August 28, 2024 • 42 mins
In today's episode of the Senior Housing Investors Podcast, we sit down with Steve Groth, a seasoned property and casualty risk consultant with INSURICA, who provides enlightening insights into this critical issue. Through a heartfelt recount of his grandmother's hospice care, Steve shares how this personal experience reshaped his perspective on the profound impact of risk management and safety in healthcare and senior living sectors.
Steve walks us through the startling reality of high injury rates among employees in skilled nursing and assisted living facilities. Drawing parallels to industries like construction and manufacturing, he identifies key injury causes and their far-reaching effects on resident care, employee well-being, and staffing. Our conversation reveals the importance of communicating these impacts beyond just financial metrics, advocating for a holistic approach to support senior living operators.
We also explore the ripple effects of workplace injuries on organizational culture and caregiver-resident relationships. Steve's personal anecdotes and professional experiences highlight the significance of fostering a positive and safe work environment. From strategies for improving safety programs to leveraging leadership's role in mitigating risks, this episode is packed with practical advice for anyone involved in senior housing. Listen in for a thought-provoking discussion that underscores the necessity of prioritizing employee safety to enhance the quality of care in assisted living communities.
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Episode Transcript
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Speaker 1 (00:07):
The moment my job became a career, it's when my
grandmother was on hospice care.
Because a guy in my 20s andaround 30, my job was a job.
I wanted to pay the rent, Iwanted to have fun with friends,
but it was a job.
I didn't really see theconnection to what I was doing
to other people's lives.
When my grandmother was onhospice care, I was able to
visit her about three times.
(00:27):
So I drove and I opened herdoor.
I walked in.
The first words out of hermouth were not hi, steve.
First thing she said is youhave to meet Julie.
Julie was her hospice nurse.
You know my grandmother,somebody not easy to gain her
trust, but once you had it itwas a really precious thing.
And when I drove home and I hada lot of thinking on my mind,
one of the things that was juststicking with me is what if
(00:49):
something prevents Julie frombeing with my grandmother during
the remaining days of her life?
That is the moment that Irealized how much this mattered.
Speaker 2 (01:04):
Welcome to the Senior Housing Investors Podcast.
If you are an owner operator,investor, developer or buyer of
senior housing, you've come tothe right place.
The best way to stay connectedwith us is to sign up for our
weekly newsletter athavenseniorinvestmentscom.
This podcast doesn't existwithout you, our community.
(01:26):
Thank you for listening andreach out to us anytime.
Speaker 3 (01:36):
Welcome back everyone .
I am so excited to introduceyou to our newest podcast.
Today our host, john Haber, ishaving a great conversation with
Steve Roth.
He is a property and casualtyrisk consultant with Insurica.
Tune in and listen to theirgreat conversation.
Speaker 4 (01:56):
John.
Thanks, kelsey.
Today we have Steve Roth andSteve is with Insurica and we're
going to be speaking aboutsafety leadership that drive key
business indicators.
Steve, welcome to the show.
Thank you, john.
Tell us a little bit aboutyourself, your background and
such, and look forward togetting to know you.
Speaker 1 (02:18):
Sure, yeah, I'm approaching 20 years in risk
management and commercialinsurance.
I've had a pretty unique anddiverse career, which I think is
a good introduction to thistopic.
I began doing risk controlinspections really across every
industry trucking, manufacturing, construction, healthcare and
(02:39):
then, like a lot of people, Iwas laid off in the housing
bubble and turned out to be acomplete blessing for me.
I was interviewing with thecompany looking for my next
chapter, and the gentleman whobecame my manager said we
specialize in health care andsenior living.
How comfortable are youtraining people on how to use a
(03:01):
gait belt?
And my answer was what's a gatebelt?
And he laughed and he explainedand he said we have PTs, we
have nurses on our team.
We'll give you all the trainingyou need if you're interested
in learning.
And, of course, that was atough recession and I was in
need of a job, so I said sure,I'd love to learn.
(03:23):
Turned out to be one of thebest decisions and career moves
in my life.
So I spent the next five yearsdoing health and safety
consulting in hospitals,assisted living communities,
skilled nursing home, health andhospice.
You know several hundredgatebelt training sessions later
, you know, working alongsidethe staff on the floor observing
(03:45):
toileting transfers and it wassuch a great opportunity to
learn the business.
But also it's where I kind ofdeveloped my personal connection
with those who provide care fora living.
Next, I was actually in aleadership role for four years.
I oversaw staff that handledservices being provided in seven
states.
(04:05):
Then I actually decided Iwanted to be a commercial
insurance broker.
I missed working with theclients but I wanted to do it in
a different way.
So I thought you know what, Iknow safety, I know risk, I know
the industry.
I actually didn't really knowinsurance so decided to be a
commercial underwriter for fouryears again, specializing in
healthcare and senior living,because I wanted to understand
(04:28):
how insurance was priceddifferent coverages.
I thought that would make me amuch better insurance broker.
And now I've been a commercialinsurance broker and risk
manager for a little over twoyears.
Speaker 4 (04:40):
Well, you're new to the insurance side of the
business but not in seniorliving side, and so to find the
problem with employee injuriesin senior living, this is huge.
I mean it's you know we'retalking about sometimes and
lifting individuals that may beeven heavier than yourself, or
(05:01):
trying to get someone out of bedor into bed.
Tell us a little bit about whatthat problem is.
Speaker 1 (05:07):
Sure, let's start with this.
I would encourage yourlisteners and you too, john, to
do a little bit of a mentalexercise.
Think about four industries inthe country.
I'll split up assisted livingand skilled nursing.
Think construction,manufacturing, assisted living
and skilled nursing.
Now, in your mind, rank thosefrom highest rate of lost time
(05:28):
injuries to lowest.
So here's the answer thehighest is skilled nursing, the
second highest is assistedliving, then manufacturing, then
construction.
Wow, so when you're drivingpast construction sites, these
employees are getting injured ona lost time rate at 25% the
rate of assisted living andabout 12% the rate of skilled
(05:50):
nursing.
I mean so for every injury on ajob site, a construction job
site, at a manufacturing plant,we're seeing four to five in
assisted living and eight, nine,10 in skilled nursing.
It's just staggering.
Speaker 4 (06:08):
So tell me some of those injuries that happen.
What are you seeing most?
So you're saying that skillednursing and assisted living are
the highest of that five groupCorrect?
Tell us what the highestinjuries that are happening
within skilled nursing andassisted living.
Speaker 1 (06:24):
Yeah, and I like to start with lost time injuries,
because that's really that's thedata that you know.
It impacts resident care, itimpacts the life of the employee
, it impacts the business'sbottom line.
Those are also tend to be themost costly.
And so when it comes to losttime injuries, by far the number
one cause is transfer andmobility assistance.
You know, skilled nursingoperators are probably providing
(06:47):
some type of repositioningassistance in bed as well.
But you know, when we get intoany kind of ADLs, you know your
toileting, your dressing,getting out of bed.
You know ambulation assistancewalking down the hall.
A big one is fall assist.
Some of the most tragic and sadinjuries I've seen for staff
have been getting somebody offthe floor and then usually
(07:09):
number two cause is slip stripsand falls or falls at an
elevation, like somebody in afacilities role working on a
ladder.
And speaking of sad, I'veactually had a client in my
career that had a fatality andit was somebody falling off a
roof doing HVAC work.
So if I were an operator and Iwas looking at this, I would
(07:30):
obviously start with my data andmy hunch is the data is going
to lead you to those two places.
We might have cuts andlacerations, needle sticks those
are frequent, they don't tendto lead to lost time.
And then another category thatwe can see is moving of
furniture, dietary services ifthey're handling large boxes of
(07:51):
maybe fruits and vegetables,meat, things like that.
And then, depending on thecommunity, some communities have
transportation services.
Sometimes we see just like anyindustry where there are drivers
we can see motor vehicleinjuries.
Speaker 4 (08:05):
That's sad when that happens yeah.
Speaker 1 (08:10):
But part of the problem.
John and I want to be reallycandid about what I think is a
challenge, and I'm guilty ofthis as well, and I've had to
learn the hard way way.
I believe a lot of industrypartners in supporting senior
living need to do a better jobof helping owners and operators
understanding the broad impactof this, how it impacts things
(08:33):
like culture, staffing,occupancy, quality of care.
Because here's another mentalexercise that I like to have
people do when I talk about thetopic of employee injuries, I'll
talk to like an executive, aCFO, a president or CEO, and
I'll say when I talk aboutemployee injuries, what is the
first thing that comes to mind?
(08:54):
And they'll think about it andusually the response is my
workers' compensation rates.
That's usually the number onething that they think of and
that's natural.
So if I'm an owner or anoperator, then I would go to my
P&L mentally and I would think,okay, here's what I'm spending
on insurance.
Then I'd think about my lastinsurance renewal and you might
(09:15):
think well, property insuranceis a lot more expensive.
General and professionalliability is a lot more
expensive.
So workers' comp is it's, bythe way, one of the only types
of insurance in the countryright now.
