NIC Chats
NIC Chats
NIC Chats Podcast On the Road with Brett Landrum
Are you ready to unravel secrets to success with the senior living workforce? In this episode of the NIC Chats podcast, broadcast live from the 2023 NIC Fall Conference in Chicago, NIC’s Head of Research & Analytics, Lisa McCracken, discusses solutions to senior living workforce challenges with Brett Landrum, Co-CEO of Procare HR.
Listen in as they uncover the crucial elements of successful human resources strategies in senior care. Learn why Landrum believes it’s all about the basics, and discover insights on:
- Gathering key metrics that unveil your employee satisfaction.
- The future of on-demand staff vs. core staff in the senior care industry.
- The age-old debate: company wages vs. company culture – what really drives employee satisfaction and retention?
Tune in and gain the knowledge you need to help your workforce thrive in senior care.
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Good morning. Welcome to the NIC Chats podcast. We're excited you're with us this morning. We are here live in Chicago at the 2023 NIC Fall Conference. If you're not familiar with the NIC Chats podcast, this is about bringing forth interesting people, thought leaders in our industry to discuss hot topics and things of interest to all of you. In terms of introductions, my name is Lisa McCracken. I serve as the Head of Research and Analytics with NIC. And I'm here today joined by the founder and Co-CEO of ProCare HR. And we're gonna hear a little bit more about ProCare, Brett Landrum. So, welcome.
Brett Landrum:Thanks for having me .
Lisa McCracken:We're glad that you're with us at the conference here today. So, obviously workforce is a hot topic. I think there've been very few conversations here at the N IC Conference that it does not come up. So Brett and I had a chance to talk in advance just about your passion around this and solutions, and we're gonna dive into that. But I think the listeners would benefit from hearing a little bit more about the background o f ProCare HR so they understand a little bit of your background and experience.
Brett Landrum:Yeah, absolutely. I think it's important to start with the vision for our company because that really drives everything else, our people, our investments, strategy, etcetera. And really the vision for ProCare is about, I'll say answering the question, really what's the impact that improved HR outcomes can have on quality of care, resident satisfaction, financial results? And the answer is I think everybody anecdotally can say, well, geez , if we do this thing, this people thing better, right ? We're gonna have, we're gonna see those three areas improve, but it's to what extent and what are the actual levers that you pull that have the greatest impact? And so ProCare is an HR services company. We exclusively partner with organizations, serve seniors and folks with disabilities. Really full spectrum outsourcing for human resources. And how we think about delivering our business model. And kind of how we differentiate ourselves is it's really, how can we create an unfair advantage for our customers in the marketplace and really do that three ways. Number one is providing industry optimized HR services delivered really consistently and predictably. Number two is highly value additive. Tools really built specifically for senior care to help control staffing, costs , labor , address some of the labor shortage issues, etcetera. And then the third is how can we aggregate the data that comes from all of our customers and really give them really fantastic insights to drive better business decisions, people outcomes.
Lisa McCracken:Right. You touched on a number of hot topics that we're definitely gonna get to data, hot topics, and technology. So we're gonna spend a little time around that. But I first want to start off with you obviously have the perspective of you come into different communities, facilities, and, have a bit of an objective view. And I'm sure there are certain things that you see are common mistakes that organizations are making. So can you comment a little bit about hurdles that you see or organizations, mistakes that they're making that can be, I would say some maybe even lower hanging fruit or things that can improve from some of their HR strategies?
Brett Landrum:Yeah, absolutely. I mean, I'm gonna be really boring throughout this podcast because I'm gonna say the word basics like a hundred times, but really, it is about the basics. Like, own the basics. Be great at the basics. And that's like making sure that we're paying people correctly every time. We're doing a great job processing benefits. We're really leveraging our HR technology to the best extent so that our managers our supervisors, our leaders are getting really good insights out of it. Like we've got clear expectations, clear accountabilities, clear measurements for all of our different roles, leaders, etcetera. I think a lot of times we think there's some big winning move. It's like, hey, if I just figure this one engagement thing out, my world's gonna change.
Lisa McCracken:It's the magic wand, right?
