.webp)
Summary
On this episode, we’re joined by Tim Craig, Managing Director of LTC 100 at Lincoln Healthcare Leadership. Tim shares the groundbreaking insights behind LTC 100’s consumer perception initiative and why the long-term care field urgently needs to rethink how it communicates its value. From the importance of storytelling and social media to the danger of clinging to outdated terminology, Tim challenges leaders to take ownership of their message — and their future.
Key Takeaways:
(00:00) Introduction.
(07:03) “Nursing home” gets negative reactions across the board.
(10:28) Skilled nursing may be more accurate and empowering.
(16:54) The future of perception starts with individual action.
(19:25) Controlling your narrative is a strategic imperative.
(24:33) Viral influence starts small — storytelling builds trust.
(27:38) Caregiver stories can shift employer and public perception.
(28:45) Many consumers don’t know what SNFs provide.
(34:25) Flexible schedules and tailored benefits drive workforce success.
(39:05) Contactless tech and AI are already reshaping skilled care.
Resources Mentioned:
Lincoln Healthcare Leadership website
Thank you for listening to “People Worth Caring About.” If you found value in this episode, please subscribe and leave a 5-star rating to help others discover these important stories.
For more information and to connect with our guests, visit PeopleWorthCaringAbout.com.
Listen on Apple | Listen on Spotify | Watch it on YouTube
Transcript
Tim Craig: It doesn't matter who you turn to, it doesn't matter who you work with, and it doesn't matter what you do, but it does matter if you do nothing. So you got to start someplace. Just do it. And the cost associated with getting in is so low that there's no excuse.
Peter Murphy-Lewis: The world does not run on headlines. It runs on people who care. I'm Peter Murphy Lewis, and this is "People Worth Caring About." Alongside my co-host, Jalene Carpenter, we sit down with the unsung heroes, caregivers, healers, helpers. The ones doing the real work, even when no one is watching. These conversations are not polished; they're personal because behind every act of care is a story worth hearing. New episodes drop regularly. Get updates at peopleworthcaringabout.com.
Hello, everyone. This is "People Worth Caring About." I'm your host, Peter Murphy Lewis, and this is my co-host, Jalene Carpenter. Say hola.
Jalene Carpenter: Oh, hello, my friend Peter. It's so good to see you again.
Peter Murphy-Lewis: That's a Nebraskan hola. Today, we are diving into leadership, perception, innovation, what it takes to move the entire long-term care industry forward. And one of the people who is at the forefront is our guest, Tim Craig. I call him the big man on campus when he's not around. He's the key architect behind LTC 100, a very, very... the premier executive-level gathering for post-acute care. Tim's work brings together the best minds in our field to tackle big-picture challenges and spark forward-thinking solutions. He's not just creating and organizing conferences; he's curating the future of long-term care. Tim, welcome to the program.
Tim Craig: Yeah. Thank you so much. It's nice to see you guys again. It's been a couple of months since we saw each other down in Florida, so always nice to see smiling faces from folks who know what we're all about. And I'm ready to dive in.
Jalene Carpenter: Yeah. So Tim, you and I connected through the always fantastic Zach Schamberg from Pennsylvania. I think he had reached out asking for ideas on something new to present, and you connected with us, and we shared "People Worth Caring About." And a few months later, Peter and I are on stage, and it was a super amazing experience. And I know we're going to talk all about some of the things that were discussed at the conference, but I have to just give you a big shout-out. That was the best-run conference I have ever been to. And in Peter and I's World, we go to a lot of conferences, so just amazing.
Tim Craig: Thank you. Well, let me just say real quickly because I know Peter likes to put me in the spotlight. There are plenty of folks who have come before me at LTC 100. I'm carrying the mantle for now. But we've got a good group, and we've been doing this for a long time, so very honored to be given the opportunity to run the work.
Jalene Carpenter: You described it as, big picture, really wanting to move the industry forward. And a big part was this concept of this research paper and this consumer playbook that you launched at the conference. Can you talk us through, maybe not just what's in it, but how you got to that point and why you commissioned the study, and what went into it?
Tim Craig: Yeah. Before there was the conference in May, before there was the idea for the playbook and the survey, there were conversations that we had been having for years about this disconnect, this belief in the skilled nursing space where the path by which a patient or a resident gets into a facility doesn't really need the same level of marketing or attention or image control, if you will, that it might in senior living. And you might say that it doesn't, but my concern all along has been that the operators in our space are just a little too reliant on a more traditional pathway, which is to say physician-directed, referral-directed, but not enough attention to the things that influence perception like hospitality, like white glove service, like the things that make people feel good. It's common sense. Hospitals, by the way, are in a very similar boat.