That is a soft market forbuyers, so I believe that it's
incumbent upon people likemyself to speak about this.
Beyond the workers'compensation benefit, there are
(09:38):
tremendous benefits with keybusiness drivers, because if
we're just thinking aboutworkers' compensation, I don't
think we're serving the industrywell, because it doesn't really
grab the attention of seniorleadership.
Speaker 4 (09:52):
So share some of the positive examples of each of
those five areas.
Speaker 1 (09:59):
Sure, why don't we start with culture?
When I was in a leadership role, I learned very quickly that if
I cared about my employees forleadership role, I learned very
quickly that if I cared about myemployees for eight hours, I
wasn't going to be successful.
Strong leaders care about theiremployees for 24 hours a day,
when they're at work and whenthey're not at work, and
work-related injuries go homewith you.
(10:19):
They impact you for 24 hours aday.
Also, think about the potentialdisruption to operations.
My cousin's a CNA and she's thetype of CNA that I'm telling
you every one of your listenerswould hire her today if they
could.
She's been on the floor forover 20 years.
She refers to her residents asfamily.
(10:40):
She truly loves what she does,family.
She truly loves what she does,and she was in a mentoring and
training role before they everactually elevated her to that
official position.
So the value that she broughtto that organization was just
profound.
And I imagine your listeners,if they took a moment to think
(11:00):
about it, they could listmultiple care providers.
Maybe they're in leadershiproles, maybe they're not.
Maybe they're in kind ofsemi-leadership roles so they
make a little bit more money foradded responsibilities.
But here's the thing when I'vemet people like this and when I
worked alongside them on thefloor, I noticed that they
tended to almost talk aboutwork-related injuries and the
(11:21):
soreness on their body almostlike a battle wound, about
work-related injuries and thesoreness on their body almost
like a battle wound Like this isjust what comes with the
territory of providing care forpeople we love.
And it kind of breaks my heart,because I've visited enough
communities, assisted livingcommunities and skilled nursing
facilities to know that itdoesn't have to be that way.
(11:42):
So we can do both.
We can care for residents andwe can care for caregivers.
So we can do both.
We can care for residents andwe can care for caregivers.
We can do both Because thinkabout the devastated impact of a
work-related injury on the lifeof an employee In our industry,
john, there are a lot of youngmothers with small children at
home and let's say you're inhuman resources and you have a
(12:03):
work-related injury for one ofyour caregivers and you get the
doctor's notice back saying theycan't lift more than 10 pounds
for maybe six weeks, maybe eightweeks, whatever.
That is Okay.
Now, as a business, we need tothink about what our next steps
are.
But let's look at it through anempathetic lens and say, well,
what's next for that individualIf they have a young child at
(12:25):
home?
That means six weeks, eightweeks, that they can't pick up
their young child.
So, first of all, just theresponsibilities of life outside
of work just got a whole lotmore difficult.
Second, you know, talk to amother.
They will tell you you don'tget certain moments in life back
if you lose the ability toprovide certain level of care
(12:47):
for your own children.
Or let's say you have a personin a facilities role or
transportation role, or maybedietary, and they just have an
upcoming golf trip.
They're going hunting and thenboom, something happens.
They slip and fall, theyfracture an ankle, something
happens.
Those personal plans arecanceled, they can't do it.
And then the last thing I wouldsay is and I've had a couple of
(13:09):
serious injuries in my life,but non-work related skiing,
playing, basketball, things likethis I learned instantly that
the topic of ADLs, these arefolks who provide support for
the activities of daily livingfor others.
The second you have awork-related injury.
You need someone else tosupport you with those things.
(13:30):
You know, when I had mybasketball injury, I was 24.
This is 16, 17 years ago, youknow, I needed a friend to carry
my groceries up to mysecond-story apartment.
You don't think about thispre-injury, you just don't,
until life becomes real.
So I would just kind of stepback and think about the impact
that all of that has on theculture of an organization,
(13:51):
because our employees talk, theyknow each other, they care
about each other and they'rehaving to pick up the slack from
one another, and it's achallenge and it can be a burden
.
So it definitely impactsculture.
So when you know and, by theway way, I don't know if I
mentioned the data, I mentionedthe comparison between different
industries, but the Bureau ofLabor Statistics publishes
(14:13):
injury data every year.
They publish it in November andit always lags behind about a
year and a half.
So the most lost time injuryrate is 4.6 incidents cases or
100 FTS, and for skilled nursingit's 9.4.
Wow.
(14:33):
So when I share these personalanecdotes, think about the
numbers.
That's every year, john.
That's every year.
So if you're an operator, thisis okay.
On average, 4.6 this year, 4.6next year.
So it's a problem and I thinkwe need to talk about it.
Speaker 4 (14:53):
Let's talk about that .
What do you recommend tooperators as it relates to their
current safety programs ornon-programs, or whatever it may
be?
Let our audience know what youdo when you come in and you talk
about safety with an operator.
Speaker 1 (15:11):
Yeah, step one is basically a baseline assessment
of where are we today, where arewe currently?
I would start with a little bitmore of a qualitative
assessment of my executiveleadership team.
I would ask questions about dolike a one to five scale, how
much do we focus on this?
Do we know our frequency andseverity of injuries?
(15:31):
Do we know it on a communitylevel?
Do we know it on a regionallevel?
What about shifts?
We talked about cause of injuryand then asking questions like
well, how do we compare to theindustry?
How do we stack up against ourindustry peers?
All of this data is availablepublicly.
How often do we do a benchmarkanalysis and see where we are
compared to the industry andcompared to ourselves?
(15:52):
What kind of goals do we have?
So that's step one is to justkind of get a finger on the
pulse of where are we?
How much have we prioritizedthis?
Because the benefits I touchedon.
If you wouldn't mind, I'd liketo jump back to a couple other
benefits and then talk a littlebit more solutions.
Okay, yeah, if you don't mind,I'd like to also touch on
(16:12):
staffing, quality of care andoccupancy, and I wanted to share
a story when it comes tostaffing.
I've done a lot of work in mycareer working with communities
in small towns and this one timeI had both of the assisted
living communities in the sametown and they were in a constant
fight over labor and I imaginepeople can relate to that.
(16:35):
And when it comes to riskmanagement again I'm in a risk
management role and that's thelens I'm looking at it these two
communities were truly aone-star and a five-star and
since I would always visit themthey were about an hour and a
half drive from my house I'dalways visit them the same day.
I had this incredibleperspective of seeing the two
(16:56):
differences.
I was meeting one day with whatI would call five-star and
these folks were.
These people were incredible.
The lady who handled all oftheir ambulation and transfer
training.
She came up to me and she saidSteve, I'm really concerned.
I said what?
What's happening?
She said you know one star thepeople who had some work to do
on the other side of town.
(17:17):
They were raising their CNA payand they were not in a position
at that time to match.
She said we're worried aboutlosing a lot of people.
And they did.
The next time I was there, whichis about three months later, I
believe, I was working with theexecutive director on a project
and she saw me that I was thereand she came running up and she
said oh, I'm so excited you'rehere.
(17:37):
I wanted to tell you something.
I said what she said remember,I told you we were going to lose
a lot of our people.
She said we did.
And she said and we neverraised our pay and they almost
all came back.
I said really.
She said human resources did aninterview of everyone, said
we're happy you're back.
Help us understand what madeyou decide to return.
She said person after personsaid over there, they don't care
(18:02):
about my safety here I know youdo.
They don't care about my safetyhere I know you do.
That was just so powerful.
Just so powerful.
And then I wanted to share apersonal story when it comes to
quality of care, and now this isa kind of an adjacent care
industry.
Again, I've done a lot of workin home health and hospice.
John, I'm 40 years old.
The moment my job became acareer.
(18:23):
It's about 10 years ago.
It's when my grandmother was onhospice care, because you know
a guy in my 20s and around 30,my job was a job.
I wanted to pay the rent, Iwanted to have fun with friends,
but it was a job.
I didn't really see theconnection to what I was doing
to other people's lives.
When my grandmother was onhospice care, I was able to
(18:44):
visit her about three, threetimes and she was a couple hour
drive.
So I drove and I opened herdoor.
I walked in.
The first words out of hermouth were not hi, steve.
First thing she said is youhave to meet Julie.
Julie was her hospice nurse andjust you know, my grandmother
somebody not easy to gain hertrust, but once you had it it
(19:06):
was a really precious thing.
And when I, you know, drove homeand I had a lot of thinking on
my mind, I've obviously had along drive after seeing my
grandmother and one of thethings that was just sticking
with me is what if somethinghappens to Julie?
What?
What if Julie is caring forsomebody else and, you know,
(19:26):
pops her shoulder?
What if she's walking intoanother patient's home and slips
and falls and breaks a bone?
What if something preventsJulie from being with my
grandmother during the remainingdays of her life?
The moment that I realized howmuch this mattered.
So when you look at, we'regoing to talk solutions.
(19:48):
When you look at your data,consider lost time, injuries,
but also consider injuries wheremaybe we're able to bring
somebody back on a modified dutyrole but they aren't caring for
residents, they're doing someother job.
