Nearly half of the state of Maryland’s for-profit retirement homes have changed hands in the past five years, putting operators like Lorien Health Services in a unique position.
Lorien, which offers a range of services from skilled nursing to assisted living across its 15 locations, was founded in 1977 by the same family that runs the business today.
“Lorien has only been owned by one company this whole time, hasn’t made any acquisitions… [The founder] builds its own buildings, so we’re basically, I would say, like the industry was compared to what’s happening today,” CEO Lou Grimmel told Skilled Nursing News.
The continuous rush of transactions is not an unfamiliar trend for the industry. The Centers for Medicare & Medicaid Services (CMS) released data in April that found more than 3,000 skilled nursing facilities changed ownership between 2016 and 2021.
Despite his long-term leadership, Grimmel said Lorien sees his efforts to bridge the gap between home and community services and nursing homes as a way for the company to prepare for the future of post-care. sharp and long lasting.
“What excites me is what’s not being done in nursing homes today, and if you have longevity in the market and the hospitals and doctors know you, I think the role at the future is a much less traditional nursing home,” Grimmel said.
This interview has been condensed and edited.
What do you see as Lorien’s role in the senior care space?
It is a stable, stable and constantly changing environment.
What do you mean? Can you elaborate a bit on that?
Look, the pandemic and especially in Maryland – all the changes and the owners and everything – is an absolutely changing environment. Lorien has only been owned by one company this whole time, hasn’t made any acquisitions… [The founder] builds its own buildings, so we’re basically, I would say, like the industry was to what’s happening today.
I know this happens in other states as well. But do you see [change of ownership] a lot in the state of Maryland?
Since 2017, 41% of for-profit nursing homes have changed hands.
Why do you think that is? What do you think is the driving force behind this?
Maryland has above-average Medicaid reimbursement for nursing homes, and it has one of the lowest managed Medicare penetrations in the nation. So you take those two factors, it makes Maryland very attractive to outside investors.
Have you seen that be pretty consistent since 2017? Or has Covid ignited this even further?
It has been constant or even accelerated. I think some of the big companies, for example Genesis, had a stronghold in Maryland… So that definitely added to that.
What keeps you up at night as an elderly care operator?
Right now in my mind there is only one thing and that is work. It’s called a nursing home for a reason, because you have nurses. If you don’t have nurses, I don’t see how you have a business. So that’s my number one issue is the staff, the nursing, all the staff.
Is this something you see on both the clinical side and the non-clinical side?
Absolutely at all levels. I mean, you’re telling me about an industry that doesn’t live it. So you add… The hard work you have in a nursing home that just adds to it.
Lorien created a career ladder program in 2021. Where is that program at this point and what are some of the other ways you recruit and retain staff?
Well, the career ladder program is very effective because… We pay the tuition up front because there are companies that say, “Well, you take the course and if you get a certain note, we will refund you. Well, when you have people working in nursing homes, and they often have kids at home and stuff like that, they don’t have the money to spend up front. We put the tuition up front.
You want to go to school, you want to make your career path, here we’re going to give you the money and we’re going to work your schedule around your school because… It’s just a common sense approach. I don’t know of many other facilities, companies that do this.
Did it help with retention? Obviously you bring people to the door, you take care of their tuition. Have you seen that pay off in terms of people who have gone through this program so far?
Yes, we have success stories that started as Nursing Assistants and belong to RNs and will graduate. So it pays. But we also recruit in high schools. I think high school is a great opportunity because when you finish your senior year in high school, not everyone knows what they want to do. I would say a lot of people do, but not everyone knows if they want to be an accountant or an architect.
So we provide that opportunity – of course we have our own CNA class and we can train them and they can, right after high school they can train and go to work, at least have a job that pays income and probably get their parents on their backs.
How is TNA training going?
This process is actually going very well. We have an association in the state of Maryland, Lifespan [Network], and they have just been approved for their CNA course where students can take their course online anytime. They have a certain amount of time to complete each chapter but they can do it on their own, they don’t need to be in front of the computer at fixed times. They take the class when it’s convenient for them, and if they have questions and stuff, they can bring the questions to work the next day and talk to their supervisor or the supervising nurse about the issues. This program works.
This is going to be the key to the success and training of people who take this class. It’s very innovative.
What is the state of the agency right now at Lorien? How many agencies do you use?
We use a lot more than we would like to, I mean, before the pandemic we were without an agency for years and then all hell broke loose.
What percentage of staff is [made up of] agency?
The majority of our staff are our employees, but we have to replace them with agencies, and then there’s a whole new hybrid of agencies out there… You take someone like me who’s been there a long time, that’s quite radical, some of that is what’s happening today with staffing and the various innovative programs that different companies have put in place to try to address the issue.
I think there are factors that come into play: Is your facility in a safe area? Is it a safe place to work? Is it a clean workplace? Are there enough supplies for patients? I mean all of those factors come into play, but there’s not one knockout. So that’s how I think as the staff, the nursing home employees mature in this market, I think those things that I just mentioned will start to take on more and more weight. Right now, I think we’re still almost in this race to the highest bidder.
What excites you about the future of the industry?
So what excites me is that I believe nursing homes can be so much more than the perception [is] and what they were. I think they can be so much more, and we’re entering an era where we have a growth in the population that uses nursing homes and I think they can be a very important cog in the home and community services (HCBS) who use the retirement home as their home base. What excites me is what’s not done in nursing homes today, and if you have longevity in the market and the hospitals and doctors know you, I think the role at the he future is a much less traditional retirement home. I think there are chapters to be written about what nursing homes can do well in the future.