Who goes to a hospital and says, "I had a great experience?" The difference might be that they solved an acute problem, so you're okay with that because you came out better healthy-wise. But no one's giving hospitals, and really no one's giving skilled nursing facilities, high scores on the way they treated them, especially in the long-term care space. So, we said, "We really need to address this." We'd been talking for a while about perception. And in year one, and this is going to be a multi-year program for us, in year one, we said, "Let's go to the jugular." We spoke with a lot of our providers and said, "We need to address the consumer perception issue." And by the way, consumers, in our mindset, are patients and adult children, family members. The decision makers on whether you're going to go there in the first place.
There are a lot of other stakeholders in the broader consumer picture. Legislators, CMS, everything else. We're putting those off aside and compartmentalizing them. And then we said, we need to get a good sense for, as a baseline, what is their perception? There's a lot of language out there. There's a lot of smoke around, is it as dire as people say it is? And so we decided, let's do this. Let's do this survey. We hitched our wagon to a group out of Nashville called Gerard. A PR firm, very well-known in the health care space. Starting to get very well known in the staff space. And they helped us field a national consumer survey where we delved into all sorts of topics around what goes into perception. And the findings were, in some cases, not so surprising because we knew some of it, and then, in other cases, surprising both positively and negatively. And I'd be happy to share that with you today.
Peter Murphy-Lewis: You teed me up for the follow-up question. I'm interested in what surprised you. I was surprised by a lot, but I didn't have my hands in it. So I want to hear what got you.
Tim Craig: Yeah. What surprised us, I guess one of the biggest things is that what surprised us is that it's maybe not as dire as you might think. A lot of people go into it saying, Ppeople don't want to go to nursing homes." And, "Oh my gosh, it's such a negative experience." That's actually not really true, but of course, the devil's in the details. So what makes for a good perception or a bad perception has a lot to do with positioning.
For example, probably one of the biggest revelations in the entire report that we did, which would have it end up over 1,000 respondents, so it was considered, in terms that data scientists use, nationally projectable by a reputable firm and a broad swath of consumers. But the big finding that surprised us is that, for example, perceptions of whatever you call it. And I'm not going to give it a term just yet, but perceptions of this level of institutional skilled care changes dramatically as to whether you call it a nursing home or a skilled nursing facility. Nursing home, just to be very clear, big X. The big X on the nursing home concept. Anyone who hears the word nursing home, they kind of recoil.
And as you're reading through all of the results of the survey, you're like, wow, that is a stark difference. And so, if you were to jump forward to actionable ideas, I don't want to get too far ahead of myself, but you could say to someone, "What you call yourself and how you position yourself is going to make this huge difference in the eyes of a consumer." And then the second piece is that, and this is no surprise to anyone in the industry, but it's something that we probably don't focus on enough: we're in two different businesses. Two completely different businesses. We're in a short-stay rehab business and a long-stay Medicaid business.
They're paid differently, they're different residents. They have different sets of leads and concerns. And the perception of the consumer of one versus the other is worlds apart. A short-stay rehab where you're there for curative care, that's younger and there's a gym and a Starbucks, it's very positive, or more positive, but definitely in the positive column. Long-stay, perhaps terminal, maybe hospice. Medicaid. There's a stigma, perhaps, about the perception of who's in that cohort. That's much more negative.
And I think that what we know about a lot of the things that happen in nursing homes, IJA's, and other sources of negativity, that emanates from the long-stay. So the way in which organizations should be focusing on those two different types of the business should be very different. And too often, we just refer to them as skilled nursing facilities. Peter, you started off by saying, "long-term care." The reality is that rehab is not long-term care. It's housed in a skilled nursing facility, but they're two different businesses. And we really owe it to ourselves to start thinking very long and hard about the gains that we could make in positivity on the short-stay rehab side, because there's a positive angle there, and the ways in which we can counteract some of the negativity on the long-stay side. We're not doing it anywhere near as well as we should be, and it's long overdue.
Jalene Carpenter: Okay. So Tim, you hit on one of my number one hot topics from the panel, where you discussed the survey, and that is using the term nursing home. And you can use that big red X. And I think, Peter, you and I, immediately following that session, had this long conversation of, is that really the right way to go? Or do we need to, how did you put it, Peter? Take ownership?
Peter Murphy-Lewis: Yeah. Yeah, take it back or own it.
