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The senior living industry has a voice. You can hear it on Bridge the Gap podcast!

Episode 38: Charles Turner

Lucas: Okay, so, Charles, welcome to Bridge the Gap podcast. Today we are recording at the Interface conference in Atlanta and we are doing a major transition here into Charles’ life. So, Charles, look, you candidly were one of our first recordings. It has been one of our higher downloaded ones and I think it’s because people like you. I’m not sure totally why-

Charles: -after this I’m not so sure either.

Lucas: No, all due respect, you definitely are an influencer in the industry and, other than today, I’d say I’ve enjoyed all the conversations that I’ve had with you. And so, let’s transition into talking about how you were a keynote speaker today and your topics were on disruption So, let’s dive into that; you had five points, maybe we can just hit some of the highlights?

Charles: So, yeah. A lot of this started several months ago, going to conferences and the conversations about this disruption. I think it’s kind of an overused word- everybody wants to talk about disruption, disruption this and disruption that.

I think the things we always hit on in senior housing is, okay, is there is there an oversupply? And yes, I think there probably is, generally speaking, you know, construction costs and all these things I think are perfect to talk about, but I think other things that are working outside our industry that are affecting our industry that we may not be considering. I think a lot of times we focus, like a lot of industries do, you know, on how can we improve ourselves in our industry but what if there are things outside of us that are affecting us?

So, some of the things that I’ve been thinking about and talking to things around are things of senior housing is starting to run headlong into the medical world, post-acute medical world. I think on one hand we can fight that but I think, like it or not, we have to start pivoting from let’s just build beautiful buildings and hire caregivers to really affecting outcomes in care, not necessarily from a nursing home standpoint and things like that.

But really start looking at how do we partner with, as kind of a care organizations are becoming more prevalent, as Medicare advantage might start looking to reimburse for senior housing, are there things that we can do as an industry to, one, see that as a separate revenue stream, also get reimbursed when we do open up to a larger market but, also, how do we change our business practices in order to be partners. We can’t just do the same old same old; we have to be able to show quantifiable outcomes.

Josh: So, when we start talking about quantifiable outcomes, a lot of people talk about that. But, our senior housing industry, we seem to be way behind the times on even, one, knowing what data to track but even our tracking systems are full of just errors, omissions and things like that. So, you know, when I walk into a senior living community- could be your average or could even be a better senior living community- I’m amazed at the lack of technology implementation that we typically have and then I’m also amazed for the companies that are I would say forward thinking and they’re implementing a lot of technology but it seems like he has no rhyme or reason.

Can you speak to that a little bit? I mean, what’s your impression of that? How do we get past all that? Because it seems like a big part of this and analytic piece in developing or capturing quantifiable data counts on our systems.

Charles: Yeah, so, one of the points I made earlier is ten years ago when I first got into this industry, the only technology that we had was a nurse call system, right? You’d pull a cord and a light goes on and, if you’re really sophisticated, send some kind of a pager- woo.

But it’s evolving now and I think we make mistake of looking at technology for technology’s sake. We’ve been just as guilty I think as anybody else. Oh, that looks cool, that looks cool, let’s try that.

At some point, a few years back, we realized our strategy. So, things that were interesting to us or not interesting to us may have been very interesting to other people and vice versa. So things like, you know, iPads and home automation, things like that, virtual reality, there’s case for that, wasn’t that interesting to us. Not that they’re bad, that just was not our strategy. Our strategy is the belief that we think an increasing number of referrals are going to come from say the broader medical community. As acuity rises, people stay in their home longer because there are technologies that are allowing people to stay in their homes longer. We’re accepting the fact that our acuity mix is going to be higher and higher.

Okay, so, if I’m working with an ACO, then have to say what data can I use, can I capture about my resident? And if Lucas is my resident, what are those 10 things I know about Lucas that no one else knows.

Now, the problem is I have 10 systems producing 10 things, pieces of information. Where we’re evolving to, one of the things we are trying as kind of a sidebar inniatitive to work on, is how do we integrate that information?

So, I can say, you know, here are the 10 things we know about Lucas and I can share with his medical professional, I can share with his family, I can share with a hospital, I can integrate to say- here are the trends in his behavior, right? Okay, yes he may be sleeping more but why? What else has been going on that we can use to help intervene and care?

So, right now, you’re right. The data, we’re gathering more and more data and none of it is being looked at because the more you have, the less it’s being looked at. Now, we’ve got some of the genie back in the bottle a little bit and focus on what are those things that are really, really important.

I think as an industry we’re starting to evolve; you’re starting to see that. I’ve actually been working with a company, it’s called Veritas Solutions, doing just that- it integrates data, formalizes it, and integrates data. So, it has the 10 things about Lucas. Now, the problem is, now you start going to companies saying, we can do this, we have the capability to do this, we have the technology. Then the next question is, people get excited because they’re asking for this, and they say the problem is, wait a second, now we have a problem- we can’t integrate, we don’t know what questions to ask from the information. How do we measure our effectiveness? So, people have to go through an existential process figuring what is important to them, what do they want to measure and then go back and say from the technological tools to figure out how to get there.

