Ep 62, A Conversation with Corey Crismon, CEO-NHA, Pioneer Place Skilled Nursing, Caring in America

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 Richard Wexler
We have a special guest this morning, Corey Crismon, who is the CEO and Nursing Home administrator of Pioneer Place, Skilled Nursing and Rehabilitation. He started in healthcare in 2013 and he eventually received his MBA and had a dream of becoming a CEO of a hospital. After working on the floor for a couple of years, he decided that senior care was definitely the place for him. For a little background, he was born and raised in Eastern Oregon. His mom's family were ranchers and his dad's family were loggers. As a child, they followed his dad to many places, to different logging camps, and lived in a multitude of towns throughout Eastern Oregon. He's been married to his wife for 34 years and they have five children, five grandchildren, two dogs, two cats, and one chicken. Corey, are you there, Sir? Where am I talking to you from? Where are you sitting today?

Corey Crismon
I am. Thank you. It's good to be here.
I am sitting at my desk here at a Pioneer Place in Vale, Oregon.

Richard Wexler
Vail, Oregon. Very interesting, you know, and obviously in doing some research about Pioneer Place, what I've noticed, and I'd like you to talk for a couple of minutes about that, it seems like it's a unique building in that you have multiple functions there. Is that correct?

Corey Crismon
That's correct. We have skilled nursing facility on one side and assisted living facility on the other and then we do take care of some long term care residents also.

Richard Wexler
Wow, that's not something that I see all the time. I mean, am I incorrect? Are there buildings like yours across the country and I'm just not aware of them?

Corey Crismon
You know, I've never seen one quite like ours. Most of the time, if they have a skilled nursing unit, it's separated from the assisted living, and the assisted living is separated from the independent living. 

Richard Wexler
Very interested. How many beds or room do you guys have within the building?

Corey Crismon
We have 64.

Richard Wexler
And how are they divided up?

Corey Crismon
We have 31 assisted living beds and 33 skilled nursing, and then we have a wall that separates the two facilities.

Richard Wexler
Wow. I mean, that's got to be pretty interesting running both sides of the house. Well, I want to ask you two questions. 1. What exactly is skilled nursing, and 2. what exactly is assisted living?

Corey Crismon
So skilled nursing is more for if somebody breaks a hip, they come here for rehab and they're usual average stay is 20-24 days. Assisted living is more there for support so they (residents) can function on their own, maybe they just need a little bit of assistance with some activities of daily living (whether it's bathing or getting dressed, stuff like that), they may just need a little bit of help and they can pretty much do everything themselves.

Richard Wexler
Interesting. So they definitely have their functions, more medical need, and correct me if I'm wrong, a more medical need on the skilled nursing side.

Corey Crismon
That's correct.

Richard Wexler
Interesting. So some questions for you: How will the staffing mandates that are affecting skilled nursing, how will they affect rural America?

Corey Crismon
Right now it's projected that around 290,000 residents in these long term care and skilled nursing facilities are going to be displaced. So we're talking about a huge number and it's kind of intimidating that (staffing( mandate so.

Richard Wexler
Why do you think they gonna be displaced?

Corey Crismon
Well, they won't be able to hire enough nurses or CNAs to care for all of the residents.

Richard Wexler
And I know places had difficulty, and again you can correct me if I'm wrong, with staffing before COVID, I know it's been challenging after COVID, so if I'm reading you right, I imagine these mandates are going to increase the demand for registered nurses, or RN's, across the country, am I correct?

Corey Crismon
Yeah, that is correct. And with the staffing mandate, it's looking like the facilities across the country are going to have to hire an additional about 100,000 RN's and nurse aids to take care of our residents.

Richard Wexler
Do we have that many RN's and nurses aides coming out of school? That you are aware of?

Corey Crismon
We haven't had enough nurses or CNA's coming out of school since I've been in the industry in 2013, so this is just going to make it even tougher so.

Richard Wexler
Wow. And and I'm, so obviously there's a dollar effect to everything, but what's going to be the financial impact on facilities like yourself if you have to bring in all these, you know, nicely paid RN's?

Corey Crismon
Yeah, we're not going to be able to accommodate that. I mean, we're a rural standalone facility, so we don't have any corporate backing or nor are we a nonprofit. So it won't be financially feasible for us to stay open to do that, I don't think we could function.