Jalene Carpenter: So I'm curious, Tim, because that was actually the most controversial thing that was said, which was, never use the term nursing home ever again. And in my brain, it's like, but that's what people know. They know that word. So I am curious, Tim. Do you really believe that? Do you really think we need to make up a whole new word that people won't know what it is? Because they already don't know what we do. Or is there an idea to take it back?
Tim Craig: It's so funny you're asking me this because, as we're doing a lot of our preps for the conference, and as I'm talking to different people, we had a think tank. Two of them, in fact, that proceeded as part of this initiative. We talked with people, and we hashed that over. And there are a lot of schools of thought around this, one of which is what you're saying. Are we really going to try to reinvent what we are? And it's a great question. I guess I would say, if it truly is as toxic as it is, then I don't know if we have much of a choice. I'm not necessarily saying that we completely revolutionize the way in which we refer to ourselves, but would it be too hard to suggest that maybe the consumer could embrace a skilled nursing facility and slowly but surely get educated onto what that is?
Because let's not forget that "nursing home" has been turned into a flat, generic term that refers to any institution. You hear it all the time. The media says, "Nursing home." "And there was a fire down at the nursing home." And you're like, "Well, wait a minute. Sunny Acres is a private-pay, assisted-living or independent living, not a nursing home." But no one knows that. So everyone just associates it with whatever it is. I don't know why there's so much negativity. You could probably go back and do a historical analysis of the last 30 years of how the word nursing home became associated with negativity. But I would definitely think that there's an opportunity to change that.
And then, the biggest reason is probably about this idea of bifurcating the business, where you'd need to make a distinction between your short-stay rehab and your long-stay because, really, at the end of the day, a lot of the, I call it sexy, to the extent that anything is sexy in this industry, but the sexy side of the business is getting lost in the equation when you use the word nursing home, because it's curative, short-stay, positive, therapy-oriented rehab facility, and nursing home just isn't doing it justice.
And so the last thing I'll say on this is that, ironically, in our survey, people did associate nurses and nursing care as a positive thing. So nurses and nursing care was a positive thing. But others have suggested that's good. That's good, but it also is a limiting factor because, at the end of the day, when you're striving for higher acuity, and you have an ambition to be a IRF or a LTACH replacement to the extent that that really exists. It's physician-directed care. And so to say it's nursing care in some respects undersells the caliber of the care that you're offering. And I'll get to that, because I'm going to put a pin in the idea. There is something in the survey very much around the credit that we are or are not getting for the care that we're delivering.
Peter Murphy-Lewis: Wow. Two things: one is I haven't been in long-term care as long as you. Also, I think you've probably heard iterations of this conversation around changing the name, the categories, and the branding more than I. But my mind goes to, how do you even go about doing it? Let's say that the report from LTC 100 confirms that this is the direction it has to go. Is this done by the 100 largest operators? Is this an American Health Care Association that... is this something that starts from the bottom? It just seems so complex to go about doing it.
And then I'm going to throw something big into this, Tim. As somebody who's fascinated by sociology and psychology, and Jalene's heard me say this before, I think no matter what we try to do in introducing the complexity of our industry, we still, it's an uphill battle because, in the US, our society is afraid of aging and even more so death. And I would say probably even after that, even more so, dementia. So if we have an inner fear that we don't even deal with as a society, how much can we do as an industry?
Tim Craig: Let me just address your first point. It's a huge question. When we originally started this idea, we're going back now with our advisory board at least a year, but probably more or less a year and a half. The kernel of at least one idea was, should we contemplate teeing up the topic of a national campaign? And that's not a new idea. The old "Got Milk" concept. It's, what do we need to do to proactively put a positive light on the image of the industry? And that would be a national campaign. And that argument, or at least that discussion, that concept, almost always starts and stops with money. You could put together the idea, you could hire the PR firm, you could put together the creative. All of that's the low-hanging fruit. Then all of a sudden you say, well, for it to be impactful, it needs airwaves, and airwaves need millions. And no one has millions.
So, I don't know what the official stance of AHCA, the American Health Care Association, is on this, but they do so many other things that I don't know that they have the bandwidth to really stand up and shepherd through a campaign. It's really not their core competency. They're a very successful national lobbying firm. So that is a great question. Who would do that, and where would you go with it? What we've been saying, and what we're trying to do with our platform or providers, is say, short of something that is a huge, overarching, industry-wide initiative, you, Mr. CEO, you, Mrs. CEO, you need to get off your duff and you need to start doing something yourself.
