Most LTC centers still believe growth will come from hospitals, and nothing else is needed.
If the census dips you just make a few calls or send faxes to the hospitals saying, “We have open beds. Send us patients now please.” This simple marketing effort doesn’t work any more.
Hospitals are now your competitors with hospital owned nursing homes, home health care, out patient therapies, and other post hospital care services. Most hospitals won’t even let you in the hospital to see patients until the patient has decided to work with your center. They control where patients are discharged by saying things like, “if you decide to use our nursing home for therapy your doctor will be able to see you there and continue to care for you.” They are very good at giving the patient a reason to pick them over all other competitors.
If the hospital does not want the patient, usually because they are at full capacity, they say, “here are a few nursing homes and assisted living centers near your home, which one would you like to go to?” It’s just up to the patient or patient advocate to pick one on the spot. They are usually in a crisis situation and don’t have time to shop. They may have a few LTC center brochures handed to them that all look the same. Each center offers the same thing and even use the same language. The doctor doesn’t decide for the patient and the discharge planner doesn’t suggest which one to chose at this point, It’s a snap decision made by the patient and patient advocates. Your center will have little chance of winning the referral if you have not won over the patient and loved ones before now.
The most effective LTC marketing is made to the real decision makers long before the patient is in the hospital.
Yet, most LTC centers still focus their efforts on getting discharge planners to like them, visiting hospitals and doctors.
Nursing and assisted living care centers continue to function as if the hospital will just send over all of the patients needed for full census. They operate under the false believe that they don’t need to be competitive or win patients before they get to the hospital. As a result, most LTC centers offer nothing unique, blend in with competitors, have poor awareness, and have operational policies that hurt census building.
You will not reach full census by repeating the same ineffective census building efforts. And adding more effort to the same old initiatives will still produce weak results. Growth starts by trying new methods, involving the entire staff, and working very differently.
In a nutshell, census growth is directly linked to your ability to make big changes.
When the census declines because the key census growth components were ignored, leaders look for a quick fix from the Marketing/Admissions employee. Top leaders become cheerleaders, saying things like, “get out there and visit the hospitals - go make it happen and you can do it!” They make no real sellable changes, nor do they fund a promotional budget. Yet, it’s the people at the top of your organization that have the most potential for increasing your census, followed by Administrators, then Marketing Directors, and lastly Admissions coordinators.
The prevalent thinking in nursing homes and assisted living centers is that census will be strong if the nursing department runs well, and the state surveys are good.
Most of the time and resources flow into the nursing areas. Little or no emphasis is put on the things that actually build your census:
- Long-term visioning
- Strategic planning
It’s the top leaders of the organization who decide what the core of the business represents, what your specialty or unique appeal will be, what’s emphasized, where resources are invested, the leadership style, and how the business runs.
The people who make key decisions in the organization ultimately decide if the business will be stalled by employees, operate like all of the other clone LTC centers, or if it will become unique and appealing to a specific target market. It’s much easier for the Marketing/Admission employee to build census when they have something unique and valuable to sell and have policies that support census growth efforts.
The Marketing/Admissions employees must abide by the company policies. For example, it’s impossible for the Marketing/Admissions employees to generate more inquiries if top leaders and Administrators require them to spend all of their time on non-census building activities, like being the night manager, or doing admissions paperwork.
Even if the Marketing/Admission person was doing all of the right things they still need to have a product that they can sell. The nursing and therapy team essentially produces the product. If the staff is unable or unwilling to be effective census will remain low.
Staffjacking prevents most nursing homes and assisted living centers from making the most basic developmental and growth changes. Meaning, the decision making control of the center has been taken from the administrator and top executives and is manipulated by the staff. All changes needed for census growth come to a stop when the staff:
- Refuse to change
- Mention state survey sanctions
- Allow care to decline
- Threaten to unionize
- Talk about a walk out or quitting
- Agree to making changes to appease management, then return to the ineffective actions
The staff sees change and census growth tasks as just more work pilled on top of an already heavy workload. They quickly discover how much control they have and they use stalling tactics to prevent change. Even if they may appear to top leaders to be willing to work differently when a new operational system is introduced, it’s back to the old work habits as soon as they are out of the spot light.
