Make Safety a Competitive Advantage

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CareSafely App | Senior Care Safety Solution

COVID-19 has shaken the trust in infection control and safety that seniors and their families place with senior care organizations like yours. 49% of seniors don’t trust safety at senior care organizations according to a recent survey. This broken trust is having a major impact on census, staff morale, and relations with residents and their loved ones.

Join us for a free webinar with a panel of industry executives and safety experts as we discuss how we can rebuild that trust and turn safety from a disadvantage to a competitive advantage. We’ll cover:

  • Latest research on consumer trust in senior care safety
  • Making safety a strategic priority
  • How other industries have successfully addressed safety
  • Effectively communicating the safety message

Click to read the full audio transcription

Safety as a Competitive Advantage

Raj Shah: Hi, everyone. My name is Raj Shah and I’ll be moderating the webinar. Three quick housekeeping notes. If you can’t see the agenda slide on your screen, you may have to adjust your settings and zoom, to make it full screen. Also, there is a Q&A question on the panel at the bottom. There’s a Q&A button. We’d love to hear from you as we’re going through the webinar. So, if you have any questions or comments, just pop into the Q&A and type it in and we’ll try to address those questions and the comments as we’re going through the sections. And then, we have a Q&A session at the end as well, so we’ll try to address all the questions you have or just comments or thoughts you have. So, feel free to just have a dialogue with us. We’ve got several hundred people that are registered so we won’t be able to turn on the audios, but we will try to connect digitally. The final point is we will have the recording of the webinar available to you all by Monday. So, we will send you an email once that is done with. So, without the housekeeping notes out of the way, I’m really excited to have you all join us today.

We have a really important discussion today, which is around making safety a competitive advantage. I’m going to kick it off by just giving you a quick overview of CareSafely and we’re going to hop in and talk about the safety challenge itself, and what is that and just three quick charts to just set the context for the discussion we are going to have. Then we have a fabulous panel, I’m going to introduce all of them in a minute here. We’re going to talk about four big topics around safety and making that competitive advantage.  

One is making safety a strategic priority in the company and how do we go about doing that culturally or organizationally and things of that nature. So, sort of a high-level discussion on the strategic priority of safety. Then, some lessons from other “Safety-First” industries both Laura Lynn, myself, and Char, we have worked together in other industries before we started working in this one.

So, we may be able to bring some perspectives and many of you probably have, as well. So, we’d love to hear from you all, as well. Then, we’ll talk a little bit about what organizations are doing across the industry in terms of investing in safety programs. And finally, we’ll talk about how to communicate the safety message more effectively and what folks like Laura Lynn and Char are doing from their perspective, as well. So, lots to talk about, lots of big beefy issues to discuss and we have a fabulous panel that’s going to help us with that journey, if you will.

So, let me introduce the panel. First, I’d like to do Char Hu. He is a man of many talents. I almost think of him as the Elon Musk of our industry. He is the founder of Georgetown Living which is an Alzheimer’s facility here, in Central Texas, north of Austin. He also has a home health business and he’s actually a CEO of a high-tech startup in the senior game industry called The Helper Bees. And Char, when we get into the conversation I would love for you if you wouldn’t mind spending a minute or two later on just talking through what the Helper Bees does and how you thought about that business adjacent to some of the other work you’ve done. Char has, I’m not even sure how to describe it, a Ph.D. in molecular biophysics and computational biology. I’m not sure what that means, but it sounds really complicated. Thank you Char for joining us. It’s an amazing set of background experiences. Thanks for joining the panel.

Laura Lynn, thank you for joining as well. Laura Lynn is the president of AMADA which is a home health agency. Her business is located in the Boston area and she’s been in the industry for quite a while. But what is interesting about Laura Lynn in addition to that she was, for many years, at Fidelity Investments which is, as most of you know, it’s a big financial institution. Laura Lynn, my personal 401ks are all at Fidelity so thank you for keeping them safe. But you know, it strikes me that Laura Lynn may have some interesting ideas around, you know, we talked about safety from personal safety and infection safety things like that, but Laura Lynn has brought a lot of experience from data safety and data security. So, we have her talk about some of that as well as her experience in senior care. Thank you, Laura Lynn, for joining us.

And then finally, Kate Wallace. She’s a colleague of mine here at CareSafely. Kate’s got over a dozen years working in the front lines of, she’s an LPN, she worked in long-term care facilities and also a master’s in health care leadership. So, she brings a lot of the strategic thinking around leadership and experience as well as that frontline experience to the table. She also leads all of our content development efforts, as well. So Kate, thank you for joining us, as well, and giving us your perspective especially as it relates to skilled nursing and nursing homes.

So that’s an amazing panel. I want to thank all of you panelists for joining us today. It’s really really great to have you on board.

CareSafely Digital Platform for Safety, Quality, Compliance

Raj Shah: Some of you may not know about CareSafely, though, I thought I would take just a minute. Not a sales pitch which is just a high-level minute to kind of talk about who we are as a company. If you think about the senior care industry, you all have done amazing work and hard work around safety. But one of the things as an outsider coming in, we notice that you all haven’t had the tools and the process and methodologies, the digital systems, if you will, to manage your safety quality compliance programs.

So, what CareSafely has done is built that digital platform. Essentially, the platform enables if you are in safety quality or compliance, any aspect of that from the corporate level, regional level, or at the facility level to manage all the risks, assess all the risks, track all the risks, manage your COVID response, do this in a much more efficient way without a lot of paper and email chasing, etc. And to identify all the high-risk employees and departments and locations early before an incident happens and not after it happens.

We would love to have a conversation with you all if you are interested in learning more about us. In many ways, if you think about, if you have an HR System for your patient records or billing system for managing your buildings and invoicing and accounting, in many ways what we have done is that platform you need for safety quality compliance.

