0:07

Welcome to Raising Tech . I'm your

0:09

host, Amber Bardon, and today we

0:11

have a very, very special guest

0:13

, someone I've known for a long time, someone

0:16

who's very famous because I talk about him

0:18

all the time as one of the original

0:20

founders and inceptors of Parasol Alliance.

0:22

Welcome to the show, Bill Lowe.

0:24

Thank you, Amber.

0:26

Bill, give us a brief intro about

0:28

yourself. Who are you, where do you work? Tell

0:30

us a little bit about yourself.

0:32

I , I'm the c e O of Chicago Methodist Senior Services.

0:34

One interesting fact about myself is

0:37

that ever since college, I've

0:39

never worked for a for-profit organization.

0:42

I've been in healthcare my whole career.

0:44

Started my career at Rush Hospital. I

0:46

wish I could tell you that I knew at like age

0:49

18 or 19 that I only wanted to work

0:51

for nonprofits. But I have to admit that Rush

0:53

was the best job offer I got out

0:55

of college that was fortunate. It was a great

0:57

place to start a career, and it sort of set me on

0:59

the path to where I am today.

1:01

Bill, you are pretty well known . I

1:03

have to tell you every time I'm talking to someone

1:06

else, and I always have to mention your

1:08

name and I always stop and say, do you know him? Because

1:10

a lot of people have heard your name, and

1:13

the thing that you're really well known for is

1:15

your vision in collaboration

1:18

and joint ventures and trying to bring providers

1:20

together to try to collaborate, inform new

1:23

entities and provide services and Paris Alliances

1:25

and output of that. You are one of the owners of

1:27

the company and the one who came up with the idea for our

1:30

business model. Today we're gonna be talking about another

1:32

service and company that you started,

1:34

and I know it's actually been around for a while , but

1:37

I think the topic is really pertinent today

1:39

because staffing is a big challenge. You

1:41

know, we saw this really crop up during Covid

1:44

with the Great Resignation. So we're

1:46

here today to talk about your nurse recruitment program.

1:49

So to start off with, let's just talk

1:51

about what is the environment today

1:53

with staffing and hiring? What are the big challenges

1:55

you're seeing and how did that drive

1:58

the creation of the program?

1:59

The creation of the program actually goes back a

2:01

ways , Amber. And so we, I guess you could say maybe

2:04

we had lucky foresight in that we anticipated

2:06

back in 2005 that there would

2:08

be a nursing shortage, but we're

2:10

a small organization as you know, and so we didn't want

2:12

to just take care of our own needs. Oh , of course, that's

2:15

always first in , in primary. But also

2:17

thought that if we were successful with nurse recruitment,

2:19

that we'd be able to affect other nonprofit

2:22

organizations by mitigating their, their

2:24

staffing needs. If we thought we had a problem back

2:26

then, we didn't know anything, right, because

2:29

it's just gotten worse and worse. And it wasn't

2:31

the year of Covid at all that

2:33

affected us as an organization on our staffing

2:35

needs. It was after that. I thought that

2:38

the great resignation was a white collar issue.

2:40

It's affected right down to our frontline

2:42

staff for sure. That's been the most frustrating

2:45

and humiliating development actually,

2:47

is that we can't find enough CNAs to

2:49

do the work. After a number of years after

2:52

starting, we've always been solid with

2:55

RNs, a hundred percent of them from, from the Philippines.

2:57

That covered that problem for us, us, but then

2:59

we did not anticipate a CNA shortage

3:01

like we have today, and it's more acute for us. And I

3:03

hear from my peer set that it's also more

3:06

difficult for most of us to recruit the

3:08

frontline staff and retain them.

3:10

So what is the program? Can you do

3:12

a little bit of a deep dive into how did the

3:14

program start? What does it do? A little

3:16

bit more of the details behind it?

3:18

Yeah. The founder of our program was Rose Poly

3:21

Cario , who , uh, for many, many years served as our

3:24

DON and running this program. But , uh,

3:26

today it's evolved to the , uh, to the point where

3:28

we're trying to reach more staff

3:30

from foreign countries and also

3:32

recruit both RNs and

3:34

frontline staff, the c n A or caregiver

3:37

level. The latter is very challenging,

3:39

but we sort of look back to our history and, and

3:41

say that I think many organizations would've

3:44

threw in the towel that point that we kept

3:46

persevering on the nurse recruitment. It took our first nurses

3:48

seven and eight years to get to the United States.

