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Retention+
Lionstone Health Group
25 Facilities · NJ · NY · PA · CT · December 2024
RL
Richard Lionstone
Org Retention Rate
63.2%
▲ +10.4pp vs. baseline
Open Alerts
120
13 HIGH · 57 MEDIUM · 50 INFO
Avg Comp Ratio
0.91
▲ +0.07 vs. baseline (was 0.84)
Dept. Cost Avoided
$847K
Estimated · 3-month cumulative
Org Retention Rate — 4-Month Trend
Improving
52.8% Baseline (Sep '24)
Sep '2452.8%Oct '2455.4%Nov '2459.1%Dec '2463.2%
Baseline
52.8%
Current
63.2%
Improvement
+10.4pp
Target (6-mo)
72%
Portfolio Status
Strong
6
Improving
8
Stable
5
At Risk
6
Open Alert Summary
HIGH
13
MEDIUM
57
INFO
50
89 alerts at baseline · 47 resolved in 3 months
AI Priority — Facilities Needing Attention
Ranked by urgency: open alerts · trend direction · data status
FacilityLocationTurnover Ratevs. BaselineOpen AlertsComp Ratio
Philadelphia Riverside Care Philadelphia, PA 51.2% ▲ 6.2pp 11 0.77
Brooklyn Heights Care Center Brooklyn, NY 48.2% ▲ 6.6pp 9 0.79
Hackensack Gardens Health Center Hackensack, NJ 44.1% ▲ 7.2pp 7 0.81
Riverdale Care & Rehabilitation Bronx, NY 49.7% ▲ 5.7pp 9 0.78
New Haven Care & Rehabilitation New Haven, CT 47.4% ▲ 5.7pp 7 0.82
Total Facilities
25
NJ (8) · NY (8) · PA (5) · CT (4)
At Risk
6
Needs immediate attention
Improving
9
Positive trend · Keep momentum
Strong
5
At or above market benchmark
# Facility Name Location Beds Turnover Rate vs. Baseline Open Alerts Comp Ratio Agency % Status
1 Cedar Grove, NJ 94 33.8% ▲ 10.4pp 1 H 3 M 2 I 0.93 18% Improving
2 Hackensack, NJ 120 44.1% ▲ 7.2pp 2 H 4 M 1 I 0.81 34% At Risk
3 Lakewood, NJ 108 35.2% ▲ 11.6pp 2 M 3 I 0.94 15% Improving
4 Princeton, NJ 86 22.4% ▲ 6.7pp 1 M 2 I 1.02 8% Strong
5 Montclair, NJ 112 37.8% ▲ 11.4pp 1 H 2 M 1 I 0.91 21% Improving
6 Summit, NJ 96 46.3% ▲ 6.4pp 1 H 3 M 2 I 0.82 38% At Risk
7 Millburn, NJ 88 24.6% ▲ 6.6pp 2 I 1.04 6% Strong
8 Morristown, NJ 130 38.4% ▲ 2.8pp 2 M 4 I 0.93 22% Stable
9 Brooklyn, NY 118 48.2% ▲ 6.6pp 2 H 5 M 2 I 0.79 42% At Risk
10 White Plains, NY 104 34.6% ▲ 12.7pp 2 M 2 I 0.95 16% Improving
11 Garden City, NY 92 21.8% ▲ 6.6pp 1 M 1 I 1.01 7% Strong
12 Bronx, NY 140 49.7% ▲ 5.7pp 2 H 4 M 3 I 0.78 46% At Risk
13 Flushing, NY 116 39.1% ▲ 4.5pp 3 M 2 I 0.88 24% Stable
14 Staten Island, NY 98 32.4% ▲ 12.7pp 1 M 3 I 0.96 14% Improving
15 Mineola, NY 110 36.7% ▲ 12.2pp 1 H 2 M 1 I 0.92 19% Improving
