Lean Behavioral Health and Stay Out Agency: Amy LaFleur of Ciena Group

Ciena Group is set to open its latest newly built skilled nursing facility in Troy, MI this fall, just one way the premier provider is looking to grow further in 2023.

With more than 9,000 beds in four states, Michigan-based Ciena isn’t just focusing on scale, but rather programmatic additions and building design innovations that will attract new partners, residents and staff, says Senior Vice President Amy LaFleur.

“My personal view is that we have been regulated for quite some time to have similar environments at home. And we’ve been criticized for having COVID in nursing homes, where we have meals and group activities together,” says LaFleur, who joined Ciena in early 2021 after years at SavaSeniorCare, Trinity Health Senior Communities and HCR extension.

“Now with new construction, with HVAC, and what we know now about the best ways to manage [infections], it will really affect the design. We will probably take more time to think about how we work with our architect and our physical technicians to try to have a familiar environment but also be able to manage infectious diseases more efficiently. Any new construction will have to take this into account.”

Amy LaFleur

While LaFleur says Ciena’s leaders are eager to bring new concepts to market, regulatory changes and the economy will have to combine to give the company and the broader industry room to improve.

Ciena plans to expand its behavioral health and substance use disorders programs in the next year. Those services will complement the types of clinical services that Ciena has become known for, including the in-demand dialysis and ventilation programs that have spurred physical expansion into more nursing homes in its network.

But while regulators have pushed for changes like private rooms, there has been some initial conflict as they try to build programs and facilities with patients with behavioral diagnoses in mind. The design for those patients includes more elopement and exit prevention and other considerations.

Serving behavioral patients in a traditional nursing home, as the Centers for Medicare & Medicaid Services have insisted, must be done in policies that promote trauma-informed care and access to substance abuse treatment, it is not necessarily an easy sell to state officials.

“In some markets, nursing homes are the solution to the lack of low-income housing for people suffering from chronic mental illness. They end up living in the nursing home by age 50, which isn’t really appropriate,” LaFleur acknowledged. “It’s not all facilities, but that definitely leans into regulatory issues when you’re caring for that nation’s grandparents and that nation’s homeless in the same place.”

New personnel techniques

Another huge obstacle in caring for complex patients is, of course, the staff. It’s a major area of ​​focus for Ciena, says LaFleur.

When the company created an agency elimination task force, it learned through staff feedback that many frontline workers felt unprepared to care for patients with increasingly complex needs, whether or not those patients had diagnoses of COVID, dementia or substance use disorders.

“We took this very seriously and started pursuing staff training with our partners. We were doing dementia training and we were doing a lot of clinical training. But there were definitely some pockets where we needed to step up the training of our people so they feel more prepared,” says LaFleur.

“We worked hard on it. So pivoting the recruiting around that experience is something we have some opportunities to do in 2023.”

The firm is now 90% out of agency. It has increased wages and taken a new approach to recruiting, using internal recruiters who base their approach on census-building techniques.

“When you think about the census, you have connections in the market to keep it moving. We needed to do the same thing from a recruiting perspective, manage Indeed and Apploi and all of those things as effectively as possible,” says LaFleur.

In addition to raising wages to stay competitive, the company also listened to worker feedback and added OnShift for access to daily payroll and to digitize scheduling and make it more flexible.

Ciena has also created multiple career paths and tracks in everything from phlebotomy to dieting and has strengthened her corporate grant writing skills to pursue new funding opportunities.

“We’re really building our workforce capital system around the grants that are available,” he said. “States have a lot of money for those grants and we need to figure out how to make them work.

“These are the kinds of changes we made systematically to not just get out of the agency once, but to get out and basically stay out,” he added.

The staff determines the growth

Ciena is also taking a closer look at local job markets as it explores potential deals.

“Our process of looking at them has changed a bit,” she says. “There could be a lot of performance improvement benefits that you can do, but if you can’t staff the building because the job market just isn’t there, then obviously you’re going to be more cautious about that. I don’t know if this weighed as much in an acquisition before the pandemic as it does now.

Even with locations that have near-guaranteed volume, such as on a hospital campus, if there aren’t enough staff, acquisitions will be difficult to optimize, LaFleur added.

In the face of economic and regulatory headwinds, more suppliers will leave the industry, he predicts. This will lead to downsizing, particularly in overcrowded markets, such as Ohio. That state is home to the most Laurel Health Care facilities that Ciena garnered in 2016.

In other markets, however, particularly Michigan, Ciena sees opportunities for growth and new construction. This includes wings and additions needed to serve patients with greater acumen in niche programs, but also large, new buildings designed to attract partners and patients.

“We are excited about doing new construction because we believe that many of the limitations affecting how it operates are, in part, physical installations,” says LaFleur.

In Detroit, the company transferred licenses from two other locations to create a new campus, the Regency of Shane, in 2020.

The pursuit of similar projects, after the completion of the building in Troy, will depend on several key factors: staffing, reimbursement and demand.

“We love new projects and our CEO, Mohammad Qazi, loves doing new things,” said LaFleur. “But projects take a long time [due to ongoing COVID- and supply-related constraints] and costs go up… The economy is going to have to change a bit.”

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