November 3, 2023 • 26 mins
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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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Lisa McCracken (00:01):
Good morning.
Welcome to the NIC Chatspodcast. We're excited you're
with us this morning. We arehere live in Chicago at the
2023 NIC Fall Conference. Ifyou're not familiar with the
NIC Chats podcast, this isabout bringing forth
interesting people, thoughtleaders in our industry to
(00:21):
discuss hot topics and thingsof interest to all of you. In
terms of introductions, my nameis Lisa McCracken. I serve as
the Head of Research andAnalytics with NIC. And I'm
here today joined by thefounder and Co-CEO of ProCare
HR. And we're gonna hear alittle bit more about ProCare,
(00:43):
Brett Landrum. So, welcome.
Brett Landrum (00:46):
Thanks for having me .
Lisa McCracken (00:48):
We're glad that you're with us at the
conference here today. So,obviously workforce is a hot
topic. I think there've beenvery few conversations here at
the N IC Conference that itdoes not come up. So Brett and
I had a chance to talk inadvance just about your passion
around this and solutions, andwe're gonna dive into that. But
I think the listeners wouldbenefit from hearing a little
bit more about the background of ProCare HR so they understand
(01:11):
a little bit of your backgroundand experience.
Brett Landrum (01:13):
Yeah, absolutely. I think it's
important to start with thevision for our company because
that really drives everythingelse, our people, our
investments, strategy,etcetera. And really the vision
for ProCare is about, I'll sayanswering the question, really
what's the impact that improvedHR outcomes can have on quality
(01:37):
of care, resident satisfaction,financial results? And the
answer is I think everybodyanecdotally can say, well, geez
, if we do this thing, thispeople thing better, right ?
We're gonna have, we're gonnasee those three areas improve,
but it's to what extent andwhat are the actual levers that
you pull that have the greatestimpact? And so ProCare is an HR
(02:02):
services company. Weexclusively partner with
organizations, serve seniorsand folks with disabilities.
Really full spectrumoutsourcing for human
resources. And how we thinkabout delivering our business
model. And kind of how wedifferentiate ourselves is it's
really, how can we create anunfair advantage for our
(02:25):
customers in the marketplaceand really do that three ways.
Number one is providingindustry optimized HR services
delivered really consistentlyand predictably. Number two is
highly value additive. Toolsreally built specifically for
senior care to help controlstaffing, costs , labor ,
address some of the laborshortage issues, etcetera. And
(02:48):
then the third is how can weaggregate the data that comes
from all of our customers andreally give them really
fantastic insights to drivebetter business decisions,
people outcomes.
Lisa McCracken (03:01):
Right. You touched on a number of hot
topics that we're definitelygonna get to data, hot topics,
and technology. So we're gonnaspend a little time around
that. But I first want to startoff with you obviously have the
perspective of you come intodifferent communities,
facilities, and, have a bit ofan objective view. And I'm sure
there are certain things thatyou see are common mistakes
(03:23):
that organizations are making.
So can you comment a little bitabout hurdles that you see or
organizations, mistakes thatthey're making that can be, I
would say some maybe even lowerhanging fruit or things that
can improve from some of theirHR strategies?
Brett Landrum (03:38):
Yeah, absolutely. I mean, I'm gonna
be really boring throughoutthis podcast because I'm gonna
say the word basics like ahundred times, but really, it
is about the basics. Like, ownthe basics. Be great at the
basics. And that's like makingsure that we're paying people
correctly every time. We'redoing a great job processing
(03:59):
benefits. We're reallyleveraging our HR technology to
the best extent so that ourmanagers our supervisors, our
leaders are getting really goodinsights out of it. Like we've
got clear expectations, clearaccountabilities, clear
measurements for all of ourdifferent roles, leaders,
etcetera. I think a lot oftimes we think there's some big
(04:23):
winning move. It's like, hey,if I just figure this one
engagement thing out, myworld's gonna change.
Lisa McCracken (04:27):
It's the magic wand, right?
Brett Landrum (04:28):
Yeah. And it's like, there's no winning move.
There's just not. It's havingthe discipline to really focus
on and get good at (04:34):
Hey, let's get really good at payroll.
Let's get really good at how wesupport our technology tools
that our clients are using orthat our employees are using,
etcetera. You know, I think itstarts with the basics. And
then when you do, when youexecute the basics really well,
that kind of earns you theright to be able to work on the
(04:56):
strategy.
Lisa McCracken (04:57):
Right. Because I would think that they garner
trust your workforce too. Whenthey see that, and you use the
word discipline. I like that.
Because I think often the teamsget stuck in the weeds and it's
the day-to-day demands, and youlose sight of some of those
important elements on theworkforce side of things. So ,
e xpenses have been obviouslytop of mind for organizations.
(05:20):
A lot o f that relates towages. But I think, a lot of
the things you do t oo, reallylook at where t here are ways
that we can have some costsavings with certain labor
solutions. So talk to me alittle bit about what that is
and what that looks like.
Brett Landrum (05:34):
Yeah. We embarked on this journey about
two or three years ago, andfrankly, shame on me maybe not
taking my own medicine. Wedidn't have a whole lot of
data. It was very anecdotal.
But what we started noticing inour customer base is , we're
coming out of this COVID timeperiod where census is all over
(05:54):
the place. But staffing'sreally short and as a result of
those two, kind of those twoforces, what was what we're
hearing from our clients waslook like we're not our at the
site level, our executivedirectors and our schedulers
aren't able to make theadjustments quick enough. When
I go from "Hey, I'm perpetuallyunderstaffed, now all of a
(06:16):
sudden my census goes up, howdo I use, you know, how do I
use that?"
Lisa McCracken (06:19):
Right.