So that caregiver resident bondhas been broken.
So that caregiver resident bondhas been broken.
We can track that data.
So quality of care is I mean itis something profoundly
(20:12):
impacted by employee injuries.
And then the last one I wasgoing to touch on was occupancy.
Again, it's another personalstory I wanted to share,
(20:45):
no-transcript, you know, and itdidn't really resonate with me
until 10 years later.
And now, in a span of abouteight months, my family has
helped two loved ones move intoassisted living and I had
independent conversations withthe family members who helped
make the decision and they both.
You know and I'm very familiarwith one of the communities that
(21:08):
they moved into.
It's a beautiful place andapparently the other place that
my other loved ones moving intois also really nice.
But my parents who helped withone, and then my two aunts who
helped with another, they bothsaid the same thing.
They talked about the people.
They used words like warm,happy, welcoming nice of
everybody, of every department,whether they were in leadership,
(21:32):
whether they were an hourlyemployee.
That was such a draw for them.
If you have chronic back pain,if you have a nagging knee
injury that hasn't yet become aworkers' comp claim, how can you
do that?
You know injuries impacteverything.
(21:53):
So you know occupancy is alittle bit tougher to quantify,
but it's real.
It's real.
Okay now we can get back tosolutions.
Speaker 4 (22:03):
We're at the beginning of the NFL season.
You're telling me assistedliving has more injuries than
the NFL.
You know I've never done thatanalysis, but you should do it.
It was.
That'd be really big impact.
That's my homework assignment,john Guild nursing.
Anyway, it's just real excitedabout the NFL start again and I
(22:28):
know a lot of injuries happenthere.
But these stories are very,very impactful.
I remember visiting mygrandmother who had Alzheimer's
and for 20 years she was in amemory care community and she
was just so happy all the timebecause those around her really
loved and cared for her.
(22:48):
And so, yes, having anindividual get injured and not
be able to continue to have thatbond with the resident impacts
everything in that relationship.
So, yeah, keep going.
I love these stories.
Speaker 1 (23:02):
Yeah, yeah.
So, from a solution standpoint,I mentioned kind of doing like
a little bit of a leadershipteam gut check.
Where are we?
I also recommend doing apersonal gut check, because the
starting point from theleadership team when it comes to
employee safety should be dataand empathy.
What are our numbers and howare we connecting with our staff
(23:22):
?
How are we connecting with ourstaff?
And you know I shared somepersonal stories of injuries
that I've had.
I would encourage everyone in aleadership role, if you're
talking about this, to askyourself how would my life be
impacted if I wasn't able to usemy dominant arm?
What about if I wasn't able touse my right leg, which is, by
the way, how we drive?
Okay, I just lost someindependence there.
(23:43):
What if you can't lift over 10pounds?
You know?
Think about just living, thinkabout your hobbies, think about
your children, yourgrandchildren, and then think
about those who depend on you.
How are they going to beimpacted?
So the ripple effect here ishuge and, by the way, I
encourage that personalassessment to be included in
(24:05):
safety training.
Personal assessment to beincluded in safety training,
like, if you're doing trainingon resident handling and
mobility, have the employeesbefore you start training at all
.
Personalize it and ask them howwill your life be impacted if
you go three months and can'tlift over 10 pounds?
And think about it.
Have them write it down.
Don't have them hand it in andsay, okay, that's for you to
(24:26):
keep.
We want you to really thinkabout this personal about it.
Have them write it down, youknow.
Don't have them hand it in andsay, okay, that's for you to
keep.
We want you to really thinkabout this.
Personalize it, because nobodythinks about the impact of an
injury before it happens.
Well, not nobody, but, trust me, very few people do.
I do this for a living and Iwasn't thinking about it.
But then the last step of theself-assessment I would
encourage you to really dig intoyour data.
Self-assessment I wouldencourage you to really dig into
(24:49):
your data.
Every community should have anannual OSHA 300 log, which is a
great source of data.
It's not the only source.
We can look at workers' comptrends as well, but I would
start with the OSHA 300 log andthe pieces of data I would
capture are how many cases oflost time did we have and how
many days of lost time?
Because that's where ourstaffing and our quality of care
(25:11):
has really been interrupted.
And then also look at any kindof injuries involving transfer
or job restriction, because,again, maybe they're able to go
to work but they can't do theirfull job or maybe they can't
provide care.
Maybe they're able to go towork but they can't do their
full job or maybe they can'tprovide care.
And then, after you've got thatdata, I would sit down with the
executive director, whoeverknows the community or the
facility inside and out, and Iwould say how many of these
(25:34):
injuries impacted our rock starsyou know how many impacted that
person who takes the new hireunder their wing, how many
impacted the person who'sthey're like a leader on the
floor, but they don't carry thattitle To really understand the
true impact on our culture, onour training, on our mentoring,
(25:56):
because we can capture all thisdata and see where we're at as
an organization.
So that's step one, but thenthe next thing I would do is I
would take a very close look athow we're responding to injuries
when they happen.
I wanted to share a story fromwhen I was in a leadership role.
I had a consultant I wasmanaging health and safety
(26:18):
consultants at the time and shehad a client who is an operator
of, I want to say, 16 assistedliving communities across
multiple states.
Who is an operator of, I wantto say, 16 assisted living
communities across multiplestates.
Their executive team talkedabout this annually.
They had an annual strategymeeting to look at their risk
management plan and see what'sworking, see what's not working
and then make changes, and theyreally valued her input.
(26:40):
She was like an extension oftheir team and she invited me to
join once and the VP of humanresources came.
So they had a lot of data theywere going over and one piece of
information they were goingover was any work related injury
over $50,000 for workers' compclaim, and I think they had like
seven or eight and we justasked her to read basically,
(27:02):
what did we learn and what didwe do about it?
Just those two things.
And she went through each oneand she was going through these
reports and there was kind ofsome awkward tension in the room
when she was done with thisbecause almost every single
instance the blame was placed onthe employee.
My consultant, who again she'sable to say things in this room
(27:25):
that a lot of people can't theyhad her trust and respect.
She said may I ask a question?
They said, of course.
She said are you hiring themstupid or are you training them
that way?
I don't know.
And everybody laughed, exceptfor the president and CEO.
The president and CEO said pointtaken.
She looked at her team and shesaid this is unacceptable.
(27:47):
She said we've had these arecostly injuries, these are
impacting care, these areimpacting our culture, these are
impacting the lives of our teammembers and we as a leadership
team don't have any kind ofaction item that we have taken
to prevent recurrence If wehaven't learned from the serious
injuries that have happened.
Well then, what good is oursafety program at all?
(28:08):
So you know, it was a leaderreally taking the reins and
showing leadership.
So they put in place a verydetailed plan to, you know, get
all the way down to thecommunity level and make sure
that when something happens,large or small, we're doing an
effective investigation, we'recoming up with the true root
(28:28):
cause of the issue Understanding.
Is it a training issue?
Is it a quality issue?
One of the common things thatI've seen in my career is safety
training used as punishment.
Oh, the employee took ashortcut.
They didn't do what they weresupposed to do.
Let's retrain them.
Hold on, we need to pause.
If they didn't know how to doit safely, then we retrain them.
(28:50):
If they did know how to do it,why are we turning training into
a management, a performanceimprovement tool?
It's important to understandthe root of the issue, but there
is almost always something thatthe leadership team can do to
work to prevent it fromhappening again.
So if I were to start anywhereas an organization, it'd be
(29:12):
understand your data, understandhow we're responding to
incidents that have occurred,especially the more severe ones.
I just love the Albert Einsteinquote.
He said if I had an hour tosolve a problem, I'd spend 55
minutes thinking about theproblem and five minutes
thinking about solutions.
Because you know, if leaders doan effective job understanding
these two things, the solutionskind of fall into place.
(29:35):
So a couple other things Iwanted to share solutions.
And you know, john, one of thereally cool things about my
career is, since I'm in and outof different locations all the
time, I'm just sharing what I'veseen that's worked.
You know I'm not reallyinventing anything new here.
You know, is safety ofemployees a priority?
Is it part of your company'score values?
(29:55):
Is it specifically laid out assomething in how you operate.
This is what we believe in.
You know, I was doing apresentation a few months ago
and in preparation I wentthrough a lot of the large
assisted living operators in thecountry and I read their core
values.
I saw employee safety listedvery seldom.
It's just not common.
(30:18):
So I would take a look at thatand say, if we're not talking
about this, how are we evergoing to move the needle?
And then the next thing I wouldsay is you know a lot of
organizations put togethersafety teams, which is a great
idea, but you need to assemblethe right team.
And when it comes to assistedliving and skilled nursing, I
would encourage you to keepresident handling and mobility
(30:41):
separate from facilities,because it's really apples and
oranges.
You know, if you have afacilities team, you know that's
great.
They're focusing on burnt outexit lights and trip hazards and
life safety.
You know these are great thingsto be focusing on, but it's
just completely different fromwhat are we going to do when a
resident falls and they're in atight area.