Our Safety Challenge

COVID-19’s Devastating Impact on Residents, Staff, Industry

Raj Shah: So, let’s talk about safety, the challenge of safety. And I’m not going to belabor the point on this but if you just step back and just think about how we got here, what where we’re at today an industry. As of December 31st, 125,000 seniors have died, a million have been infected and it is in fact, it has impacted 29,000, almost 30,000 facilities. It is not just a skilled nursing facility issue, right? It’s a challenge across the entire industry and about 40% of all the deaths have been linked to nursing homes themselves, skilled nursing. So, it’s a really, really big challenge and as a result of that, consumer confidence and consumer trust have dropped dramatically.

Consumer Distrust of Safety in Senior Care

Raj Shah: This is a survey that Qualtrics did back in August which asked consumers of all different age groups “What is your confidence in safety in the senior care facilities and in-home health organizations?” And if you look at the numbers, they are pretty striking. For the silent generation, the folks that are 75 and older, 44% of them do not believe in safety practice, trust the safety practice in senior care organizations. These are the client base and the decision-makers, right? Baby boomers, it is even worse, nearly 50% don’t trust safety practices in senior care. Gen X, 42.5%. These are all the future clients of the industry or they are the kids of the folks that are in your facilities or getting home help services from you all.

So, it’s a really, really important thing to kind of just step back and realize consumer trust is everything. You may have the best amenities, the best food, the best activities but none of those matters, and non-negotiable for everyone is the safety of their loved one. And this is a stark reminder that we have got a lot of work to do. This data as of August. So, my sense is this is probably that the numbers are much worse now in January than they were back in August. So, this is what we are trying to solve for is – How do we bring that trust back? And what do we need to do from a safety point of view to make it, currently a disadvantage, and turn it back into an advantage itself?

Senior Housing Vacancies Highest Ever Recorded

Raj Shah: This distrust, of course, has had a business impact and you can see that in the numbers. This is information from Moody’s, back at the end of Q3. The occupancy rates, vacancy rates have just shot up to 15%. And I just saw the numbers this morning and I see the numbers are continuing to deteriorate. As the analyst said in this report that he wrote, unless fundamental changes are made in terms of safety protocols and processes, the properties will continue to deteriorate in terms of occupancy rates. So, this is the challenge we face as an industry and this is why we are having these kinds of important conversations with this type of panel.

So let’s get on with it. I am going to turn off all the slides and let’s get on to some of these big questions. Char and Laura Lynn, starting off with two of you, just your reactions to these numbers. I just mentioned in terms of consumer trust. 

Laura Lynn Morrissey: I am not surprised. Obviously, these numbers are important and certainly, we watched folks who were having home care, you know, worry about how they were going to respond to COVID and worrying about how we were going to respond to COVID, and as a result, there was certainly a level of mistrust with home care, as well. And you know, I am not surprised that, you know, these numbers certainly will continue to increase, but I think the most important thing is that the industry has recognized that they have an issue with regards to trust and I believe that there is a lot of opportunities that the very best of the best have taken advantage of and it started to turn the market around. And I certainly am seeing, you know, a lot more positive things coming out of what started out to be a very devastating situation.

Raj Shah: Yeah. Char, your thoughts?

Char Hu: Yeah, trust is an interesting thing in our industry. I definitely don’t disagree with the stats. I think what happens though is when you are a smaller dementia community, dementia only, we don’t do a traditional AL. We establish a bond, we are sort of a boutique. We really meet with the families, we earn their trust. Our industry though, is fluid, meaning you lose it quickly, you lose it really quickly. You could take great care of her very difficult resident for a number of years. You have one fall that starts to happen that starts to break it a little bit and then you have enough one to the short amount of time afterward. And if you didn’t do your prep work beforehand that could really sever that trust which is ironic because, given all of our lines of work, everything’s degenerative, aging is degenerative, dimensions are degenerative. So, you will get worse, it’s an eventuality of everything. When you get worse, Kate can probably speak from a clinical perspective, things start to happen quickly. So, we’re fighting a losing battle. So, what I found is, starting my facilities in my late twenties, I had no clue what I was doing, I assisted research scientists, and I was just blown away. I took it personally when we lost that trust, it was just me and a 16 bed facility, and I realized I didn’t do anything to fortify that trust over time. And that’s not just having a good relationship when they come in through the door and we talk about how great activities are, etc. I needed to show my homework. I needed to show that we were getting smarter, we were getting better, and we were improving on a constant basis. So sort of, fast forward, now, into my 11th,12h year, we show our work, we show it constantly. And during the pandemic, it has become harder because we can’t interact with them as much, so we’ve had to seek out different ways to showcase that, either through daily update emails or weekly update emails, using new tools, you’re constantly trying to innovate. These are things that when falls occur when infections incur inevitably, we have a corpus of information that we can fall back on then they now trust us. It’s not just “Hey Char, you’re a good guy, I really enjoyed talking to you over the years.” It’s like, “Oh, no, you know your stuff now, you’re actually improving.”

Raj Shah: You’re doing like constant messaging reinforcement around the things that you’re doing on a regular basis. Essentially, to continue to fortify the trust, I guess. Is that what you’re saying?

Char Hu: Yeah. Absolutely. I mean, the competition is crazy. We are in Central Texas, a really dense area for communities. There’s sort of the business aspect of it from sales and retention and reducing churn. There’s like an adage I think nurses used to have when I was being trained early on with my first nurse, which essentially “If you did document it, it didn’t happen.” We would just do things behind the scenes and it wouldn’t be that showing. Now, some families do want to see that. So, yeah, it’s elevating that level of communication but it’s not just about that individual. Like I find now folks want to know what we’re doing as a community. What are we doing as a company, what are we doing as a facility, for our employees, which is something a little newer, as well as for the residents.