Brett Landrum (06:20):
Or "How do I use those resources?" Or my census
goes down but I've beenunderstaffed for the last two
months, so how do I think aboutmaking the appropriate
adjustments I need to, and so,we've embarked on this journey
of like how can we helpoperators do this better? And I
think one of the fundamentalprinciples of Schedule A, this
(06:43):
business unit of ours is reallylike if something's critically
important and you don't have aleader waking up every morning,
and that's all they thinkabout, and they're focused on
it, like it's not gonna getdone. And what we hear from our
operators is that like, youreds and your regionals and your
administrators, like, they'reall supposed to be focusing on
labor costs and managing thatpayroll expense, but they're
(07:05):
also focused on quality andadmissions and this thing and
this fire. And so ultimatelythat doesn't get the focus that
it deserves. So what we'vereally tried to do is build a
model that's laser focused onmanaging payroll expense where
we have seasoned operators,they wake up every day and
(07:25):
it's, How do we support theschedulers? How do we support
the eds? How do we support theregionals on knowing their
data? But then, you know,really using that data to build
the execution plan and drivingbetter outcomes.
Lisa McCracken (07:38):
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 ofeverything, right? They're
doing everything. They're doingthe employee of the month,
they're managing benefits,they're , you know, all of
that. And I think what you'resaying is it's having those
experts at their levels andbeing able to utilize that data
for important decision making .
Brett Landrum (07:59):
Yeah, a hundred percent. And it's focus . And I
also think it's education. Imean, one of the things that's
kind of surprising to me alwaysis that we don't actually , we
often , as an industry, I don'tthink we train the folks that
are managing our P&L like thescheduler has got 40 to 60% of
(08:21):
the expenses in the business.
But like, do they reallyunderstand the tactical changes
they can make to scheduling tohave a really significant
impact. Both on quality ofcare, on employee satisfaction,
because, you're managing yourstaffing, you're more
responsibly from employeeexperience perspective, quality
of care, etcetera. And so oneof the things that we've tried
(08:42):
to do is use that data to thencircle 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 aboutscheduling PTO months out.
Things of that nature.
Lisa McCracken (08:57):
Right. Perfect examples of where organizations
may not have the expertise orresources in-house to just
navigate that themselves. Sobeing able to supplement
existing staff. So we talkedabout data, and I wanna talk
about technology, and I knowthey're often intertwined, but
, the role of technology as itrelates to workforce and
(09:17):
staffing. So what's yourperspective on that, where we
are now, and maybe where weneed to go?
Brett Landrum (09:23):
Yeah. So a lot of different people have
opinions on where seniorliving's at or senior care is
at as far as technologyadoption. My personal opinion i
s, I actually think theindustry as a whole has worked
really hard and driven towardsgood technology adoption. I've
been impressed by the pace atwhich I've seen the industry
and operators adopt.
Lisa McCracken (09:43):
That's good to hear.
Brett Landrum (09:44):
Where I think the industry is struggling and
falls down is an execution andadoption throughout the
organization. So it's likeexecutives as executives, we
say, Hey, I , we recognize theneed for technology. It's how
do you really get thethroughput with all your
leaders, all your teams?
Lisa McCracken (10:06):
The buy-in piece.
Brett Landrum (10:07):
Hundred percent.
Lisa McCracken (10:08):
So is that , and I didn't mean to interrupt,
but that's what I think of is Ithink of the buy-in, are there
other obstacles? I mean, do yourun, do you see infrastructure
issues, things of that nature?
And where does training come inwith what all of you do?
Brett Landrum (10:21):
Yeah. I mean, I think we're trying to use a lot
of different technologyplatforms, and so, training is
critical. Because you have lotsof different folks in the
organization who need to usethe technology different for
different purposes. Andoftentimes these tech companies
are like one configuration andimplementation implementation
(10:46):
rarely goes well. So that meansyou're shift , you're already
shifting the burden of thatexercise to the operator. But
then, once the initialimplementation's off the
ground, all these differentpeople have to use it
differently to perform theirjobs. So it's not just about
like, Hey, go in and trainingon the system. It's about
helping them understand. And Ithink at different levels in
(11:09):
the organization, helpingeverybody kind of map the , how
they use the tool into theirworkflow so that it's not like,
Hey, here's a random tool. Yougotta figure out how to work it
into your daily routine andyour life, and etcetera. It's,
Hey, look, these are theworkflows that you're
following. Here's where thetool fits. And so then when you
(11:29):
train you're training to thatend.
Lisa McCracken (11:34):
Yeah. And it's making the connection, what's
in it for me? How does thisrelate to me? As opposed to
this tool you're importing uponme. So , another related
question. We're talking aboutsort of where the puck's going.
So in , in these times, we'vehad to get creative about
workforce tactics, models, andthere's a lot of conversation
(11:55):
around how do we need to thinkdifferently moving forward? So
, because the workforcestruggles might be here with us
for a period of time, you know, shortages, retention issues
and so forth. But if you had acrystal ball, what does this
workforce need to look like inthe future? And you can cover a
(12:16):
lot of ground with that. Imean, who comprises the
workforce , a variety ofdifferent things. But I mean,
where do we need to be headingas an industry as it relates to
workforce?
Brett Landrum (12:27):
Yeah. I mean, I don't think this is anything
terribly groundbreaking, but Ithink one thing is we as an
industry have to do better atcareer pathing. Like period.
We've gotta retain people,we've gotta keep 'em in the
industry. And that's hard todo, right? When 70% of your
workforce is unskilled orunskilled roles. But we have to
(12:51):
get better at it so that we canattract and retain. I think
we're gonna see the nature ofwork shift a lot. I mean, look
like a l ot of the operators wet alk to, everybody's 70, 80% o
r, you know, staffed at, 70,80% of where they'd like to be.