That's just completelydifferent from what are we going
(31:01):
to do when a resident falls andthey're in a tight area.
That's a completely differentintervention and the teams are
going to have a different makeup.
So I would encourage that.
And then the last thing I wouldencourage you to do is really
tap into the resources that youalready have.
A lot of HR and quality systems.
You don't need to like reinventsomething, but you can say what
(31:22):
are we already doing and can wemake it a little bit more
robust and include training andquality assurance when it comes
specifically to our employeesafety?
And then also, I mean obviouslyI'm on the commercial insurance
broker side.
I was on the insurance companyside for 16 years.
Both tend to have a lot ofresources available.
(31:42):
The one thing to keep in mindand I can say this from
experience anybody who works foran insurance company they know
who signs their check.
Your insurance broker works foryou.
I am extremely fortunate I havea nurse on my team.
My clients can be 100% candidwith her.
They don't have to worry aboutit because she works for them.
(32:02):
So there are a lot of insurancecompanies that have really part
of their job is to communicateto the person who prices it,
which used to be me.
Hey, here are the good thingsthey're doing, but here's the
(32:27):
bad things they're doing.
So just understand that.
And then also, you know, osha,cdc and the VA actually have
some really phenomenal resources.
There are a lot of good toolsout there.
So anyway, john, I can send yousome links after this if you're
interested.
Speaker 4 (32:42):
Yes, Steve, a piece of our community or a subset of
our community are individualsthat are acquiring communities.
They want to be in thisbusiness.
They just sometimes don't haveall the answers to the questions
.
They aren't familiar with theback end side of operations.
(33:04):
How can they use you tominimize the risk associated
with acquiring a community thatis currently in business?
Speaker 1 (33:15):
Sure, you know, I imagine when folks are doing you
know, people who are doingacquisitions are kind of like,
in a sense, underwriters.
They're evaluating objectiveinformation to weigh risk versus
benefit.
That's really all underwritersare doing.
So I would encourage them toalmost put on their workers'
compensation underwriter hat hat.
(33:43):
I would want to look at fiveyears of injury history.
I would want to see theirexperience modification
worksheet.
So, for those who don't know,every company and I'm in Texas,
which is a little bit differentyou don't need to buy workers'
compensation in Texas, but mostdo, and I encourage companies to
they have a multiplier.
Basically rule of thumb ifyou're at a one, you're average.
(34:03):
If you're below one, you get acredit and you're above average
If you're below one.
So if you're at a 0.75, you'regoing to get a considerable
credit, and if you're above aone, then you're going to get a
debit on what you're paying inworkers' comp.
Now, it doesn't tell the fullstory.
One bad claim can potentiallydrive that up, which is why I
(34:24):
would want to sit down and I'dreally want to have a
comprehensive look.
And then the last piece ofinformation which is required
for regulatory purposes is theOSHA 300 log.
And, by the way, john, one ofthe things that's great about
looking at OSHA 300 logs is, ifthey don't have them, that tells
you where they're at from acompliance standpoint.
Because because they need to be.
So those are three really goodpieces of information and, you
(34:48):
know, if you look at all three,any one on its own doesn't
really tell the full story.
I would look at all threetogether.
Speaker 4 (34:56):
So I know that you want this discussion that we're
having to be focused on risk andoperational impact beyond
insurance.
Can you share the insurancebenefits as well?
Yeah, absolutely.
Speaker 1 (35:09):
First of all, I always start at the basics.
What is insurance?
It's simply the transfer ofrisk for premium, and the reason
why I'm really passionate aboutthe risk side of things is
because it's upstream from yourrenewals.
Pretty much every insurancebroker, most insurance brokers,
do a really fine job of shoppinginsurance, but what are we
(35:31):
doing to actually improve ourorganization and strengthen our
negotiating position?
That's where risk managementcomes in and that's something
that every employer can control.
So that's really the startingpoint that I would, that I would
look at.
But you know, even when itcomes to insurance I mentioned,
I think, there are four benefitsthat come before insurance.
When it comes to employee safetyand the benefits there, I
(35:54):
personally this is just myopinion I believe general and
professional liability evencomes before workers come,
because when you talk to generaland professional liability
insurance companies, the numberone thing they're asking about
is staffing.
It is just critical to thequality of care and they want to
know the organizations that areleast likely to have some kind
(36:15):
of allegations, some kind ofliability claim, which we know
can be very expensive.
So they focus like a laser onstaffing.
I've even seen a general andprofessional liability
application that asks about thecompany's last two years of
workers' comp experience mods.
Well, why would they ask that?
Because they know if somebodyhas a higher mod it's going to
(36:38):
impact lost time, injuries andstaffing and it's just an
indication into how employeesare being cared for and then
they in turn care for theresident.
So that's the first benefit andwe already touched on kind of
the workers' comp benefit whichis workers' comp is.
It's really the only type ofinsurance that right now
employers are in the driver'sseat.
I mean, I'm sure your listenerswhen it comes to property
(37:00):
insurance and depending on thestate and jurisdiction,
liability might be out ofcontrol.
That's all location dependent.
But workers' comp is the onetype of insurance that's a
little bit less painful rightnow.
So I would encourage people ifthey're experiencing pain with
workers' comp.
It's not a market issue.
The market is actually veryfavorable right now.
(37:22):
It's got to be because ofsomething risk-related.
So that means there's a realopportunity there.
Speaker 4 (37:29):
Excellent.
So, steve, tell us about yourcompany InsureCup, and how you
benefit the marketplace.
Speaker 1 (37:39):
Sure InsureCup was started in 1957.
We're the 44th largest agencyin the country, privately held.
It's a fantastic place to work.
In fact, in 2022, we were namedbest agency to work for by the
insurance journal.
When I say I was an underwriter, that meant that my clients
were insurance agents.
(37:59):
That was my client base and soI was able to you know, really
across three states in themiddle part of the country get
to know agencies.
You know dozens of agencies andI chose to work at Insurica, the
reason being we are a largeenough company to have all the
bells and whistles and resourcesand industry expertise of the
(38:22):
worldwide insurance brokers.
But, yeah, we're small enoughto have that personal touch.
My clients know me, we have agreat relationship and so it was
a really good balance.
Like I mentioned, I'm reallyfortunate.
I've got a nurse on my team,I've got independent claims
people that work on my team,because we don't just want to be
an insurance agency.
We want to be a risk managementpartner.
(38:42):
We want our clients to view theinsurance program as one pillar
of their risk managementprogram.
You know, we want our clientsto think about how can we
improve so we can become best inclass.
You know, that opens the doorto different, creative
self-funding options, differentrisk financing options where you
can, as an employer, can, takemore of your own risk, and so
(39:06):
we're a company that we lovebringing forward those resources
.
We have clients as well thatthey just want us to take care
of their insurance and theydon't want a lot of hands-on
assistance.
We understand that.
But those who really want toneed help or they think they're
best in class and they want toget even better that's where we
get really excited.
So that's a little bit aboutour team.
(39:28):
Yeah, I'm part of our healthcareand senior living practice.
We basically break our companyinto 14 industry practice groups
.
Healthcare and senior living isone of them.
Healthcare and senior living isone of them, and one of the
reasons why they brought me onboard was to really spearhead
senior living because we've gotsome folks who are really strong
in home healthcare.
The head of that practice groupis a former hospital
(39:49):
administrator, so he's reallystrong working with health
systems and hospitals.
But I got to develop arelationship with Insurica and
they understood my backgroundconsulting in senior living and
they said we think you'd be agood fit to join the team.
Speaker 4 (40:04):
Steve, your stories, your passion, your enthusiasm
for the senior living space isevident in this discussion, and
so it's always a pleasure tohave an individual like yourself
on the Senior Housing InvestorPodcast, because you bring great
value to those that arelistening.
(40:26):
And so how do individuals findyou and connect with you so that
they can get questions answeredor even new insurance or
replacing insurance, whateverthat may be?
Speaker 1 (40:39):
Yeah, I would say the easiest way.
I mean I'm not too active onLinkedIn.
I actually have a newsletter asI build relationships with
people.
It's a semi-monthly newsletter.
I call it an underwriter's take.
I'm trying to get people to seethings through the lens of the
person who prices theirinsurance.
So I'd say if somebody justwants to get on my you know,
(40:59):
I'll mail it to them paper copy,if they want it.
If they're old fashioned, ifthey want me to put them on an
email list, I'll do that and my,my phone number is 214-422-6098
.
Am I supposed to give that out?
I don't know.
Yeah, email's the best way toreach me.
Stevegrowth, that's G-R-O-T-Hat insuricacom.
So I would say, if you knowthere's a lot of people who are
(41:20):
really happy with theirinsurance broker, but if they
want to get on my newsletterlist and just you know, know me
as a resource would ever want tograb coffee, just have like a
quick virtual conversation.
You know I love supporting theindustry and I know if somebody
is in really good hands withtheir broker but they value a
conversation, well then it'svaluable to me as well and I
(41:40):
know that always rewards me inthe long run.