3:51

What we learned is that they were patient, they were still

3:53

excited to get here, and we learned that we had the

3:55

patience and the discipline to stay with it. And so

3:58

we're really glad we did a few years ago. It

4:00

really took off and we were really proud

4:02

to have a lot of our workforce shoulder

4:04

to shoulder with their American-born nurse

4:06

peers. Uh , during the pandemic really was a relief.

4:09

We are proud because, you know , we're not reducing the

4:11

workforce and then deploying them elsewhere.

4:13

We're actually increasing the workforce from a

4:15

country whose number one economic

4:18

engine is sending human resources

4:20

abroad and then people sending money back

4:22

home. We've learned that US immigration

4:24

, uh, can be a challenge. And uh , right

4:26

now we're under a program called Retro Aggression

4:28

that the US Immigration Department uses

4:30

to basically stall immigrants from

4:32

coming in and they sort of fall into limbo for

4:35

a period of time before they open up the gates again.

4:37

And , and that's challenging. What we've tried to do is

4:39

reach out and just be very creative. I

4:41

would say at this point I consider it almost

4:44

a personal, as well as organizational mission for

4:46

me to find workforces from wherever.

4:48

However, we've expanded to Liberia

4:51

and Ghana and Ghana we think will have

4:53

success bringing in nurses quicker

4:55

than we will be able to get them from Liberia, but

4:57

they're both English speaking countries and we're

4:59

optimistic that, you know, someday have an

5:01

abundance of those , uh, folks arriving. We've

5:03

also tried and successfully to assimilate

5:06

with the Ukrainian immigrants that have come in,

5:08

and we've been to three different job fairs.

5:10

Not sure that we're gonna have a whole lot of

5:12

success out of the box, but we're just gonna stay with it.

5:15

We become a known commodity and

5:17

sort of a friend to the Ukrainian immigrants, which

5:19

is, we're a very mission-based organization, so

5:21

we're proud of that, but also , uh, trying to

5:23

help impact the workforce. It's super

5:26

challenging. I'll , I'll just say that, but we,

5:28

we go at it every day . New opportunities, even

5:31

daunting things like, you know, trying to assimilate

5:33

overabundance of arriving immigrants into

5:36

our city and all across the country. Uh , I'm

5:38

being patient with that one because there's just too much politics

5:40

afoot, but when they decide that they wanna put those

5:42

people to work, we'll be prepared to serve

5:45

them and hopefully disseminate those workers across

5:47

the country to other nonprofit organizations.

5:50

This program, any community in

5:52

the country could reach out to you to potentially

5:54

look at hiring people through this program, is

5:56

that correct? Correct.

5:57

It can, and in fact, we have a pretty long waiting list

5:59

for both , uh, CNAs and RNs.

6:02

And also today we have close to 120

6:05

nurses working across the country at other

6:07

facilities by rule , we have to be the

6:09

employer. Then we report them to other nonprofits where

6:12

, uh, on a full-time three-year

6:14

contract , uh, agency basis. So when

6:16

they arrive, you know, the hope is everyone

6:18

that recruits one of our nurses, the hope is of course,

6:20

they stay 20 years. That's usually

6:22

pretty unrealistic. Uh , we've had some

6:24

people that have stayed longer in our organization, but on

6:26

average there's no nursing homes in the Philippines.

6:29

They've worked in hospitals ERs or,

6:31

and after their service with us, many

6:33

matriculate into hospitals.

6:35

Walk me through, what does this look like for a

6:37

community? So if they work with you and they're

6:39

able to get a nurse or c n a, what

6:42

does the process look like? And I also know you have some

6:44

, um, assimilation tips. One

6:46

Of the things that we insist upon is that

6:48

between our organization and their organization,

6:50

that we provide two months of free housing

6:53

for the nurses. There's the , the first time they'll

6:55

, they land at O'Hare, they don't have the resources,

6:57

so we support and we ask our clients

6:59

to support them with the housing. The other thing

7:01

is to make sure that, that they inculcate

7:03

them properly in into the organization. If they

7:05

treat them like agency workers, that's not

7:07

gonna work for morale. So again, hearkening

7:10

back to dreadful days of covid, you

7:12

know, if people were doing a hero's bonus for

7:14

their own staff, we strongly encouraged

7:17

that. If they wanted to retain Filipino nurses that

7:19

they, they should treat them and give them the same bonus. Basically

7:21

they're on our payroll, you know, we would just say , just tell us

7:24

what you're gonna pay. We'll pass it through without any markup

7:26

at all, and it's really gonna help for morale

7:28

and retention. Another factor of the program is

7:30

it's, we don't separate families. We

7:32

usually wait , uh, about two months until

7:35

they're more on their feet, and then we'll bring over

7:37

a spouse and children. So that's something

7:39

that was very important to our board to make sure that

7:41

we weren't, you know, taking nurses from a third world

7:43

country that needed them to work in our workforce. That

7:46

the reality is, is they have an overabundance

7:48

of nurses in the Philippines all eager to

7:50

work abroad. And so, you know, that that

7:52

was a moral thing that was, IM important to our board.