It starts with the individual organization and then, collectively, if there are efforts that build up across the initiative, and perhaps it's the top 100, like you say, Peter, that are getting off the ground, or the top 25 or 30. Now, we're starting to get someplace. But when you start to think about, what are the means by which organizations can do this? And let's just say for argument's sake that the low-hanging, low-cost fruit, not saying it's easy, but low-hanging and low-cost might be proactive creative social media initiatives. That is a huge behavioral change because, like I was saying earlier, senior living, AL/IL, is built on a chassis of marketing.
Most of the CEOs in that space came up through the marketing ranks. Look at the biographies of the CEOs in senior living. They were people who came up through the marketing ranks, and so they get... in the Smith space, they are people who may have come up through the administrator role or through the real estate role or some other role, but not the marketing role. And so there's an inherent disconnect about the roles which they should play at individual organizations to push a positive message. And if we can get 100 organizations to get on the bandwagon to start doing more social media, doing videos like you all are doing, it's... the only thing that stands in our way, because it's really not expensive, is the creativity and the wherewithal and the will. And so, slowly but surely, I guess you could say that there's a campaign. The campaign is to get people on board with this idea that no one's going to do it for them. They have to start doing it themselves.
Jalene Carpenter: And Tim, the group that attends your conference is clearly the group that is willing to take some of these risks. But I'm curious, your thought. Social media has... it is amazing when you look at our industries and their social media pages and the lack of creativity. And you said it earlier. We're just so traditional, and we're so scared, it seems like, to actually show anything and what it really looks like. And I'm curious, how do you push that? With an industry that is unbelievably traditional on every level, even getting people to have a social media presence is difficult.
Tim Craig: Yeah. It's such a great question because now, as is often the case, topics start merging. So now we're merging a topic that has been an albatross around the neck of this industry for years, and that's tort reform. Everybody in this industry is scared shitless of being sued. And so, to air your laundry, which I think most people would say is what a social media campaign might possibly do, is to show the inner workings. I think that there are people who are like, "Are you kidding me? I'm not going to show the inner workings of my skilled nursing facility." But God, that's such a short-sighted way of viewing it because, at the end of the day, you control the message.
And incidentally, that is a larger theme, which is, are we going to control the message or is someone else going to control the message? And as an aside, one of the things we discovered early on in this whole initiative around promoting positivity is, we need to take the reins of controlling the message. The message has been co-opted by someone else. The narrative is no longer our narrative. Who's controlling the narrative? It's probably a left-of-center media that is a junior editor that leads... the whole story about how that comes up through the ranks, and someone pitches a story, and it looks like investigate journalism, but a lot of the times, they're just printing bad stuff. But I'd say that's not even the real problem.
The real problem is tort reform and lawyers who have their field day in this industry. I'm not suggesting that a decent amount of that is unjustified. I think a lot of it is justified, but I also think it's gotten too far. And so you're combating against that. And so maybe that's part of the reticence, is that there are folks out there who are saying, "I just don't know if we're ready to open up." That is a big issue, but that's just not a good argument. It's just not a good argument because you control the message. I think a bigger issue is behavioral change is very hard, and if you're not living and breathing a marketing DNA, it's going to take not only time but it's going to take a certain ROI.
And I think that's probably the next best thing that we can do as an industry, is to start to show the ROI. How are we moving the needle on perception based on some of the campaigns and some of the things that we're doing so that people say, "Yeah, this is worth my while. I love it, and let's do it?" But right now, I'm not even sure we're in the batter's box. We're kind of just approaching the field, if you look at it as the proverbial, what inning are we in? We're so early. How many people have dedicated social media folks on their marketing teams? I'd be afraid to know the answer to that. It might be one in five or one in 10. That's not a good track record. So we need to change that, and we need to change that quickly.
Peter Murphy-Lewis: When you were talking about, kind of, social media and the need for marketers to just jump on board and start moving, my mind started going to three channels that either my wife or I consume that I'm sure that they do it on the most bootstrapped budget, and now they have tens of millions of followers. There's this channel in Eastern Europe that my wife and I follow. It's a husband and wife who are 60 years old. They never once speak in the entire video. All they do is cook and work outside. And I'll try to pull these themes together, at least off the cuff. I haven't thought about this before. Another one is Soft Underbelly. It's this guy, it's an interviewer who never shows his face. He interviews sex workers and drug addicts on the streets of LA, and he follows them over time. Does an update every year, if he can find them.
