#47 - Long-Term Care Nurse Staffing Solutions with Rebecca Love, IntelyCare

In this Episode:

Nursing shortages combined with COVID have accelerated the nurse staffing crisis for both acute and long-term care facilities. When there aren’t enough nurses to staff SNFs and ALFs, those downstream bottlenecks create capacity issues for acute care facilities as well. Discover how IntelyCare is using technology to match nurses with open shifts – and empowering nurses to choose when and where they work -- to alleviate some of the staffing strain for long-term care facilities.

Jeff Terry:
Okay. Hello and welcome. I'm Jeff Terry, delighted to be joined today by Rebecca Love, who is the chief clinical officer of IntelyCare, which is a five-year-old company that helps match nurses with open assignments in post-acute care facilities.

And as I have begun to learn about it, important to say, they employ the nurses and they maintain the network with post-acute care facilities so that they can match the two, and they provide the software to make it easy for all involved. So a true solution, not just a software company or a staffing company, but a true solution. Rebecca, thank you for joining.

Rebecca Love:
Jeff, it's so great to be here, and thank you for having me.

Jeff Terry:
Wonderful. So to start, could you describe the problem that IntelyCare helps to solve and put that in context a bit as something that's on virtually everyone in the audience's mind, which is the challenge of nurse staffing and the shortage, frankly, of great caregivers that we need more of.

Rebecca Love:
Absolutely, Jeff. And I think you know this, in the United States, nursing represents the largest healthcare workforce. So when you see there's a shortage, it really blows everybody's mind because how can you have 4 million strong, the largest profession, not only in healthcare, but actually the largest profession of any profession in the United States... There's more nurses than there are doctors and lawyers and teachers and bus drivers. Anything that you think of, there are more nurses than anyone else, so how could there possibly be a shortage?

And the reality is I think there's a fundamental fracture of several factions that are coming into play. We knew that there was this nursing shortage before COVID. We know that COVID is accelerating that. We saw that in 2020-21, it was the largest exodus ever recorded by nurses at the bedside in the profession history. We're predicting another 500,000 nurses to leave the bedside by 2022, which accelerated that 1.1 million nursing shortage that was supposed to hit in 2030 is hitting by the end of 2022.

And what we're seeing at that means that there is a 20% nursing shortage within our acute care space, which is our upstream, our hospital systems. And we're seeing 130% turnover within our long term or post acute space, in our nursing homes and things such as that. And we're finding that everything has compounded into these moments.

And I think that there are a number of issues. We can talk about pay. We know that that's been an issue where nurses have only made 1.5% increase in salary on average over the last 20 years, which is absolutely one of the fundamental problems that's leading to the amount of driving in the travel nurse market to increase salaries in that.

But I also think there's been a fundamental disconnect that nurses seem to cover 24/7 care, have been treated much like a commodity, a cog in a wheel, just to keep people by the bedside. And their lack of ability to balance work/life balance, and now with downward pressure, means nurses are not only dealing with trauma and stress that existed because of PTSD because of COVID, but also are constantly being barraged in their days off to come back in, and it's further burning out a workforce that is already incredibly exhausted because of what they've lived through in the last two years. So IntelyCare uses technology-

Jeff Terry:
May I just say, by the way-

Rebecca Love:
Yeah, please

Jeff Terry:
... Then we'll come back to it. And thank you for describing that so clearly. I think just to connect a couple dots, I think many in our audience, the generational change going on in nurses has been on their mind. So I had not heard that before. So you're saying that's really one way to think about it that, that's accelerated from where we were going to be in 2030 is where we are now, compounded with PTSD, compounded with travelers driving up rates. So it's compounding to this place.

And clearly there's no silver bullets for that. And I know it's top of mind for a lot of people. But IntelyCare helps in a meaningful way, please talk more about that.

Rebecca Love:
Substantially. And we're only in the long term care space. So within our SNFs and our ALFs, which as you know, have been so hard hit by COVID, and we don't have a strong workforce that's already there. It's very transient along those lines. And per diem is where we tend to sit, it's how do you fill those back minute, last minute needs?

And in our long term care space, still many of the staffing was done on paper, which I know probably blows a lot of us around that are in technology, but there hasn't been a massive investment into staffing and scheduling into the nursing workforce, both in the acute and the subacute space.

What we did is we created a community of nurses and nurses aids that create profiles that we credential to be able to work in any environment as long as they are licensed in their state, which easily allows them to mobilize and access any place that needs assistance they can go to.

Which is very different than traditional healthcare, you work at one place, your credentialed to work there, and it's very hard to work anywhere else. So we address that problem, making an easily credentialed workforce to meet those needs in the subacute place.

