Sara Well spent 12 years as a critical care trauma nurse on the acute side. She watched again and again as her facility’s money was put into much less pressing issues than staffing and saw how it impacted not just care and quality outcomes but overall revenue.

She saw how archaic many of the systems in place for staffing were, and with her tech background realized that this comprehensive issue was a scalable solution with a huge addressable market. 

Nurses are often perceived as a cost rather than a revenue driver. They have been historically under-appreciated despite how much their presence and work directly impacts the length of stay which is not always covered by insurance.

The flaws already present in the healthcare conveyor belt were exacerbated by the arrival of the pandemic. An estimated 500,000 nurses were lost to COVID fatigue, switching to other less taxing professions. 

At the same time many new travel nursing and outsource labor companies began to pop up, luring staff away from their traditional in-house positions with the promise of higher pay. These companies then sold the nurses back to the same types of facilities they came from at a much higher cost. 

Though facilities were able to get staff quickly and easily, it was not cheap and cost them the integrity of their in-house teams.

Dropstat seeks to re-empower healthcare organizations, working with them to update and automate safe staffing processes, and give total transparent insight into their labor costs.

They see the most important relationship as the triad between patient, provider, and the organization that brings them together.

Dropstat uses machine learning and AI to predict a facility's staffing needs 60 days in advance.  are able trace increased costs of standard labor and premium labor costs whether its agency or overtime bonuses. With this data they create patterns and recommendations and feed them back to the client.

When asked about the problem of staff leaving for a $2-3 raise Sara had some powerful insight to share. 

She states that just like those serving in the military, healthcare workers see death and loss on a sometimes daily basis. But while the military has instigated an entire culture of comradery and airtight family dynamics within groups, the same is often not present in healthcare.  

Sara concludes that if a facility is able to culture hack and ensure with authenticity that nurses feel loved, valued, connected, appreciated, that they are the key to aiding the aging population, they won't have to worry about losing staff because of pay.

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After returning from military service, Eric Alvarez got his start in academia before moving to healthcare and delving into startups. It was this time working with students that led him to the idea of Grapefruit Health. 

By the year 2026 healthcare will be short by 3.2 million healthcare workers. Eric states that many of the current solutions for this problem greatly reduce performance and output while driving up costs. 

The year 2030 was always slated to be the year that our clinical aging workforce would max out, with baby boomers retiring at a much higher ratio than newcomers entering the profession. Many clinicians have either transitioned to part time or moved on to a gig economy platform. 

We have heard from various perspectives on the healthcare staffing shortage on this podcast and Grapefruit Health brings a new solution to address this monumental problem. They have created the world's first and only healthcare workforce composed solely of clinical students. 

Healthcare facilities often run programs to employ students, but this calls for a training preceptor and ultimately leads to an unproductive workflow. Grapefruit Health employees on the other hand provide assistance with remote, low acuity, high volume, repetitive telephonic tasks.

These include medication adherence, senior isolation and loneliness outreach calls, and post discharge follow up calls. All of these tasks are clinical in nature but do not require licensure.

About 10% of these telephonic tasks need a pharmacist interaction, in which case the employee will do a warm transfer to a pharmacist. This cuts down time greatly for short staffed pharmacy teams who would otherwise have to make all these repetitive calls themselves. 

Grapefruit Health offers their services at $5 per interaction and doesn’t charge for unsuccessful interactions such as when a call goes through to voicemail or a patient hangs up. 

Typically their client organizations have a program that's failing and are looking to supplement it or outsource it. After understanding the situation and what tasks and roles need to be filled, Grapefruit Health can build scripts and employ students and train them for the job in just six weeks.

Eric states that students are eager to learn with their clinical education fresh in their mind. Grapefruit Health leaves their employees with great skills and experience and even full time opportunities with the client organizations they worked with once they graduate.

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Erica has had 30 years of experience as a nursing home administrator and specializes in regulatory compliance. 

Her nonprofit senior living campus is so excellent at staffing retention that they have managed successfully to never bring in outside agencies. 

In today's senior care facilities, where administrators constantly struggle to keep staff from leaving, this is an incredible achievement. Erica outlines some of the means by which she and her leadership team have made it happen. 

Firstly, they have made sure to be visible in the local community. They are involved with two chambers of commerce, hold lots of events, and have great working relationships with the local high-schools.

High-school seniors who have completed one year as nursing assistants and want to stay on, will receive 75% tuition reimbursement towards starting a nursing degree at community college. 

They also hold raffles for those applying and bonuses to current employees for referring someone. 

For current employees, there is a career ladder in place throughout all departments and excellent tenure. Staff can work to advance themselves and see results for their hard work rather than feeling stuck in a static position. 

There are also many amenities provided including an excellent break room, and regular socials that help to create a great work atmosphere. 

Above all, Erica holds that having a work family, all pulling together towards the same mission statement, is essential. 

Right from the interview she assigns new hires a mentor in their department. By being present at the interview, that person will also be able to decide on behalf of their department whether they want to move forward with hiring. 

She maintains a strong philosophy of servant leadership and strives to let all her staff know that she cares for and appreciates them. 

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Sam Gopinathan only got started in his field after the 2008 recession when he was forced to leave his job as a mechanical engineer. But Sam didn’t get into his current field by chance.  

After a life-changing experience of helping to provide relief to a community devastated by a natural disaster, he learned that establishing a connection is a fundamental foundation of caring for others.  

He decided to work in home health care because it aligned with his professional goals and personal values. Every day he goes to work he is helping someone with their life.  

Sam states that long-term care insurance is the only product that will definitively cover the costs of care when one needs it.  