Lisa McCracken (13:08):
Right
Brett Landrum (13:09):
So, when we get in the late twenties, early
thirties, you're gonna havethis huge influx of demand, but
we're not seeing the workforcedynamics change. So we're
already understaffed and nowwe're gonna have this huge
influx of demand, we're gonnahave to do senior care
differently. My personalopinion is, I think you're
(13:30):
gonna see a lot more remotemonitoring solutions. You're
gonna start seeing, how do wedo more with less? Which maybe
means, which actually could bea really good thing for the
industry, because it may meanthat like, Hey, we're gonna
upskill some of these, youknow, some of these unskilled
positions so they can do moreand kind of cover more ground
(13:50):
because of how we can deploytechnology into our buildings,
Lisa McCracken (13:55):
Right. Yeah.
And the future. Well, and youcould argue that younger
generation workers now, I wouldsay demand some of these tech
solutions, right? So if we'relooking to generate, increasing
workforce among the youngergenerations, we've gotta be on
top of the data and thetechnology. You mentioned the
(14:16):
career ladders. That's, and Ithink you and I talked about
this in some of our previousconversations, the importance
of scale. Yeah. That's wherewhen you've got an organization
that's a little larger, you cangive some career ladders and
some training in that regard.
Brett Landrum (14:29):
Yeah. I think your point on the technology
tools is a really importantone. So maybe outside of senior
living, like ProCare is goingthrough this right now as an
organization. As we scale andhave had to look at how do we
do better at being able toonboard train , and help our
employees be really effectivethinking about solving problems
(14:51):
for our clients versus doing abunch of manual things because
we haven't built internaltools.
Lisa McCracken (14:56):
Right.
Brett Landrum (14:56):
And so I think one of the things that one of
opportunities in senior careoperations is to look at what
are the tools that we're usingand how do we make it easier
and simpler, and how do weremove steps and I think that's
a really big driver of jobsatisfaction that often gets
ignored. Is what are the toolswe're using? How simple are
(15:17):
they to use? And do I feel likeam I just doing a bunch of
administrative work? 'cause thetools are cumbersome? Am I
actually getting to step in andmake a difference somewhere?
Lisa McCracken (15:27):
Right. Because at the end of the day, a lot of
people do come into this fieldbecause of , you know,
particularly in the direct carestaff side of things, the
interactions with the residentsand so forth and that direct
caregiving. So if they feelthere's gonna be things
employed that are going to bedifficult and distract them,
from some of that's , it'sdifficult to adopt for sure .
(15:48):
Are there other things that youwould just comment on that we
haven't talked about in termsof specialty things that all of
you focus on? You know, commonthings that you see on your end
of things coming intoorganizations?
Brett Landrum (16:00):
Yeah. I would say maybe not necessarily
specific just to ProCare, butyou know, some lessons that
we've learned in our ownbusiness and maybe some
insights that I've beenthinking about a lot specific
to senior care is when we talkabout going back to the basics
and that really drivesengagement. Like people talk
about this like employeeexperience, employee
(16:20):
engagement. Yeah. Like, whatdoes that actually mean? And,
and I think it's, how do thosefolks connect with the
organization? And I think justreally focusing on good solid
management practices. Andbasics. Will does a lot of that
covers a lot of more of thatengagement ground than we give
it credit for.
Lisa McCracken (16:41):
Because , so the career ladder's great, but
if you are advancing peoplethat don't have the tools and
the training.
Brett Landrum (16:46):
Yeah, correct.
Or if nobody knows, you know,what's expected of 'em or how
they're measured or , what arethe tools, they need to be
successful, need to leverage todo their job well.
Lisa McCracken (16:55):
How do you measure the employee
satisfaction engagement? Sowhat metrics do you look at to
know, okay, so the staff seemmore satisfied here with this
because of X, Y, Z ?
Brett Landrum (17:05):
Yeah, so, we have used E MPS,
Lisa McCracken (17:10):
Which is?
Brett Landrum (17:10):
Employee net promoter score.
Lisa McCracken (17:12):
Got it . Okay.
Brett Landrum (17:12):
And I personally like that a lot because you're
benchmarking yourself bothagainst other employer peers,
but also you can get specificto the industry. It also looks
at a number of differentdimensions. So it's gonna ask
questions like (17:26):
Do you have a good friend at work? Do you
have a close friend at work?
And, how likely are you toleave for 10% more money? And
it asks a number of differentquestions. So it gives you a
lot of insight into yourorganization and how your
employees are thinking andfeeling. And things of that
nature. but what we've seenwhen we've both at ProCare with
(17:50):
our own internal employees, butalso when we've done some of
this work with customers, it isshocking 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 inwhich we measure people, doing
(18:15):
the basics of HR, j ust, h ey,process payroll accurately.
It's amazing how much, justthose really good solid
business practices that arelike really hard to do
consistently day in and day outdrives enormous i mpact on
(18:37):
engagement and employeesatisfaction.
Lisa McCracken (18:39):
I wanna touch on communication because, you
know , it's one of those thingsI think communicate,
communicate, communicate. So Iknow I've seen reports come out
for employee engagementreports, and there's a comment,
we didn't know X, Y, Z, and themanagers saying, oh my gosh,
we've told them 20 times that.
So have you seen any bestpractices on the communication
side of things? Are we talking,some organizations I've seen
(19:00):
have an app for staff, you'vegot newsletters, you may have
meetings. What communication,what do you see works?
Brett Landrum (19:07):
Yeah. So one, I'll preface this with, it's
easy for me to sit up here anarmchair quarterback. If you go
pull all the ProCare internalstaff, they're gonna tell you
that we've got our owncommunication issues. Right.
But I think more often not whatwe've seen is that it's not the
little stuff, it's the bigstuff. Like, Hey, where are we
going as an organization? We'remaking this big strategic
(19:28):
change. Like, Why are we doingit? Help me understand and wrap
my head around, and feel boughtinto a part of that, part of
that process. I think thatthose are the types of things
that we hear and bothquantitatively and
qualitatively is it's usuallynot the little stuff. It's the
(19:49):
more sweeping changes. It'swhere are we going as an
organization. Why are we makingthe decisions that we're
making. And again, I thinkthose are things that if
they're hard to communicatewell because oftentimes, like
this is a really fast movingbusiness environment, right ?