Raj Shah: Kate, your thoughts from a skilled nursing front lines point of view in terms of the consumer distrust data, and what’s your perspective?

Kate Wallace: Being a nurse myself and working the floors for a long time and not that long ago. Safety is so important and trust is so important for these families. They’re constantly checking the CMS readings to decide where they’re going to send their family members, too. And if you don’t have a high enough, you know, star rating they’re going to choose to go elsewhere. You know, it’s just that simple and it’s just that transparent coming from CMS. All these skilled facilities are rated differently obviously from home health and from assisted living. But there’s also an issue of trust within your employee staff, you know. Being a clinician myself, when you’re on the floors, especially in crisis mode, your employees are your most valuable asset, and their trust is a very valuable commodity especially during times of crisis. And you know, with staffing shortages, with rotating staff and staff working between multiple facilities and other staff knowing that their peers are doing this and not having, as Char said, you know, great messaging coming from the top down, you lose trust in your employees and that certainly is an issue. Something that I even saw personally, when the pandemic first started there was such an issue with getting proper staff in all these facilities. And I was in Massachusetts at the time, right outside of Boston, and DPH was sending emails to registered nurses, to LPNs, to aides, just to get staffing into various facilities that you had never even heard of or worked at before. So, think about what that says to the people that someone that’s working next to you, to someone that’s been sent there, that they’ve never seen before. You know, it’s crazy. But that’s what happens with lack of preparedness and with that goes lack of, sometimes and a lot of times especially in a crisis, lack of trust. So that’s my perspective, Raj.

Char Hu: I want to jump in. I think, on the staffing, I didn’t even need to think about that. We had, with a COVID outbreak, I think I had 30% of my care giving staff quit within five days. Again smaller communities, we have a couple of communities, the average tenure of those individuals who quit was 27 months. So, they’re like people who’ve been with us for a little while. These weren’t just new folks. They were scared out of their minds and we were doing mass texting. You know, we’ve got a pretty good communication protocol, but we were running like our hair is on fire. So, we did not do, objectively, a great job of communicating the stuff, sort of holistically about things like “These are directions that we are going.” Frankly, we had no freaking clue where we’re going. It was just sort of early on and we were just running around. So, I think Kate brings a really interesting point of, now after that, it was incredibly difficult to weather that storm, not going to happen again. Like we’re bringing in stuff, there are a lot of safety decisions, infectious control, like what we’re doing, and what we’re seeing now is just a lot more cohesiveness and a lot more trust in what we’re doing because we’ve brought them into that. We’ve brought them into what the challenges we have with the PPE, the challenges we have coordinated with the state and community and local governments, which has been sort of non-trivial.

Raj Shah: Essentially, partners in solving the issues rather than just…

Char Hu: Yeah, making a partnership and letting them know that we actually care. The reason that we’re doing these things is to help. We do have challenges. I think all too often, we were just, my admin team here was just burning and solving problems. We weren’t communicating that outwardly and then you know lack of communication, especially during hard times, you’re going to perceive the worst. That’s human nature.

Raj Shah:  Laura Lynn, from a home health perspective, has this actually been positive for you in terms of just, folks not willing to, you know, go into assisted living, they’re just choosing to stay at home and delaying the decisions? How has the COVID been for you, from a business point of view?

Laura Lynn Morrissey: Well, last year, March, April, I was at lunch with a wealth manager and a geriatric care manager and we were networking. We knew that things were going south with regards to COVID. But we never thought that you know, literally the next day they would shut down Massachusetts. And it’s been that way really since, to some degree. So, initially, you know, for me, I was thrown into a situation with a young team that had never been through anything dramatic as this and so trying to maintain my composure at all times because everyone’s looking at you. They’re watching you. They want to know, you know, whatever you do, they’re going to do. But in the meantime, you didn’t know what to do. So, really, at first, it was definitely thoughtfully sitting down and figuring out what messaging I need to provide to my team so that it calms them down. Because at the end of the day, assisted living facilities, discharge planners, not so much rehab per se, but so many other facilities were having issues with caregivers. And they were looking to me to help provide because I have a pretty large organization, they were looking to me to help provide a solution, but I didn’t really know and they weren’t really forthcoming with what exactly they were going through. So, I was going to potentially put my staff at risk. So, I was very careful how I navigated all of this while communicating and really being a partner but I was very careful about how I committed my resources. While also feverishly looking for PPE and everything else. Ultimately, over a 60-day period exactly what Char was talking about, communication was number one. Whatever my communication protocol wasn’t internally, now we’re working remotely, my communication externally to the marketplace, to all the different constituents. And then watching different referral sources begin to leverage me in a way that I hadn’t been leveraged before. I started to see scales tip in terms of where my business was coming from. As a result, I was able to meet the demand ultimately and my business grew by 60 percent. So, we are, I would consider we’re in a very strong position now. We decided to limit how we cared for those with COVID and that also accelerated trust with the caregivers. So, we were very, very clear about who we were caring for them when they had COVID and who wasn’t. Again communication. So, it was really, having an extremely comprehensive understanding of your constituents, trying to think in terms of how they’re thinking, and then trying to figure out how to service them in a way that maybe I hadn’t done before. While, quite frankly, begging for PPE. You know, we had the National Guard pull up in front of my building and you wouldn’t believe all the doctors and whatnot, coming outgoing “What is going on?” So, it’s just PPE because I had made connections with various constituents that perhaps others didn’t know about, you know, there was a real lack of communication as to where to get PPE. So, I’m, you know, I am very happy to say that I am in a very strong position. But you know, I have to maintain that position and I have to be constantly aware of what’s going on in the marketplace in order to adjust my messaging and how I approach the business.