Imagine any business that produces something, like toasters for example, being controlled by the people who produce the product. The factory staff says, “we will not produce the product the way you want it made if you don’t give us what we want!” Then the leaders say, “Ok, we will stop all necessary growth progress because you don’t want to make changes.” That’s nuts!
A more effective business leader would say, “I will do all I can to have a win/win outcome with the staff. But, if I don’t get the growth related changes that I want - you will all be replaced with people who will give me what I want. I am willing and prepared to do what I have to do to, even if it means replacing the staff, to make the business successful”.
The leaders of most LTC centers are not prepared or willing to make the tough moves needed to become successful and that is why they continue to struggle with a low census.
Your center may be staffjacked if census building actions are typically halted while the staff catches up. Employee challenges and ineffective systems consume all of your time and resources. The prevalent thinking is that census will be strong when the nursing department runs well, and the state surveys are good. That day never happens because the operational challenges are approached with the same ineffective leadership, actions, and nothing ever changes. Little or no emphasis is put on the things that actually build your census because all of the time and resources are invest in just trying to produce a basic care product.
Only a change in top leadership management style will enable true census growth.
I suggest you have your administrators and top executives visit this web site to learn more about how to develop an effective leadership style. Once that is in place we can help you make the necessary changes that build your census. The census building actions include:
- Developing something unique to differentiate from your competitors and appeal to customers
- Long-term visioning
- Strategic planning
- Awareness building
Obtaining a full census in your nursing home or assisted living center starts at the top of your organizations and flows down to the Marketing/Admission level.
The census building ideas for the Vice President and Board of Directors (Non-Executives) differ from that of the Administrator or Marketing/Admissions Director.
This web site offers census growth ideas for Non-Executives, Executives, Administrators, and Marketing/Admissions roles. Take a look at what you can do in your specific job to boost your census.
Marketing / Admissions
Marketing and Admissions staff ideas
for census growth.
For long-term census stability you need to stand out from your competitors. You also need awareness among the potential new residents and the people who influence where patients receive long-term or rehab care. Does your organization have anything unique and valuable to sell or does it blend in with your competitors? Potential customers need a reason to pick your organization over your competitors for long-term census stability.
Potential new residents will select a long-term care organization based on location alone if nothing unique is offered.
Likewise, even if you have a world class, unique care center you will still have a low census if you don’t have enough awareness among the people who influence where patients receive LTC or rehab.
We’ve created a four-step process for increasing census.
1. Develop a unique specialty
2. Create a vision and plan
3. Build awareness
4. Increase your inquiry to admission conversion rate
The top executives in your organization should complete the first two steps. A specialty is something that is of value to your customers, profitable, and sets your organization apart from your competitors.
Top executives are best suited for this task because it requires top down and long-term, company wide support. Its counter productive to develop a specialty and create a long-term vision only to have some departments refuse to participate or top managers change direction before the new concepts are implemented.
The Administrator or Marketing employee can create the first two steps. They must have the top leaders complete long-term support to make the growth concepts work. You’re ready to start promoting your specialty after the new niche is identified and a long-term plan is written to map out how the specialty will be developed.
It would be silly to build a unique product and then not promote it. You’ve created a compelling reason for customers to choose you over your competitors. Now you need to let them know what you have to offer.
Most LTC organizations promote themselves inadequately, if at all.
They mistakenly believe that senior center bingo, church visits, and hospital calls are all they need for success. It’s self-defeating that LTC organization will not think twice about investing hundreds of thousands of dollars in hiring additional nurses, equipment, renovations, even pay for outside lawn care services… but they refuse to fund an adequate promotional budget. Seriously, an unknown business will always fail.
If I asked potential new residents and their adult children in a 50 mile radius of your center to “name the top two LTC centers that come to mind” - would they mention your organization? How about if I asked the news media the same question? How many of them would even know the name of your organization?
Most LTC centers wait for local hospital discharge planners to call.
The aggressive facilities send representatives to the hospitals and try to build relationships with them. If 95% of your referrals come from discharge planners and if they like your organization your marketing is not in a strong position.
What happens if tomorrow her boss says "send all future LTC discharges to the hospital’s new LTC centers"? What if your competitor builds a relationship with your potential patients before they got to the hospital and they demanded to go to your competitor, Now what?
A few good relationships with hospital referral sources do not equate to a strong marketing position.