Medicare will only pay for the medical side of things. It covers high acuity events, but not the nursing home stays that many people will need afterward. Unless someone has less than $2,000 in assets, they won't qualify for Medicaid coverage and will instead pay for the latter privately.  

So how much care is provided by home healthcare? Sam explains that New Wave Home Care offers a minimum of 4 hours of care and a maximum of 24 hours. They help out with basic necessities like showering, meal preparation, and any other tasks that someone might not be able to complete physically.

Having the right amount of care early on can save expenses down the line, such as those that will occur if someone is injured.

In regards to payment, Sam states that 80-85% of clients pay via private funds, with 15% of clients using long-term care insurance. Depending on what policy someone has, they can get almost 100% off care expenses.

Lastly, Sam examines the benefits of a professional long-term caregiver over a private caregiver such as a family member, friend, or trusted employee. By seeking out help privately, someone can be risking a lot.

If you are employing someone privately, you are their employer on all records which can lead to a lot of trouble with lawsuits. It is also difficult to do background checks on a potential caregiver.  

In theory, a family member or spouse would be the best solution. Still, the emotional burdens often become a problem made even more complicated if the caregiver is a similar age. With their assurance of expertise and knowledge, and ability to do complex background checks, agencies are the best option.  

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Lindsay Mclaughlin is an expert multitasker! Managing to juggle running a successful full-time venture, teaching others to do the same, and being a working mom, she wears many hats.

Her high-poweredness can be seen in the fact that she recorded this episode with us only a few days after the birth of her new baby! 

Despite going into nursing school, Lindsay knew for a long time that she wanted to be self employed before her thirties.

Developing and running residential assisted living homes allows her to combine her background and skill-set with her long-time ambitions of entrepreneurship. 

But what are residential assisted living homes and how do they differ from traditional, larger assisted living facilities?

Lindsay states that even though she prefers to build most of her homes from the ground up, the buildings themselves look and feel like cozy residential homes. 

Instead of hundreds of residents, most residential assisted living homes usually only have 8-10 beds, and no more than two-dozen. 

Rather than a host of amenities, clubs, and excursions to fill residents’ schedules, the homes offer a cozy, close environment where residents can gather in the common area, get to know each other, and feel like they are living in a real house with a found family. 

Though they can’t provide care to higher acuity patients, such as those who need feeding tubes, residential assisted living homes can take on most patients and provide them with more focused and hands-on care.

Lindsay says that the set up of these homes is also very encouraging to the families who may be nervous and reluctant to send their loved one to a large, traditional facility.

The smaller setup allows for a more direct line of communication that families can use to receive more personal news and updates. They are also more inclined to feel better about sending their loved one to somewhere that feels like a home. 

To sum it all up, Lindsay states that anyone looking to get into this sector of the senior care industry has to know what they want realistically before entering the business. 

The job can be hands-on and emotionally taxing, but it also allows an owner to build a space from the ground up, set their own culture, and run their own show, even if they do not have a large budget going into it.

For those interested in this growing field, Lindsay is holding a 2023 flagship event where she gives attendees hands-on experience in running a residential assisted living home.

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Nebras Hayek’s incredible career in marketing throughout multiple industries is the result of her high-powered mindset and can-do attitude.  

Though she has worked in a number of interesting places, Nebras got into healthcare marketing partly through the connections she made while hosting events for various healthcare related groups.

In addition to her intensive day job, she is also an active military combat engineer in North Carolina, a position which on top of everything else demonstrates her love for challenges.  

Nebras started out at Gentell as a regional manager covering only a few states but rapidly ascended to assistant vice president of the company, covering all 49 states.  

Her significant experience in senior care has shown that progress is best made through building authentic connections and establishing dependability and trust with others in the industry.  

Senior care faces a lot of current challenges. While the largest issue may be staffing, census is still a very high priority problem for many facilities.

So what can a nursing home do to fix its census?

Nebras advises that before judging that a nursing home is struggling, you need to go in, find out what’s actually going on, and only target that specific issue rather than making a lot of large irreversible changes.

She states that some major points to be examined and evaluated are the facility’s current Medical Director and the actions of its Admission Directors.

Medical Directors are supposed to be representatives and advocates for their facility. They should be ready to fix the problems they encounter or delegate the process of fixing.

It is important to check in regularly with Admission Directors and find out what they are doing. Ask what challenges they are facing, who they are marketing to, and what's happening with referrals.  

Lastly, when asked about the relevance of social media for both facility and vendors in senior care, Nebras states that, for both of these parties, the more recognition and familiarity the better. This is best done through authentic video content which is more informative than pictures.

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Having served as assistant administrator at a small facility with extensive experience in the senior care industry, Avi Richman understands the extreme challenges facilities face these days in staffing

There is a constant fight over employees and many states cap admissions when a facility is only operating at very low levels of staff. 

Many facilities attempt to address the problem of staffing through working on their public appearance to prospective employees.

Avi states that this method often won’t work because it's almost impossible for most facilities to scale the idea of what they want their vibe and company culture to feel like. 

The only situation in which this would work would be if the facility concerned was small, and standalone.

Avi gives an example of such a facility that deepened their company culture by creating an employee counsel that served as a legitimate decision making body.

But is there a sole strategy that will contribute with certainty to the success of staffing endeavors? 

Avi asserts that facilities need to focus their time and energy on making sure the processes they plan are executed smoothly and to completion from start to finish. 

It is easy to say that this will happen but very difficult in reality, the only way it will work is if the process is monitored and nurtured 24/7.

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