I've never seen his face. Has millions of people. And he humanizes areas of the world that many of us might not feel comfortable talking about or going or visiting. And then the other one is there's this Dutch guy who is rebuilding a stone house in some outside place, some rural place in Italy. And he only speaks to himself. And the theme, I think, is that there's always some type of fear there. Like, I'm afraid to leave the city. Could I ever live just with my partner in such silence? Or the gentleman who's rebuilding his home. Could I ever rebuild without having any running water or electricity? With "Soft Underbelly," it's very obvious. We're afraid of drugs and homelessness and prostitution. And those three people are changing the perception of these three areas that I'm not anywhere close to in my life. And I guarantee that they're all doing it on less than $1,000 a month on their budget. In the US, that might be a $10,000 budget, and it's crazy, but somebody just believes in one step at a time.
Tim Craig: They do. And thanks to you for the commercial on the power of social media. I buy an instrument, I believe in it. I follow a guy named Jacob Knowles. And Jacob Knowles, I don't know how it popped up in my stream, but he's a lobsterman in northeast Maine. And in relative terms, in the blink of an eye, he has hundreds of millions of followers. And it started off as educational about lobster fishing. So, in terms of ROI, maybe in your case, the story is the ROI of overcoming your concerns, and then suddenly seeing the benefits of that. In his case, I'm going to try it and see what happens. And now he's having a hard time self-identifying as a lobster man. He's now a social media influencer, which is a very interesting thing. I'm not suggesting that companies need to allocate so much time that they're going to become social media influencers, but you've got to start someplace.
If there was one message that I really hoped got through to the provider community on that Tuesday night at LTC 100, it is it doesn't matter who you turn to, it doesn't matter who you work with, and it doesn't matter what you do, but it does matter if you do nothing. So you got to start someplace. Just do it. And the costs associated with getting in is so low that there's no excuse. You just have to do it. What they probably need, however, is they need people like you, Peter, and you, Jalene, because they may not have the creative vision. They need the creative vision. They need to go hire a $70,000, 22-year-old and get that person to lean in with some creativity. And then the next thing you know, they'll be their chief creative officer, and they'll really be an important person in that company. That's the role that we're not seeing often enough in this industry.
Peter Murphy-Lewis: This show is powered by AAG Health, the team behind the teams. If you're building a care team that actually cares, nurses, doctors, techs, admin pros, AAG doesn't just fill jobs. They find people who show up and stay. Visit AAG.health and see how fast the right people can make all the difference.
Jalene Carpenter: I got to comment first about, Peter, thank you for the three plugs. Also, my thought was Peter's never not going to be on camera. That's where Peter shines. So I don't think you're going to break through, not being on camera, Peter. But this idea of the different ways to share this story is sort of how "People Worth Caring About" came about. And one of it was just a focus on the caregivers themselves, of actually highlighting and celebrating the people who work in the facilities. And when you talk about what's out there and different ways to approach it, very rarely do facilities approach it from that way. They show pictures of bingo or when somebody comes and plays music. So I think you're completely right, Tim. That needs to be big, next steps.
Tim Craig: Yeah. I'm glad you brought that up because when you get even more granular into who you're messaging to and what you're messaging with, I agree that there is, and I think a lot of people have woken up to this, a very dire need to the employee or really, more importantly, the prospective employee. That's a big deal. That's a whole other ball of wax because that's about, you actually can make a career out of this. And that you know that you're not just going to be changing bed pans? And we've got decent benefits and make a difference in people's lives. And I do think that messaging, when it's done right and when it resonates with the employee, then creates some resonance with the consumer. So they're, "Oh, I heard that's a good place to work. I heard people like it." And they get a good vibe from that organization, and so that's good for the consumer.
There's a whole other thread that admittedly very few people are doing right now, and I would say it might be even as important than communicating a message to the employee and the prospective employee, and that is direct to consumer. So what are the things that would resonate to the consumer? How many people are talking about the impact they're having on employment in their area? How many people are talking about the care that they're providing? And if you really want to get in the weeds, the relief that they create for the hospital that has a discharge capacity problem? It's a little wonky, so you've got to find the right way to do it. Unfortunately, we don't have a lot of groundbreaking ceremonies right now. There's not a lot of shovels in the ground in this industry, so you'd have to find other things. Opening a new wing, introducing new technology into your building.
But there are a lot of things. Again, going back to creativity. What are the things that you can do to stay ahead of the messaging directly to the consumer that would resonate with them? I'll tell you one thing that came out of the survey that shocked me a little bit. And by shocked, I also immediately in the same breath say, "Big opportunity." And that is, astonishingly, a lot of the services that we think the consumer knows we offer, they don't. So I wrote a couple of things down that I want to share with you that I think are really interesting. You may not know this, but fewer than half of consumers, when surveyed, like we did in the survey, fewer than half give a skilled nursing facility credit for offering wound care, speech therapy, behavioral health, respiratory rehab. Are you kidding me? These are core to what we do, and fewer than half the consumers even know that we do it.