Raj Shah: Essentially, you took leadership and saw where the trend was and you moved forward within a very strategic way, I guess. I wanted to kind of pull back on this conversation in terms of, as an industry, safety’s always been important, right? It’s never been a non-important issue. I was talking actually to the CEO of a very large, over a hundred units, a combination of assisted living and others. What he says is ”Look, Raj. Business performance, operational excellence are sort of the two key strategic priorities that we have, and what COVID has made us realize is we need a third strategic priority around safety like safety has got to be elevated to the same level as these other two priorities.” As leaders, has your thinking evolved or changed much, or is it primarily on communication, or has safety become much more of a top-of-mind issue as a leader of an organization?

Laura Lynn Morrissey: It’s funny because the marketplace, as healthcare workers, obviously I’m not from healthcare originally. So, being in healthcare and the conversations that we would have amongst ourselves, you know, that’s one thing, but we are now having safety discussions with families. Families understand what PPE is and they understand how important hand-washing is. So, you’re having conversations about safety in a way that you never had before. Internally, from a business the size of mine, everything that I was doing and continue to do is manual. So, I have to enjoy working with you folks because again, I’m looking for a scalable solution that can help me better manage and get in front of, just evaluating the risk in my business and being able to do it in a scalable fashion. Because at the end of the day, my business is remote, all my caregivers are out in family homes. I have to be able to quickly evaluate, whether or not I’m in a position of risk or whether or not I’m in a position of strength. And I need to be able to do that more quickly than I did last year. In order to maintain my level of care that I’m providing and the level of quality that I’m providing and the level of safety that I assure. It’s one thing to say that you’re a safe organization and you can talk all day long about protocols you have in place. But if you can’t manage and measure it, you’re going to end up with another issue at some point and it’s going to catch you. So, I think 2021, especially the first quarter, as we all are turning the corner hopefully with regards to the vaccine. This is an opportunity for us to look at, you know, how can we scale the safety measures that we needed to put in place last year.

Raj Shah: So, Laura Lynn, do you think about safety as a strategic priority? In your mindset, has it become much more of a priority than before?

Laura Lynn Morrissey: I mean it was always a priority before, I mean risk management and safety go hand-in-hand. So, this is a business that is full of risk, so you must be in front of it at all times. You got to develop a culture and DNA in your culture, top to bottom. But at the end of the day, you need to be able to quickly and more quickly evaluate. You are doing all the right things, you’re validating and you’re supervising and all of that. But you need to be able to do it quickly and you need to be able to evaluate where your risks and your holes are much quicker. Because at the end of the day, it’s life or death right now, with regards to the pandemic and it really is going to help shore us up in the long run.

Char Hu: I think she is well ahead of where we are, I think, Raj. The word safety, just the pure word safety has started to enter my facilities’ director and admin lexicon more than it had ever before. Maybe we were terrible but that was just a word we would never use. And Raj, even prepping for this webinar, you have got some anecdotes from your past, from the food and other industries where y’all were really hyper-focused on this. We just did not have those same words. Now, maybe we got to in a different way, but I just think one of the last vestiges of the pandemic is going to be the word safety. And I think safety encompasses a lot, from staff health to infectious control. You ask what is the percentage of the time, I have a relatively small community, repurpose one of our outreach to one of our marketers into purely internal facing, looking at safety, looking at compliance. Not only because you could go out into the world and do traditional outreach but because we had a huge need. Just from the vocabulary change I think is pretty stark what we’re going to start thinking about. I know OSHA had looked at more of Kate’s industry, skilled nursing facilities, as well as hospital work, but I felt like AL’s private pay, we were sort of immune a little bit from that. I don’t want to say I didn’t pay attention to it. We definitely were focusing, we weren’t creating an unsafe environment, but it wasn’t as top of mind now as your anecdote to open this particular section was. I think that’s true. I think now that it is a third thing that we need to think about to have or Laura Lynn’s been searching for a scalable solution because she has a disparate workforce. I always thought we didn’t need a scalable solution, which is interesting given sort of my background now as building software but we absolutely do. Safety now is a real-time initiative as opposed to something that we had the luxury of doing monthly checks like fire drills.

Raj Shah: Kate, did you want to add something?

Kate Wallace: Yeah, I mean to go on what Char and Laura Lynn have said, you know, I think skilled nursing facilities. Absolutely. There are just greater complexities, sometimes even more so than in assisted living. There’s an added level of folks with greater medical, worst medical conditions, chronic and comorbidities. They are in environments where they don’t have the luxury like Char may have, where folks are in their own rooms and their own apartments. You know, they’re sharing rooms. You have two and three sometimes residents, patients to a room and because it’s not private pay, there’s a lack of government funding in a lot of these cases. So, those are all other complexities that add to these safety concerns, obviously and issues of trust that creep up in skilled nursing facilities. And I think over time certainly it’s going to be really important from a strategic standpoint, for it to come from the top down, you know, all the way from the executive level down to the student, directors down to supervisors on the floor. This is an everyday, as Char was saying, an everyday word that’s talked about with a strategy in place. An efficient strategy in place and a scalable strategy in place. So, in order to make these facilities as safe as families need them to be, as employees need them to be, and as these residents most importantly need them to be over time.

