Kingda Ka, at New Jersey’s Six Flags, is the world’s tallest, most terrifying roller coaster ride. It comes with a warning: “Not Recommended for Wimps.” Seconds after take-off, you’re hurtling 128 miles an hour toward a 90 degree vertical, 45 stories high, then catching your stomach in time before “free-falling” into a 270 degree spiral. And that’s just the first few minutes.
Riding the twin rails of Patient Driven Payment Model (PDPM) and a global pandemic can feel a little like the rehab industry’s version of Kingda Ka. Definitely not for the faint of heart …
Navigating the ride
Our senior care industry is tough and resilient, but PDPM, COVID-19 and more changes ahead, will certainly leave company casualties. To help minimize the impact, industry leaders like Consonus Healthcare, a contract rehab and long-term care pharmacy provider with 100 facilities across the U.S., and its parent company Marquis, offering post-acute rehab, assisted living care and I-SNP [Institutional Special Needs Plan] services across the Pacific Northwest, are sharing insight on what’s working.
Noteworthy, data-driven results include:
- Consistent quality in patient outcomes and experience, despite the challenges of PDPM and COVID-19.
- Consistent pricing, even with additional costs.
- Employees feel protected and financially stable.
Here are six proven strategies to help navigate this dynamic time in senior care while helping patients and employees feel safe and secure.
1. Prepare to pivot
Early on, Marquis Companies and Consonus Healthcare’s strategy-minded CEO and fourth generation owner, Phil Fogg, asked every employee to embrace one word: Pivot.
“These are unprecedented times and there isn’t a playbook for the challenges we’re all facing,” says Fogg. We need to constantly look ahead, access what’s working and what’s not, and, when needed, quickly pivot. As an inudstry we are in this together and we feel a responsibility to share our learnings and best practices with other senior care providers. The health and safety of the residents and patients we all serve demands that we all work together for the greater good.”
2. Identify your core guiding teams
Q: Jonalyn, you say it all began with creating what sounds like a special ops team.
The ability to navigate change starts with communication and collaboration. We found success in developing a special ops team for PDPM, then COVID-19. For PDPM, we started nearly five years ago, meeting every quarter to discuss the future of reimbursement. Not knowing what model would be chosen, we just planned for each one so we could quickly deploy our plan. Then we identified leaders who would bring value to the process. With any big change, you need other perspectives — not just your own — to help you see potential barriers and avenues for success. We picked people from different teams. In our case, there was representation from therapy, pharmacy, skilled nursing, home health care and others. And we chose people with a variety of personality types: people who can make quick decisions, some more thoughtful and strategic, some more data driven, and others more financially focused.
Then we pulled in marketing — one of the most critical pieces of our plan. It’s really remarkable what they’ve been able to accomplish. It’s important to proactively communicate during a crisis, or the lack of transparency and information can fuel misinformation and confusion. We created an internal communication team that focused on all of our employees, residents, their families as well as our external partners. We reached them through email, social media and video conference.
That guided a similar process in our rehab division. This approach proved particularly critical during the rise of COVID-19 outbreaks where we were able to quickly deploy our plan, giving all our stakeholders’ peace of mind through webinars, emails and video messaging.
3. Protect your employees and residents
Creating a dedicated team with clear roles and responsibilities as the beginning of the COVID-19 outbreak assured employees and residents that their health and safety was a priority. It also enabled us to move very quickly and we had the support of our CEO, Phil, who said to us all, “at any cost to the company, we need to keep our residents and employees safe.”
Immediately, he asked our leaders to secure PPE [personal protective equipment], check inventory systems, create a clinical team with specific procedures and training for this kind of infection control. Both Marquis and Consonus teams have great relationships with our partners which helped us with our PPE acquisition. For instance, our partner who supplies our uniforms told us they could secure additional PPE, and even had space to become our warehouse where we continue to resupply.
We’ve been quick to pivot to any CDC requirements, reducing exposure through the four pillars: PPE, hand hygiene, social distancing, and testing. We’ve implemented new infection control policies and changed our staffing models to reduce unnecessary risk of potential exposure. For example, we reduced the number of therapists working in multiple sites. Through some furloughs at facilities impacted by COVID, we adjusted the amount of staff entering the facility to meet exact patient care needs and reduce risk of exposure.
