Speaker 1: And there's a staffing shortage throughout the country in certain areas, and when you move into the rural environment, it's even more of a challenge. So what I often suggest is that sometimes the needs assessment and even building the facilities is the easy part. It's staffing and operations and then retention often is the larger challenge. Especially if, for example, where we are, we're conservatively an hour and a half to two hours from any major metropolitan area. So the other element of that, in this instance, was it's necessary to have staff housing for us. Many of the projects that I've seen not succeed might have succeeded if they had had staff housing on site so that there was ability to pull from that group.

Speaker 2: And I think you can have retention by creating an environment that is good for your residents. When the environment is good for the residents, chances are it's good for the staff. And that means you treat the residents with respect, you treat the staff with respect. There's an offset to that because you're staffing sometimes at a slightly higher ratio, but the return on your investment by reducing falls, providing quality of care, and the fact that staff say that they like to work at Anna John Nursing Home because they feel good about how they are allowed to do their jobs. That is a key component.

Speaker 3: We don't have a lot of money, so we can't pay a lot. So getting workers is hard. So we somehow have to build in extras, a lot of praise for the dedication and the hard work they do. These women and these men do the hardest job in the world, I think. They are cleaning up people's bodies, they are cleaning up messes in the house, and they get paid next to nothing. And so they truly deserve all the praise and everything that you can give them. And without them, we would have no program. Your home care provider is the most important thing that you have.

Speaker 4: And then just the whole challenge of long-distance supervision, being in touch with them, building a relationship with them so that they trust you and you're able to trust them. It's not like you're punching in at the office every day and you see your supervisor. So it's a call to me, so talking to me on the phone, it's just not the same thing as actually seeing the person face-to-face and getting to know them.

Speaker 5: And so the challenge is recruiting nurses, particularly nurses, that are willing to come here. We want to train our own. You know, our hope is that we train our own. We have a large percentage of our staff are enrolled members of the Eastern Band. And we would like for all of them to be, quite honestly, because then we have family taking care of family.

Speaker 6: One of the things that I've enjoyed doing here at Native Health is looking at a way that we can improve access to care by looking at the improvements in patient care model to see how we can best utilize the staff that we have now in being able to maximize the time that we have to provide for patients. That's been one of the really exciting things about being here. Currently, we're in the process of empaneling patients with different providers. We're in the process of actually engaging and building teams as opposed to just a provider. And finally, the thing that I really think is going to help us a lot is looking at every staff person that we have here, looking at the work that they're doing, and having them to work at the top of their license to be able to provide that care.