Char Hu: Raj, one real quick comment. I didn’t think about it until Kate was talking which has happened twice now, so it’s really insightful. It’s on the staff. So, I really have been focusing a lot on the residents, but it’s like the incoming staff. As what we have had to do is not all the incoming interviews with, they are talking about our COVID procedures, they are talking about others because, you know, obviously, it’s top of mind for a lot of individuals. But I start to see us through competitive pressures for hiring, we are in an insane market for us. We have to address it and it might actually become a strength for us when it comes to recruitment. That’s what we’re finding, like we’re trying to find where we’re putting that out, you know, on the job posting but certainly, on interviews, we’re trying to recruit individuals by showing sort of our commitment to safety. So, not only churn of current employees but bringing on new ones and like others, you know, it’s a cold war as other competitors around us start to take it seriously, like we’re going to up our game. And it’s sort of this constant thing just like activities. I think you had mentioned that it used to be who’s got the coolest activities. I mean, hell, that’s why we have longhorns on our facility. Is it just to help with goats and donkeys like, you know, it’s like a fun thing, but it works but now for us, we have to start thinking about that it’s not just paying another 50 cents. It’s taking seriously our policies and procedures, just from a recruitment perspective. I hadn’t really thought about it, but it’s definitely something that changed fairly quickly for us.

Raj Shah: Let me pick up on this and there’s an interesting conversation around employees themselves and let’s shift this conversation to around other industries and what other industries have done in the past. I wanted to kind of share with the audience some, I came for the last seven years or so, I was in the food industry, working on safety and compliance and if I can I’ll just spend a minute kind of giving a background on that. If you think about it, as consumers of food, obviously, all of us are 330 million of us, food safety is a big deal. E. Coli, Salmonella, foreign particles in our food, etc. And 15 plus years ago, you know, safety is always important in the food industry, but with all the outbreaks that were happening with beef and cantaloupe, alfalfa sprouts, etc., safety became a much bigger issue. The government created the Food Safety Modernization Act. Walmart said “If you want to stock food in our shelves, you have to have really good safety.” And the entire food industry has shifted its focus from safety for the sake of compliance because the FDA or USDA is going to show up to safety as a cultural thing. Like, it was an important part of the entire culture. I remember talking to a client of mine, a big, big company, a billion-dollar food company. They had a Salmonella outbreak and 22 people had died, consumers. They fundamentally change their culture around safety including, and I will never forget this. Every single meeting that they have, no matter it’s an internal meeting, a meeting with vendors like us, meeting with outsiders, whatever meeting that they have, every meeting starts with a safety moment where they’ll spend just two minutes talking about a safety tip. It could be at home. It could be at work. It could be in the drive to work whatever it was and safety became a mantra for how they operate their facilities and their lives. And I think about car making, think about companies like Volvo and Honda around safety and things like that. If other industries have helped to deal with these issues, in terms of the auto crashes, for example over the 50 year period. And coming back to the employee issue that you guys are all bringing up and the importance of safety with them, as well. I did some research and I don’t know if it will shock you or not. But employee injury rates in this industry are two times higher than construction work or coal mining. This is all Bureau of Labor Statistics data. It is just kind of interesting to see that like, you know, the others used to reduce their injury rates by about 80% with their employees, but we haven’t made the same kind of progress in this industry as other industries have. And so I’m curious as to how the industry will look at how we bring these other practices in, that others have done, airline industry, manufacturing industry, other industries done. So, it’s one of those things that not only impacts the patients and the residents and the clients, but also the employees themselves. We need to keep that in mind. Laura Lynn, I’d love to ask you, from your background in financial services and Fidelity and all, when we think about data security, data safety of our data. My personal 401K data that’s on your servers, when you were there in Fidelity. You know, how did a company like Fidelity or any of the financial services companies think about data security at a strategic level? And what lessons do you have for our industry in terms of bringing those kinds of thinking, not necessarily the technical aspect, but the thinking over to our industry?

Laura Lynn Morrissey: Well, it’s interesting when starting around the early 2000s and mid-2000s, the financial services industry went through this huge integration evolution and, you know, a lot of the systems, in some cases, in some parts of the country, in some parts of the world, there’s still a desperate system. There’s a huge integration effort in order to streamline and speed up trade settlement and money movement or what have you. And then there was this onset of data security issues, password protection and encryption, and whatnot. And of course, fidelity is a very important member of the financial service industry. So they’re a major league target. So, the idea of risk management was always a big issue. So, for those like myself who are on the front lines, I manage the sales relation management group. You know, we were all licensed and we all were audited and we all had protocols and whatnot. And we were all aware of making sure that, you know, our desks were cleared and all the data that we made that access to, we couldn’t keep data on our local laptop. So, there was a whole mindset around the safety of your data. But taking all of that. So, you have all that going on in the financial services industry over the past, you know, 25 years. I don’t think people really realize that the healthcare industry began hiring folks out of financial services for knowledge that they had, in fact, I was actually talking to a healthcare company that was looking to integrate their healthcare systems and I had a background in that. So, all that experience in financial services and all of the integrity work that was going on to keep the data safe and to make the data free flow became very attractive to folks in healthcare. So, all of that risk management, all of that mindset into the healthcare business I think has been a bit of competitive advantage because I come in with a different perspective around hiring, around managing information and managing communication, and anytime there is a financial service crisis, the first thing I had to do was get on the phone calling my clients. So, through all of that, I sort of scrapped all that back on and began doing just what I was trained to do, and that is communicating. And I think that this industry needs to really embrace that as part of their day-to-day conversation, like you said Raj, with regards to food service, that safety should be front of mind, top of mind, out front and really you can make it, I think something that can be fun. It can be something that is engaging and it shouldn’t be something that’s just a piece of paper stuck on the wall in the lunchroom.