Brett Landrum:Yeah. And it's like, there's no winning move. There's just not. It's having the discipline to really focus on and get good at: Hey, let's get really good at payroll. Let's get really good at how we support our technology tools that our clients are using or that our employees are using, etcetera. You know, I think it starts with the basics. And then when you do, when you execute the basics really well, that kind of earns you the right to be able to work on the strategy.
Lisa McCracken:Right. Because I would think that they garner trust your workforce too. When they see that, and you use the word discipline. I like that. Because I think often the teams get stuck in the weeds and it's the day-to-day demands, and you lose sight of some of those important elements on the workforce side of things. So , e xpenses have been obviously top of mind for organizations. A lot o f that relates to wages. But I think, a lot of the things you do t oo, really look at where t here are ways that we can have some cost savings with certain labor solutions. So talk to me a little bit about what that is and what that looks like.
Brett Landrum:Yeah. We embarked on this journey about two or three years ago, and frankly, shame on me maybe not taking my own medicine. We didn't have a whole lot of data. It was very anecdotal. But what we started noticing in our customer base is , we're coming out of this COVID time period where census is all over the place. But staffing's really short and as a result of those two, kind of those two forces, what was what we're hearing from our clients was look like we're not our at the site level, our executive directors and our schedulers aren't able to make the adjustments quick enough. When I go from "Hey, I'm perpetually understaffed, now all of a sudden my census goes up, how do I use, you know, how do I use that?"
Lisa McCracken:Right.
Brett Landrum:Or "How do I use those resources?" Or my census goes down but I've been understaffed for the last two months, so how do I think about making the appropriate adjustments I need to, and so, we've embarked on this journey of like how can we help operators do this better? And I think one of the fundamental principles of Schedule A, this business unit of ours is really like if something's critically important and you don't have a leader waking up every morning, and that's all they think about, and they're focused on it, like it's not gonna get done. And what we hear from our operators is that like, your eds and your regionals and your administrators, like, they're all supposed to be focusing on labor costs and managing that payroll expense, but they're also focused on quality and admissions and this thing and this fire. And so ultimately that doesn't get the focus that it deserves. So what we've really tried to do is build a model that's laser focused on managing payroll expense where we have seasoned operators, they wake up every day and it's, How do we support the schedulers? How do we support the eds? How do we support the regionals on knowing their data? But then, you know, really using that data to build the execution plan and driving better outcomes.
Lisa McCracken:Well, and I think you're getting to the point of the HR specialist, because if you go back in time, HR is a little bit of everything, right? They're doing everything. They're doing the employee of the month, they're managing benefits, they're , you know, all of that. And I think what you're saying is it's having those experts at their levels and being able to utilize that data for important decision making .
Brett Landrum:Yeah, a hundred percent. And it's focus . And I also think it's education. I mean, one of the things that's kind of surprising to me always is that we don't actually , we often , as an industry, I don't think we train the folks that are managing our P&L like the scheduler has got 40 to 60% of the expenses in the business. But like, do they really understand the tactical changes they can make to scheduling to have a really significant impact. Both on quality of care, on employee satisfaction, because, you're managing your staffing, you're more responsibly from employee experience perspective, quality of care, etcetera. And so one of the things that we've tried to do is use that data to then circle back to those schedulers and educate them on like, Hey, look, are we utilizing all of our full-time employees well? How are we thinking about scheduling PTO months out. Things of that nature.
Lisa McCracken:Right. Perfect examples of where organizations may not have the expertise or resources in-house to just navigate that themselves. So being able to supplement existing staff. So we talked about data, and I wanna talk about technology, and I know they're often intertwined, but , the role of technology as it relates to workforce and staffing. So what's your perspective on that, where we are now, and maybe where we need to go?
Brett Landrum:Yeah. So a lot of different people have opinions on where senior living's at or senior care is at as far as technology adoption. My personal opinion i s, I actually think the industry as a whole has worked really hard and driven towards good technology adoption. I've been impressed by the pace at which I've seen the industry and operators adopt.
Lisa McCracken:That's good to hear.
Brett Landrum:Where I think the industry is struggling and falls down is an execution and adoption throughout the organization. So it's like executives as executives, we say, Hey, I , we recognize the need for technology. It's how do you really get the throughput with all your leaders, all your teams?
Lisa McCracken:The buy-in piece.
Brett Landrum:Hundred percent.