Prior to COVID-19 we delivered an average of 75 minutes a day of therapy seven days a week. During COVID-19, due to the importance of dedicating essential staff to a facility and the limitations of requiring treatment in the patient’s rooms, we saw about a 20% reduction in our therapy services. Despite this decrease, our data shows that we’ve protected the patient outcomes and their experience. And with the concerns surrounding social isolation due to visitor restrictions, the positive attitude of the therapists has frequently made therapy the highlight of the patient’s day.
4. Collaborate with existing and new partners
Leverage existing and engage new partners to support your efforts. You don’t need to reinvent the wheel. First, look for your existing partners. For instance, Consonus Rehab has an advantage in being affiliated with Marquis Companies. It’s a fourth generation post acute provider with experience managing and navigating a crisis situation. We collaborated closely with them to leverage their knowledge and strategies, and then shared that with our customers.
I recommend companies reach out to all partners — your pharmacy, therapy, industry peers, your associations. Ask about resources, advice, best practices and infection control policies, labor and staffing models and PPE sources. Keep those communications flowing with updates and best practices. Many of our customers are leaning on us as trusted advisors for basic procedures and policies. We love sharing information with them through our routine emails, webinars and informal conversations with key customers.
Good, long-standing relationships allowed us to secure PPE and testing support early on in order to maintain compliance with new requirements. We’ve been able to adapt to each facility’s unique policies and procedures and support those in dire need.
5. Develop an internal and external communications plan
At first, no one really knew how challenging PDPM would be and COVID-19 continues to be. However, our goal is always total transparency with our employees and partners. We identified the internal and external audiences and were thoughtful and intentional about how we communicated.
Because of our financial stability and focus on data and technology, we were able to create a supplemental income policy early on for any employee affected by fewer hours.
We did that for the first six weeks, then realized that COVID-19 wasn’t going away anytime soon. We had to pivot. We began planning temporary furloughs, allowing those affected to tap into benefits from unemployment and the CARES act. We also committed to continuing their health care benefits. Salaries for other employees were not cut and we offered a return to work bonus to minimize the financial impact.
We wanted to ensure affected employees heard from us first and understood why decisions were being made. Our internal guiding team identified appropriate messaging and impact. Our legal representation made sure we were following labor laws. Then our leadership teams called each employee and we followed up with consistent messaging to the organization via video conference and a private message from our president. I’m so proud of our employees, and truly believe they felt supported and informed.
6. Continue to celebrate your company’s culture
During a time of so much change, it’s easy for fear and toxic thoughts to enter. So it’s really important to refocus on the key elements of your culture and stay engaged. We’ve always loved celebrating the stories of our residents and employees. We do that in a variety of ways, through social media, enjoyable competitions and our Fun Fridays. We’ve also launched a three-part Positivity Campaign as a rallying cry to support our residents and staff. We want everyone on the frontlines and in isolation to feel they are loved and supported. Our virtual visits include training for families on how to use the platform. Through it all we’re remaining positive, thankful, and collecting so many fun stories for our residents, employees and partners.
In summary, our industry has learned some valuable lessons that will help us in the future: The need to plan early, pivot fast and be extremely thoughtful on how we operate — infection control, collaboration, partnerships, communications and building trusted systems that make change easier. I know we’ve experienced an even deeper level of understanding, respect and trust for our partners. We all need to lean in and embrace change. The future of rehab is yet to be determined by COVID-19, but the value of rehab is really up to us to define.
Jonalyn Brown is vice president of operations for Consonus Health. A sought-after speaker on long-term care, she’s responsible for developing and implementing Consonus rehab services nationwide. She earned a master’s degree in speech language pathology and specializes in lean management and leadership development. She serves on the National Association for the Support of Long-Term Care and remains active with the Oregon Speech Hearing Association. Visit Consonus Healthcare’s live PDPM Hub and COVID-19 Updates to learn more.