Raj Shah: That’s really good insights. Char, you know, you’re a software entrepreneur now, as well as managing actual facilities and all. First of all, why don’t you just tell us a little about Helper Bees first, and then I’d love to get sort of what lessons have you learned in the tech world that you’re applying to the senior care industry as it relates to prioritization of things like safety.

Char Hu: So, Helper Bees, we are a digitally enhanced home care option. We work with a large long-term care insurance company source for the leader in-home care provided directly through carriers. We do a whole host of things, we do the nursing assessment, we have a social work care management component, as well as building quite a bit of software for some of the big home care insurers that people on the webinar undoubtedly have a residence with. And we do a lot of data analytics. So, what we are trying to do is understand aging in America, from the home through the data, powering through the interventions. So, it’s interesting, it took a pandemic, like cutting-edge tech, we do a lot of machine learning, we do data models, it’s sort of my background, slightly. But it took a pandemic to have that bleed over into this world, facilities where we don’t use a lot of technology. We had an eMAR system that we built because I didn’t like what was out there. It’s a little buggy because we built it, but it works well here. UX was specifically designed. But that’s it. I think one of the biggest things that I realize, actually, you helped me realize, is on the software side, we have dashboards for everything. I get uptime on pages, if anything takes 20 seconds to load, that’s a problem. We have that, we have a scorecard, we have metrics everywhere, constantly reporting. I would imagine six out of 10 conversations within the company are probably around the dashboard or metric. I don’t really have that in the facilities in the sense that we have paper, we go on intuition, we go on group force, directors being on the floors, assistant directors being on the floor, we do of course have done reporting that we do monthly and weekly. We are going through all the papers like shift reports, nurses notes, but we don’t have alert systems. We’ve got motion sensors. I’m talking about more like internal operations. So I think that’s what made me realize is bleeding over from the tech sector. I need a dashboard that prevents me from being reactionary. I think that’s where this has really pushed me. I want a dashboard on everything now. We have an eMAR system for instance. Great. Dealing with paper, faster to train people, reduces med errors. But do I have a learning system on sort of missed meds, missed time points? Can I correlate that with an actual individual caregiver who’s administering that medication and retrain them? I don’t. That’s something that I do need. We had to check PPE, Laura Lynn was mentioning that. I got to check PPE, I got to track temperature. At one point it was like twice a shift and then it went down to one time in a shift. It was like residents once. It was all over the place and we could not react quickly enough with paper and we were drowning in paper. We got surveyed and we missed a couple of signatures, literally a couple of signatures out of however many. And a good dashboard and a good scorecard system which the tech sector really beats into your head. The input to that needs to be digitized then. So, that’s another thing like now. I want the convenience of other companies that I have of pulling up my cell phone and being able to check into the status of the company. That’s what I want for my facility. Now I’m letting that bleed into everything, from our safety protocols, infection controls to fall detection. All of those things. Some people on the call might be more advanced than us, but we didn’t have those, and I thought it was something we didn’t need because we had an intuitive grasp of everything that was happening in our communities. But that wasn’t accurate.

Raj Shah: So, you’re essentially wanting to go from after-the-fact reactive to a real-time at least, and eventually ahead of the fact.

Char Hu: At a minimum real-time. The holy grail of any sort of tracking system is predictive analytics, right? So, you have to track it first and so for us, it’s at a minimum in real-time. 

Raj Shah: We have a question from Lauren. Her question is: “How are y’all selling safety to your potential resident?” And we’re going to talk about this little later, but let’s get started with that now. Laura Lynn, if you want to get started. How are y’all doing that?

Laura Lynn Morrissey: When we were in the sales evaluation point, you know, we’re talking about what our safety protocols are and what we do every day. And then you follow up with documentation so that they remember what you said, but a lot of it is, you know, they want to show me, they want to see. So, they’re going to watch a caregiver come in and they are going to want to make sure that caregiver was going right through the sink to wash their hands before they start a shift. So, clients are smarter now than they ever have been around safety. And so you are going to have to deliver what it is you’re talking about. So, the supervision right now is very, it has been stepped up. So, our case managers are in people’s homes more frequently making sure the caregivers are doing what we say, what I say they’re going to do around safety. You know, we measure, we actually go in and look at and look for masks, you know, do they have a mask on. So, things that I tell my clients we are going to do, I then have to make sure because I’m dealing with a remote workforce. I have to make sure we’re doing it. Now, the one thing that I do talk about to Char’s point, our love of technologies. So, we moved to a new platform, so that caregivers could be screened in their cards before they go into a shift and ask certain questions that they have to validate before they get into their shift. That was something we didn’t have back in June. So, that’s one small step. Clients really appreciate that. How are you going to make sure your caregiver is safe before they come into the house? They are not allowed to clock in if they have any symptoms, and they have to validate. So, those are just some of the things that we do.

Char Hu: For us, not to be too cute with it, we talk about it. So, how do we sell it? We have to talk about it and we lead with it. It became a weird state of the world, as everyone here could probably say like a new resident now became a pretty significant risk for us. So, we stopped admitting folks we could have but I just stopped. It might have been the wrong decision, but for us, it became a huge risk and a liability to us until we started realizing that we’re doing the right things. We need to talk about it with families and some other communities were a little slower to respond to some of the safety measures. But I think showcasing it just like we would on our activity program which just stopped a little bit obviously. All external activities have stopped. But being open with potential residents and their families. The one “good” thing about it is that everyone’s dealing with this in their personal and private life, either through occupations or going to the store and so we get to commiserate on that. But what we need to do when it comes to the actual selling process of talking is showcasing ourselves as leaders and knowledgeable.