Josh: So, with that, you know, we’re talking about some technology, strategic implementation of that, asking the right questions to get the right data- it seems like there’s also this, to use the term a lot, but there’s a big gap that can exist between, you know, the community, your traditional senior care community, and the healthcare system which we acknowledge that that is the future, more referrals are coming.

So, where does that, you know, how do you bridge that gap-

Charles: -How do you bridge the gap? Pun very much intended, right?

Josh: Yes.

Charles: Yeah and that’s the last mile. The way I see it is you have major hospital systems, major medical systems that have the Cerner and things like that have those EHR platforms and what we have and what they have are night and day.

How do you bake it at work flow? Well, one of the things that we’re looking and exploring is actually creating what is called a PHR, so it’s a personal healthcare record. It’s almost sort of like EHR light where you catch key information about your resident that becomes very portable within a manage-care environment.

So, you find manage-care communities, you find and ACO, and you work within the confines of that system and maybe you actually create your own account of care organization, your own manage-care network where you’re managing the population, maybe it’s of 20 different senior housing communities that get together to do this, and then you sort of dictate that as a record.

But, that is the last mile. So, in that interim step, if nothing, before we can even get there, we have to consolidate the information on our own side to say, okay, here’s a simple record of things that are very, very critical and maybe it’s you print it out and you PDF it and bring it to the doctor, but at least you have a way to start interacting.

And those things, we’re starting to see companies build tie-ins into EHR, inner-operability, and it’s going to happen. But, to prepare for that, we have to get our own house in order first.

Josh: I agree. So, opinion poll here, because I ask a lot of people this and I guess I’ve had opinions but want to know yours. So, when you start looking at systems there’s, gosh emerging systems all the time, right? And it seems to me and, correct me if I’m wrong, it seems like there’s a category of you’ve got very unique systems, whether it’s a CRM, you know, a billing system, an HER, an e-mart, you’ve got all these individual systems and software companies, must of them are cloud-based now. But then you have these all in one systems, or claim to be all in one systems and I get people asking me all the time, they think I’ve got the answer and I don’t have it figured out.

What’s best- is it the all in one solution and the theory of all that data communicating with each other, and again I use the word theory because some of them don’t do that better than others, or is it better for an operator to go out and pick that best in class in each category and mine the information. Do you have thoughts on that?

Charles: I do and I kind of go both ways. Traditionally, we’ve always used sort of an all-in-one system because frankly it’s easier off the shelf. But, one of the things we see is your CRM, there’s really not a lot of information that needs to tie into your clinical care processes. The greater integration really would probably be on your financial side. I think a lot of these companies, I’m not picking on any particular one because they all want to be all things for all people, but each one do something really, really well and there are things that are okay at best.

I guess I tend to give more to the all-in-one only because we’ve found that it’s less expensive to kind of go all-in-one. It’s an easier install and then we don’t have to try to integrate data on the backend.

That’s not the right answer for everybody but for the size of the company, we are trying to build- the more systems you add, the more change in management, the more difficult it is. It can be complicated. So, you may not get the best CRM or EHR, but is it good enough? That’s how it comes down to to me.

Josh: I could get in the weeds, Lucas, all day and talk about these kind of things. I think we have a unique audience and it’s just about every stakeholder. So, we’re talking about technology companies- there’s technology companies out there listening- stakeholders in that we would love to be able to influence as well, you know. That’s why I think this is a relevant conversation because what is the missing link in these that operators need, you know, giving them that constructive feedback and building up those systems?

I do believe exactly what Charles says is, you know, whether we like it or not, we’re now part of the true healthcare continuum. It’s hospitality has met healthcare and we can either put our head in the sand and fight that as he said, or we can we can adapt and adopt. So, good insight.

Charles: The story that I always tell, it’s very eye-opening an alarming for me at the same time. A few months back, I was talking to someone who’s one of the, if not the largest integrative care providers United States. She does a lot of business- developer relationship building, kind of national accounts.

She says, Charles, I was in Dallas working with two different ACO’s and both the ACO’s are stack ranking all the senior housing communities around them based on the frequency of admission to their hospital. Again, as our acuity mix increases, the medical community is going to be more and more referral source and they’re already judging us based on their own terms. Not our terms, but their terms. And so, it was alarming to me. You may not be getting referrals from hospitals and you may not even know why because, you know what, the state regs say, you have an acute episode, send them to the ER and we have a conflict there.

So, you have to balance out your referral source with what the state requires and it can be very complicated. It’s a lot of work to do on the regulatory front with that.