That's a big blind spot. The blind spot is our focus has been too much on the institutional B2B side of marketing. We do a job of talking to the hospitals, or at least I think we do, and maybe to the payers. But we don't talk to the consumers, and I think it's a whole new chapter in marketing. And I, personally, think that there's a lot more that can be done. And I think there's a role for LTC 100 to continually beat that drum of, you've got to get out there. And there's no such thing as too small because right now we're doing zero. So everything is incremental.
Peter Murphy-Lewis: I like those ideas, especially the B2C is definitely something I wouldn't have thought of. And as a want-to-be, a pseudo creative, my mind goes to a lot of ideas of how I would take that input and turn it into something visual. I wanted to ask you, Tim. What's the most interesting idea you've heard in the last year or two as you've been working on this report around perception? And skilled. You obviously might deal with less marketers, but you're still dealing with brilliant executives, yourself being a marketer. I'm sure you've heard of some interesting things, and I'll give you 15 seconds to think on it. Plus Jalene's is going to make fun of me because I always fill the space and talk more. Where my mind went, Tim, when you were talking about ideas is one of the books, I would probably say the second most important book that I've read in my life, had an impact on me is "The Regrets of the Dead and Dying."
I think it's the Five Regrets of the... Regrets of the Dead and Dying. It was a hospice nurse from Australia, and she wrote a book about the regrets of the people she took care of. And I could easily imagine an Instagram channel or a YouTube channel where all I did was interview residents 100 days after they move into a skilled nursing. And I would consume that information up and down. And this is long before I worked at a long-term care, when I read that book. And that book has been top three for me for the last 15 years of my life. I would love to listen to a 60-year-old and a 105-year-old talk to me about what they are proud of. What are the things that they've done? What are they taking to their grave that they're so happy? And things they would do differently.
Tim Craig: I've got a couple of ideas. One is, it's not so much a provider-driven initiative, but the Ted Danson series, "A Man on the Inside." There were no Wizards of Oz pulling the curtain and making that happen from inside the industry, I don't think. But it did happen, and I think everyone talks about it. And it shines a positive light. It's senior living, so I want to be very careful. I acknowledge it's not a skilled nursing facility. You might not be able to do some of the same things as skilled nursing. I will give you credit for the documentary series that you all produced that, when I saw that, it put a very, very big smile on my face because I think that's the same type of thing, is deliberately shining a light on the positive, happy, curative side of things. And sometimes also the not-so-happy side of things, but doing it in a responsible way.
There are so many examples. There's an organization called the Dwyer Workforce Group. And a little bit of a tangent because it's not directly designed for marketing, but they do some things where they intentionally, as part of their business model, provide housing and true social support for people who are trying to break into the industry on the CNA level. And so some of those examples of the ways in which you're really leaning hard into super creative workforce solutions, I think, is an extremely positive way of positioning the industry. And we can do a lot more of that. Again, workforce or positioning, consumer positioning, it's all limited by creativity.
And so someone had to come up with that idea. And I think that it's going to probably be the consultants and the consultants who have the best ideas that are going to win the day, because I don't know a lot of organizations that are necessarily going to come up with these ideas on their own. But collectively, as we start to see this propagate, I think people are going to start to see that it makes a difference, and we're going to start to see more of it.
Jalene Carpenter: You segue nicely into one of the big themes, which, I think, all this conversation has been about innovation. But there were some pretty cool ideas and innovative thinking that happened at LTC 100 and I know it happens every time. What are the things that excite you most when you look at the innovation landscape in long-term care? Because we're definitely not known for that.
Tim Craig: I'll start with workforce because you can segment these. Innovation is one of those big, hairy, gray terms that, it's like AI. Unless you really start to parse it out, it's just too broad. But in the very specific area of workforce innovation, I mentioned Dwyer and coming up with solutions. I think the thing that we need to do desperately in this industry, and people are starting to do, is to stop thinking about how employees fit into our model and start to think about how our model fits into employees' lives.
And so it starts right off the bat with flexibility. There are a lot of people out there that have three or four jobs, and they need flexibility. And you can just imagine the care coordinators or the DON's. And they're saying, "I'm sorry. We don't offer flexible hours that way."