A better move would be to create something unique that potential patients want, then cast a wide net of awareness amongst potential patients, patients' helpers, the entire medical community, and media sources. Strive to impress the world rather than a hand full of hospital referral sources.
If you're interested in attracting more inquiries from more effective awareness building techniques we offer an e-book that will walk you through the process, step-by-step.
How to work with a limited budget
We’re guessing that your promotional budget is rather limited - if you even have one. So, the real question is how to become known with a limited budget. Furthermore, what messages will generate inquiries? You don’t have to be a marketing communications expert because we are, and we would love to work with you.
Step four is to Enhance the sales and admissions effectiveness. You will get more admissions if your center is easy to work with, responsive, and helpful to referral sources and customers. That means 24/7 admissions and company wide focus on the entire admissions process. We have found that Administrators usually have the most influence in these areas and that is why we suggest they are responsible for step four.
Increase your inquiry to admission conversion rate
You can win more admissions from your inquires with a few simple changes. What most LTC centers sell is not what customers need or want to buy. Sales training for your entire sales and back-up team is critical to your long-term success.
Take a look at your sales results. What percentage of sales opportunities does your organization close? Do you know how much revenue is lost on average with each lost sale? If our ideas and training could enable you to win just one of the sales you routinely lose - would it be worth reading our “how to” e-book on improving your sales techniques? We can help you boost your sales results with our training.
Start with a marketing Plan
Set a few targets and create plans for reaching them before you begin your work. You will bounce around like a ping-pong ball and never reach your goals if you don’t work from a detailed marketing plan. Remember, you need to work differently to obtain better results. Your marketing plan goals will usually include targets for inquiries and census.
One way to determine your marketing plan inquiry target is to calculate your average monthly number of open beds and inquiries. What percentage of the inquiries became residents? For example, if you average 10 inquiries a month and 7 of them became new residents you have a 70% inquiry to new resident conversion rate. Using the 70% conversion rate, If you average 20 open beds each month, you need 29 inquires each month to remain full. Your marketing plan goal would be: to increase your monthly inquiries from 10 to 29 in three months from today.
The old ways of boosting your inquiries don’t work. New approaches are needed to get impressive results. What you likely need is an extensive new niche with company wide support. Realistically, what your administrator and top leaders want is a quick fix. They are not willing to make big changes. Yet, they want big census changes. The census advancements you’ll see are usually in proportion to the size of changes your organization is willing to make.
How do you make census increases when you’re limited on what you can do? Begin by having your Administrator and top leaders read the sections written for them on this web site. You will have a much easier job at building census if everyone is on the same page, knowing how to build census and supporting the necessary steps for census development. Again, to get different outcomes you need to do things differently.
We have a few census building ideas for you if your unable to get upper management support. We have ideas on how you can be more attractive to prospective customers and referral sources. We have ideas for increasing your hospital referrals, find new ways to connect with referral sources and customers, outsmart your competitors, and keep your census high. Learn more about the e-book here.
Ideas for leading your team to full census.
Administrators have a huge impact on the census. You set the tone and focus of the center.
Your marketing support determines your center’s success or failure. LTC leaders are less likely to encourage or support marketing if they do not understand and value marketing. A basic marketing and business knowledge is essential for long-term success.
Nurse managers, not business professionals, influence and run most LTC centers. The LTC product, nursing care, has become so over-emphasized that everything in the center evolves around nursing. As a result most of the time and resources are invested in supporting nursing and not on competitive positioning or marketing. This is why it’s so important for the Administrator to understand and support marketing. You are ultimately responsible for the census results. In a nutshell, marketing will enable your center to:
• Stand out from your competitors
• Develop a specialty
• Build awareness
• Generate inquiries
• Improve census
• Produce more profits
• Create forward moving momentum and innovation
Marketing/Admissions employees are required to work under the rules and parameters set by the Administrator and top managers.
You set the Marketing/Admission person up for failure when you fill their time with non-marketing related tasks and then hold them accountable for census results. Likewise, you’re unlikely to succeed if you don’t support any of the marketing efforts. Ultimately the Administrator and top managers have the greatest impact on the census because they enable or prevent the real census building efforts.
We understand the challenges of Administrators. In working with hundreds of LTC centers we have found that most Administrators bounce from emergency to emergency all day, every day. Over time a reactive leadership style is the norm.
