Big Shifts in Nonprofit Senior Living Staffing and Tech Usage, But Familiar Names Top Largest Providers List

Last year brought big changes in the way non-profit senior living providers are staffing their communities and using technology.

That is not surprising, given challenges related to the Covid-19 pandemic, but the huge impact on staffing is reflected in the latest LZ 200 report, which shows the average number of full-time employees at its lowest level since 2010.

The report from industry association LeadingAge and specialty investment bank Ziegler, now in its 18th year, annually ranks the largest senior living non-profits in the U.S. and identifies trends in the space.

The big-picture takeaway is that this year’s report shows “consistent movement forward,” according to Ziegler Director of Senior Living Research and Development Lisa McCracken.

“Despite there being a global pandemic, we have still seen growth, reinvestment in campus projects, and plans to do so moving forward,” McCracken told Senior Housing News. “That isn’t to understate the stressors brought on by the pandemic, but probably more to acknowledge the fortitude of the LZ 200 organizations.”

The top 10 largest organizations did not change between 2019 and 2020 — although some of them swapped places, like Presbyterian Homes and Services and Ascension Living, which traded the no. 4 and no. 5 largest provider spots. Other providers that traded places on the list include HumanGood and Trinity Health Senior Communities; and Lifespace Communities and Covenant Living Communities & Service.

The top 10 largest organizations by unit count in this year’s list are:

— National Senior Campuses, 21,313 units

— The Evangelical Lutheran Good Samaritan Society, 15,507 units

— ACTS Retirement Services, 9,563 units

— Presbyterian Homes and Services, 8,579 units

— Ascension Living, 8,129 units

— HumanGood, 5,503 units

— Trinity Health Senior Communities, 5,496 units

— Lifespace Communities, 5,234 units

— Covenant Living Communities & Services, 5,203 units

— Benedictine, 4,616 units

Staffing disruption, tech adoption

The pandemic brought some big changes to the non-profit senior living sector. Chief among them: the way operators are staffing their communities and the different types of technology they are using.

Regarding staffing, the non-profit senior living sector was not immune to the rest of the industry’s headwinds. In fact, the operators tracked in this year’s LZ 200 reported an average of just 882 full-time employees — the lowest amount since at least 2010.

“It indeed dropped, for many of the reasons we know: admissions being shut down and occupancy dropping; individuals leaving their jobs; et cetera,” McCracken said. “That was probably a bigger drop than what I anticipated — we knew the numbers were likely to go down, but that was significant.”

In response to industry headwinds, many organizations created corporate-level positions relating to technology, revenue, finance, home- and community-based care and human resources.

Six operators on this year’s list added chief information/technology officers, while four added chief revenue officers and three added chief financial officer/finance manager roles in 2021.

Other newly added positions included chief life officer/home health and hospice executive (three operators); chief operating officer (three operators), chief administrative officer (two operators) and chief HR/people officers (two operators).

Another trend noted in the report was an increase in the adoption of social engagement/resident connectedness technologies and telehealth among others.

Last year, 44% of non-profit LZ 200 operators reported using telehealth or remote monitoring technology, more than double the number of operators who said the same a year prior. Similarly, 56% of those operators reported using medication monitoring technologies in 2020, a gain over the previous year, when 54% said they did. Use of social connectedness and resident engagement tech also grew in 2020, rising to 66% from 61% in 2019.

More operators also converted units to private rooms in 2020, according to McCracken.

“Among the LZ 200, the average percentage of private skilled nursing units jumped to 72%, compared to 53% in 2019,” she said. “Much of that was forced because of Covid mitigation efforts, but it shows the forces at work.”

In 2019, nonprofit affiliations accelerated, and the number of new affiliations in 2020 held steady at 17. And the pace of affiliations could increase in the next LZ 200.

“Knowing the level of activity going on behind the scenes, we predict that the 2022 report, which will reflect YE 2021 data, will show higher numbers than what we’ve seen,” McCracken said.

Despite growing in other ways, nonprofit senior living providers have not been adding many new communities to their owned and/or managed portfolios. In 2020, just eight operators reported growing by adding a new location. For reference, non-profit operators added 53 new locations between 2015 and 2019, averaging about 13.25 per year.

Although many of the leading operators in the LZ 200 are pivoting to the challenges of the pandemic age, it will take several years for the full impact of Covid-19 to take effect.

“When we get five years down the road and look back, the overall characteristics of the LZ 200 organizations will likely look a little different than today,” McCracken said.

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