You've got AI, you've got, itis a lot of headwinds that
senior care is still facing, Ithink getting a little bit
(20:12):
better. And so executives arelike, they're having to be
really adaptable and movequickly. And so sometimes it's
hard to slow down and kind ofbring everybody else along.
Certainly is for me, but Ithink it's critical.
Lisa McCracken (20:28):
Right. So I wanna talk a little bit about
the staff pool and again, I'mgonna largely focus on the
direct care staff. So we've gotyour , the core staff,
full-time staff, and we know inrecent years there's been a lot
of the agency staff usagethat's been responsible and
driving a lot of the expenses.
But it's the agency staff orthat on demand staff. And I'm
(20:51):
not an expert in that, but Ihave heard conversations and
people say, at the end of ,there's always that individual
that just wants to be the ondemand type . They don't wanna
be the full-time staff . Isthat segment here with us, you
know, long term or talk to meabout some of those dynamics
and what we're seeing. Do youhave any observations?
Brett Landrum (21:11):
Really good question. Yeah. I would like to
know more than I do given ourbusiness. But, I think there's
always going , there's alwaysgonna be a place for agency.
There just is, period. I thinkhow we do agency is gonna
change and transform Probablymore towards kind of on demand
(21:34):
type staffing. But I personallydo not see like, I know there's
been this, like it's , the ideahas been kicked around of like
Uber for caregiving. And Ijust, like I personally find
that really hard to believeprimarily because you need
those caregivers, like, youknow, trained and focused on
your residents bought into yourvision, your mission, and I
(21:57):
just don't think you get thatsame impact, human impact. And
quality outcome, etcetera. Whenyou've got on d emand staffing
versus a cohesive team that'strying to take care of folks.
Lisa McCracken (22:10):
Right. And it's potentially sort of one
strategy or one spoke of thewheel. There's a lot of
conversation to around thenon-traditional workers, older
adult workers that gets moredifficult at the direct care
staff level. You know,obviously. But , yeah, it's
thinking potentiallydifferently. And I think it
relates to that futureconversation too.
Brett Landrum (22:29):
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 (22:35):
Yes.
Brett Landrum (22:36):
How do we do on demand ? Like, rather than
outsourcing and paying apremium for an agency, like,
can we chain , that allows usto keep that cohesive team
feeling. But we get some of theadvantages of on demand
flexibility, adaptability thatyou get from agency and some of
(22:57):
these new organizations,
Lisa McCracken (22:58):
Right. Yes, I've heard of that as well. And
some organizations have hadgreat success with the internal
staffing agency. I think thetrick there is to make sure you
don't cannibalize your ownstaff.
Brett Landrum (23:07):
It's hard. Yeah.
It's really hard. 'cause it's ,
Lisa McCracken (23:09):
You're like , wait, they're getting paid how
much an hour I'm gonna go dothat.
Brett Landrum (23:12):
It's incentives, and so it's really like being
intentional about how do yousystematize it? How are you
gonna roll it out? How do youcommunicate it? Back to
communication, we have 10buildings and I'm working at a
building and I find out throughanother per , dietary aid, we
found out from a caregiver thatwe now have an internal
staffing pool, and those peopleare making $4 an hour more.
Lisa McCracken (23:35):
Right .
Brett Landrum (23:35):
I'm like, how do I feel about that? So your
point about cannibalizing, Ithink that's a real concern.
Lisa McCracken (23:41):
You need to be very smart and strategic, I
think is what I've observedfrom a lessons learned
standpoint. So, I think we'regonna wrap up with this
question. Wages versus, and I'mnot suggesting this isn't
either or I'm gonna let youanswer any way you want. Wages
versus culture and sort of, youknow, what trumps, what do you
(24:03):
think ? You know, we'veobviously been deploying a lot
of the wage escalation inrecent years and I think
needed. Can you pay somebodyenough if you don't have the
culture? I mean, just talk tome about sort of the either and
or proposition with that.
Brett Landrum (24:20):
I mean, look, like , money works look at
Amazon. Like, people love it orthey hate it and there's a lot
of people that stay therebecause it's, they can't afford
to leave 'cause they're paidtoo well. Right? Amazon's a
different world than seniorcare. Like we can't, I don't
think I , maybe I'll go neutraland say it's not, not either
(24:42):
or. It's an and and I thinklike, we have to be strong
enough with wages. It's thebalancing act. We have to be
strong enough with wages, butlike, we've gotta get better at
the engagement and the cultureand, you know, mission,
etcetera. How we rally peoplearound what we're trying to
accomplish. But , look like,senior care is not large tech
(25:02):
where you have 80% grossmargins, and we can have crazy
benefits and compensate peopleto that level. So I just, I
think there's a practicalfinancial barrier where like,
we're never gonna be able to beso strong on wages that we can,
you know, not work at theemployee experience thing. I
(25:24):
think it's gonna have to beboth in every organization,
depending where they're at intheir life cycle , what their
vision is, what their strategyis, is gonna have to figure out
like, how do we think aboutcompensation? How do we think
about our value prop toemployees where compensation
fits into that versus thiswhole engagement thing. So it's
a little bit of a non-answer toyour question .
Lisa McCracken (25:45):
I think it gets back to the discipline word
that you used earlier, havingthe discipline to know, okay,
when do we use the wage leverand how far can we go versus
when we say no, you know, weneed to deploy that capital
into really working harderpotentially onthe retention
elements. You know, otherthings that you can choose
outside of the pay.
Brett Landrum (26:04):
Well, and I think what's important is
making sure all the differentelements of the strategy are
congruent, and go together. Andthat's like, I think it's easy
to kind of fall out ofalignment in some of those
different areas.
Lisa McCracken (26:15):
Fantastic.
Thank you for being with usthis morning. And you've got a
team of ProCare HR folks hereat the conference. And ,
appreciate all of you beingwith us. Continue to pay
attention to future NIC Chatspodcasts and have a great rest
of the conference.