Richard Wexler
So, if I'm reading you right, and again I say this all the time, correct me if I'm wrong, but at some point, you guys in rural America, may have to close your doors because you're not gonna be able to bring in the adequate staff....Is that what I'm hearing?


Corey Crismon
That's that's correct, yeah.

Richard Wexler
Wow. I mean this, this conversation is kind of shocking me. You know, this better than I do, and I talk about the numbers that are out there, about 110 million people that are 50 and older or almost 80 million are the baby boom generation that I'm smack in the middle of. We really haven't started seeing the effect from the baby boom generation. Which kind of leads me to another question. What would you say on the skilled nursing side - what would you say the average age of your patient/resident is?

Corey Crismon
On skilled nursing, we're running 71 is the average age.

Richard Wexler
Wow. And that kind of leads me to what I was thinking about and talking to other folks across the country about... I've been in enough skilled nursing facilities, I was actually a patient in one years ago and I've been in enough assisted living facilities, you know I'm talking 10 years ago, the average age was about 85 and I'm hearing, and you're kind of verifying it, that we're starting to see, you're saying on the skilled nursing side, folks that are the younger boomers, in their early 70s needing care. Have you been seeing that for a while?

Corey Crismon
Yes, we have.

Richard Wexler
When did that start? I mean, how many years ago? Recent or many years ago? What are you seeing?

Corey Crismon
It's been it's been before the pandemic - it's probably 2018-2019, that's when we started seeing it.

Richard Wexler
Wow. And again as I said a couple of minutes ago, and we have 80 million baby boomers moving north and we're just starting to see a fraction of them needing care. You're verifying what I heard in that younger boomers, I mean the the youngest boomers are turning 60 this year, they were born in 64, but those boomers that are my age, 71, are starting to need care a lot sooner than their parents. And then you're telling me a few minutes ago, due to the financial impact at some point down the line, you may have to shut your doors.

Corey Crismon
Yeah, I mean that, that's correct. The CMS, Center for Medicare and Medicaid, want these mandates, which we're going to have to meet and they're not giving us any more reimbursement to be able to take care of that. So we're going to be stuck.

Richard Wexler
I was gonna ask that next. I mean is the CMS, are they, and it sounds like you already answered that question, you're not seeing further in reimbursements from a dollar perspective to offset those costs. I mean, I'm kind of sitting here early in the morning a little bit in shock we have all of these people aging and you're telling me, and I'm hearing it from other people too, we're starting to see people need care. What I've seen around the country, maybe you're seeing the same thing, I've never seen, "never" is a big word, but I rarely have ever seen someone, their parents, who maybe mid 80s, late 80s, nineties, being overweight, but I see a lot of boomers that are overweight. There's a lot of boomers that I'm aware of that have diabetes and things like that. And it sounds like that generation that I'm part of, really hasn't taken care of themselves well, and we're kind of walking into a really tough situation that we need to change when we have all these people in this country that are aging. Do you have any any thoughts on that?

Corey Crismon
Yeah, I mean you hit it right on the head. It's it's kind of, it's very interesting and it doesn't really feel like they (CMS) took that into consideration when they made the mandate. We are already being short staffed and the average RN at a hospital makes about about $96,000 a year, and we pay about anywhere from 60-70k so we're competing with these hospitals and we can't pay them anymore because we don't get reimbursed enough for it. So yeah, I don't think they took any of that into consideration when they made this mandate but that's above my pay grade, I guess.

Richard Wexler
What this is leading me to is obviously even a bigger subject matter, we need to have some serious conversations on a national basis. What are we going to do with the 30 or so million people above the boomer generation, their parents, their aunts, their uncles, their grandparents. A 60 year old can possibly, a good chance, they have grandparents still alive that maybe in their 80s or 90s. What are we going to do with all these people when they need care, medical care? What are we going to do with the boomers as they age? Another question, are the staffing mandates affecting hospitals and in their timely discharges?

Corey Crismon
Yeah, you know, to meet the requirements to meet this staffing mandate, and I got these facts off the American Healthcare Association, we would have to lower our, right now as it is, we'd have to lower our census and we couldn't take any more discharges from the hospitals because we'd have to be at the specific mandate. The specific staffing ratio, so it's going to affect their timely discharges and they (hospitals) get reimbursed on that.

