The Covid-19 pandemic has pressured just about every facet of senior living operations — but for some senior living providers, it has been an opportunity to learn, grow and evolve.
From creating new worker positions that have helped prevent move-outs during the pandemic to re-engaging residents after a long period of isolation, leaders with Integral Senior Living, Brookdale Senior Living (NYSE: BKD), Five Star Senior Living (NYSE: FVE) and Merrill Gardens have evolved their operations to meet the needs of staff, residents and families in the midst of Covid-19.
As the saying goes, a fire that burns red hot can also temper steel. And while the fire has burned plenty hot for the senior living industry, it has also created many opportunities for improvement since early in 2020.
“I would never want to repeat this,” said Integral Senior Living (ISL) President and CEO Collette Gray during a panel discussion at the annual Argentum conference in Phoenix Tuesday. “But I think there were a lot of lessons learned.”
‘Stay with us’
Staffing is not a new problem for the senior living industry, but the Covid-19 pandemic has made it more difficult to keep and hire workers than at any time in recent history.
While vaccines offered a glimmer of hope that the worst was behind the industry earlier this year, the spread of new Covid variants such as delta has thrown the timing of the ongoing recovery into question. This has taken a real toll on employees’ wellbeing, and that fatigue is no doubt contributing to the industry’s staffing challenges, among other factors.
For Brookdale’s outgoing president of senior living, Cindy Kent, now is the time to re-energize associates and reassure them that they are appreciated and supported.
“The teams are weary and they’re tired,” Kent said. “[We need] to stay motivated as leaders and then transmit that hope to our team and say, ‘It will get better, stay with us.’”
To Five Star President and CEO Katie Potter, the pandemic has proven that senior living workers are resilient, even in the face of historic adversity.
“When you operate senior living communities, you live through fires and hurricanes and all kinds of things — but they only last maybe a week,” Potter said. “So for me, being reminded constantly of the resiliency of our team members … was certainly motivation.”
Strong company cultures are rooted in trust and transparency, and Kent stressed that “communication, communication, communication” has been at the core of the company’s pandemic response with residents, families and staff.
Some senior living leaders have been transparent about their own challenges, too. For example, as Covid-19 case counts climbed at the height of the pandemic, Merrill Gardens President Tana Gall learned that letting her guard down and showing real emotions — even negative ones — was not a bad thing.
“I wasn’t afraid to let my teams know that I was sad, I was vulnerable, this was hurting for me, too,” Gall said. “I may have looked at that as a weakness, and … now I don’t. Vulnerability is not weakness.”
Recruitment and retention are top of mind for all four companies, and each has implemented ways to find and keep top talent in their markets.
Merrill Gardens has tackled this effort a number of ways, including by looking for current employees for whom the pandemic delayed evaluations and raises, and by re-examining starting wages for possible increases.
The company also stepped up its employee referral program by doubling referral bonuses for employees, an effort that Gall estimates has netted 200 new hires.
On the recruitment side, Merrill Gardens has also employed creative techniques, such as a card with a QR code on it that can be given to service workers in other industries who show promise for senior living.
“You scan the QR code, and it goes straight to our careers page on our website,” Gall said.
The company has also worked to create new career paths for employees. For example, at the operator’s new middle-market Truewood brand, some workers are designated as resident experience partners, or REPs. These are universal worker positions where employees are typically handling many kinds of duties in one day. While the practice is partly aimed at controlling labor costs, it is also a way for employees to do many different jobs and gain experience.
The program offers “a career path in our industry that we probably wouldn’t have thought of if we hadn’t had to be creative in creating this position,” Gall added.
Brookdale has “doubled down” on recruiting, wage analysis and training for employees, Kent said. The company has also worked to build relationships with academic and educational institutions in Nashville, near its headquarters in Brentwood, Tennessee.
“It’s looking for other creative ways of doing it, and not just relying on what we’ve always done,” Kent said.
Potter believes the industry must do a better job of educating prospective employees on what senior living is at its core, and that the industry can offer many opportunities for career growth and self-fulfillment.
Gray echoed that sentiment, and added that providers shouldn’t be afraid of the fact that working in senior living is not “rainbows, sunshine, and unicorns.”
“At the end of the day, we’re changing lives,” Gray said. “So even when it’s a bad day, you’ve done something to impact and affect someone’s life in some way.”
Another aspect of senior living that has become harder with the pandemic is resident engagement. Doing so is harder today not only because of the pandemic and its many challenges, but also because the fundamental senior living consumer is changing with every passing day.
“The customer in the silent generation that we have served for the last several years is quite different from the boomer customer,” Potter said. “The boomer really wants a curated individualized experience, and as they move into senior living, we have to really look at [whether] this is a product that’s attractive to them.”
While safety and care are the cornerstones of Five Star, Potter is focused on creating experiences for older adults that they embrace, not dread. That is underscored by the fact that the senior living industry’s greatest competitor is the home setting.
“We as an industry have an opportunity to create a platform to transform the narrative around aging, and say, ‘This is a way for you to live a wonderful and fulfilling life,’” Potter said.
Early on in the pandemic as residents sequestered in their rooms, ISL tasked certain workers, such as those in the culinary department, to visit residents in their rooms and check in on them when housekeeping was being done.
“We did visits to make sure that our residents weren’t isolated,” Gray said. “It was engaging the residents so there wasn’t that sense of isolation.”
Merrill Gardens took a similar approach by piloting a new “ally” position in eight communities with the goal of engaging residents who may be struggling with isolation. The resident allies came from across the community, and would spend time with the same residents every day.
The program’s success is measurable in its impact on residents. Gall said the program prevented three residents from moving out, and even helped residents who were depressed and at possible risk of self-harm.
“If we hadn’t had that ally that was watching that person, what could have happened?” Gall said.
Regulations and technology
The pandemic also had a seismic effect on two longstanding areas of focus for the senior living industry: technology and regulations.
Potter believes the industry has an opportunity to work with technology companies that are eyeing health care with growing interest, such as Amazon, Google and Apple.
“They’re looking at the demographics and the fundamentals of the people we serve and it’s … a market opportunity that they haven’t really considered before, and have been working toward figuring out how to tap into it,” Potter said. “Here we are with all the expertise, and so we really need to work with one another … to think about how we can better serve the residents.”
One challenge for operators now is to figure out how to experiment and pilot new technologies while realizing a return on their investment.
“Where I get hung up a little bit is that I want to deploy all of it,” Gall said. “But I have to be able to show it does make the job of a caregiver or a server more efficient or enhances that resident experience.”
All four operators have also learned lessons with regard to working with local regulators. That is an especially hard job for a company with the scale of Brookdale, which has communities in nearly every U.S. state. Still, she said that when Brookdale invited regulators into its communities in the early days of the pandemic, they were often impressed by the level of organization that they saw.
“They didn’t realize that we had the protocols that we had,” Kent added.
The company was able to build on those relationships in the time since, and Kent said keeping regulators in close contact has helped the operator in other similar situations.
“It builds trust so that when the next situation comes up, you’ve got a relationship from which to build,” she said.
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