Lisa McCracken:So is that , and I didn't mean to interrupt, but that's what I think of is I think of the buy-in, are there other obstacles? I mean, do you run, do you see infrastructure issues, things of that nature? And where does training come in with what all of you do?
Brett Landrum:Yeah. I mean, I think we're trying to use a lot of different technology platforms, and so, training is critical. Because you have lots of different folks in the organization who need to use the technology different for different purposes. And oftentimes these tech companies are like one configuration and implementation implementation rarely goes well. So that means you're shift , you're already shifting the burden of that exercise to the operator. But then, once the initial implementation's off the ground, all these different people have to use it differently to perform their jobs. So it's not just about like, Hey, go in and training on the system. It's about helping them understand. And I think at different levels in the organization, helping everybody kind of map the , how they use the tool into their workflow so that it's not like, Hey, here's a random tool. You gotta figure out how to work it into your daily routine and your life, and etcetera. It's, Hey, look, these are the workflows that you're following. Here's where the tool fits. And so then when you train you're training to that end.
Lisa McCracken:Yeah. And it's making the connection, what's in it for me? How does this relate to me? As opposed to this tool you're importing upon me. So , another related question. We're talking about sort of where the puck's going. So in , in these times, we've had to get creative about workforce tactics, models, and there's a lot of conversation around how do we need to think differently moving forward? So , because the workforce struggles might be here with us for a period of time, you know , shortages, retention issues and so forth. But if you had a crystal ball, what does this workforce need to look like in the future? And you can cover a lot of ground with that. I mean, who comprises the workforce , a variety of different things. But I mean, where do we need to be heading as an industry as it relates to workforce?
Brett Landrum:Yeah. I mean, I don't think this is anything terribly groundbreaking, but I think one thing is we as an industry have to do better at career pathing. Like period. We've gotta retain people, we've gotta keep 'em in the industry. And that's hard to do, right? When 70% of your workforce is unskilled or unskilled roles. But we have to get better at it so that we can attract and retain. I think we're gonna see the nature of work shift a lot. I mean, look like a l ot of the operators we t alk to, everybody's 70, 80% o r, you know, staffed at, 70, 80% of where they'd like to be.
Lisa McCracken:Right
Brett Landrum:So, when we get in the late twenties, early thirties, you're gonna have this huge influx of demand, but we're not seeing the workforce dynamics change. So we're already understaffed and now we're gonna have this huge influx of demand, we're gonna have to do senior care differently. My personal opinion is, I think you're gonna see a lot more remote monitoring solutions. You're gonna start seeing, how do we do more with less? Which maybe means, which actually could be a really good thing for the industry, because it may mean that like, Hey, we're gonna upskill some of these, you know, some of these unskilled positions so they can do more and kind of cover more ground because of how we can deploy technology into our buildings,
Lisa McCracken:Right. Yeah. And the future. Well, and you could argue that younger generation workers now, I would say demand some of these tech solutions, right? So if we're looking to generate, increasing workforce among the younger generations, we've gotta be on top of the data and the technology. You mentioned the career ladders. That's, and I think you and I talked about this in some of our previous conversations, the importance of scale. Yeah. That's where when you've got an organization that's a little larger, you can give some career ladders and some training in that regard.
Brett Landrum:Yeah. I think your point on the technology tools is a really important one. So maybe outside of senior living, like ProCare is going through this right now as an organization. As we scale and have had to look at how do we do better at being able to onboard train , and help our employees be really effective thinking about solving problems for our clients versus doing a bunch of manual things because we haven't built internal tools.
Lisa McCracken:Right.
Brett Landrum:And so I think one of the things that one of opportunities in senior care operations is to look at what are the tools that we're using and how do we make it easier and simpler, and how do we remove steps and I think that's a really big driver of job satisfaction that often gets ignored. Is what are the tools we're using? How simple are they to use? And do I feel like am I just doing a bunch of administrative work? 'cause the tools are cumbersome? Am I actually getting to step in and make a difference somewhere?
Lisa McCracken:Right. Because at the end of the day, a lot of people do come into this field because of , you know, particularly in the direct care staff side of things, the interactions with the residents and so forth and that direct caregiving. So if they feel there's gonna be things employed that are going to be difficult and distract them, from some of that's , it's difficult to adopt for sure . Are there other things that you would just comment on that we haven't talked about in terms of specialty things that all of you focus on? You know, common things that you see on your end of things coming into organizations?