So just supporting the industryseems like the best way to also
grow the size of my business.
So that's the best way peoplecan get in touch with me.
But I would encourage thenewsletter because a lot of
these personal stories I shareand it just helps businesses be
better insurance buyers andbetter risk managers just helps
(42:02):
businesses be better insurancebuyers and better risk managers.
Speaker 4 (42:08):
Well, thank you for your time, Steve.
You're a valuable resource forthe space and I encourage our
audience to get in touch withyou and see if you can help them
.
Sounds great.
Thanks so much, Jeff.
You're welcome.
Have a great day, Steve.
Thanks.
The moment my job became a career, it's when my
grandmother was on hospice care.
Because a guy in my 20s andaround 30, my job was a job.
I wanted to pay the rent, Iwanted to have fun with friends,
but it was a job.
I didn't really see theconnection to what I was doing
to other people's lives.
When my grandmother was onhospice care, I was able to
visit her about three times.
(00:27):
So I drove and I opened herdoor.
I walked in.
The first words out of hermouth were not hi, steve.
First thing she said is youhave to meet Julie.
Julie was her hospice nurse.
You know my grandmother,somebody not easy to gain her
trust, but once you had it itwas a really precious thing.
And when I drove home and I hada lot of thinking on my mind,
one of the things that was juststicking with me is what if
(00:49):
something prevents Julie frombeing with my grandmother during
the remaining days of her life?
That is the moment that Irealized how much this mattered.
Speaker 2 (01:04):
Welcome to the Senior Housing Investors Podcast.
If you are an owner operator,investor, developer or buyer of
senior housing, you've come tothe right place.
The best way to stay connectedwith us is to sign up for our
weekly newsletter athavenseniorinvestmentscom.
This podcast doesn't existwithout you, our community.
(01:26):
Thank you for listening andreach out to us anytime.
Speaker 3 (01:36):
Welcome back everyone .
I am so excited to introduceyou to our newest podcast.
Today our host, john Haber, ishaving a great conversation with
Steve Roth.
He is a property and casualtyrisk consultant with Insurica.
Tune in and listen to theirgreat conversation.
Speaker 4 (01:56):
John.
Thanks, kelsey.
Today we have Steve Roth andSteve is with Insurica and we're
going to be speaking aboutsafety leadership that drive key
business indicators.
Steve, welcome to the show.
Thank you, john.
Tell us a little bit aboutyourself, your background and
such, and look forward togetting to know you.
Speaker 1 (02:18):
Sure, yeah, I'm approaching 20 years in risk
management and commercialinsurance.
I've had a pretty unique anddiverse career, which I think is
a good introduction to thistopic.
I began doing risk controlinspections really across every
industry trucking, manufacturing, construction, healthcare and
(02:39):
then, like a lot of people, Iwas laid off in the housing
bubble and turned out to be acomplete blessing for me.
I was interviewing with thecompany looking for my next
chapter, and the gentleman whobecame my manager said we
specialize in health care andsenior living.
How comfortable are youtraining people on how to use a
(03:01):
gait belt?
And my answer was what's a gatebelt?
And he laughed and he explainedand he said we have PTs, we
have nurses on our team.
We'll give you all the trainingyou need if you're interested
in learning.
And, of course, that was atough recession and I was in
need of a job, so I said sure,I'd love to learn.
(03:23):
Turned out to be one of thebest decisions and career moves
in my life.
So I spent the next five yearsdoing health and safety
consulting in hospitals,assisted living communities,
skilled nursing home, health andhospice.
You know several hundredgatebelt training sessions later
, you know, working alongsidethe staff on the floor observing
(03:45):
toileting transfers and it wassuch a great opportunity to
learn the business.
But also it's where I kind ofdeveloped my personal connection
with those who provide care fora living.
Next, I was actually in aleadership role for four years.
I oversaw staff that handledservices being provided in seven
states.
(04:05):
Then I actually decided Iwanted to be a commercial
insurance broker.
I missed working with theclients but I wanted to do it in
a different way.
So I thought you know what, Iknow safety, I know risk, I know
the industry.
I actually didn't really knowinsurance so decided to be a
commercial underwriter for fouryears again, specializing in
healthcare and senior living,because I wanted to understand
(04:28):
how insurance was priceddifferent coverages.
I thought that would make me amuch better insurance broker.
And now I've been a commercialinsurance broker and risk
manager for a little over twoyears.
Speaker 4 (04:40):
Well, you're new to the insurance side of the
business but not in seniorliving side, and so to find the
problem with employee injuriesin senior living, this is huge.
I mean it's you know we'retalking about sometimes and
lifting individuals that may beeven heavier than yourself, or
(05:01):
trying to get someone out of bedor into bed.
Tell us a little bit about whatthat problem is.
Speaker 1 (05:07):
Sure, let's start with this.
I would encourage yourlisteners and you too, john, to
do a little bit of a mentalexercise.
Think about four industries inthe country.
I'll split up assisted livingand skilled nursing.
Think construction,manufacturing, assisted living
and skilled nursing.
Now, in your mind, rank thosefrom highest rate of lost time
(05:28):
injuries to lowest.
So here's the answer thehighest is skilled nursing, the
second highest is assistedliving, then manufacturing, then
construction.
Wow, so when you're drivingpast construction sites, these
employees are getting injured ona lost time rate at 25% the
rate of assisted living andabout 12% the rate of skilled
(05:50):
nursing.
I mean so for every injury on ajob site, a construction job
site, at a manufacturing plant,we're seeing four to five in
assisted living and eight, nine,10 in skilled nursing.
It's just staggering.
Speaker 4 (06:08):
So tell me some of those injuries that happen.
What are you seeing most?
So you're saying that skillednursing and assisted living are
the highest of that five groupCorrect?
Tell us what the highestinjuries that are happening
within skilled nursing andassisted living.
Speaker 1 (06:24):
Yeah, and I like to start with lost time injuries,
because that's really that's thedata that you know.
It impacts resident care, itimpacts the life of the employee
, it impacts the business'sbottom line.
Those are also tend to be themost costly.
And so when it comes to losttime injuries, by far the number
one cause is transfer andmobility assistance.
You know, skilled nursingoperators are probably providing
(06:47):
some type of repositioningassistance in bed as well.
But you know, when we get intoany kind of ADLs, you know your
toileting, your dressing,getting out of bed.
You know ambulation assistancewalking down the hall.
A big one is fall assist.
Some of the most tragic and sadinjuries I've seen for staff
have been getting somebody offthe floor and then usually
(07:09):
number two cause is slip stripsand falls or falls at an
elevation, like somebody in afacilities role working on a
ladder.
And speaking of sad, I'veactually had a client in my
career that had a fatality andit was somebody falling off a
roof doing HVAC work.
So if I were an operator and Iwas looking at this, I would
(07:30):
obviously start with my data andmy hunch is the data is going
to lead you to those two places.
We might have cuts andlacerations, needle sticks those
are frequent, they don't tendto lead to lost time.
And then another category thatwe can see is moving of
furniture, dietary services ifthey're handling large boxes of
(07:51):
maybe fruits and vegetables,meat, things like that.
And then, depending on thecommunity, some communities have
transportation services.
Sometimes we see just like anyindustry where there are drivers
we can see motor vehicleinjuries.
Speaker 4 (08:05):
That's sad when that happens yeah.
Speaker 1 (08:10):
But part of the problem.
John and I want to be reallycandid about what I think is a
challenge, and I'm guilty ofthis as well, and I've had to
learn the hard way way.
I believe a lot of industrypartners in supporting senior
living need to do a better jobof helping owners and operators
understanding the broad impactof this, how it impacts things
(08:33):
like culture, staffing,occupancy, quality of care.
Because here's another mentalexercise that I like to have
people do when I talk about thetopic of employee injuries, I'll
talk to like an executive, aCFO, a president or CEO, and
I'll say when I talk aboutemployee injuries, what is the
first thing that comes to mind?
(08:54):
And they'll think about it andusually the response is my
workers' compensation rates.
That's usually the number onething that they think of and
that's natural.
So if I'm an owner or anoperator, then I would go to my
P&L mentally and I would think,okay, here's what I'm spending
on insurance.
Then I'd think about my lastinsurance renewal and you might
(09:15):
think well, property insuranceis a lot more expensive.
General and professionalliability is a lot more
expensive.
So workers' comp is it's, bythe way, one of the only types
of insurance in the countryright now.
That is a soft market forbuyers, so I believe that it's
incumbent upon people likemyself to speak about this.
Beyond the workers'compensation benefit, there are
(09:38):
tremendous benefits with keybusiness drivers, because if
we're just thinking aboutworkers' compensation, I don't
think we're serving the industrywell, because it doesn't really
grab the attention of seniorleadership.
Speaker 4 (09:52):
So share some of the positive examples of each of
those five areas.
Speaker 1 (09:59):
Sure, why don't we start with culture?
When I was in a leadership role, I learned very quickly that if
I cared about my employees forleadership role, I learned very
quickly that if I cared about myemployees for eight hours, I
wasn't going to be successful.