16 Suffern, NY 88 26.3% ▲ 7.8pp 1 M 1 I 0.99 10% Strong
17 Philadelphia, PA 132 51.2% ▲ 6.2pp 2 H 6 M 3 I 0.77 48% At Risk
18 Pittsburgh, PA 96 37.8% ▲ 2.4pp 2 M 2 I 0.91 20% Stable
19 Allentown, PA 108 34.1% ▲ 12.2pp 2 M 2 I 0.93 17% Improving
20 Doylestown, PA 84 23.7% ▲ 7.1pp 2 I 1.03 8% Strong
21 Chester, PA 118 40.2% ▲ 4.6pp 3 M 2 I 0.87 26% Stable
22 Hartford, CT 102 38.6% ▲ 3.7pp 2 M 3 I 0.90 23% Stable
23 Stamford, CT 94 31.8% ▲ 12.9pp 2 M 1 I 0.95 14% Improving
24 New Haven, CT 120 47.4% ▲ 5.7pp 1 H 4 M 2 I 0.82 36% At Risk
25 Greenwich, CT 86 19.4% ▲ 7.3pp 1 I 1.06 5% Strong
Turnover Rate
44.1%
Baseline: 51.3% · ▲ 7.2pp improvement
Open Alerts
7
2 HIGH · 4 MEDIUM · 1 INFO
Avg Comp Ratio
0.81
Below market avg · LPN gap largest
Agency Dependency
34%
Monthly premium: ~$18,200
Turnover Rate Trend
Trending Down
Sep '2451.3%Oct '2448.2%Nov '2446.1%Dec '2444.1%
Note: Turnover still above org average (36.8%) and significantly above the best-performing facilities in the portfolio. Two HIGH priority salary adjustments pending.
Priority Actions
Maria G. — CNA salary review
Due before Dec 18 (24-mo. milestone)
James K. — LPN salary review
$5.05/hr gap · Due before Dec 21
LPN dept comp review
Entire LPN cohort below market (avg 0.85)
Agency utilization review
34% dependency · Monthly cost $18,200
Avg Org Comp Ratio
0.91
+0.07 vs. baseline (was 0.84)
Roles Below Market
3
LPN most significantly below
Roles At Market
2
Housekeeping · Dietary
Salary Adjustments Made
26
Over 3-month turnaround
Compensation Band — All Roles · Org Average
CNA
0.954
At Market
LPN
0.882
Below Market
RN
0.925
Near Market
Med Tech
0.97
At Market
Dietary
0.978
At Market
Housekeeping
1.025
At Market
Role Detail — Organization Average
RoleHeadcountYour Avg RateMarket P50Comp Ratio3-Mo TrendBand StatusFlagged
CNA712$19.24/hr$20.16/hr0.954▲ +0.032Near Market14
LPN284$28.10/hr$31.85/hr0.882▲ +0.018Below Market18
RN186$37.20/hr$40.21/hr0.925▲ +0.041Near Market8
Med Tech178$22.40/hr$23.10/hr0.970▲ +0.014Near Market4
Dietary204$17.40/hr$17.80/hr0.978▲ +0.022Near Market2
Housekeeping186$16.60/hr$16.20/hr1.025▲ +0.038At Market0
Benchmark: AHCA/NCAL 2025-26 · CMS publishes no compensation data
HIGH Severity
8
Immediate action required
MEDIUM Severity
14
Address within 7-14 days
INFO
10
Informational
Resolved (3 months)
47
Of 89 baseline alerts
Open Alerts
Click any HIGH alert to view full AI explanation and recommended action.