Brett Landrum:Yeah. I would say maybe not necessarily specific just to ProCare, but you know, some lessons that we've learned in our own business and maybe some insights that I've been thinking about a lot specific to senior care is when we talk about going back to the basics and that really drives engagement. Like people talk about this like employee experience, employee engagement. Yeah. Like, what does that actually mean? And, and I think it's, how do those folks connect with the organization? And I think just really focusing on good solid management practices. And basics. Will does a lot of that covers a lot of more of that engagement ground than we give it credit for.
Lisa McCracken:Because , so the career ladder's great, but if you are advancing people that don't have the tools and the training.
Brett Landrum:Yeah, correct. Or if nobody knows, you know, what's expected of 'em or how they're measured or , what are the tools, they need to be successful, need to leverage to do their job well.
Lisa McCracken:How do you measure the employee satisfaction engagement? So what metrics do you look at to know, okay, so the staff seem more satisfied here with this because of X, Y, Z ?
Brett Landrum:Yeah, so, we have used E MPS,
Lisa McCracken:Which is?
Brett Landrum:Employee net promoter score.
Lisa McCracken:Got it . Okay.
Brett Landrum:And I personally like that a lot because you're benchmarking yourself both against other employer peers, but also you can get specific to the industry. It also looks at a number of different dimensions. So it's gonna ask questions like: Do you have a good friend at work? Do you have a close friend at work? And, how likely are you to leave for 10% more money? And it asks a number of different questions. So it gives you a lot of insight into your organization and how your employees are thinking and feeling. And things of that nature. but what we've seen when we've both at ProCare with our own internal employees, but also when we've done some of this work with customers, it is shocking how much, just like having a clear vision, communicating it well, disseminating information, having clear goals that we're all talking about, all moving, rowing the boat in the same direction, clear method in which we measure people, doing the basics of HR, j ust, h ey, process payroll accurately. It's amazing how much, just those really good solid business practices that are like really hard to do consistently day in and day out drives enormous i mpact on engagement and employee satisfaction.
Lisa McCracken:I wanna touch on communication because, you know , it's one of those things I think communicate, communicate, communicate. So I know I've seen reports come out for employee engagement reports, and there's a comment, we didn't know X, Y, Z, and the managers saying, oh my gosh, we've told them 20 times that. So have you seen any best practices on the communication side of things? Are we talking, some organizations I've seen have an app for staff, you've got newsletters, you may have meetings. What communication, what do you see works?
Brett Landrum:Yeah. So one, I'll preface this with, it's easy for me to sit up here an armchair quarterback. If you go pull all the ProCare internal staff, they're gonna tell you that we've got our own communication issues. Right. But I think more often not what we've seen is that it's not the little stuff, it's the big stuff. Like, Hey, where are we going as an organization? We're making this big strategic change. Like, Why are we doing it? Help me understand and wrap my head around, and feel bought into a part of that, part of that process. I think that those are the types of things that we hear and both quantitatively and qualitatively is it's usually not the little stuff. It's the more sweeping changes. It's where are we going as an organization. Why are we making the decisions that we're making. And again, I think those are things that if they're hard to communicate well because oftentimes, like this is a really fast moving business environment, right ? You've got AI, you've got, it is a lot of headwinds that senior care is still facing, I think getting a little bit better. And so executives are like, they're having to be really adaptable and move quickly. And so sometimes it's hard to slow down and kind of bring everybody else along. Certainly is for me, but I think it's critical.
Lisa McCracken:Right. So I wanna talk a little bit about the staff pool and again, I'm gonna largely focus on the direct care staff. So we've got your , the core staff, full-time staff, and we know in recent years there's been a lot of the agency staff usage that's been responsible and driving a lot of the expenses. But it's the agency staff or that on demand staff. And I'm not an expert in that, but I have heard conversations and people say, at the end of , there's always that individual that just wants to be the on demand type . They don't wanna be the full-time staff . Is that segment here with us, you know, long term or talk to me about some of those dynamics and what we're seeing. Do you have any observations?
