
important to tackle challenging cases and situations head on. I look at these as opportunities to step up and improve the ways we deliver our services.
Whether at the local, state, or national level, there are opportunities through healthcare associations and other partners to band together, make phone calls, send letters, etc. – and that consistent message about the challenges we face can help us drive change.
Looking ahead, what are your hopes and goals for the nursing home industry?
We will continue to focus on attracting staff to serve the geriatric population, and I expect to see continued improvement in quality of care with a person-centered emphasis. As we see more baby
boomers in long-term care, they will have different needs and wants in terms of amenities and services; and we need to adapt to meet those needs. I hope we will see more support and recognition at the national level, particularly from legislators, recognizing the important work that goes on in long-term care and providing their support with resources and reimbursement.