Sev.EmployeeRoleFacilityStateAlert TypeTrigger DetailStatusDays
HIGHMaria G.CNAHackensack Gardens Health CenterNJComposite Flight Risk23 mo. → 24-mo. milestone · $1.06/hr below P50Open4d
HIGHJames K.LPNHackensack Gardens Health CenterNJComposite Flight Risk22 mo. → 24-mo. milestone · $5.05/hr below P50Open7d
HIGHSarah M.CNAPhiladelphia Riverside CarePAComposite Flight Risk34 mo. → 36-mo. milestone · $1.26/hr below P50Open3d
HIGHThomas R.LPNRiverdale Care & RehabilitationNYComposite Flight Risk14 mo., past 12-mo. milestone · $4.35/hr below P50In Review12d
HIGHDept: CNAsCNA DeptBrooklyn Heights Care CenterNYPay Equity Flag18.4% differential within role/tenure bandOpen6d
HIGHDavid L.RNNew Haven Care & RehabilitationCTComposite Flight Risk11 mo. → 12-mo. milestone · $6.01/hr below P50Open2d
HIGHAll rolesRiverdale Care & RehabilitationNYDeparture Spike9 departures · 71% above 3-month rolling avgOpen8d
HIGHPatricia N.CNASummit Ridge Skilled NursingNJComposite Flight Risk23 mo. → 24-mo. milestone · $0.76/hr below P50Open1d
MEDNicole R.CNALakewood Pines Skilled NursingNJBelow-Market Comp$18.50/hr · $1.66 below P50 · 8 monthsOpen14d
MEDKevin M.LPNMontclair Meadows Health CenterNJTenure MilestoneApproaching 12-mo. milestoneOpen9d
MEDLisa P.CNAQueens Boulevard Health CenterNYBelow-Market Comp$18.80/hr · $1.36 below P50 · 19 monthsOpen6d
MEDMarcus T.RNPhiladelphia Riverside CarePABelow-Market Comp$34.10/hr · $6.11 below P50 · 6 monthsIn Review11d
MEDAll rolesPhiladelphia Riverside CarePAUpload OverdueFile not received by Dec 5 cutoffOpen3d
MEDDana W.LPNHartford Hills Care CenterCTBelow-Market Comp$27.80/hr · $4.05 below P50 · 14 monthsOpen8d
MEDRobert H.LPNHackensack Gardens Health CenterNJBelow-Market Comp$27.10/hr · $4.75 below P50 · 8 monthsIn Review18d
MEDAngela T.Med TechHackensack Gardens Health CenterNJBelow-Market Comp$21.40/hr · $1.70 below P50 · 16 monthsOpen5d
MEDJames W.LPNRiverdale Care & RehabilitationNYBelow-Market Comp$26.90/hr · $4.95 below P50 · 18 monthsOpen7d
MEDDenise K.CNABrooklyn Heights Care CenterNYTenure MilestoneApproaching 12-mo. milestone · $1.40 below P50Open5d
MEDMichael B.LPNNew Haven Care & RehabilitationCTBelow-Market Comp$27.20/hr · $4.65 below P50 · 10 monthsOpen4d
MEDSandra L.RNSummit Ridge Skilled NursingNJBelow-Market Comp$34.80/hr · $5.41 below P50 · 7 monthsOpen6d
MEDCarlos M.LPNDelaware Valley Care CenterPABelow-Market Comp$27.50/hr · $4.35 below P50 · 12 monthsOpen9d
MEDChristine A.CNAHackensack Gardens Health CenterNJBelow-Market Comp$18.80/hr · $1.36 below P50 · 14 monthsOpen11d
INFOCNACedar Grove Care & RehabilitationNJNew Hire x22 new CNA hires detectedInfo4d
INFORNGarden City Skilled NursingNYCMS Rating ChangeFive-Star staffing: 4 → 5 starsInfo2d
INFOAllMillburn Senior Care CenterNJNew Hire x33 new hires across departmentsInfo4d
INFOCNAWestchester ManorNYNew Hire x11 new CNA hireInfo3d
INFOLPNBucks County RehabilitationPANew Hire x22 new LPN hiresInfo5d
INFOAllGreenwich Manor Skilled NursingCTCMS Rating ChangeStaffing rating maintained 5 starsInfo2d
INFOCNAPrinceton Care & RehabilitationNJNew Hire x11 new CNA hireInfo1d
INFORNRockland Ridge RehabilitationNYCMS Rating ChangeFive-Star staffing: 3 → 4 starsInfo3d
INFOLPNLehigh Valley Senior CarePANew Hire x11 new LPN hireInfo2d
INFOAllStamford Senior RehabilitationCTNew Hire x22 new hiresInfo4d
Important: CMS data lags 6–18 months behind real-time. CMS publishes staffing hours and turnover metrics — it publishes no compensation data whatsoever. Compensation benchmarking comes from AHCA/NCAL, not CMS.