Brett Landrum:Really good question. Yeah. I would like to know more than I do given our business. But, I think there's always going , there's always gonna be a place for agency. There just is, period. I think how we do agency is gonna change and transform Probably more towards kind of on demand type staffing. But I personally do not see like, I know there's been this, like it's , the idea has been kicked around of like Uber for caregiving. And I just, like I personally find that really hard to believe primarily because you need those caregivers, like, you know, trained and focused on your residents bought into your vision, your mission, and I just don't think you get that same impact, human impact. And quality outcome, etcetera. When you've got on d emand staffing versus a cohesive team that's trying to take care of folks.
Lisa McCracken:Right. And it's potentially sort of one strategy or one spoke of the wheel. There's a lot of conversation to around the non-traditional workers, older adult workers that gets more difficult at the direct care staff level. You know, obviously. But , yeah, it's thinking potentially differently. And I think it relates to that future conversation too.
Brett Landrum:Well , we're starting to see a lot of operators get creative and say, Hey, how do we create our own internal staffing?
Lisa McCracken:Yes.
Brett Landrum:How do we do on demand ? Like, rather than outsourcing and paying a premium for an agency, like, can we chain , that allows us to keep that cohesive team feeling. But we get some of the advantages of on demand flexibility, adaptability that you get from agency and some of these new organizations,
Lisa McCracken:Right. Yes, I've heard of that as well. And some organizations have had great success with the internal staffing agency. I think the trick there is to make sure you don't cannibalize your own staff.
Brett Landrum:It's hard. Yeah. It's really hard. 'cause it's ,
Lisa McCracken:You're like , wait, they're getting paid how much an hour I'm gonna go do that.
Brett Landrum:It's incentives, and so it's really like being intentional about how do you systematize it? How are you gonna roll it out? How do you communicate it? Back to communication, we have 10 buildings and I'm working at a building and I find out through another per , dietary aid, we found out from a caregiver that we now have an internal staffing pool, and those people are making $4 an hour more.
Lisa McCracken:Right .
Brett Landrum:I'm like, how do I feel about that? So your point about cannibalizing, I think that's a real concern.
Lisa McCracken:You need to be very smart and strategic, I think is what I've observed from a lessons learned standpoint. So, I think we're gonna wrap up with this question. Wages versus, and I'm not suggesting this isn't either or I'm gonna let you answer any way you want. Wages versus culture and sort of, you know, what trumps, what do you think ? You know, we've obviously been deploying a lot of the wage escalation in recent years and I think needed. Can you pay somebody enough if you don't have the culture? I mean, just talk to me about sort of the either and or proposition with that.
Brett Landrum:I mean, look, like , money works look at Amazon. Like, people love it or they hate it and there's a lot of people that stay there because it's, they can't afford to leave 'cause they're paid too well. Right? Amazon's a different world than senior care. Like we can't, I don't think I , maybe I'll go neutral and say it's not, not either or. It's an and and I think like, we have to be strong enough with wages. It's the balancing act. We have to be strong enough with wages, but like, we've gotta get better at the engagement and the culture and, you know, mission, etcetera. How we rally people around what we're trying to accomplish. But , look like, senior care is not large tech where you have 80% gross margins, and we can have crazy benefits and compensate people to that level. So I just, I think there's a practical financial barrier where like, we're never gonna be able to be so strong on wages that we can, you know, not work at the employee experience thing. I think it's gonna have to be both in every organization, depending where they're at in their life cycle , what their vision is, what their strategy is, is gonna have to figure out like, how do we think about compensation? How do we think about our value prop to employees where compensation fits into that versus this whole engagement thing. So it's a little bit of a non-answer to your question .
Lisa McCracken:I think it gets back to the discipline word that you used earlier, having the discipline to know, okay, when do we use the wage lever and how far can we go versus when we say no, you know, we need to deploy that capital into really working harder potentially onthe retention elements. You know, other things that you can choose outside of the pay.
Brett Landrum:Well, and I think what's important is making sure all the different elements of the strategy are congruent, and go together. And that's like, I think it's easy to kind of fall out of alignment in some of those different areas.
Lisa McCracken:Fantastic. Thank you for being with us this morning. And you've got a team of ProCare HR folks here at the conference. And , appreciate all of you being with us. Continue to pay attention to future NIC Chats podcasts and have a great rest of the conference.