7:55

And of course, not separating families . Super, super

7:57

important. But as far as the process goes, it

7:59

starts with a, you know, with a job order and, you

8:01

know, then we , we maintain and honor that waiting list. We

8:04

don't know which nurse is going to arrive

8:06

next or which group of nurses, but when they

8:08

do, then we introduce them to the organizations.

8:10

They can Skype or communicate with them however

8:12

they want. But no one has ever said, we

8:14

don't want that nurse <laugh>, you know , I think people are

8:16

just happy to have the cavalry arriving with,

8:18

you know, with some nurses in to . It's worked out really well.

8:21

Uh, again, the only drawback is when the

8:23

US governments to slow the, the

8:25

flow and it , it , it seems counterintuitive. The politicians

8:28

aren't really alert to the issue. Do

8:30

believe that just like we can't grow food in this

8:32

country without immigrants, I don't think for very much longer

8:34

we're gonna be able to provide quality healthcare without

8:36

immigrants arriving to help out.

8:38

Can you describe how does using a

8:40

program like this differ from

8:43

an agency or other types

8:45

of staffing solutions out there?

8:47

The one thing that we profess we never want it to be,

8:49

because it's very difficult work, is to be

8:51

like a sort of agency that you have a third shift

8:53

calling and you call us to fulfill that. That's

8:55

for others to do. And there's, you know, really extreme

8:58

premiums paid in order to get that emergency

9:00

staff and they're, they're never familiar with your organization.

9:03

So you know, you're paying for something that's not necessarily a

9:05

really good solution. We have vowed to

9:07

put full-time workers in and mitigate the

9:09

need for those third shift call in replacements

9:12

and so on. And to a large extent, we , of course

9:14

we've mitigated the problem. I have to admit

9:16

it's a drop in the bucket, but we feel that any

9:18

movement expanding the workforce is good work.

9:21

How does this work from a cost perspective? I

9:23

know you mentioned that they work for your company

9:25

and they're sort of treated like agency. Can you just

9:28

explain that? Sure.

9:29

It's very , uh, simple system and we're very

9:32

transparent about the approach. So, you know , it starts with

9:34

a , uh, $1,000 non-refundable

9:36

deposit to place a job order per nurse. And

9:38

so frankly, you know, we use those funds to

9:40

do our recruitment while we're waiting for nurses to

9:43

arrive. When the nurses arrive, there's an upfront placement

9:45

fee that binds pay. And then after that,

9:47

during the three year period, we send an

9:50

invoice to the client that includes

9:52

the hours that were paid for that

9:55

pay period at most, 25% for

9:57

benefits. And then there's an hourly mark, which

9:59

can range from like seven 50 to

10:01

$10 an hour in many cases. We

10:03

cover the , you know , practice for the nurses, we cover

10:05

their health insurance. The nurse costs nowhere

10:08

near like an hour of overtime, which

10:10

is really great for the staff. So when we started out,

10:12

we were delivering nurses even less than $40

10:14

an hour with our markup included. Today it's

10:17

mostly above 40, but always generally under

10:19

50, unless it's say on the East coast where

10:21

the market just demands that they make five or $6 more

10:23

an hour than here in the Midwest. Thanks

10:25

For explaining that. I think that'll be interesting for

10:27

our listeners to hear and consider, you

10:30

know, the impact and the options that are out there to address

10:32

staffing challenges. I know you mentioned you

10:35

are currently bringing in nurses

10:37

and CNAs. What do you see

10:39

as the future of a program like this? Do you see it growing

10:42

and you know, starting to work with more countries like you

10:44

mentioned? Do you see other positions possibly

10:46

being offered in the future?

10:48

Yes, it's possible to add other positions.