Facilities Below RN Minimum
7
Federal min: 0.55 RN hrs/resident/day
Facilities Below Total Min
4
Federal min: 3.48 total hrs/resident/day
CMS Turnover (Portfolio Avg)
36.8%
Lagged 6–18 months · Retention+ real-time: 36.8%
CMS Rating Changes (30 days)
3
2 improved · 1 declined
CMS vs. Real-Time Comparison — Select Facilities
CMS reported measures alongside Retention+ real-time data for the same period
FacilityState RN Hrs/Res DayCMS Min Total Hrs/Res DayCMS Min CMS TurnoverRetention+ Real-TimeCMS Data Age
Hackensack Gardens Health CenterNJ 0.480.55 min 3.123.48 min 44.1% 32.4% ~3 months ago
Brooklyn Heights Care CenterNY 0.440.55 min 2.983.48 min 48.2% 38.8% ~4 months ago
Riverdale Care & RehabilitationNY 0.420.55 min 3.043.48 min 49.7% 41.2% ~3 months ago
Philadelphia Riverside CarePA 0.410.55 min 2.913.48 min 51.2% 43.6% ~3 months ago
Princeton Care & RehabilitationNJ 0.610.55 min 3.683.48 min 22.4% 18.9% ~2 months ago
Millburn Senior Care CenterNJ 0.640.55 min 3.723.48 min 24.6% 20.1% ~2 months ago
Garden City Skilled NursingNY 0.580.55 min 3.543.48 min 21.8% 17.4% ~3 months ago
Greenwich Manor Skilled NursingCT 0.680.55 min 3.813.48 min 19.4% 15.8% ~2 months ago
Federal staffing minimums per CMS final rule (May 2024): 0.55 RN hrs/resident/day · 0.45 CNA hrs/resident/day · 3.48 total hrs/resident/day. Failure to meet minimums affects Five-Star Quality Rating staffing sub-score.
What CMS Shows vs. What Retention+ Provides
CMS Shows
  • ×Turnover data lagged 6–18 months
  • ×Facility-level aggregate only — no individual employees
  • ×Zero compensation data
  • ×Public — visible to your competitors and regulators
  • ×No early warning before a position goes vacant
Retention+ Provides
  • Real-time data — current within 30 days of upload
  • Individual employee-level signals and alerts
  • Market-based compensation benchmarking (AHCA/NCAL)
  • Private — only you and Retention+ see this data
  • Predictive alerts before positions go vacant
Org Agency Fill Rate
30.4%
▼ Down from 38.2% at baseline
Monthly Agency Premium
$142K
Estimated cost above direct-hire equivalent
High-Dependency Facilities
6
>35% agency fill rate
Agency Cost Reduction
24%
vs. baseline · $44K/mo. saved
Agency Dependency by Facility — Top 8 (Sorted by Fill Rate)
FacilityLocationAgency Fill RateEst. Monthly Hours CostMonthly Premium vs. DirectDependency Status
Philadelphia Riverside CarePhiladelphia, PA 48% $24,960 $13,728 High Dependency
Riverdale Care & RehabilitationBronx, NY 46% $23,920 $13,156 High Dependency
Brooklyn Heights Care CenterBrooklyn, NY 42% $21,840 $12,012 High Dependency
Summit Ridge Skilled NursingSummit, NJ 38% $19,760 $10,868 High Dependency
New Haven Care & RehabilitationNew Haven, CT 36% $18,720 $10,296 High Dependency
Hackensack Gardens Health CenterHackensack, NJ 34% $17,680 $9,724 Moderate
Delaware Valley Care CenterChester, PA 26% $13,520 $7,436 Moderate
Queens Boulevard Health CenterFlushing, NY 24% $12,480 $6,864 Moderate
Methodology: Blended rate = ((Direct hrs × direct rate) + (Agency hrs × agency rate)) ÷ total hrs. Monthly premium = (blended rate − benchmark P50) × total hours. All figures labeled as estimates. Total labor costs may differ for union facilities — a disclosure note appears on all views for union-flagged facilities.