We further use AI and data science to work within our systems that are largely been on paper, put them onto a digital platform that allows us to use and do predictive modeling as to their healthcare staffing needs. So they're no longer in these dire moments when suddenly that they haven't been able to predict what their needs are going to be. We help them do that, and we match the local supply along with their needs and help fill those last minute needs. And actually up to 30% of often their shifts because of the needs and the shortages.

So we've really taken technology that helps meet the facilities needs to staff that, but we've also created a platform that does not put this downward pressure onto the nurse because we only mandate one shift per year. They're W-2 employed. They pick up shifts when and where they want. They know that tomorrow they want to work, they can go on the shift. They can find something that matches their needs.

And viola, suddenly the magic happens, and we're filling at a much higher rate. As opposed to bombarding these nurses and CNAs constantly with text messages and phone messages when they don't want to be bothered to come and work. We put the power back in their hands to meet the demand. So it's a much more seamless process.

Jeff Terry:
Well, it sounds like an elegant and an impactful solution to make it easy for the nurse to find the shifts that she wants to work at the places that work on the cadence and the frequency that work. So you get more people in the workforce, and to make it a lot easier for the provider to access that pool, and also to manage the credentialing of that, which obviously gets complicated. It sounds like a very elegant solution. So where do you expect to take this in the future?

Rebecca Love:
Well, so I think that right now we're in 25 states. We're expanding rapidly into another 32 by 2022, and potentially even faster into all 50 states. And I think the demand of what we're seeing is going very much in the subacute space. Because the issue that we're facing, Jeff, is our hospital systems. When they don't have an ability to discharge people into the subacute market, into the long term care space, it backs up bed throughput, which means it prevents access to healthcare. So we're very much focused on the long term care space at this time.

I believe that there are other opportunities that we're looking at to keep going and potentially into home healthcare as well because we know that as these markets move, keeping that bed throughput, keeping everybody staffed, moving them into both the long term care space, but then into the home is absolutely critical to the success of managing the entire healthcare system.

There are some wonder suppliers already in the acute space, not saying that we're not eventually going to be going up into the hospital space. But right now we know that the need, and I think that is just not... I think COVID brought to the market, is recognizing that if we do not keep our downstream open and functioning, all healthcare is going to fail.

And right now those needs are substantial. And the truth is the workforce can also easily translate when you use a system like ours. Between a SNF versus a home care, many of those nursing skillsets easily translate without the necessary needs of credentialing or further training to make them easily mobilizable to do those.

So that's where we're looking. We're really looking at moving across the spectrum into home care to help staff those per diem positions within home care, who again, as you know, very analog system run by many smaller mom and pop shops. They don't have the ability to invest heavily into these resources. But if we cannot get people into the home and with nursing staffing, the entire system fails us.

So really trying to look innovatively at how you mobilize a home care workplace with the technology that we have and do predictive model in that space so that we can keep working at that entire bed throughput and getting people back into their homes safely. Because, let's be honest, I think we all want to be in our home. And right now there is not a good model for that out in the market.

Jeff Terry:
Absolutely. Well, it makes a ton of sense that the hospital networks have a lot of sophistication and critical mass and can offer nurses options within their hospital network. And obviously, health systems are pushing further all the time, but it seems to me, yeah, the further you get today from the center of that hospital network, the more difficult it is to match nurses and demand on a dynamic basis all the time. It just isn't the tools or the critical mass. That's great.

So, one other question, speaking of nurses, and we were speaking earlier, would you mind sharing a bit about your career path? You're a nursing executive that's doing technology and all these things. And how do you go from nurse to where you are today?

Rebecca Love:
I wish it was a straight path. But I want to tell people, I think my life changed because of a hackathon. And I don't know if the audience is well familiar with a hackathon. I know I didn't. Back in 2015, I was a struggling nurse entrepreneur. I taught at a community college. I was working at a nursing home. Like all of us, we had three or four jobs as nurses. It's typical of what we do. We piecemeal things together to make a life, a quality of life.

And I had a struggling startup, and a friend of mine said, "Hey, Rebecca, you have to go to a hackathon." And I said, "Well, Nick, what is a hackathon?" And he actually went on to run MassChallenge for five years, a wonderful friend. And he said, "Rebecca, it's a three day event where people come together and pose problems over the course of the weekend, come up with solutions. And there's going to be one at this hospital next's weekend. You should go."

So this was the middle of January. There was a blizzard going on. I had three babies at home. I looked at my husband, and I said, "I'm going to this event." And I drove in, and I showed up at this gorgeous reception center at the hospital. And in I walked, and there was the president and the CEO of the hospital, the heads of major healthcare companies all convened in this room.