A reactive style of leadership causes a low census. Census building requires long-term proactive work. It includes proactive big picture vision, proactive planning, long-term efforts at developing new operational systems, and an unshakeable commitment to marketing. Marketing must become a top priority above all of the non-marketing tasks and the emergencies of the moment to build and maintain a full census.
Administrators with a low census usually require the Marketing/Admissions person to invest the majority of their time in activities that do not build census. When the census drops they look for a quick fix. Now the census is the emergency of the moment. In a knee jerk reactive mode they send the Admission/Marketing person off to senior center bingo, calling the hospitals, or joining the Chamber of Commerce. None of which will actually increase your census.
The Marketing/Admissions employee is going to invest his/her time as they are required and directed by the Administrator and top managers. Most Marketing/Admissions employees are required to invest their time and energy in work that does not build the census. The list includes:
• Night and weekend manager
• Committee member
• Special projects
• Assisting with dining
• Answering the telephone
• Admissions paperwork
• Financial and business department functions
• Assisting with nursing tasks
• Discharge activities
Employees with both Marketing and Admissions tasks typically invest 50% of their time in admitting new residents, 45% goes to the non-marketing related tasks listed above, and only 5% or less is free for marketing (census building work). In a 40-hour week only two hours would go toward marketing. You can’t build a census growth program that keeps your center full with only two hours a week.
One quick way to boost your census is to cut all non-marketing related tasks out of the Marketing/Admissions person responsibilities and devote 100% of their time to only census building activities, AKA - marketing.
You can readjust the marketing time investment after your census stabilizes at 100% occupancy. Do this only if you can maintain full census with the new marketing time allocation. Keep in mind that none of the Administrator’s emergencies or nursing issues matter if there are not enough patients to keep the business running.
Take a look at your marketing efforts. Who in your organization is responsible for, and works on:
• Understanding the market place and what impacts LTC
• Grasping what the future will look like for LTC
• Leading the center to be competitive in the current marketplace
• Identifying the right customers to attract
• Creating an effective niche
• Developing and managing the right company image
• Creating ideas to outsmart your competitors and win more market share
• Business and marketing planning
• Designing and running promotional campaigns that build awareness and generate a constant flow of inquiries
• Identifying new referral sources and building mutually beneficial relationships with them
• Planning where the next new patients will come from and developing a path for them to follow (steps they take, moving from strangers to new residents)
• Improve the inquiry to admission conversion rate (Sales)
• Positioning the center for future profitability
These are a few of the essential tasks that need to be done to consistently maintain a full and profitable census. We have found that most struggling centers don’t understand marketing and consider marketing irrelevant or less important. They are less inclined to hire a person devoted only to marketing. They don’t have a vision or marketing plan. They are staffjacked, reactive, and unable or willing to make the necessary changes. They are more inclined to quickly give up when census dips with expense and employee cuts rather than make changes and advancements for growth. They demand results from the Marketing/Admissions employee, and then prevent them from having enough time or resources to be effective. As you may have discovered, the things you focus on, plan for, support, and work toward tend to improve.
We have developed a four-step process for maintaining full census.
1. Develop a unique specialty
2. Create a vision and plan
3. Build awareness
4. Increase your inquiry to admission conversion rate
We suggest that your organization’s top executives complete the first two steps. (Develop brand niche and create a vision and long-term strategy)
A specialty or niche is something that is of value to your customers, profitable, and sets your organization apart from your competitors. Once the new niche is identified a long-term plan is written to map out how the specialty will be developed internally in every department.
We suggest that top company executives complete the first two steps because these initiatives require long-term and company wide backing to be successful. It’s counter productive to develop an unique specialty and create a long-term vision only to have top managers change direction before the new concepts are developed. The Administrator or Marketing employee can create the first two steps, but, they must have the top leaders long-term support to make the growth concepts work.
The third step is to create a marketing plan that tells your target market about your new specialty. It also creates paths or steps for prospective new customers to follow as they move from strangers to becoming residents and raving fans. Your target market customers won’t call if they don’t know your center or have a reason to pick your center over all other care options. Creating marketing plans and building awareness are typically marketing functions and best delegated to your Marketing/Admissions employee. Do all you can to hire a marketing expert if you don’t have one on staff. We can help you with your marketing functions. Send Mike an email right now. Also, you desperately need to read our e-book if your marketing results are not filling your census.