You've got to be flexible. And so the organizations that are coming up with the greatest amount of flexibility are the ones that are going to have a happy workforce. And I think benefits is another one. How creative can you be with your benefits? And the benefits, it's not just, oh, you get an extra day off or you get a smiley face or you get into a lottery. What about child care? What about the things? When you really deconstruct it, what are the needs of the workforce?
Deconstruct the needs of the workforce and figure out how you're going to deliver that because, we haven't really gotten into it, but it's a topic for an entirely separate podcast, but it is the disconnect between the demand for care and the supply of the workforce, the caregiver workforce. And one is going up and one is going straight down. And I think the number I cited is, the ratio goes from six caregivers to every one person needing care to three in about a 20-year period.
The second area, I would say, are new models. New models of care are probably the biggest one. And in innovation. I hear a lot of people come to the table with a lot of reticence around value-based care. And I don't mean value-based care as in value-based purchasing. I'm talking about value-based care as in, you're taking the risk because you know the spectrum. You could be in the mandated programs. You could be in support of someone else's risk-taking or you could take some risk yourself.
Well, if the world and the walls are collapsing around you because Medicare is paying 60 cents on the PDPM dollar and Medicaid is about to take more than a haircut but a machete to the side, then do you have much choice than to take a little bit of risk? So it's about confidence and wherewithal. Do you have the confidence to say, "We're going to become a PACE program." Or, and here's a good one, a great example of an innovative model, and it's really hard to retell the iSTEP story because we've been telling the iSTEP story for God knows how many years now, 10 or so.
But we found an example of an organization that was working with a convener, and the convener is allowing the provider entity to take a greater than 50% ownership stake in the iSTEP. And so they can not really dictate terms, but they have an out should they want to get out. They can control some of the terms, they can go back to the table more easily to negotiate a dean's share. There are new iterations. And then, I guess I would say, anything in the area of very proactive, creative solutions. I've been wondering for a long time when an organization has the wherewithal and the vision to hire their own physicians.
It seems like... well, you talked about needing to align with physicians, but what if you hired your own physician? What if you were the convener? What if you owned the Reach ACO? If you owned all of that, then you'd have a lot more control over that. That goes back to my comments about this reticence to get too exposed to risk. But risk is risk. The upside is directly correlated to the downside. So if you're not willing to take downside, there's no upside. So stop scratching your head and say, "We're three years into a risk model, and we're not happy with the gain share." You've got no downside. And so, if you're not taking the downside, you're not going to take much upside.
The last thing I would say, Peter, is the piece that I would say layperson or the typical consumer who associates the Affordable Care Act just with the marketplace doesn't see with the Affordable Care Act is that there was a massive change to payments and gave rise to a whole coterie of value-based initiatives that have been changed and sunsetted and re-initiated and re-advanced. And incidentally, we're in a period right now where there's some question marks as to what's going to be coming down the road, but you can't be afraid of risk because it may actually be your best payer if you handle it right.
The last piece in innovation, of course, is technology. Again, when you look across the senior care spectrum, it's probably not surprising to see that the skilled space, because it's government reimbursement, has allowed itself to adopt a mentality that we can't invest in technology because we aren't reimbursed enough in technology. And I say, "Okay. Don't invest in technology at your own perils because if you're not investing in technology, you're going to fall behind." And there are some really fascinating innovations in AI. And we're really just scratching the surface, but things that can read large data sets in a way that humans never could so that you can do things like NVS coding and authorization at a speed and an accuracy we've never been able to do before. I think we're getting past the trust honeymoon phase.
There was a trust honeymoon phase for the first three or four years where it's like, "I don't know if I trust AI." And I heard about hallucinations and everything else. That's not what we're talking about. We're talking about using tools that are really good, and it's very accurate. And by the way, in the same vein that an auto-driving car has a much lower incidence of accidents as a human, these things are actually technologies that are much more accurate and that are really coming along quickly. I'm very encouraged to see the advent actually in practice of some of these contactless, radar-based remote patient technologies.
We talked with an organization when we were purposely trying to find the leading-edge technologies almost a decade ago. And everyone was scratching their head and saying, "Yeah. I don't know if that's ever going to make it to market." And here we are less than 10 years later, and they're becoming more commonplace. It's something that you attach on the wall that monitors biometrics and feeds it into your PCC automatically.
That's becoming a standard. And that's, again, just the tip of the iceberg. You merge those two, AI and contactless remote radar-based technology, and suddenly, the way in which you monitor patients not only is more efficient. I guess you could say there's a way in which it'll reduce FTEs. And it's a little bit of a dirty word. People are like, "We don't want to get into the business of getting rid of people," but you actually are in the business of getting rid of people, because the economics of health care are getting rid of people for you. Demographics going up need going up, and available resources on the workforce going down. You're going to have to go in that direction.
