STAFFING STRATEGIESTO GET AHEAD

10 Tips to Accelerate Success

Quality Measures Spotlight Staffing

SENIOR LIVING 2025: A ROADMAP

Payment Shift For Quality Care

• Category 1– Fee for Service (FFS) not linked to

value

• Category 2– FFS linked to value

• Category 3– Alternative payment models built

on FFS

• Category 4– Population-based payment

Historic Performance

Goals

Largest Expense Getting Larger

• Proposal to increase minimum pay threshold of overtime-eligible workers– From $455/wk to $970/wk

($23,660/yr to $50,440/yr)

• Minimum wage on the rise– LA & NY mandates minimum

wage of $15/hr by 2020

Wage Increase Study• 110 unit AL with 55 FTEs• Increased entry-level

wage by $1.50/hr

Results• 10.2% Increase in annual

payroll • 4.5% Increase in total

expense• 3.4% decrease in net

operating margin

Payroll-Based Journal • Quarterly electronic

staffing & census data • Widely believed to be used

in Five Star Quality Ratings• Voluntary submission

begins today!• Full implementation by July

1st, 2016

Focus On Staffing Transparency

“The inclusion of verified staffing

information based on payroll data is especially

important, as staffing levels are often the best

proxy for quality.”

Cheryl Phillips, M .D .Senior Vice President of Public Policy

and Advocacy, LeadingAge

Payroll-Based Journal Submission Details

• Direct care worker information – including agency & contract workers– Unique ID

– Hire & termination date

– Pay type code (Non-exempt, Exempt, Contract)

• Daily hours worked by employee– Include job title code for services provided

• 37 codes have been provided by CMS

• Census on the last day of each month, broken down by primary payer (Medicaid, Medicare, Other)

All staffing hours worked must be

able to be verified through payroll, invoices and/or tied back

to a contract

Achieving High Quality

“Staffing is one of the strongest determinants of

long-term care quality.”Better Jobs Better Care Practice & Policy Report

Labor is the major area where organization leaders can exert control to:• Tighten spending• Streamline

resident/patient care

• Boost efficiencies

Prioritize Staffing & Labor Management

10 Tips To Accelerate Success

• Begin budgeting early & engage employees in the process for appropriate line items– Provides a deeper

understanding of decisions– Allows management to take

ownership of budget decisions, making them accountable

• Discuss overarching goals • Allow management to devise

an execution plan Bottom-Up Budgeting

#1 Involve Middle Management In Budgeting

• Plan for the future– What will your business needs

be in the future?

• Professional nurses in your area– How many will be in the

market in two years, five years?

• Universal workers – Will it work in your

organization?

Projections Matter

2.5MAdditional Workers

Needed to provide long-term care to older adults

in the United States between now and 2030

- Research from University of California San Francisco

Analyze Your Staffing Rating#2• Benchmark your rating against competition • Identify the thresholds and what it would take to improve your rating

• RNs matter - changing your skill mix may improve your star rating

* “SUMMARY OF THE CHANGES TO FIVE STAR ANNOUNCED BY CMS,” AHCA, 2015

• Identify & classify all direct care staff in accordance with CMS codes

• Assign primary role for each employee & shift

• Define data collection processes– Contract & agency work

– Corporate staff at a community

– Salaried staff

• Understand what hours count, what doesn’t– Ex. If a salaried employee works 10

hours but is only paid for 8 hours, only 8 hours should be submitted

• Conduct an internal audit

Get PBJ Ready

• Identify key staffing metrics for:– Labor budget adherence

– Cost control

– Hiring

– Staff satisfaction

• Speed & timely analysis of data is key for success– Predictive analytics is ideal

– Real-time information is a must

– Historic data has little value

#3“Measurement is the first step that leads to control

and eventually to improvement. If you can’t measure something, you can’t understand it. If you can’t understand it, you

can’t control it. If you can’t control it, you can’t

improve it.”

- H. James Harrington

Implement Data-Driven Decision Making Processes

• Management must be kept informed – Get data visibility across

buildings

• Integration of disparate staffing systems is important

• Provide transparency to staff

Gain Insight To Information

• Know where you stand• Evaluate staffing requirements every

shift to meet HPPD/PBJ/Five Star staffing goal– Historical HPPD reviews – too late to