Good morning.
Welcome to the NIC Chatspodcast. We're excited you're
with us this morning. We arehere live in Chicago at the
2023 NIC Fall Conference. Ifyou're not familiar with the
NIC Chats podcast, this isabout bringing forth
interesting people, thoughtleaders in our industry to
(00:21):
discuss hot topics and thingsof interest to all of you. In
terms of introductions, my nameis Lisa McCracken. I serve as
the Head of Research andAnalytics with NIC. And I'm
here today joined by thefounder and Co-CEO of ProCare
HR. And we're gonna hear alittle bit more about ProCare,
(00:43):
Brett Landrum. So, welcome.
Brett Landrum (00:46):
Thanks for having me .
Lisa McCracken (00:48):
We're glad that you're with us at the
conference here today. So,obviously workforce is a hot
topic. I think there've beenvery few conversations here at
the N IC Conference that itdoes not come up. So Brett and
I had a chance to talk inadvance just about your passion
around this and solutions, andwe're gonna dive into that. But
I think the listeners wouldbenefit from hearing a little
bit more about the background of ProCare HR so they understand
(01:11):
a little bit of your backgroundand experience.
Brett Landrum (01:13):
Yeah, absolutely. I think it's
important to start with thevision for our company because
that really drives everythingelse, our people, our
investments, strategy,etcetera. And really the vision
for ProCare is about, I'll sayanswering the question, really
what's the impact that improvedHR outcomes can have on quality
(01:37):
of care, resident satisfaction,financial results? And the
answer is I think everybodyanecdotally can say, well, geez
, if we do this thing, thispeople thing better, right ?
We're gonna have, we're gonnasee those three areas improve,
but it's to what extent andwhat are the actual levers that
you pull that have the greatestimpact? And so ProCare is an HR
(02:02):
services company. Weexclusively partner with
organizations, serve seniorsand folks with disabilities.
Really full spectrumoutsourcing for human
resources. And how we thinkabout delivering our business
model. And kind of how wedifferentiate ourselves is it's
really, how can we create anunfair advantage for our
(02:25):
customers in the marketplaceand really do that three ways.
Number one is providingindustry optimized HR services
delivered really consistentlyand predictably. Number two is
highly value additive. Toolsreally built specifically for
senior care to help controlstaffing, costs , labor ,
address some of the laborshortage issues, etcetera. And
(02:48):
then the third is how can weaggregate the data that comes
from all of our customers andreally give them really
fantastic insights to drivebetter business decisions,
people outcomes.
Lisa McCracken (03:01):
Right. You touched on a number of hot
topics that we're definitelygonna get to data, hot topics,
and technology. So we're gonnaspend a little time around
that. But I first want to startoff with you obviously have the
perspective of you come intodifferent communities,
facilities, and, have a bit ofan objective view. And I'm sure
there are certain things thatyou see are common mistakes
(03:23):
that organizations are making.
So can you comment a little bitabout hurdles that you see or
organizations, mistakes thatthey're making that can be, I
would say some maybe even lowerhanging fruit or things that
can improve from some of theirHR strategies?
Brett Landrum (03:38):
Yeah, absolutely. I mean, I'm gonna
be really boring throughoutthis podcast because I'm gonna
say the word basics like ahundred times, but really, it
is about the basics. Like, ownthe basics. Be great at the
basics. And that's like makingsure that we're paying people
correctly every time. We'redoing a great job processing
(03:59):
benefits. We're reallyleveraging our HR technology to
the best extent so that ourmanagers our supervisors, our
leaders are getting really goodinsights out of it. Like we've
got clear expectations, clearaccountabilities, clear
measurements for all of ourdifferent roles, leaders,
etcetera. I think a lot oftimes we think there's some big
(04:23):
winning move. It's like, hey,if I just figure this one
engagement thing out, myworld's gonna change.
Lisa McCracken (04:27):
It's the magic wand, right?
Brett Landrum (04:28):
Yeah. And it's like, there's no winning move.
There's just not. It's havingthe discipline to really focus
on and get good at (04:34):
Hey, let's get really good at payroll.
Let's get really good at how wesupport our technology tools
that our clients are using orthat our employees are using,
etcetera. You know, I think itstarts with the basics. And
then when you do, when youexecute the basics really well,
that kind of earns you theright to be able to work on the
(04:56):
strategy.
Lisa McCracken (04:57):
Right. Because I would think that they garner
trust your workforce too. Whenthey see that, and you use the
word discipline. I like that.
Because I think often the teamsget stuck in the weeds and it's
the day-to-day demands, and youlose sight of some of those
important elements on theworkforce side of things. So ,
e xpenses have been obviouslytop of mind for organizations.
(05:20):
A lot o f that relates towages. But I think, a lot of
the things you do t oo, reallylook at where t here are ways
that we can have some costsavings with certain labor
solutions. So talk to me alittle bit about what that is
and what that looks like.
Brett Landrum (05:34):
Yeah. We embarked on this journey about
two or three years ago, andfrankly, shame on me maybe not
taking my own medicine. Wedidn't have a whole lot of
data. It was very anecdotal.
But what we started noticing inour customer base is , we're
coming out of this COVID timeperiod where census is all over
(05:54):
the place. But staffing'sreally short and as a result of
those two, kind of those twoforces, what was what we're
hearing from our clients waslook like we're not our at the
site level, our executivedirectors and our schedulers
aren't able to make theadjustments quick enough. When
I go from "Hey, I'm perpetuallyunderstaffed, now all of a
(06:16):
sudden my census goes up, howdo I use, you know, how do I
use that?"
Lisa McCracken (06:19):
Right.
