Which “Struggle Bus” Are You On? Census? Staffing? Both?

 In Preparing for the Future, Reducing Employee Turnover

The COVID-19 pandemic has rocked the world of healthcare. Its impact has affected so many facets of the entire healthcare system – starting with hospital overloads and their ripple effect on care provided at other facilities as well as at the homes of patients.

My colleagues at Transcend and I are in continuous contact with providers of non-hospital care (with an emphasis on senior care) across the nation. Whether they’re a client, a prospect or comrades-in-arms trying to cope with the new parameters triggered by the pandemic, virtually all of them are wrestling with one of the challenges discussed below. When my daughter is dealing with difficult circumstances, she likes to say she is “on the struggle bus.” I can relate!

Do any of these conditions feel familiar? Which “struggle bus” are you on, along with thousands of your peers in the industry?

The struggles are real.

Lower census. When many hospitals started discharging multitudes of patients nationally to handle the COVID surge, post-acute care providers may have expected an influx of new patients. A few of our hospice clients experienced a substantial uptick in census at first. Few of them sustained that growth. Plus, a variety of ripple effects started to happen. COVID outbreaks in nursing homes made families wary of placing loved ones in skilled nursing centers or even assisted living facilities. Hospitals postponed non-emergency surgeries, so home health providers lost a lot of rehab business. Fear of COVID prompted many families to not allow any home care providers into their houses. As the Delta variant caused a new wave of sickness and fear, many providers who lost census at the beginning of the pandemic have yet to recover.

Staff shortages. A persistent plague that’s pounding all kinds of businesses has hit healthcare particularly hard. As reported widely in the media, legions of professionals and laborers in practically all industries have left the workforce – at least temporarily. The COVID-19 Relief Bill enabled people to survive financially without going to a job. The urgent demand for workers sparked hefty increases in hourly wages … meaning that paychecks for positions such as CNAs that require education and training were being matched or exceeded by low skill jobs such as fast food servers. The migration of workers out of healthcare positions left remaining staff feeling overworked, underpaid and burned out – prompting others to leave the industry in droves. As competition for staff skyrocketed, especially for highly trained positions such as RNs, larger providers offered hard-to-resist sign-on bonuses. I’ve seen a couple of sign-on bonuses as high as $30,000 for RNs. Smaller providers can’t compete as everyone in healthcare is vying for the same shrinking talent pool.

Both census and staff challenges. The double whammy is when providers have experienced significant drop-offs in both census and staffing. And it also brings up a dilemma for recovery. If providers are short-handed for staff now, do they dare grow their census with the risk of not having staff coverage for quality care – especially if they grow back too quickly?

Some thought-starters for solutions.

Grow Icon

Growing census. Providers must rebuild trust while giving patients, families and referrers alike great reasons to entrust care to their expert teams. While a robust debate continues about COVID vaccination mandates, having one in place can help assure families that care providers are doing all they can to keep loved ones safe. Consistent and continuous communication about other safety protocols being followed by facilities and policies for professional caregivers entering patients’ homes also help instill confidence.

Another major factor is for providers to define and differentiate themselves as to why they should be a family’s or referrer’s top choice for patient care. Multiple national surveys by Transcend Strategy Group have shown that key target audiences just don’t know the difference among providers. Surveys of more than 25,000 family healthcare decision makers report that, on average, fewer than 10% can come up with the correct brand name of home-based care providers with unaided recall. A recent survey of physician office managers said a staggering 81% see little or no difference in the quality of senior care providers in their area. Another recent survey of hospitalists echoed that 72% see little or no difference among senior care providers.

So how do you differentiate your agency? The most meaningful way is with relevant data. Prove the quality of your care with quantified outcomes. Report on results that are top priorities for your referrers and payers – outcomes such as fewer ER visits, reduced hospital admissions and readmissions, and patient and family satisfaction scores. Tailor your data to the specific interests of each audience. Make the appeal of the care you provide irresistible by aligning your outcomes with the goals of your patients, families and referral partners.

Strategy IconRecruiting and retaining staff. As you well know, healthcare is really hard work. Without deep passion and compassion when it comes to caring for seniors, there are many other easier roads to similar or even bigger paychecks.

The key is developing and nurturing a culture that is purpose-driven – an agency where every team member is driven by the “why” of your organization. Transcend recently delved deeper into this topic in another blog post, “Developing an Engaged Workforce: A Proven Framework for Retaining Staff and Building Competitive Advantage.” If you missed it, check it out when you have a moment.

In addition, a strong culture can be the most important differentiator of all for your brand. Because your brand is your culture. Your team members are the representatives of everything your brand stands for, every day. And your culture is one factor that your competitors can never truly duplicate.

Erik Madsen, CEO of Home Care Pulse, summarized it well: “Turnover rates will continue to improve for agencies that invest in company culture, treat workers with respect and double down on their mission of caring for seniors.”

Heart IconDeepening the connection between patients and provider purpose. For those facing the dual-edged sword of growing both census and staff, you have an ideal opportunity to develop them in sync. Hire staff who share your values and want to contribute to your mission. Train them in maximizing the metrics that are meaningful to your audiences as you deliver first-class care. The performance of your staff will differentiate your agency and attract more patients. The opportunity to enrich more lives of seniors will attract more talent looking for that fulfillment. And thus can the cycle continue.

The challenges you and your peers are facing in the healthcare space can be daunting. I hope the thoughts shared in this article can help provide a renewed mindset as you seek solutions that are right for your organization. May you soon be able to pull the cord and signal that you’re exiting whatever “struggle bus” you’re on.

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