10:50

When we first started out, because of the slowness

10:52

with which nurses could get here, we were

10:54

providing therapists, physical therapists,

10:57

and occupational therapists. We actually were a part

10:59

owner of a therapy company at the time with a

11:01

dozen other organizations here in the Chicago

11:04

land area. All of us nonprofits. And so we

11:06

were basically providing the staff to the

11:08

company we had a part ownership of. So that felt

11:10

really good. And you know, we never were a significant part

11:13

of the workforce, but we always had some percentage

11:15

of the workforce was provided by our labor. So,

11:17

and I think you can address that. There's a teacher shortage

11:19

right now, right? Uh , we tend to believe we'll

11:21

stay healthcare space and largely the

11:24

older adult space. But you know, the idea of

11:26

just speaking back to our motives again, when

11:28

we make profits off of that, I call that substitute

11:30

philanthropy. That's like philanthropy, that it's

11:33

like philanthropy in that those are dollars we can use

11:35

to support our mission. It's hard, I think it's

11:37

harder to raise money for, certainly

11:39

for a long-term care organization than it is

11:41

to support an organization that supports education

11:45

or hunger or museums <laugh>

11:47

. So we, we try to be as resourceful

11:49

as possible and adding to the pool of funds

11:51

that can augment the mission. When you have a

11:53

lot of programs like we do where there's no fees

11:56

for the service, they have to be supported some

11:58

way, right? So this helps. I think for others,

12:00

and I should say anyone can petition just

12:03

like we did. The tips I would have there is that it

12:05

takes patience and perseverance. I guess I would

12:07

encourage anyone who thinks they're gonna be in

12:09

business 10, 20, 25 years

12:12

into the future, it would behoove them now to start, you

12:14

know, either working with an agency like ours, others,

12:16

or, or doing it themselves, getting an immigration

12:19

attorney and learning the ropes and just start petitioning.

12:21

And our track record shows that eventually they

12:23

will come. And when they do, it's always

12:26

a joyful thing, you know, for the receiver of those

12:28

nurses. And we have yet to,

12:30

you know, the process for CNAs will take longer. We

12:32

have yet to have our first one arrive, and

12:34

it's a much smaller pocket of the immigration

12:37

program that allows CNAs to

12:39

come over the , the US government prefers higher

12:41

paid, higher skilled people to come in.

12:43

Bill, this has been such an interesting conversation.

12:45

It's, you're doing something so unique

12:48

and different and you've come up with a really,

12:50

you know, different approach to a problem that a

12:52

lot of communities have. So I've really enjoyed having this conversation

12:55

with you. Is there anything else that you

12:57

want our listeners to know or you think that they should

12:59

be aware of about this program or about this

13:01

concept in general?

13:02

I would just reiterate that I think people should take advantage

13:05

of either doing it themselves or

13:07

working with someone else that that has the same

13:09

sort of ethic that we do, which is to not

13:11

exploit the shortage. I have one interesting fact

13:13

that I'm talking to our insurance agent and belly

13:16

yanking about that difficulty in finding and retaining

13:18

CNAs. He brought up a really interesting point. He

13:21

said that, you know, a few years ago when he attends his, the

13:23

conferences like in our space, there might

13:26

be one, you know, at the exhibitor's booths, right?

13:28

There might be one in the staffing agency.

13:30

The last time we went, he said there were 17 of 'em

13:32

. And so we both began to

13:34

realize is that what's happening in

13:37

this situation with the shortage is you have

13:39

, uh, and this is America, right? And we're capitalists,

13:41

so you can't blame people, but so you have people

13:43

leveraging the shortage. What they do is they actually

13:46

shrink the pool of workers by saying, Hey, you

13:48

know, you don't have to go work for Wesley Place, our skilled

13:50

nursing facility. You can work for whoever you

13:52

want to and whenever you want to, you know, and you'll make

13:54

a couple more dollars an hour, you know , we'll set you up

13:56

with technology, which I know any of us could do, Amber,

13:59

and you help people all the time, but you know, you so you can

14:01

be paid any time you want. That kind of

14:03

thing. So that can be attractive with

14:05

younger workforce and the gig economy. And

14:07

so, but basically what happens is, is they shrink the

14:09

pool for people that work directly for the employer,

14:12

they expand the pool of those come at what

14:14

I would call you, serious rates of hourly

14:16

rates. And it just, it's just awful. And

14:18

so the only way to fight that is, is

14:20

to get in the game yourself with an approach

14:22

that you know is not exploitative.

14:24

I think many of our listeners will resonate with that, for

14:26

sure. Not , not the person . I've heard that

14:29

sentiment.

14:29

Yes. Yes.

14:31

Well, bill, thank you so much. As always, it's

14:33

always a pleasure to speak with you, and I really

14:35

appreciate the time you took to talk to us about

14:37

this topic. Thanks

14:38

For the opportunity, Amber. I enjoyed it.

14:40

And listeners, if you like this episode, you can

14:42

find more of our episodes on our website raising

14:45

tech podcast.com. If you'd like to send

14:47

us any feedback, you can also do that through our website,

14:50

parasol alliance.com . And as always, thank

14:52

you for listening.