Strong leaders care about theiremployees for 24 hours a day,
when they're at work and whenthey're not at work, and
work-related injuries go homewith you.
(10:19):
They impact you for 24 hours aday.
Also, think about the potentialdisruption to operations.
My cousin's a CNA and she's thetype of CNA that I'm telling
you every one of your listenerswould hire her today if they
could.
She's been on the floor forover 20 years.
She refers to her residents asfamily.
(10:40):
She truly loves what she does,family.
She truly loves what she does,and she was in a mentoring and
training role before they everactually elevated her to that
official position.
So the value that she broughtto that organization was just
profound.
And I imagine your listeners,if they took a moment to think
(11:00):
about it, they could listmultiple care providers.
Maybe they're in leadershiproles, maybe they're not.
Maybe they're in kind ofsemi-leadership roles so they
make a little bit more money foradded responsibilities.
But here's the thing when I'vemet people like this and when I
worked alongside them on thefloor, I noticed that they
tended to almost talk aboutwork-related injuries and the
(11:21):
soreness on their body almostlike a battle wound, about
work-related injuries and thesoreness on their body almost
like a battle wound Like this isjust what comes with the
territory of providing care forpeople we love.
And it kind of breaks my heart,because I've visited enough
communities, assisted livingcommunities and skilled nursing
facilities to know that itdoesn't have to be that way.
(11:42):
So we can do both.
We can care for residents andwe can care for caregivers.
So we can do both.
We can care for residents andwe can care for caregivers.
We can do both Because thinkabout the devastated impact of a
work-related injury on the lifeof an employee In our industry,
john, there are a lot of youngmothers with small children at
home and let's say you're inhuman resources and you have a
(12:03):
work-related injury for one ofyour caregivers and you get the
doctor's notice back saying theycan't lift more than 10 pounds
for maybe six weeks, maybe eightweeks, whatever.
That is Okay.
Now, as a business, we need tothink about what our next steps
are.
But let's look at it through anempathetic lens and say, well,
what's next for that individualIf they have a young child at
(12:25):
home?
That means six weeks, eightweeks, that they can't pick up
their young child.
So, first of all, just theresponsibilities of life outside
of work just got a whole lotmore difficult.
Second, you know, talk to amother.
They will tell you you don'tget certain moments in life back
if you lose the ability toprovide certain level of care
(12:47):
for your own children.
Or let's say you have a personin a facilities role or
transportation role, or maybedietary, and they just have an
upcoming golf trip.
They're going hunting and thenboom, something happens.
They slip and fall, theyfracture an ankle, something
happens.
Those personal plans arecanceled, they can't do it.
And then the last thing I wouldsay is and I've had a couple of
(13:09):
serious injuries in my life,but non-work related skiing,
playing, basketball, things likethis I learned instantly that
the topic of ADLs, these arefolks who provide support for
the activities of daily livingfor others.
The second you have awork-related injury.
You need someone else tosupport you with those things.
(13:30):
You know, when I had mybasketball injury, I was 24.
This is 16, 17 years ago, youknow, I needed a friend to carry
my groceries up to mysecond-story apartment.
You don't think about thispre-injury, you just don't,
until life becomes real.
So I would just kind of stepback and think about the impact
that all of that has on theculture of an organization,
(13:51):
because our employees talk, theyknow each other, they care
about each other and they'rehaving to pick up the slack from
one another, and it's achallenge and it can be a burden
.
So it definitely impactsculture.
So when you know and, by theway way, I don't know if I
mentioned the data, I mentionedthe comparison between different
industries, but the Bureau ofLabor Statistics publishes
(14:13):
injury data every year.
They publish it in November andit always lags behind about a
year and a half.
So the most lost time injuryrate is 4.6 incidents cases or
100 FTS, and for skilled nursingit's 9.4.
Wow.
(14:33):
So when I share these personalanecdotes, think about the
numbers.
That's every year, john.
That's every year.
So if you're an operator, thisis okay.
On average, 4.6 this year, 4.6next year.
So it's a problem and I thinkwe need to talk about it.
Speaker 4 (14:53):
Let's talk about that .
What do you recommend tooperators as it relates to their
current safety programs ornon-programs, or whatever it may
be?
Let our audience know what youdo when you come in and you talk
about safety with an operator.
Speaker 1 (15:11):
Yeah, step one is basically a baseline assessment
of where are we today, where arewe currently?
I would start with a little bitmore of a qualitative
assessment of my executiveleadership team.
I would ask questions about dolike a one to five scale, how
much do we focus on this?
Do we know our frequency andseverity of injuries?
(15:31):
Do we know it on a communitylevel?
Do we know it on a regionallevel?
What about shifts?
We talked about cause of injuryand then asking questions like
well, how do we compare to theindustry?
How do we stack up against ourindustry peers?
All of this data is availablepublicly.
How often do we do a benchmarkanalysis and see where we are
compared to the industry andcompared to ourselves?
(15:52):
What kind of goals do we have?
So that's step one is to justkind of get a finger on the
pulse of where are we?
How much have we prioritizedthis?
Because the benefits I touchedon.
If you wouldn't mind, I'd liketo jump back to a couple other
benefits and then talk a littlebit more solutions.
Okay, yeah, if you don't mind,I'd like to also touch on
(16:12):
staffing, quality of care andoccupancy, and I wanted to share
a story when it comes tostaffing.
I've done a lot of work in mycareer working with communities
in small towns and this one timeI had both of the assisted
living communities in the sametown and they were in a constant
fight over labor and I imaginepeople can relate to that.
(16:35):
And when it comes to riskmanagement again I'm in a risk
management role and that's thelens I'm looking at it these two
communities were truly aone-star and a five-star and
since I would always visit themthey were about an hour and a
half drive from my house I'dalways visit them the same day.
I had this incredibleperspective of seeing the two
(16:56):
differences.
I was meeting one day with whatI would call five-star and
these folks were.
These people were incredible.
The lady who handled all oftheir ambulation and transfer
training.
She came up to me and she saidSteve, I'm really concerned.
I said what?
What's happening?
She said you know one star thepeople who had some work to do
on the other side of town.
(17:17):
They were raising their CNA payand they were not in a position
at that time to match.
She said we're worried aboutlosing a lot of people.
And they did.
The next time I was there, whichis about three months later, I
believe, I was working with theexecutive director on a project
and she saw me that I was thereand she came running up and she
said oh, I'm so excited you'rehere.
(17:37):
I wanted to tell you something.
I said what she said remember,I told you we were going to lose
a lot of our people.
She said we did.
And she said and we neverraised our pay and they almost
all came back.
I said really.
She said human resources did aninterview of everyone, said
we're happy you're back.
Help us understand what madeyou decide to return.
She said person after personsaid over there, they don't care
(18:02):
about my safety here I know youdo.
They don't care about my safetyhere I know you do.
That was just so powerful.
Just so powerful.
And then I wanted to share apersonal story when it comes to
quality of care, and now this isa kind of an adjacent care
industry.
Again, I've done a lot of workin home health and hospice.
John, I'm 40 years old.
The moment my job became acareer.
(18:23):
It's about 10 years ago.
It's when my grandmother was onhospice care, because you know
a guy in my 20s and around 30,my job was a job.
I wanted to pay the rent, Iwanted to have fun with friends,
but it was a job.
I didn't really see theconnection to what I was doing
to other people's lives.
When my grandmother was onhospice care, I was able to
(18:44):
visit her about three, threetimes and she was a couple hour
drive.
So I drove and I opened herdoor.
I walked in.
The first words out of hermouth were not hi, steve.
First thing she said is youhave to meet Julie.
Julie was her hospice nurse andjust you know, my grandmother
somebody not easy to gain hertrust, but once you had it it
(19:06):
was a really precious thing.
And when I, you know, drove homeand I had a lot of thinking on
my mind, I've obviously had along drive after seeing my
grandmother and one of thethings that was just sticking
with me is what if somethinghappens to Julie?
What?
What if Julie is caring forsomebody else and, you know,
(19:26):
pops her shoulder?
What if she's walking intoanother patient's home and slips
and falls and breaks a bone?
What if something preventsJulie from being with my
grandmother during the remainingdays of her life?
The moment that I realized howmuch this mattered.
So when you look at, we'regoing to talk solutions.
(19:48):
When you look at your data,consider lost time, injuries,
but also consider injuries wheremaybe we're able to bring
somebody back on a modified dutyrole but they aren't caring for
residents, they're doing someother job.
So that caregiver resident bondhas been broken.
So that caregiver resident bondhas been broken.
We can track that data.
So quality of care is I mean itis something profoundly
(20:12):
impacted by employee injuries.
And then the last one I wasgoing to touch on was occupancy.
Again, it's another personalstory I wanted to share,
(20:45):
no-transcript, you know, and itdidn't really resonate with me
until 10 years later.
And now, in a span of abouteight months, my family has
helped two loved ones move intoassisted living and I had
independent conversations withthe family members who helped
make the decision and they both.
