Raising the Bottom Line

5 Steps to Building a Strong Census In Your Skilled Nursing Facility

Posted by Jim Crisp, CPA on Thu, Nov 08, 2018 @ 10:02 AM

nursing home decorations fun

We get it. As an administrator, you’re overloaded. You’re wrestling with staffing shortages, complex reimbursement issues, and keeping up on regulatory requirements – all while giving top notch care to your residents.

When polled for our 2018 Maryland Skilled Nursing Facility Survey, skilled nursing facility administrators, owners and senior financial staff said their top three concerns are finding and retaining qualified employees; changes in payment/reimbursement systems; and the level of outside regulatory requirements.

These three issues consistently top our list of top concerns in our annual skilled nursing facility survey. Coming in at fourth in 2018 is maintaining census.

Maintaining census is an excellent thing for administrators to be concerned about. Here's why.

While changes in payment/reimbursement systems and outside regulatory requirements fall outside of your control, one thing you CAN control is maintaining your facility’s census.

Although maintaining census is more difficult than ever because there are so many alternatives to skilled nursing facilities – like assisted living, in-home companions, home healthcare, and living with relatives – without strong census-building tactics in place, your facility will, quite frankly, fall short.

Census building is something we talk about with our skilled nursing facility clients regularly. While some facilities embark on large-scale renovations and add impressive amenities to make their facility more appealing, we’ve seen many facilities spend a lot less money on census building tactics. Let’s look at a few of those tactics.

1. Recognize who the buyer is.

Psst the resident is rarely the buyer. The buyer is his or her loved ones.

The majority of your buyers are probably feeling some guilt over admitting Mom or Dad into a skilled nursing facility. It’s an emotionally charged decision. They might be feeling overwhelmed and just flat out be exhausted after dealing with a parent’s declining health.

Make the process easier for them by being compassionate, patient and accessible.

2. Improve first impressions without spending a bundle.

Like so many things in this world, perception is reality. The plain, hospital-like facility with beige walls might give outstanding care and have experienced nurses and staff. But walking into that facility won’t necessarily wow a family.

On the other hand, a family walking into a newly-built modern facility might “ooh” and “ahh” over its resort-like amenities and colorful interior. On the surface, it looks like the perfect facility for their loved one, but in reality, that facility might be direly short staffed and fall short in skilled nursing care.

Creating a pleasant environment for your residents, staff, visitors – and your buyers – will go a long way toward building and maintaining your facility’s census (more on census later). And it doesn’t need to cost thousands of dollars.

Here are just a few inexpensive ideas for creating a more positive first impression:

  • Invest in some festive decorations, whether it’s for Halloween, Valentine’s Day or Christmas.
  • Spruce up the landscaping by your main entrance by planting some flowers.
  • Add warmth by supplementing fluorescent lighting with natural and non-fluorescent lighting.
  • Place fresh flowers in your reception area.
  • Play upbeat music throughout your facility.
  • Place a welcome sign in your reception area.

3. Train your staff members to be census-building machines.

A smile goes a long way toward making a weary family member feel welcome in your facility.

Will the family taking a tour of your facility choose your facility, where they are greeted with a warm smile, or your nearby competitor, where they were ignored and hastily greeted by a clearly overworked employee? The answer is obvious.

Training your employees to create a positive impression costs nothing.

Here are a few things you can do to ensure your staff is helping, and not hindering, your census-building efforts:

  • Double check to make sure your admissions staff is covering the most important points on his or her tours.
  • Call your facility from outside the building, anonymously. Assess how your phone is being answered, who is answering calls, and how your staff answers questions. Communicate any shortcomings to your staff and guide them in creating a better impression. (Pro tip: when you see your staff doing all the right things, reward them. A $10 gift card to a local bagel shop is a small but memorable gesture.)
  • Assess whether your staff members are friendly to visitors. If you’re giving a family a tour of your facility and pass a caregiver in the hallway, does he say hello? If he doesn’t, that’s probably a strike against your facility in a buyer’s eyes. Why would they want their loved one living in an unfriendly environment?

4. Embrace your competitors as referral sources.

As we mentioned earlier, skilled nursing facilities face fierce competition from sources that were not so prevalent decades ago, such as home healthcare, assisted living and live-in companions. While these sources of competition will not go away, skilled nursing facilities are wise to embrace them as referral sources.

A resident at an assisted living facility might not need skilled nursing care right now, but they might need a step up in care in five years. Likewise, someone who can live fairly independently at home with the help of a home healthcare provider who visits twice a day might need skilled nursing care down the road. You get the idea.

Administrators and admissions directors should foster relationships with anyone – including assisted living facilities, hospitals, retirement communities, physical therapists and home healthcare providers – who is in the position to refer new residents.

5. Understand exactly where you stand with census.

When you consistently monitor your census, you can spot holes in your marketing and admissions efforts. Monitoring census against your current staffing might also shed light on when you need to step up your recruiting. When your staffing isn’t adequate, your facility’s ability to deliver good care drops. In fact, McKnight’s Long-Term Care News recently reported that a staggering 1,400 skilled nursing facilities have lost a star rating due to inadequate numbers of registered nurses.

Your star rating is paramount. Most buyers will factor in a facility’s star rating as they make a decision on where to place their loved one. Knowing where you stand with census and staffing, and taking appropriate actions to maintain adequate staff, will help your facility rank well in the all-important Five-Star Quality Rating System.

Recognizing the importance of monitoring census is one thing, but actually monitoring it in real time can be a different story. Have no fear, though. There are technology tools that can help you and your team monitor census.

For example, PointClickCare has a census management capability for clinical and billing purposes. It also allows you to manage staff resources according to your census, and to see what is coming down the pipeline in the way of incoming and wait listed residents.

Get Data On Maryland's Skilled Nursing Facilities

For data and insights on the climate of Maryland’s skilled nursing industry, download a free copy of the 2018 Benchmark Report for Skilled Nursing Facilities in Maryland here.

2018 Maryland Skilled Nursing Facility Benchmark Study

Tags: 2018 MD Skilled Nursing Facility Outlook Study, Jim Crisp, nursing home