Richard Wexler
Wow. And and and this is a tough subject as well, I mean obviously discharge needs to be at the appropriate time per individual patient, and you know like I do, a lot of people go home, some people whether they're gonna cross the wall and go to your assisted living, some people going to another assisted living, some people, if they have the dollars to afford it, going home with professional care. But this is just making things even that more complex. I don't want to put words in your mouth, but obviously we don't want situations where people are being discharged too early for financial reasons. Am I barking up the right tree? I mean, what do you think?

Corey Crismon
Yeah, you are. I mean we run into that even right now - just getting discharged too soon. They come here for, you know, it's supposed to be a one step lower level of care, and we're running into where some of our assisted living residents are, what the skilled nursing industry saw five years ago. You know it's just, it's a mess.

Richard Wexler
This is it's an interesting conversation and a really tough conversation. Again, I'm going to repeat what I said a few minutes ago, folks, if you're out there reading this, I mean, contact me and I'll give you that e-mail from me in a few minutes. We need to have bigger discussions about this and we need to figure out, with all these people that are aging, including my age group, which Corey is seen as the average patient on his skilled nursing side, early 70s, we have to figure this out - What are we going to do? Are we just going to wait until there's someone breaks their hip. OK, get discharged from the hospital, good luck and go home? I almost know what that's like personally and trying to get from a wheelchair to a walker and to be able to walk again without the walker and so on. It takes time and the older you are, and I'm sure Corey can back me up on this, it takes even more time and for a lot of people simply with a broken bone like that, rehab is tough. It's work and some people don't want to put that work in, but to obviously recover like they want to recover, and I'm sure their family wants them to recover, it's it's difficult again, am I correct on that?

Corey Crismon
You are correct on that.

Richard Wexler
Interesting and let's talk about CARE. That tiny little 4 letter word that I didn't understand and years ago, I mean, before these mandates- How is care going to be affected? We're already talking about possibly having to discharge folks early. Can you talk about the the levels of care and how care is going to be affected?

Corey Crismon
Yeah, and I think Oregon did a good thing and they thought out some stuff before they started our CNA staffing mandate here. We we are required to have one CNA to every seven residents on the floor during day Shift, one CNA to 9.5 residents on evening, and one to 17 on NOC (overnight) shift, which I I think is a great thing and that gives a level of here that we need.

Richard Wexler
Yeah. I can hear it in your voice and kind of hear it in your laugh... I mean, we're again, we're walking into this period in our country with all these people aging. Parents had fun after World War II, and they produced a lot of children and we've never been in the position that we're in now, before with a lot of those folks still being around and those kids that they produced. And this little tiny word called care, what we just talked about, a lot of the boomers needing care earlier, again going back to what I've said a couple times, now we need a much bigger conversation on a national level about this issue and what are we going to do to financially to help? There has to be a lot of buildings like yours around the country that are in rural environments, they may not have both sides of the house, but let's say they're skilled nursing only. How are you guys going to be able to bring in the staff that you need to give the appropriate care to those patients and get them discharged at the appropriate time per their medical needs? So as we wrap this up, any final thoughts, Corey?

Corey Crismon
Yeah, it's gonna cost us, those in this industry, about $6.8 billion to staff for this mandate. We've already had an independent assisted living and skilled nursing facility in Lake View, Oregon shut down. Our facility is the only one in four counties that has skilled nursing here in rural Eastern Oregon and we need to be here for our community. In Iowa, I don't know the exact number, but they've probably had 15-20 skilled long term care facilities shut down and they haven't even had the mandate yet so.

Richard Wexler
Wow. I mean, I take a breath. That's scary again. I don't know if I was expecting this conversation, but it's a great conversation and it's something that we as a nation have to look into because literally someone breaks a hip, OK, you've had your stay in the hospital, "Good luck". Or someone is recovering from a stroke, normally go to a beautiful facility like yours, and as they progress along that line, and if we don't have the buildings, we don't have the staff, the staff can't be paid, etc-  That's going to be very problematic. As we get ready to wrap up, can you give our audience some contact information, e-mail, phone number, website, whatever you want to give out?

Corey Crismon
​Sure, my. E-mail address is [email protected]. Or visit our website at www.pnhvale.org

Richard Wexler
​Very good, and thank you, Corey. You know folks, as I say all the time and I've mentioned a couple times here, if you want to connect with me, ir you have comments, if you have questions, if you want to talk further about this issue that Corey and I were talking about today, the best e-mail is [email protected].

Until we talk again, have yourself an awesome day.