And as I walked around the room, I realized, "Oh my gosh, I'm the only nurse here. Maybe I'm not supposed to be here. This is where all the decision-makers are. As a nurse, maybe that's why... These are where the decisions happen. And as a nurse, I'm not sure I'm supposed to be with the decision-makers."

But nobody asked me to leave, so I joined a team and the most incredible things would happen. I would have physician sitting next to me, my engineer, the doctor, everybody would be sitting in this room, and in would walk the CEO of a healthcare system. And they would sit down, and we'd start talking about our solution market fit.

And the doctor would say, "Well, this is how we're going to roll it out." And the engineer is going to say, "This is how we are going to use the technology." And I would say, "Well, you know what? But we can't do it that way. That's not at all how it's being done on the hospital floor. Nurses don't use the technology that way, and this is how it's done."

And the executive would turn to me, and they would go, "Really? Why don't I know this?" And suddenly everybody at that hackathon was seeking me out for advice like, "Rebecca, how do nurses do this? What goes on on the hospital floor?" And I started to realize that nurses have practical knowledge that few others have onto the state of healthcare on a day-to-day understanding.

So I left that environment, learned more about the business of healthcare in one weekend, and I started to study the environment of healthcare hackathons and realized as I started to hear from people, very small amounts of nurses attended hackathons, but a large portion of teams that [inaudible 00:12:01] had nurses on them.

So I hypothesized nurses had that experience to create great healthcare solutions. And I started to really dive into that community. And we went on, and I started to call nursing schools, and eventually we hosted our first ever nurse hackathon in the United States in 2016, launched the first healthcare initiative around nurse innovation, entrepreneurship in the United States out of Northeastern. I spun that out with a group of other nurses into a national nonprofit called SONSIEL 2018 and the rest has been history.

And so, if I had anybody to tell, the truth is, as a nurse, we often feel that we are put into a bucket of where we fit into healthcare. And that decisions that we want to make, where we're taught I think, I feel, I believe, those very empathetic things, nobody ever taught us the business skillsets to say, "Hey, you might think this way, but when you're speaking to your CFO or your CTO, you have to talk about the strategy and the financial impact and the operational impact it's going to have to an organization."

Because, as you know, Jeff, nurses are rolled into cost centers into healthcare systems. And because of that, when they come up with ideas that deal with them, they don't understand how to financially make that case to drive the impact, especially if it relates to the nursing workforce.

And that fundamental experience of learning to have that conversation and understand those things very much can be changed by going to a hackathon and learning how and why healthcare makes the decisions they do, and bringing nurses to those tables. So my life changed because of a hackathon, and I can only tell you how many others I hope it would experience as well.

Jeff Terry:
Well, that's brilliant. And we certainly agree. Our work we do is in service to nurses. And you said it when we were chatting earlier, that nurses are the hospital. The hospital is nursing. That's what the hospital is. So absolutely, that's, in many cases, who has the best perspective on what needs to happen, and in most cases, the most end-to-end perspective. It all touches the nurse. Amen.

Rebecca Love:
Well, and you said, Jeff, the reason people are in hospitals, the reason they're in nursing homes, it's not because of needing access to a doctor. They're there because if they were discharged home, they would die without 24/7 monitoring and care by a nurse. You go to hospitals, you stay in hospitals, you go to nursing homes because you need to have that nurse to keep you alive.

And the truth is is that we are experts in caring and the science of maintaining life in a way that others are not. And fundamentally, if there are no nurses to deliver care, that means healthcare itself will fail and people will die. And we're seeing that today. We're seeing that these shortages are driving patients to die waiting in emergency rooms and to die for access to care because there are not enough nurses by the bedside.

And that is fundamentally heartbreaking to me as a nurse, and one that if we don't readily as corporations take part ownership of to solve this problem, I think it's going to hit us all very hard. And it's going to hit us personally because when you need access to healthcare, it's never planned. It's always an acute situation that you're standing in often moments between life and death. And that is absolutely the role of the nurse to help sustain that moment of life. And and we need them.

Jeff Terry:
Right. Brilliant, we need them. Here's to all the caregivers in this time. And I sure do hope that... I appreciate your work and appreciate your sharing about it. And I hope that from all this stress right now, if we see a sustained increase investment in nursing, well, that's at least a silver lining. Brilliant. Thank you so much, Rebecca, for joining us.

Rebecca Love:
Jeff, thank you so much for having me and keep doing brilliant work with everything that you're doing over at GE Healthcare.

Jeff Terry:
Yes, ma'am, you're very kind. And with that, we'll close the podcast. Okay.

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