Agency Trend — Org Average
Sep '2438.2%Oct '2435.6%Nov '2433.1%Dec '2430.4%
Agency fill rate declining as retention improves and more positions are filled directly. Target: <20% by Q2 2025.
Blended Rate by Role — Org Avg
RN$$44.80(+$+$4.59 premium)
LPN$$38.20(+$+$6.35 premium)
CNA$$25.40(+$+$5.24 premium)
3-Month Turnaround Summary — Lionstone Health Group
$847K
Estimated departure
cost avoided
34
Estimated positions
saved from departure
+10.4pp
Retention rate
improvement
47
Alerts resolved
of 89 at baseline
Estimated Monthly Departure Cost — Declining Trend
↓ Down 48.2%
Sep '24284000%Oct '24241000%Nov '24196000%Dec '24147000%
Sep '24 (Baseline)
$284,000/mo
Dec '24 (Current)
$147,000/mo
Monthly Savings
$137,000/mo
3-Month Total
$847,000
Cost methodology: CNA departure cost $3,000–$6,000 (Staff Relief Inc, 2025) · LPN estimated $10,000–$20,000 (industry estimate) · RN average $61,110, range $49,500–$72,700 (NSI, 2025). Figures represent indirect costs: separation, recruitment, orientation, productivity loss. Labeled as estimates throughout.
Before vs. After
MetricBaselineCurrentChange
Retention Rate52.8%63.2%▲ +10.4pp
Turnover Rate47.2%36.8%▼ −10.4pp
Open Alerts8942▼ −47 alerts
HIGH Alerts318▼ −23 alerts
Avg Comp Ratio0.840.91▲ +0.07
Agency Fill Rate38.2%30.4%▼ −7.8pp
Est. Monthly Cost$284K$147K▼ −$137K/mo
Interventions Made
Salary adjustments made26
Alerts resolved47
HIGH alerts resolved23
Facilities improved (status)9
Avg time to resolve HIGH alert5.2 days
Recent Activity
HIGH 2 min ago
New HIGH alert: Patricia N. — CNA, Summit Ridge Skilled Nursing. Approaching 24-month milestone, $0.76/hr below market.
HIGH 1 hr ago
HIGH alert escalated: Thomas R. (Riverdale Care) — open 12 days. Assigned to RP Manager for review.
INFO 4 hrs ago
Data upload complete — Hackensack Gardens Health Center. 120 employee records processed. 0 anomalies detected. 7 alerts evaluated.
MEDIUM Yesterday
Upload overdue: Philadelphia Riverside Care. Workforce file not received by Dec 5 cutoff. Reminder sent to facility admin.
INFO Yesterday
CMS data sync complete — Dec 1, 2024. All 25 facilities updated. 1 CMS rating change detected: Garden City Skilled Nursing (4→5 stars staffing sub-rating).
HIGH 2 days ago
Alert resolved: Jennifer M. — CNA, Westchester Manor. Resolution note: Salary adjusted to $20.50/hr (market median). Employee confirmed retention.
INFO 2 days ago
Monthly Compensation Intelligence update complete. AHCA/NCAL benchmark recalculation applied across all 25 facilities. 3 roles with band status change.
HIGH 3 days ago
Alert resolved: Kevin R. — LPN, Cedar Grove Care & Rehab. Resolution note: $2.00/hr salary increase approved. Milestone acknowledged.