Laura Lynn Morrissey: So, transparency. That’s something that I’ve worked with my whole career is transparency. Every single thing that I’ve done in my career I had to be able to communicate that outside my company. And so in this business that I’m in, I have seen it underscore time and time again that the more transparent I’ve been, even if I didn’t know the answer the more clients exhaled and said, “Okay. We’re in this together.” And I think every conversation, as I tell my team, you know, “Bad news is not like wine. It doesn’t get better with age.” So, you want to get out in front of, I’ve got a million of them, in front of clients as soon as possible. Even if it’s hurt, even if it’s not comfortable, clients will always appreciate information because they feel as though you care when you’re out in front. Don’t be under your desk, hoping for it to go away. So, transparency and safety are going to be me where we are in 2021. And those that do it, even if they haven’t figured it out a hundred percent, they’re going to be in much better condition and shape. I will tell you the number one complaint I have with anybody that complains to me about this industry is “I just don’t know what my mother’s doing. I just don’t know how my father’s doing. I just don’t know what they’re doing.” And I’m like “I assure you everybody has nothing but your parents’ health and mind.” The problem is these wonderful people aren’t communicating and as a result, it just continues to undermine. So, safety has to be part of that conversation now.

Raj Shah:  Kate, did you want to add something there?

Kate Wallace: Yes. I agree transparency is absolutely key. Especially the skilled setting, you know, these skilled settings are very different than assisted living and very different than home health and are being limited at times with visitors because they just have so many residents. You can’t have a ton of visitors and all the time. So, families that are concerned about what’s going on with mom or dad. They can’t necessarily stop by like they used to, at any time of day, throughout the day with grandkids with whomever. The transparency, the messaging, the communication between the facility and the families is paramount, and ensuring trust and safety right now, illustrating that there are clear protocols in place. The families need to be able to see these two. I mean, they don’t want to see piles of paper everywhere and, you know, as Char said because things get lost, you know, and it’s not an effective way to manage that or to message, you know. Hospitals have moved towards electronic medical records and families are familiar with that right thing. They go to the doctor’s office. They go to the hospital. They see that in place and that makes them feel safer that their data is being kept safe. Same thing with the nursing homes. When protocols are clear, there’s not clear transparency, you know, it’s and they see piles of paper, that doesn’t make them feel safe. So, I think clear messaging is going to be key, especially in the skilled nursing sector.

Raj Shah: Laura Lynn, you were mentioning that you’re doing more supervision of your employees, ensuring that their competencies are actually done in the homes themselves. I wanted to share with the audience some research we had done at my last company around this whole notion of observations and staff competency observations. The research we did showed that if you just hired somebody and just put them on the floor, in our case food processing floor, in your case in the home, without any training. Just you know “You have experience. We’re going to hire you and put you, go out there and go serve a client.” 68% was the compliance with safety standards. 68. If you did really good training, onboarding training, that number went all the way up to 82%. And if you observed them and recorded it and did that three times over a two-month period, that number went to 94% compliance with safety standards. So, I was connected to the conversation you were just having a few minutes ago about the notion you’re doing a lot more proactive competency test checks of your employees, to make sure that you’re you know walking the talk that you’re talking about, right? They want to see that and you want to see that as an executive, as well. So, I just wanted to share that with the audience in terms of the impact observations can have because it’s a conversation. It’s not just an observation and recording it. But it’s an opportunity to have a coaching conversation, too. “Hey Jill, you did these four steps right for donning PPE, but these are the two things you missed. We must talk about it now. Let’s retrain now. So, the next person you visit, not a month from now or a year from now when you do the annual test. We’re going to fix it now.” So, I just wanted to connect on that front, as well. It is really, really interesting. So, you are walking the talk, right? It’s not just about the communication, it’s that you had to make some changes in the behaviors and retraining and things of that nature. So, really, really interesting conversation. I want to shift to investments in safety programs in terms of what are the kinds of things that you all have been doing. Char, let’s start with you, in Georgetown Living, what have you done in terms of additional safety, other training, or PPEs system? I think, Kate, you were talking about some clients who have done HVAC improvements in terms of air filtration systems. Just, all the kinds of investments people are making, just to have a quick round-robin on that, it would be great. Char, if you want to start.

Char Hu: Yeah, I read a little bit of science. So, we did humidifiers early on, everyone’s now a scientist. You know, viruses propagate easier through dry air, so we humidified the air and I married that with HEPA 13 filters with UVC light. I put one in every single resident room, as well as every common area. It serves as white noise, but they turn over the air four or five times an hour. When I did some research. No viruses will not be captured by HEPA 13, but the particles that are in the will. So, who knows? I’m not sure that helped. Definitely additional training. So, actively seeking better infectious control, better training on hand washing techniques, those sorts of things, and an insane amount spent on PPE, just an absolutely insane amount of that. I think we are definitely not alone. I think everybody on this call has, And then, looking at monitoring solutions. I mentioned the paper. It was really eye-opening when we were surveyed and we knew they had taken their temperature but they hadn’t documented it. If you don’t document it, it didn’t happen. And we didn’t have what Laura Lynn had with the app at the time, it was like preventing login. What I wanted to do is marry that with my time tracking system. And so, actually, this is when I sought out Raj. So, the shameless plot for him, but we were one of the first who, I think, just immediately integrated the solution. He did a 10-minute call with me and I am like “Yeah, we need this” and sort of connected with our team because things were moving quickly and we needed a better tracking system. So, those were most of the things thus far.

Raj Shah:  Kate, from skilled nursing, is there anything else that you are seeing, or Laura Lynn?

Kate Wallace: Lots of PPE certainly. I think there is an interest now in technology that never was before in the skilled nursing sector. But it’s taking hold slowly, it’s a new thing, it’s a crazy time. But I definitely see an interest, absolutely.

Laura Lynn Morrissey: I would agree with Kate and Char, we’ve done all that, as well.