fix the problem

• Flex staff as needed– Cancel shifts or call in staff as needed

– Re-allocate staff to direct care positions – be sure this is documented

#4 Align Schedules To Meet Staffing Goals

Allow For Activity

• Evaluate potential activity in advance– 1 day ahead

– At the start of every shift

– Review trends, patterns

• Manage high activity like an employee absence– Establish a policy

• Identify potential replacements

• Utilize your float pool

• Consider non-overtime employees first

• Share extra shifts fairly

– Balance within existing staffing levels

Get Predictable & Proactive

• Keep management informed– Alert management when

approaching staffing risk

• Communicate open shifts to all available & qualified staff members

• Correlate labor staffed to needs based on estimated future census

• Consistent Assignment– Educate staff, residents,

families

– Consider “best fit” pairings

– Make contingency plans

– Don’t overload high acuity cases

– Continually monitor & assess

#5 Tighten the Resident/Staff Connection

Key Benefits of Consistent Assignment

29% less turnoverAfter 1 year of using consistent assignment Campbell S. “Primary

nursing: It works in long-term care.” Journal of Gerontological Nursing

• Career ladders• Engaged daily huddles• Mentor aides• Scholarships & internships• Competency education &

training– For ALL LEVELS of

employees

#6 Focus On Engagement

Monitor Satisfaction & Performance

• Survey your staff– Rank issues

– Put a plan in place to address

– Execute!

– Re-evaluate & repeat

• Reward & Celebrate– Above & beyond performance

– Staff tenure

National Research Corp.SNF with a high rate of

employee satisfaction have fewer survey deficiencies and

a higher Five Star quality rating

Top 2 drivers of resident and family recommendation are

both related to employees — care (concern) of staff and

competency of staff

Engage Employees In Scheduling

• Give staff more control over their schedule

• Identify work preferences & availability

• Make scheduling transparent• Offer convenient mobile

access• Work in repeatable schedules

“It’s so convenient to have my schedule on my

phone. It’s great!”Senior Living Communities

• Less turnover• Higher quality care & service• Better resident & family

relationships• Higher financial performance

Key to Success

147% higher earnings per share

Engagement Pays Off

• Adjust to census change• Reduce unnecessary extra hours/shifts

Eliminate Overstaffing

• Get predictable• Call-offs: go to non-OT first• Understand what causes your OT

Control Overtime

• Look out for clock riders!• Compare punch ins/outs with schedule• Adjust throughout the day

Minimize Punch

Variances

#7 Manage Unnecessary Labor Costs

Significant Cost Savings

Overscheduling Reduction Annual Savings, Single Facility (100 beds)

.1 PPD $75,600

.2 PPD $151,200

Overtime Rate Reduction % Annual Savings, Single Facility (100 beds)

1% $24,000 – $60,000

5% $120,000 - $300,000

“What proved to be even more exciting was that I turned around and

reinvested $1.8 million of those dollars back into the centers’ staffing models to enhance my nursing hours

per patient day and increase my professional nursing staff mix.”

Dale Zaletel, Senior Operations Consultant, Post-Acute Strategist & Former CEO of Lexington Health Network

REACTIVE HIRING• Examine labor budget variance, agency use & overtime

• Map gaps and excess costs to current schedules – determine where/when

staff is needed by position

cite employees leaving triggers the

hiring process*

50%* “Workforce Insights: Get Ahead” OnShift & McKnight’s Long-Term Care News, 2015

#8 Manage Your Roster

Assess Staff Utilization

• Use underutilized staff to plug holes– Measure hours staff are able to

work vs hours worked

• Consider employee’s schedule preferences– Make adjustments to employee’s

schedules that have indicated they’d prefer to work different shifts

• Hire for the shifts that are left– Consider part-time and PRN mix to

add flexibility

• Engage your employees to identify process improvements within workflows– For Example: Conduct a two

week time study on MDS staff with data collected on work performed.

• What are findings? Recommendations?

• Identify most time-consuming processes

#9 Examine Productivity & WorkflowsBefore

Use QAPI Tools To Assess Problems

• To access tools and resources visit CMS website: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/nhqapi.html

• Too many moving parts with information in multiple systems to do this all manually:– Integrate hiring, scheduling, time-

clock, clinical systems

• Software can provide the needed insight to get predictive & proactive:– Identify positions to hire

– Meet PBJ/Five Star staffing goals

– Automate scheduling & labor management

– Staff to resident need, acuity levels

#10Utilize Technology

After

Key Benefits Of Proper Staffing

• Positive outcomes & better service• Lower hospital readmissions

Higher Quality Care

• Higher occupancy, more post-acute residents• Higher quality & reimbursements

Revenue Enhancements

• Higher ratings based on staffingFive-Star Rating

• Improved customer & family satisfaction• More engaged staff and lower turnover

Higher Satisfaction

• You have a better story to tell• Attract new families, residentsMore Marketable

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