So definitely watching AI-enabled technology and other technologies coming online that, I think, could probably gain a better foothold elsewhere, certainly in senior living where they can beta test it with a small patient population. If the adult children are willing to pay for it, we need to sort of take a page from their innovative thinking and start putting that into skilled nursing. And again, the smartest people are doing it. We often refer to them as the progressive 10%. The progressive 10%, they're all doing it. It's unfortunate that there's a fairly large swath of people that are concerned and scared, and they find as many excuses in your process as they possibly can. And they need to be doing it more often. So those are just some examples.
Peter Murphy-Lewis: Tim, I got one last question for you, but before I do that, I want to thank you. If it weren't for Zach, Jalene and I wouldn't have met you. And if it weren't for you, Jalene and I wouldn't have met LTC 100 and your team. And you gave us a platform, and you gave us a stage, and we've got a lot of feedback. And you introduced me to your team, Jim and Jen. And I presented at Senior Living 100. So I really appreciate it. You're helping the industry think bigger. You've shown it here for the last hour. And your role might be behind the scenes 362 days out of the year and on stage a few days out of the year, but your impact is at the forefront. And thank you. My last question for you is, who should we interview next on "People Worth Caring About" podcast in either innovation or public perception that you admire, that you think is innovating?
Tim Craig: Yeah. Well, I'll answer your question, but I do think really, honestly, I want to thank you as well. It's not every day that I get super excited about something that comes across my desk, and when I learned about some of the things that you guys were doing, I did get super excited, because when you're on a mission to try to get a message across and you're really turning over every stone, and you can't find examples, you know they're out there but you can't find them. And then one falls in your lap that is not only good but it's exemplary. It gets you jazzed.
And so, you guys are doing some great things, and I'm excited to see what you do next because I think it'll be really important. There are a couple of names that come to mind, to answer your question. And these may be people that you've already spoken to or you've already considered and approached. The first one is probably the CEO of Ignite Medical Resorts, Tim Fields. I'm sure he's on your radar. When we brought a group of providers from the industry, our advisory board, to visit one of his facilities outside of the Chicago market in the greater Chicagoland area, when I tell you that jaws dropped to the ground, they really did because it really represents a model that people have been talking about forever.
There was a period when Main Street came along and teed up the promise of the next generation of nursing homes. And they got way out over their SKEs, and it crashed and burned and it didn't do well. And it gave that segment of the Super SNF a black eye. Tim said, "Yeah. That's because they went too fast." And the reality is that it's a slow, deliberate, gross vehicle. But he's done it and done it really well, and he has his finger on the pulse of what it looks like to build something that... and this is a great yardstick.
That was a woman in the senior living space, Lynne Katzmann, who you may know, who runs an organization called Juniper. Her whole thing has always been, if we're not building buildings that we want to live in, because we're almost at that age, then what are we doing? We should want to live in our own buildings. In the skilled nursing space, although you don't live in a building like Tim's, you'd go and visit it for rehab, it's the type of building where everyone would say, "I want to go there."
So when they're at the hospital and they're offered options of where they'd get rehab, and they hear Ignite and they look it up on Google or Yelp or whatever source they're using, it's going to be five stars because he's built and cultivated not only a model but a concept that is resonating with everyone, including the consumer. And I think he just has his finger on the pulse of what it really takes on a lot of levels. Investing in technology, motivating people, creating care solutions, everything he's doing behind the scenes with Bespoke Contracting or with Medicare Advantage plans. It's a really good model, and I think that you'd be very pleasantly surprised to hear how he is embracing innovation in this space.
Peter Murphy-Lewis: I love it. Thank you so much, Tim. When Jalene asked me who was the first person that I wanted to have on the podcast, I said I wanted to be the first person who reached out to us to give us exposure about what we were doing with the documentary. Thank you for your time, Tim. You never cease to surprise and impress us.
Tim Craig: Thank you. And we'll see you very soon at another LTC 100.
Peter Murphy-Lewis: That's a wrap on "People Worth Caring About," born from the documentary, built to keep the stories going. Shout out to Nebraska Health Care Association and Jalene Carpenter for helping launch it, and to Ohio and New Mexico for making future seasons real. Watch the docuseries online or at peopleworthcaringabout.com. And if this episode meant something to you, leave a review. It matters. Take care of yourself and the people worth caring about.
#HealthcareLeadership #WasteManagement #SkilledTrades #PeopleWorthCaringAbout