Josh: Well, I think that’s an important piece too because just being informed and tracking, I mean, without a really good system to capture data, to even understand where inquiries and referrals are coming from and where they’re not coming from and tracking that month over month but without a good system of data and analytics, you’re never going to know that, I mean, before your buildings at 50 percent.

Lucas: Well and as you well know, these systems are only as good as the information you put in it and then it’s the staff that has the lion share of actually implementing it, maintaining it, inuting all this stuff, they have to be trained.

Charles: Right, they have to be trained. And, you know, we talk about the last mile being trying in the medical world, really the last mile is to train your staff. We’re just as guilty of this stuff. Yes, we implement great technologies, but, yes there’s training, you’re obviously not going to have a lot of turnover, but it’s also where I’m looking to go with our operating platform. Let’s build, I don’t know, eight, ten KPIs, no more do we say we’re going to look at these things every single day. Every day we’re going to look at them. Every single day and we’re going to have a red, yellow and green, where are you every single day on those things? And we bake it in part of everyone’s DNA workflow and there’s going to be a lot of weeping and gnashing your teeth probably getting to that because, Lord knows, EDs have a thousand things they need to work on. But here’s 10 things that are important to our corporate strategy, to our company strategy and our community strategy. Every day, what are you doing with these things and so now, it becomes part of the workflow and almost passively say, we’re looking at the outcomes and the only thing that can affect the outcomes is to actually use the systems appropriately.

Lucas: So, transitioning here as we round out the show, what’s next for Charles Turner? Give us a little insight and it can be anything, just things you’re into-

Charles: -yeah, there’s a lot of things I’m working on. Some things I can’t talk about, those are pretty exciting and scary at the same time.

Lucas: We’re going to hold you down and make you.

Josh: Why not Charles? I feel totally neglected right now. Just give us everything.

Charles: Not going to happen. But, there are some things that I am working on that are interesting and I’ll tell you one thing I’m working on. I’m working with a company in Houston that they come from the medical world. It’s a startup and I’m actually very excited about it. I think it can actually solve a lot of our labor problems. These are guys I know but I just kind of stumbled into it. They’ve been doing this for the medical world. Essentially, it’s like Uber for nursing shifts. Like, I’m a hospital and I have an open nursing shift, I can either pay overtime or I can call an agency and all they do is kind of set up. Okay, they interview nurses and qualify them and say, okay, I need a med-surgeon nurse at 11:00 and they’re qualified and there’s a rating system like Uber. There’s a whole senior housing application for this and if we can provide labor at the same cost as full-time employees- so, you know, an $11 an hour employees are really $15 because of the payroll taxes and PTO and things like that. Well, if we can charge you $15, you’re indifferent, you know if they’re good or not, because I’ve already interviewed them, other communities will have ranked them and then they can be hired immediately. And if you want to hire them permanently, great, you can try before you buy and it shortens the hiring cycle from 45 days to a couple hours.

So, I’m very interested in seeing how that comes out in the senior housing world. We’re going to pilot it in Houston, in a handful of communities in Houston, then we’re going to look to role it out, city by city, kind of like how Uber did, nationwide, but we’re going to start small and they’ve already been doing it on the nursing side and there’s a big cost savings that senior housing communities can leverage.

Josh: So, you guys are going to be piloting this. When do you think this will be available to your ordinary operator that’s anywhere?

Charles: It’s hard to say because we’re looking to do first a couple pilots by the end of the year maybe into Q1, really refine the product, the application for senior housing itself and then we’re going to do a couple more cities and once we get a foothold on some of those cities, then it’s okay, let’s go out and look at a major funding round and see here and there and then at that point it’s like, okay, let’s start hitting the top 20 cities or whatever and then by then, our goal is as we start to get into regional senior housing communities, it’ll start to spread on its own.

Josh: That’s awesome. That’s exciting. So, kudos to you, for being a risk taker and piloting that and working out the kinks. I think that could be a game changer.

Lucas: Well, we’ll definitely stay close to that Charles. We appreciate your time and your sense of humor.

Charles: Listen, you know, all joking aside, I think this is a wonderful thing you guys did. We kind of started early on this and looking at where you guys have come. And so, listen, congratulations to both of you guys for what you’ve done. Y’all should be really proud- you’re creating a voice for the industry. I think you said it best, earlier- all the knowledge that we gain here, you’re sort of spreading it to everybody and that’s exciting. I appreciate that, so thank you guys.

Lucas: Well, we appreciate your collaboration and giving it back to the audience. So, as we do with every show, we’ll definitely post connections to you in our show notes, we’ll post on social media because we want the conversation to continue. Ask us questions, engage with us, we love our listeners. To them, we just thank you for listening. You might be driving, you might be traveling, walking your dog, working out and we thank you for tuning in to Bridge the Gap with Charles Turner today. Great job guys, safe travels and another great episode of Bridge the Gap.

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Episode 38: Charles Turner