Brett Landrum (06:20):
Or "How do I use those resources?" Or my census
goes down but I've beenunderstaffed for the last two
months, so how do I think aboutmaking the appropriate
adjustments I need to, and so,we've embarked on this journey
of like how can we helpoperators do this better? And I
think one of the fundamentalprinciples of Schedule A, this
(06:43):
business unit of ours is reallylike if something's critically
important and you don't have aleader waking up every morning,
and that's all they thinkabout, and they're focused on
it, like it's not gonna getdone. And what we hear from our
operators is that like, youreds and your regionals and your
administrators, like, they'reall supposed to be focusing on
labor costs and managing thatpayroll expense, but they're
(07:05):
also focused on quality andadmissions and this thing and
this fire. And so ultimatelythat doesn't get the focus that
it deserves. So what we'vereally tried to do is build a
model that's laser focused onmanaging payroll expense where
we have seasoned operators,they wake up every day and
(07:25):
it's, How do we support theschedulers? How do we support
the eds? How do we support theregionals on knowing their
data? But then, you know,really using that data to build
the execution plan and drivingbetter outcomes.
Lisa McCracken (07:38):
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 ofeverything, right? They're
doing everything. They're doingthe employee of the month,
they're managing benefits,they're , you know, all of
that. And I think what you'resaying is it's having those
experts at their levels andbeing able to utilize that data
for important decision making .
Brett Landrum (07:59):
Yeah, a hundred percent. And it's focus . And I
also think it's education. Imean, one of the things that's
kind of surprising to me alwaysis that we don't actually , we
often , as an industry, I don'tthink we train the folks that
are managing our P&L like thescheduler has got 40 to 60% of
(08:21):
the expenses in the business.
But like, do they reallyunderstand the tactical changes
they can make to scheduling tohave a really significant
impact. Both on quality ofcare, on employee satisfaction,
because, you're managing yourstaffing, you're more
responsibly from employeeexperience perspective, quality
of care, etcetera. And so oneof the things that we've tried
(08:42):
to do is use that data to thencircle 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 aboutscheduling PTO months out.
Things of that nature.
Lisa McCracken (08:57):
Right. Perfect examples of where organizations
may not have the expertise orresources in-house to just
navigate that themselves. Sobeing able to supplement
existing staff. So we talkedabout data, and I wanna talk
about technology, and I knowthey're often intertwined, but
, the role of technology as itrelates to workforce and
(09:17):
staffing. So what's yourperspective on that, where we
are now, and maybe where weneed to go?
Brett Landrum (09:23):
Yeah. So a lot of different people have
opinions on where seniorliving's at or senior care is
at as far as technologyadoption. My personal opinion i
s, I actually think theindustry as a whole has worked
really hard and driven towardsgood technology adoption. I've
been impressed by the pace atwhich I've seen the industry
and operators adopt.
Lisa McCracken (09:43):
That's good to hear.
Brett Landrum (09:44):
Where I think the industry is struggling and
falls down is an execution andadoption throughout the
organization. So it's likeexecutives as executives, we
say, Hey, I , we recognize theneed for technology. It's how
do you really get thethroughput with all your
leaders, all your teams?
Lisa McCracken (10:06):
The buy-in piece.
Brett Landrum (10:07):
Hundred percent.
Lisa McCracken (10:08):
So is that , and I didn't mean to interrupt,
but that's what I think of is Ithink of the buy-in, are there
other obstacles? I mean, do yourun, do you see infrastructure
issues, things of that nature?
And where does training come inwith what all of you do?
Brett Landrum (10:21):
Yeah. I mean, I think we're trying to use a lot
of different technologyplatforms, and so, training is
critical. Because you have lotsof different folks in the
organization who need to usethe technology different for
different purposes. Andoftentimes these tech companies
are like one configuration andimplementation implementation
(10:46):
rarely goes well. So that meansyou're shift , you're already
shifting the burden of thatexercise to the operator. But
then, once the initialimplementation's off the
ground, all these differentpeople have to use it
differently to perform theirjobs. So it's not just about
like, Hey, go in and trainingon the system. It's about
helping them understand. And Ithink at different levels in
(11:09):
the organization, helpingeverybody kind of map the , how
they use the tool into theirworkflow so that it's not like,
Hey, here's a random tool. Yougotta figure out how to work it
into your daily routine andyour life, and etcetera. It's,
Hey, look, these are theworkflows that you're
following. Here's where thetool fits. And so then when you
(11:29):
train you're training to thatend.
Lisa McCracken (11:34):
Yeah. And it's making the connection, what's
in it for me? How does thisrelate to me? As opposed to
this tool you're importing uponme. So , another related
question. We're talking aboutsort of where the puck's going.
So in , in these times, we'vehad to get creative about
workforce tactics, models, andthere's a lot of conversation
(11:55):
around how do we need to thinkdifferently moving forward? So
, because the workforcestruggles might be here with us
for a period of time, you know, shortages, retention issues
and so forth. But if you had acrystal ball, what does this
workforce need to look like inthe future? And you can cover a
(12:16):
lot of ground with that. Imean, who comprises the
workforce , a variety ofdifferent things. But I mean,
where do we need to be headingas an industry as it relates to
workforce?
Brett Landrum (12:27):
Yeah. I mean, I don't think this is anything
terribly groundbreaking, but Ithink one thing is we as an
industry have to do better atcareer pathing. Like period.
We've gotta retain people,we've gotta keep 'em in the
industry. And that's hard todo, right? When 70% of your
workforce is unskilled orunskilled roles. But we have to
(12:51):
get better at it so that we canattract and retain. I think
we're gonna see the nature ofwork shift a lot. I mean, look
like a l ot of the operators wet alk to, everybody's 70, 80% o
r, you know, staffed at, 70,80% of where they'd like to be.
Lisa McCracken (13:08):
Right
Brett Landrum (13:09):
So, when we get in the late twenties, early
thirties, you're gonna havethis huge influx of demand, but
we're not seeing the workforcedynamics change. So we're
already understaffed and nowwe're gonna have this huge
influx of demand, we're gonnahave to do senior care
differently. My personalopinion is, I think you're
(13:30):
gonna see a lot more remotemonitoring solutions. You're
gonna start seeing, how do wedo more with less? Which maybe
means, which actually could bea really good thing for the
industry, because it may meanthat like, Hey, we're gonna
upskill some of these, youknow, some of these unskilled
positions so they can do moreand kind of cover more ground
(13:50):
because of how we can deploytechnology into our buildings,
Lisa McCracken (13:55):
Right. Yeah.