You know and I'm very familiarwith one of the communities that
(21:08):
they moved into.
It's a beautiful place andapparently the other place that
my other loved ones moving intois also really nice.
But my parents who helped withone, and then my two aunts who
helped with another, they bothsaid the same thing.
They talked about the people.
They used words like warm,happy, welcoming nice of
everybody, of every department,whether they were in leadership,
(21:32):
whether they were an hourlyemployee.
That was such a draw for them.
If you have chronic back pain,if you have a nagging knee
injury that hasn't yet become aworkers' comp claim, how can you
do that?
You know injuries impacteverything.
(21:53):
So you know occupancy is alittle bit tougher to quantify,
but it's real.
It's real.
Okay now we can get back tosolutions.
Speaker 4 (22:03):
We're at the beginning of the NFL season.
You're telling me assistedliving has more injuries than
the NFL.
You know I've never done thatanalysis, but you should do it.
It was.
That'd be really big impact.
That's my homework assignment,john Guild nursing.
Anyway, it's just real excitedabout the NFL start again and I
(22:28):
know a lot of injuries happenthere.
But these stories are very,very impactful.
I remember visiting mygrandmother who had Alzheimer's
and for 20 years she was in amemory care community and she
was just so happy all the timebecause those around her really
loved and cared for her.
(22:48):
And so, yes, having anindividual get injured and not
be able to continue to have thatbond with the resident impacts
everything in that relationship.
So, yeah, keep going.
I love these stories.
Speaker 1 (23:02):
Yeah, yeah.
So, from a solution standpoint,I mentioned kind of doing like
a little bit of a leadershipteam gut check.
Where are we?
I also recommend doing apersonal gut check, because the
starting point from theleadership team when it comes to
employee safety should be dataand empathy.
What are our numbers and howare we connecting with our staff
(23:22):
?
How are we connecting with ourstaff?
And you know I shared somepersonal stories of injuries
that I've had.
I would encourage everyone in aleadership role, if you're
talking about this, to askyourself how would my life be
impacted if I wasn't able to usemy dominant arm?
What about if I wasn't able touse my right leg, which is, by
the way, how we drive?
Okay, I just lost someindependence there.
(23:43):
What if you can't lift over 10pounds?
You know?
Think about just living, thinkabout your hobbies, think about
your children, yourgrandchildren, and then think
about those who depend on you.
How are they going to beimpacted?
So the ripple effect here ishuge and, by the way, I
encourage that personalassessment to be included in
(24:05):
safety training.
Personal assessment to beincluded in safety training,
like, if you're doing trainingon resident handling and
mobility, have the employeesbefore you start training at all
.
Personalize it and ask them howwill your life be impacted if
you go three months and can'tlift over 10 pounds?
And think about it.
Have them write it down.
Don't have them hand it in andsay, okay, that's for you to
(24:26):
keep.
We want you to really thinkabout this personal about it.
Have them write it down, youknow.
Don't have them hand it in andsay, okay, that's for you to
keep.
We want you to really thinkabout this.
Personalize it, because nobodythinks about the impact of an
injury before it happens.
Well, not nobody, but, trust me, very few people do.
I do this for a living and Iwasn't thinking about it.
But then the last step of theself-assessment I would
encourage you to really dig intoyour data.
Self-assessment I wouldencourage you to really dig into
(24:49):
your data.
Every community should have anannual OSHA 300 log, which is a
great source of data.
It's not the only source.
We can look at workers' comptrends as well, but I would
start with the OSHA 300 log andthe pieces of data I would
capture are how many cases oflost time did we have and how
many days of lost time?
Because that's where ourstaffing and our quality of care
(25:11):
has really been interrupted.
And then also look at any kindof injuries involving transfer
or job restriction, because,again, maybe they're able to go
to work but they can't do theirfull job or maybe they can't
provide care.
Maybe they're able to go towork but they can't do their
full job or maybe they can'tprovide care.
And then, after you've got thatdata, I would sit down with the
executive director, whoeverknows the community or the
facility inside and out, and Iwould say how many of these
(25:34):
injuries impacted our rock starsyou know how many impacted that
person who takes the new hireunder their wing, how many
impacted the person who'sthey're like a leader on the
floor, but they don't carry thattitle To really understand the
true impact on our culture, onour training, on our mentoring,
(25:56):
because we can capture all thisdata and see where we're at as
an organization.
So that's step one, but thenthe next thing I would do is I
would take a very close look athow we're responding to injuries
when they happen.
I wanted to share a story fromwhen I was in a leadership role.
I had a consultant I wasmanaging health and safety
(26:18):
consultants at the time and shehad a client who is an operator
of, I want to say, 16 assistedliving communities across
multiple states.
Who is an operator of, I wantto say, 16 assisted living
communities across multiplestates.
Their executive team talkedabout this annually.
They had an annual strategymeeting to look at their risk
management plan and see what'sworking, see what's not working
and then make changes, and theyreally valued her input.
(26:40):
She was like an extension oftheir team and she invited me to
join once and the VP of humanresources came.
So they had a lot of data theywere going over and one piece of
information they were goingover was any work related injury
over $50,000 for workers' compclaim, and I think they had like
seven or eight and we justasked her to read basically,
(27:02):
what did we learn and what didwe do about it?
Just those two things.
And she went through each oneand she was going through these
reports and there was kind ofsome awkward tension in the room
when she was done with thisbecause almost every single
instance the blame was placed onthe employee.
My consultant, who again she'sable to say things in this room
(27:25):
that a lot of people can't theyhad her trust and respect.
She said may I ask a question?
They said, of course.
She said are you hiring themstupid or are you training them
that way?
I don't know.
And everybody laughed, exceptfor the president and CEO.
The president and CEO said pointtaken.
She looked at her team and shesaid this is unacceptable.
(27:47):
She said we've had these arecostly injuries, these are
impacting care, these areimpacting our culture, these are
impacting the lives of our teammembers and we as a leadership
team don't have any kind ofaction item that we have taken
to prevent recurrence If wehaven't learned from the serious
injuries that have happened.
Well then, what good is oursafety program at all?
(28:08):
So you know, it was a leaderreally taking the reins and
showing leadership.
So they put in place a verydetailed plan to, you know, get
all the way down to thecommunity level and make sure
that when something happens,large or small, we're doing an
effective investigation, we'recoming up with the true root
(28:28):
cause of the issue Understanding.
Is it a training issue?
Is it a quality issue?
One of the common things thatI've seen in my career is safety
training used as punishment.
Oh, the employee took ashortcut.
They didn't do what they weresupposed to do.
Let's retrain them.
Hold on, we need to pause.
If they didn't know how to doit safely, then we retrain them.
(28:50):
If they did know how to do it,why are we turning training into
a management, a performanceimprovement tool?
It's important to understandthe root of the issue, but there
is almost always something thatthe leadership team can do to
work to prevent it fromhappening again.
So if I were to start anywhereas an organization, it'd be
(29:12):
understand your data, understandhow we're responding to
incidents that have occurred,especially the more severe ones.
I just love the Albert Einsteinquote.
He said if I had an hour tosolve a problem, I'd spend 55
minutes thinking about theproblem and five minutes
thinking about solutions.
Because you know, if leaders doan effective job understanding
these two things, the solutionskind of fall into place.
(29:35):
So a couple other things Iwanted to share solutions.
And you know, john, one of thereally cool things about my
career is, since I'm in and outof different locations all the
time, I'm just sharing what I'veseen that's worked.
You know I'm not reallyinventing anything new here.
You know, is safety ofemployees a priority?
Is it part of your company'score values?
(29:55):
Is it specifically laid out assomething in how you operate.
This is what we believe in.
You know, I was doing apresentation a few months ago
and in preparation I wentthrough a lot of the large
assisted living operators in thecountry and I read their core
values.
I saw employee safety listedvery seldom.
It's just not common.
(30:18):
So I would take a look at thatand say, if we're not talking
about this, how are we evergoing to move the needle?
And then the next thing I wouldsay is you know a lot of
organizations put togethersafety teams, which is a great
idea, but you need to assemblethe right team.
And when it comes to assistedliving and skilled nursing, I
would encourage you to keepresident handling and mobility
(30:41):
separate from facilities,because it's really apples and
oranges.
You know, if you have afacilities team, you know that's
great.
They're focusing on burnt outexit lights and trip hazards and
life safety.
You know these are great thingsto be focusing on, but it's
just completely different fromwhat are we going to do when a
resident falls and they're in atight area.
That's just completelydifferent from what are we going
(31:01):
to do when a resident falls andthey're in a tight area.
That's a completely differentintervention and the teams are
going to have a different makeup.
So I would encourage that.
And then the last thing I wouldencourage you to do is really
tap into the resources that youalready have.
A lot of HR and quality systems.
You don't need to like reinventsomething, but you can say what
(31:22):
are we already doing and can wemake it a little bit more
robust and include training andquality assurance when it comes
specifically to our employeesafety?
And then also, I mean obviouslyI'm on the commercial insurance
broker side.
I was on the insurance companyside for 16 years.