Raj Shah: I have a note from Michael. I will read it to you. It’s a really interesting question he’s got. He says “PPE restrictions on visitation closed dining rooms, etc., that are prudent, necessary, sometimes mandated by the state can be perceived as negative or reflect poorly on the community when the competition doesn’t have the same high standards. So, how do we ensure that high standards are seen as our commitment to safety and not as a response to ongoing problems?” It’s a really good question. Thank you for sending that to me.

Laura Lynn Morrissey: I talk about this all day long. So, I deal with clients, all that I have are high net worth and ultra-high net worth clients. So, I will talk to clients when they complain about the fact that they feel as though that some of these organizations are too restrictive and I will talk about the numbers. So, that’s when your facts are really helpful. So, you know, for those that have lockdowns and in the amount of safety measures that are put in place that seem restrictive versus, you know, the impact of COVID positive cases is significant. And I think that, again, just managing that versus the competition. It speaks for itself now. Obviously, if you’re doing all of that you have high COVID positive results. That is another issue now. But I, personally, have seen those programs work, and honestly when at the end of the year, when COVID started to slow down for a little while just before the holidays, there was a huge outflow of residents living at home that had memory issues going to memory care. And now we’re back to, I call it, “point O”, so back to home care is spiking again because folks, you know, want us to come in for a time people saw that window “Okay. I’m going to move mom and dad into memory care because I feel that no matter their programs, even if they’re restrictive, they’re still going to keep mom and dad safe.”

Raj Shah: Another question, what kind of clean air stories are being told by existing and prospective residents in house assisted living facilities to display a proactive preventative measure against COVID? Clean air stories?

Char Hu: I will answer both of, sort of questions. We had to be cautious. I mentioned we had an outbreak and we were x number of months away from that. I took the decision to be really cautious with, like, celebrating that too much, because with my luck, also which is basic math, tomorrow will be different. The probability is significant with an explosion of cases. So if you celebrate it too much, as an endpoint then it’s liable to bite you. I wonder if the clean air stories are around successes. So, instead, what I was thinking, what we’ve done is treat it as a continuum and a journey. So, this is a safety journey or infectious control journey like today we are doing great and outlining some of the successes that we continue to implement which is one of the questions around. I lived around this competition where some of the competition, you go to the social page, staff aren’t wearing masks which blows me away, interacting with residents and families, everything, they are the big congregation of groups. I’m like “How do they get away with it?” I think what we’ve done, I take a long term, long ballgame approach to this. If that resident, if that resonates with them, the no mask approach and everything, they’re going to be risky, they are going to bring it in my community, and I lose more. It’s like, how does it seem this commitment to safety not be perceived as a problem? We turn it into a strength. We are committed to safety, we are not going to do an in-person tour until the state allows us to. We are going to limit the times for in-person tours. We had people annoyed and we lost residents. In my mind, I definitely think I won in that form of long term perspective because of the sheer volume of cases. So, play a long game on all of this. And same with how you are communicating the clean air stories which is what I assume is like reduction and turning the corners when it comes to clustering cases. Say how it worked really well. I am pretty open with families like “It’s going to happen again, here is what we are going to do, and here is why I think it will go a little bit better.”

Raj Shah: That’s a really good point. You are playing the long game because you have got a long-term business to build around your, in your community, for example, in your neighborhood, etc. So, you have to have a long term victory, it’s not about the small victories. It’s how you are preparing for the long term. Another question, probably for Char, it comes from Vendy. “How are you dealing with memory care clients wearing their masks or shields and things like that? How are you dealing with the actual clients themselves?” Same for you, Laura Lynn, when your folks visit at home. Can you talk a little bit about what you’re doing, from their point of view? Not just your staff members.

Char Hu: My answer will be short. They’re not. They are not wearing them. It’s impossible. So, social distance as best as we can, those air filters I mentioned, humidifiers. We are just trying any sort of passive way we could do it. They are not going to wear it. It leads to agitation and leads to a lot of problems. What you look at is what is it supposed to prevent, six feet distance, the air particles, those sorts of things solve that problem. But they are not the problem really, the individuals, it’s our staff. So, I think it’s a better issue for us.

Laura Lynn Morrissey: We do business, we provide support for those that fall below baseline within assisted living facilities, but also at home. And at the end of the day, if they’re at home and they’re not wearing their masks and anyone else in the family is not wearing their masks and they are a risk to my caregiver. So, I evaluate that case overall. If that person is home and they’re in a bubble and they’re not wearing their mask and then I will do whatever I need to do to make my caregiver comfortable, including wearing full long PPE if they want.

Raj Shah: Hey guys, amazing conversation. Wish we could go a little longer but we’re running out of time. Kate, if you wouldn’t mind, just real quick, our next webinar coming up. I think you’re going to be leading that on the CARES Act. Just talk about that for just 20 seconds and we’re going to have to go.

Kate Wallace: Yeah, absolutely. So, Congress and generous taxpayers have given about 185 billion dollars to health care providers under the Provider Relief Fund, under the CARES Act. And we’re going to have a webinar on January 28th at 2 o’clock, to discuss that. Also, Raj will do a quick demo on the CareSafely platform, but we’re going to discuss how the CARES Act funds that were disbursed in 2020 but also now being disbursed even more under incentivization programs in 2021, can be used under the technology criteria to help infection control in these facilities in the new year. We hope you can join us.

Raj Shah: Char, Laura Lynn, and Kate thank you guys so much for joining us. Fabulous conversation. I really, really, enjoyed it and thank you so much for your insights and perspectives. Really appreciated it. Thank you all for joining us. We really appreciate all the hard work you all are doing in the front lines. Stay safe and take care. Bye.

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