Enhance the sales and admissions effectiveness
The Administrator is the best person to complete this step. Customers tend to take the path of least resistance. In other words, if you make it easy for your prospective customers to do business with your organization - they will be more inclined to work with you.
We’re amazed how difficult long-term care organizations are to work with even when prospective clients want to use their services. The phone isn't answered, the sales/admissions person is unavailable, calls are not returned, the staff acts as if prospective and new patients are an inconvenience to their real jobs. Then, if the inquiring customer is still hanging in there, trying to work with you, they hear something like, “we don’t do admissions after 4:00 pm. Or, we can’t complete the admission until you get us the H&P from the patient’s physician… In shock they respond, "WHAT? NO!, really?!”
The last of the five census building steps is to increase your inquiry to admission conversion rate. Your Admissions employee is the best person for this task.
A poor sales or follow-up effort could cost your center many new admissions. We have helped hundreds of LTC centers improve their sales results with our e-books and one-on-one training sessions.
Administrators are usually too close to their organization to objectively see the real challenges and opportunities. We can help. Ongoing marketing education and ideas are a key component to your success. We can help you with these steps. Start by reading our e-book on census development.
Executives and non-executives (Board of Directors)
Ideas for leading your centers to profitability
Corporate policies usually flow top down. Therefore, the organizations top leaders have the most control over census and profit results. If your policies are designed to enhance and protect the nursing staff, you might have a good nursing product, and you will have a weak census.
Most LTC leaders assume that by creating a strong or stable nursing care and therapy product they will automatically have a good census by reputation alone. This is not true because most LTC centers offer the same general “good nursing and therapy product”. Most LTC centers also say they are “caring”. The things most centers strive for and promote are common and expected among customers.
Convenience of location becomes the deciding factor for customers when none of the competitors stand out as being uniquely valuable. You can test your centers customer appeal and marketing by discovering how far patients are willing to travel to receive your care. If you have no distinct and compelling advantage you will only attract the people living near your center.
The best way to keep a high census is to completely transform your organization.
It starts with redesigning your core offerings and then moving outward. These reconstructive initiatives are an entirely new way of doing business that will enable you to offer customers a convincing reason to select your center while creating barriers for your competitors. You'll create a specific value for your business that other LTC centers will not take the time nor invest necessary resources to compete with. Your competitors are likely too busy trying to win back leadership control from the staff to compete with your new specialty.
You can try some new marketing programs for a temporary spike in your census; but if your core business offering doesn't attract customers it needs revamping. In the long-run you would have saved money and time by reinventing your business first and then using the quick census growth tactics. Let's look at what changes are necessary for long-term success.
Your center needs to stand for something of great value to future residents to generate more inquiries and admissions. This uniqueness is your specialty. Your specialty is what referrals sources and customers associate with your business. You need a niche that differentiates your center from your competitors.
Creating a unique specialty should be introduced, led, and supported by the entire organization, starting with the top leaders. Your specialty is the core or essence of the business. All decisions and systems in the organization should flow from and enhance your niche. Top leaders must start and support the specialty process or it cannot even get started. With out proper specialization and marketing your census will continue to flounder.
Ideas Coach has created a four-step process for helping census challenged nursing homes and assisted living centers become successful.
1. Develop a unique specialty
2. Create a vision and plan
3. Build awareness
4. Increase your inquiry to admission conversion rate
The top executives in your organization should complete the first two steps. (Develop a unique specialty, create a vision, and long-term strategy.)
Once the new specialty is identified a distant vision of what the center looks like, does, and is know for is developed. A long-term plan is written to map out how the specialty will be developed internally.
We suggest that top company executives complete the first two steps because these initiatives require long-term and company wide backing to be successful. It’s counter productive to develop a unique specialty and create a long-term vision only to have top managers change direction before the new concepts are developed.
Develop a unique specialty
Most LTC or rehab centers try to be everything to everybody. They are not nearly as effective as the ones that specialize. For example, the hourly rate of a cardiologist is about five times more than a family practice physician, and they have more patients. Specialists have a reputation for being more knowledgeable, experienced and effective.
They make fewer mistakes. That is why customers prefer specialists to generalists.
The same specialist principle that works for cardiologists also works for long-term care centers.