And the future. Well, and youcould argue that younger
generation workers now, I wouldsay demand some of these tech
solutions, right? So if we'relooking to generate, increasing
workforce among the youngergenerations, we've gotta be on
top of the data and thetechnology. You mentioned the
(14:16):
career ladders. That's, and Ithink you and I talked about
this in some of our previousconversations, the importance
of scale. Yeah. That's wherewhen you've got an organization
that's a little larger, you cangive some career ladders and
some training in that regard.
Brett Landrum (14:29):
Yeah. I think your point on the technology
tools is a really importantone. So maybe outside of senior
living, like ProCare is goingthrough this right now as an
organization. As we scale andhave had to look at how do we
do better at being able toonboard train , and help our
employees be really effectivethinking about solving problems
(14:51):
for our clients versus doing abunch of manual things because
we haven't built internaltools.
Lisa McCracken (14:56):
Right.
Brett Landrum (14:56):
And so I think one of the things that one of
opportunities in senior careoperations is to look at what
are the tools that we're usingand how do we make it easier
and simpler, and how do weremove steps and I think that's
a really big driver of jobsatisfaction that often gets
ignored. Is what are the toolswe're using? How simple are
(15:17):
they to use? And do I feel likeam I just doing a bunch of
administrative work? 'cause thetools are cumbersome? Am I
actually getting to step in andmake a difference somewhere?
Lisa McCracken (15:27):
Right. Because at the end of the day, a lot of
people do come into this fieldbecause of , you know,
particularly in the direct carestaff side of things, the
interactions with the residentsand so forth and that direct
caregiving. So if they feelthere's gonna be things
employed that are going to bedifficult and distract them,
from some of that's , it'sdifficult to adopt for sure .
(15:48):
Are there other things that youwould just comment on that we
haven't talked about in termsof specialty things that all of
you focus on? You know, commonthings that you see on your end
of things coming intoorganizations?
Brett Landrum (16:00):
Yeah. I would say maybe not necessarily
specific just to ProCare, butyou know, some lessons that
we've learned in our ownbusiness and maybe some
insights that I've beenthinking about a lot specific
to senior care is when we talkabout going back to the basics
and that really drivesengagement. Like people talk
about this like employeeexperience, employee
(16:20):
engagement. Yeah. Like, whatdoes that actually mean? And,
and I think it's, how do thosefolks connect with the
organization? And I think justreally focusing on good solid
management practices. Andbasics. Will does a lot of that
covers a lot of more of thatengagement ground than we give
it credit for.
Lisa McCracken (16:41):
Because , so the career ladder's great, but
if you are advancing peoplethat don't have the tools and
the training.
Brett Landrum (16:46):
Yeah, correct.
Or if nobody knows, you know,what's expected of 'em or how
they're measured or , what arethe tools, they need to be
successful, need to leverage todo their job well.
Lisa McCracken (16:55):
How do you measure the employee
satisfaction engagement? Sowhat metrics do you look at to
know, okay, so the staff seemmore satisfied here with this
because of X, Y, Z ?
Brett Landrum (17:05):
Yeah, so, we have used E MPS,
Lisa McCracken (17:10):
Which is?
Brett Landrum (17:10):
Employee net promoter score.
Lisa McCracken (17:12):
Got it . Okay.
Brett Landrum (17:12):
And I personally like that a lot because you're
benchmarking yourself bothagainst other employer peers,
but also you can get specificto the industry. It also looks
at a number of differentdimensions. So it's gonna ask
questions like (17:26):
Do you have a good friend at work? Do you
have a close friend at work?
And, how likely are you toleave for 10% more money? And
it asks a number of differentquestions. So it gives you a
lot of insight into yourorganization and how your
employees are thinking andfeeling. And things of that
nature. but what we've seenwhen we've both at ProCare with
(17:50):
our own internal employees, butalso when we've done some of
this work with customers, it isshocking 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 inwhich we measure people, doing
(18:15):
the basics of HR, j ust, h ey,process payroll accurately.
It's amazing how much, justthose really good solid
business practices that arelike really hard to do
consistently day in and day outdrives enormous i mpact on
(18:37):
engagement and employeesatisfaction.
Lisa McCracken (18:39):
I wanna touch on communication because, you
know , it's one of those thingsI think communicate,
communicate, communicate. So Iknow I've seen reports come out
for employee engagementreports, and there's a comment,
we didn't know X, Y, Z, and themanagers saying, oh my gosh,
we've told them 20 times that.
So have you seen any bestpractices on the communication
side of things? Are we talking,some organizations I've seen
(19:00):
have an app for staff, you'vegot newsletters, you may have
meetings. What communication,what do you see works?
Brett Landrum (19:07):
Yeah. So one, I'll preface this with, it's
easy for me to sit up here anarmchair quarterback. If you go
pull all the ProCare internalstaff, they're gonna tell you
that we've got our owncommunication issues. Right.
But I think more often not whatwe've seen is that it's not the
little stuff, it's the bigstuff. Like, Hey, where are we
going as an organization? We'remaking this big strategic
(19:28):
change. Like, Why are we doingit? Help me understand and wrap
my head around, and feel boughtinto a part of that, part of
that process. I think thatthose are the types of things
that we hear and bothquantitatively and
qualitatively is it's usuallynot the little stuff. It's the
(19:49):
more sweeping changes. It'swhere are we going as an
organization. Why are we makingthe decisions that we're
making. And again, I thinkthose are things that if
they're hard to communicatewell because oftentimes, like
this is a really fast movingbusiness environment, right ?