Both tend to have a lot ofresources available.
(31:42):
The one thing to keep in mindand I can say this from
experience anybody who works foran insurance company they know
who signs their check.
Your insurance broker works foryou.
I am extremely fortunate I havea nurse on my team.
My clients can be 100% candidwith her.
They don't have to worry aboutit because she works for them.
(32:02):
So there are a lot of insurancecompanies that have really part
of their job is to communicateto the person who prices it,
which used to be me.
Hey, here are the good thingsthey're doing, but here's the
(32:27):
bad things they're doing.
So just understand that.
And then also, you know, osha,cdc and the VA actually have
some really phenomenal resources.
There are a lot of good toolsout there.
So anyway, john, I can send yousome links after this if you're
interested.
Speaker 4 (32:42):
Yes, Steve, a piece of our community or a subset of
our community are individualsthat are acquiring communities.
They want to be in thisbusiness.
They just sometimes don't haveall the answers to the questions
.
They aren't familiar with theback end side of operations.
(33:04):
How can they use you tominimize the risk associated
with acquiring a community thatis currently in business?
Speaker 1 (33:15):
Sure, you know, I imagine when folks are doing you
know, people who are doingacquisitions are kind of like,
in a sense, underwriters.
They're evaluating objectiveinformation to weigh risk versus
benefit.
That's really all underwritersare doing.
So I would encourage them toalmost put on their workers'
compensation underwriter hat hat.
(33:43):
I would want to look at fiveyears of injury history.
I would want to see theirexperience modification
worksheet.
So, for those who don't know,every company and I'm in Texas,
which is a little bit differentyou don't need to buy workers'
compensation in Texas, but mostdo, and I encourage companies to
they have a multiplier.
Basically rule of thumb ifyou're at a one, you're average.
(34:03):
If you're below one, you get acredit and you're above average
If you're below one.
So if you're at a 0.75, you'regoing to get a considerable
credit, and if you're above aone, then you're going to get a
debit on what you're paying inworkers' comp.
Now, it doesn't tell the fullstory.
One bad claim can potentiallydrive that up, which is why I
(34:24):
would want to sit down and I'dreally want to have a
comprehensive look.
And then the last piece ofinformation which is required
for regulatory purposes is theOSHA 300 log.
And, by the way, john, one ofthe things that's great about
looking at OSHA 300 logs is, ifthey don't have them, that tells
you where they're at from acompliance standpoint.
Because because they need to be.
So those are three really goodpieces of information and, you
(34:48):
know, if you look at all three,any one on its own doesn't
really tell the full story.
I would look at all threetogether.
Speaker 4 (34:56):
So I know that you want this discussion that we're
having to be focused on risk andoperational impact beyond
insurance.
Can you share the insurancebenefits as well?
Yeah, absolutely.
Speaker 1 (35:09):
First of all, I always start at the basics.
What is insurance?
It's simply the transfer ofrisk for premium, and the reason
why I'm really passionate aboutthe risk side of things is
because it's upstream from yourrenewals.
Pretty much every insurancebroker, most insurance brokers,
do a really fine job of shoppinginsurance, but what are we
(35:31):
doing to actually improve ourorganization and strengthen our
negotiating position?
That's where risk managementcomes in and that's something
that every employer can control.
So that's really the startingpoint that I would, that I would
look at.
But you know, even when itcomes to insurance I mentioned,
I think, there are four benefitsthat come before insurance.
When it comes to employee safetyand the benefits there, I
(35:54):
personally this is just myopinion I believe general and
professional liability evencomes before workers come,
because when you talk to generaland professional liability
insurance companies, the numberone thing they're asking about
is staffing.
It is just critical to thequality of care and they want to
know the organizations that areleast likely to have some kind
(36:15):
of allegations, some kind ofliability claim, which we know
can be very expensive.
So they focus like a laser onstaffing.
I've even seen a general andprofessional liability
application that asks about thecompany's last two years of
workers' comp experience mods.
Well, why would they ask that?
Because they know if somebodyhas a higher mod it's going to
(36:38):
impact lost time, injuries andstaffing and it's just an
indication into how employeesare being cared for and then
they in turn care for theresident.
So that's the first benefit andwe already touched on kind of
the workers' comp benefit whichis workers' comp is.
It's really the only type ofinsurance that right now
employers are in the driver'sseat.
I mean, I'm sure your listenerswhen it comes to property
(37:00):
insurance and depending on thestate and jurisdiction,
liability might be out ofcontrol.
That's all location dependent.
But workers' comp is the onetype of insurance that's a
little bit less painful rightnow.
So I would encourage people ifthey're experiencing pain with
workers' comp.
It's not a market issue.
The market is actually veryfavorable right now.
(37:22):
It's got to be because ofsomething risk-related.
So that means there's a realopportunity there.
Speaker 4 (37:29):
Excellent.
So, steve, tell us about yourcompany InsureCup, and how you
benefit the marketplace.
Speaker 1 (37:39):
Sure InsureCup was started in 1957.
We're the 44th largest agencyin the country, privately held.
It's a fantastic place to work.
In fact, in 2022, we were namedbest agency to work for by the
insurance journal.
When I say I was an underwriter, that meant that my clients
were insurance agents.
(37:59):
That was my client base and soI was able to you know, really
across three states in themiddle part of the country get
to know agencies.
You know dozens of agencies andI chose to work at Insurica, the
reason being we are a largeenough company to have all the
bells and whistles and resourcesand industry expertise of the
(38:22):
worldwide insurance brokers.
But, yeah, we're small enoughto have that personal touch.
My clients know me, we have agreat relationship and so it was
a really good balance.
Like I mentioned, I'm reallyfortunate.
I've got a nurse on my team,I've got independent claims
people that work on my team,because we don't just want to be
an insurance agency.
We want to be a risk managementpartner.
(38:42):
We want our clients to view theinsurance program as one pillar
of their risk managementprogram.
You know, we want our clientsto think about how can we
improve so we can become best inclass.
You know, that opens the doorto different, creative
self-funding options, differentrisk financing options where you
can, as an employer, can, takemore of your own risk, and so
(39:06):
we're a company that we lovebringing forward those resources
.
We have clients as well thatthey just want us to take care
of their insurance and theydon't want a lot of hands-on
assistance.
We understand that.
But those who really want toneed help or they think they're
best in class and they want toget even better that's where we
get really excited.
So that's a little bit aboutour team.
(39:28):
Yeah, I'm part of our healthcareand senior living practice.
We basically break our companyinto 14 industry practice groups
.
Healthcare and senior living isone of them.
Healthcare and senior living isone of them, and one of the
reasons why they brought me onboard was to really spearhead
senior living because we've gotsome folks who are really strong
in home healthcare.
The head of that practice groupis a former hospital
(39:49):
administrator, so he's reallystrong working with health
systems and hospitals.
But I got to develop arelationship with Insurica and
they understood my backgroundconsulting in senior living and
they said we think you'd be agood fit to join the team.
Speaker 4 (40:04):
Steve, your stories, your passion, your enthusiasm
for the senior living space isevident in this discussion, and
so it's always a pleasure tohave an individual like yourself
on the Senior Housing InvestorPodcast, because you bring great
value to those that arelistening.
(40:26):
And so how do individuals findyou and connect with you so that
they can get questions answeredor even new insurance or
replacing insurance, whateverthat may be?
Speaker 1 (40:39):
Yeah, I would say the easiest way.
I mean I'm not too active onLinkedIn.
I actually have a newsletter asI build relationships with
people.
It's a semi-monthly newsletter.
I call it an underwriter's take.
I'm trying to get people to seethings through the lens of the
person who prices theirinsurance.
So I'd say if somebody justwants to get on my you know,
(40:59):
I'll mail it to them paper copy,if they want it.
If they're old fashioned, ifthey want me to put them on an
email list, I'll do that and my,my phone number is 214-422-6098
.
Am I supposed to give that out?
I don't know.
Yeah, email's the best way toreach me.
Stevegrowth, that's G-R-O-T-Hat insuricacom.
So I would say, if you knowthere's a lot of people who are
(41:20):
really happy with theirinsurance broker, but if they
want to get on my newsletterlist and just you know, know me
as a resource would ever want tograb coffee, just have like a
quick virtual conversation.
You know I love supporting theindustry and I know if somebody
is in really good hands withtheir broker but they value a
conversation, well then it'svaluable to me as well and I
(41:40):
know that always rewards me inthe long run.
So just supporting the industryseems like the best way to also
grow the size of my business.
So that's the best way peoplecan get in touch with me.
But I would encourage thenewsletter because a lot of
these personal stories I shareand it just helps businesses be
better insurance buyers andbetter risk managers just helps
(42:02):
businesses be better insurancebuyers and better risk managers.
Speaker 4 (42:08):
Well, thank you for your time, Steve.
You're a valuable resource forthe space and I encourage our
audience to get in touch withyou and see if you can help them
.
Sounds great.
Thanks so much, Jeff.
You're welcome.
Have a great day, Steve.
Thanks.
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