For example, let’s say your mother is hospitalized with congestive heart failure. She is about to be discharged from the hospital and she needs to go to a long-term care center. A friend told you about a skilled nursing facility (SNF) that specializes in congestive heart failure. On average, their therapy, recovery outcomes and quality of life for patients with congestive heart failure are 64 percent better than the national average.
With the help of leading Cardiologists, they designed everything in their center around the goal of making life significantly better for patients with congestive heart failure. Even the colors of the rooms were select around the goal. They are often mentioned in the news for their new breakthroughs in therapy and care approaches. In fact, Cardiologists from around the world know about their innovative congestive heart care and frequently refer their patients for sub-acute or long-term care.
The facility's specialized care is so remarkable that patients come from world wide to receive it. Now, where do you want to send your mom? To the brand new SNF right down the street from your home, or to the SNF with the older looking building, 50 miles away, with the best congestive heart care in the world?
Reality check time.
Right now you’re probably saying to yourself, “I can’t even get my CNA’s and nurses to answer call lights, there is no way I can create a world-class specialty”. Keep in mind that it takes time to build and promote a niche. A new leadership style will likely be needed. This is not a quick growth strategy. You will need to believe that you can do it, get started now, and stick with it for the long-run. In fact, the most difficult challenge you will face is your attitude and belief. If you believe 100% that you can and will build a world-class LTC center, you probably will.
Furthermore, what are your chances of survival, let alone success if you remain where you are now, struggling to perform basic operations? You need huge changes now. You don’t have time to wait for your basic operations to get under control before you begin. That day will never come with your current systems.
Making huge core operational changes to enhance your new niche is your best long-term growth move.
Again, this is not a new quick growth marketing program. It redefines everyone's job, excites everyone, and gives everyone a new reason to surpass basic operations and achieve your new niche.
We can help you create a specialty that is appealing, achievable and profitable. Email Mike to learn more. We would love to help you outsmart your competitors.
Create a vision and plan around your specialty
After your specialty is selected it's time to dream and plan how it will take shape in your organization. You essentially custom build your own image, operations and future around your new specialty. Keeping the niche in mind; what does your organization look like 5 years from today? For example, Lets say you specialize in Congestive Heart Failure.
Your dream is to attract patient’s nation wide. Now you create a Step-by-step plan. What do you have to do to go from where you are today to realize your dream in just 5 years? We start with the big vision and work backward to daily action steps.
Be aware: just being a caring organization; having good state surveys; or smooth staffing does not constitute a specialty or inspiring vision. All of your competitors have these same basic objectives. Trying to sell that to your customers would be like Ford Motor Company trying to sell the same cars that they did in 1978 every year. Then they run a huge ad campaign that says, “We put four round tires on all of our new cars”.
Most LTC organizations offer nothing unique, remarkable, or news worthy. Think bigger. Dream! Think on a national or international level. Dream of the perfect LTC center for your own parents or yourself.
Sounds too big of a task and too risky. As in, lose-your-job-if-it-fails kind of risky! Not really. Look at it this way, if you don’t create something unique you will at best blend in with all your competitors. The real danger is becoming invisible and irrelevant. It’s sad how bland the long-term care industry has become. A new building or remodeling tops the list as being
"unique". LTC marketing has been reduced to sending a fax to hospitals announcing open beds. Most of the hospitals are also your main competitors with their own post hospital care products. Imagine a shoe manufacturer who's only marketing effort was send faxes to other shoe manufacturers, saying, "we now have shoes to sell!"
A world-class healthcare example:
The Mayo clinic has a world famous niche. They give people a convincing reason to travel the world to access their healthcare services. You can do the same. You must develop an effective leadership style and take risks to become successful. This is not a project of the month. It’s a whole new way of thinking and working.
Creating a really big dream for your organization builds hope and excitement.
The vision-energy generated motivates everyone in contact with your organization. Motivated employees, managers, referral sources, customers and communities will give their support, flexibility, and hard work. The positive force gained by embracing a big dream propels the organization to success.
You will need that positive energy to make the difficult changes required for becoming successful. Struggling LTC centers don’t have big dreams that they re-invent their entire organization around because they are too busy trying to master basics operations with the same ineffective leadership style, systems, and mentality.
You can learn more about how to build a successful LTC center by reading our
e-book. The book will help turn your organization around, step-by-step.