You've got AI, you've got, itis a lot of headwinds that
senior care is still facing, Ithink getting a little bit
(20:12):
better. And so executives arelike, they're having to be
really adaptable and movequickly. And so sometimes it's
hard to slow down and kind ofbring everybody else along.
Certainly is for me, but Ithink it's critical.
Lisa McCracken (20:28):
Right. So I wanna talk a little bit about
the staff pool and again, I'mgonna largely focus on the
direct care staff. So we've gotyour , the core staff,
full-time staff, and we know inrecent years there's been a lot
of the agency staff usagethat's been responsible and
driving a lot of the expenses.
But it's the agency staff orthat on demand staff. And I'm
(20:51):
not an expert in that, but Ihave heard conversations and
people say, at the end of ,there's always that individual
that just wants to be the ondemand type . They don't wanna
be the full-time staff . Isthat segment here with us, you
know, long term or talk to meabout some of those dynamics
and what we're seeing. Do youhave any observations?
Brett Landrum (21:11):
Really good question. Yeah. I would like to
know more than I do given ourbusiness. But, I think there's
always going , there's alwaysgonna be a place for agency.
There just is, period. I thinkhow we do agency is gonna
change and transform Probablymore towards kind of on demand
(21:34):
type staffing. But I personallydo not see like, I know there's
been this, like it's , the ideahas been kicked around of like
Uber for caregiving. And Ijust, like I personally find
that really hard to believeprimarily because you need
those caregivers, like, youknow, trained and focused on
your residents bought into yourvision, your mission, and I
(21:57):
just don't think you get thatsame impact, human impact. And
quality outcome, etcetera. Whenyou've got on d emand staffing
versus a cohesive team that'strying to take care of folks.
Lisa McCracken (22:10):
Right. And it's potentially sort of one
strategy or one spoke of thewheel. There's a lot of
conversation to around thenon-traditional workers, older
adult workers that gets moredifficult at the direct care
staff level. You know,obviously. But , yeah, it's
thinking potentiallydifferently. And I think it
relates to that futureconversation too.
Brett Landrum (22:29):
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 (22:35):
Yes.
Brett Landrum (22:36):
How do we do on demand ? Like, rather than
outsourcing and paying apremium for an agency, like,
can we chain , that allows usto keep that cohesive team
feeling. But we get some of theadvantages of on demand
flexibility, adaptability thatyou get from agency and some of
(22:57):
these new organizations,
Lisa McCracken (22:58):
Right. Yes, I've heard of that as well. And
some organizations have hadgreat success with the internal
staffing agency. I think thetrick there is to make sure you
don't cannibalize your ownstaff.
Brett Landrum (23:07):
It's hard. Yeah.
It's really hard. 'cause it's ,
Lisa McCracken (23:09):
You're like , wait, they're getting paid how
much an hour I'm gonna go dothat.
Brett Landrum (23:12):
It's incentives, and so it's really like being
intentional about how do yousystematize it? How are you
gonna roll it out? How do youcommunicate it? Back to
communication, we have 10buildings and I'm working at a
building and I find out throughanother per , dietary aid, we
found out from a caregiver thatwe now have an internal
staffing pool, and those peopleare making $4 an hour more.
Lisa McCracken (23:35):
Right .
Brett Landrum (23:35):
I'm like, how do I feel about that? So your
point about cannibalizing, Ithink that's a real concern.
Lisa McCracken (23:41):
You need to be very smart and strategic, I
think is what I've observedfrom a lessons learned
standpoint. So, I think we'regonna wrap up with this
question. Wages versus, and I'mnot suggesting this isn't
either or I'm gonna let youanswer any way you want. Wages
versus culture and sort of, youknow, what trumps, what do you
(24:03):
think ? You know, we'veobviously been deploying a lot
of the wage escalation inrecent years and I think
needed. Can you pay somebodyenough if you don't have the
culture? I mean, just talk tome about sort of the either and
or proposition with that.
Brett Landrum (24:20):
I mean, look, like , money works look at
Amazon. Like, people love it orthey hate it and there's a lot
of people that stay therebecause it's, they can't afford
to leave 'cause they're paidtoo well. Right? Amazon's a
different world than seniorcare. Like we can't, I don't
think I , maybe I'll go neutraland say it's not, not either
(24:42):
or. It's an and and I thinklike, we have to be strong
enough with wages. It's thebalancing act. We have to be
strong enough with wages, butlike, we've gotta get better at
the engagement and the cultureand, you know, mission,
etcetera. How we rally peoplearound what we're trying to
accomplish. But , look like,senior care is not large tech
(25:02):
where you have 80% grossmargins, and we can have crazy
benefits and compensate peopleto that level. So I just, I
think there's a practicalfinancial barrier where like,
we're never gonna be able to beso strong on wages that we can,
you know, not work at theemployee experience thing. I
(25:24):
think it's gonna have to beboth in every organization,
depending where they're at intheir life cycle , what their
vision is, what their strategyis, is gonna have to figure out
like, how do we think aboutcompensation? How do we think
about our value prop toemployees where compensation
fits into that versus thiswhole engagement thing. So it's
a little bit of a non-answer toyour question .
Lisa McCracken (25:45):
I think it gets back to the discipline word
that you used earlier, havingthe discipline to know, okay,
when do we use the wage leverand how far can we go versus
when we say no, you know, weneed to deploy that capital
into really working harderpotentially onthe retention
elements. You know, otherthings that you can choose
outside of the pay.
Brett Landrum (26:04):
Well, and I think what's important is
making sure all the differentelements of the strategy are
congruent, and go together. Andthat's like, I think it's easy
to kind of fall out ofalignment in some of those
different areas.
Lisa McCracken (26:15):
Fantastic.
Thank you for being with usthis morning. And you've got a
team of ProCare HR folks hereat the conference. And ,
appreciate all of you beingwith us. Continue to pay
attention to future NIC Chatspodcasts and have a great rest
of the conference.
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