The impact of Covid-19 on nonprofit senior living continues to reverberate, and is forcing leaders in the space to reconsider approaches to foundational pillars such as staffing models and hospitality-forward care.
Covid-19 highlighted the heroism of senior living workers but an ongoing labor crisis means that providers should be thinking big about future changes. In fact, the “whole model” of staffing should be reevaluated, Sean Kelly, CEO of The Kendal Corp, said during a recent Senior Housing News webinar on the future of nonprofits.
At the same time, providers such as Christian Living Communities are beginning to reassess senior living’s hospitality component, shifting away from a customer-centric approach in order to give residents more agency in how they live their lives, with the promise of improved positive health outcomes and longer, more fruitful years.
And, the pandemic forced many nonprofit providers to look for ways to offset revenue losses brought about by lockdowns and lower census counts. Now, the nonprofit space recognizes the untapped potential for bringing the services typically offered on its campuses to home settings. Many either launched or expanded home care lines over the past 18 months, and more are exploring the space.
New approaches to hospitality
The post-pandemic era may serve as the launching point for a new way of viewing the hospitality component of senior living, Christian Living Communities CEO Jill Vitale-Aussem said. The Englewood, Colorado-based provider ranks 96th on the 2020 LZ 200, with five campuses totaling 921 units.
Providers across the industry have long viewed residents as customers, and have focused on satisfying them from that perspective. Vitale-Aussem views this as an opportunity to reframe residents as “citizens,” and take a deeper look into what they need to live long and healthy lives.
She notes that one of the biggest objections of people considering transitioning to senior housing is a lack of independence once they move. Yet, the current model sells dependence instead of purpose, a sense of belonging, and opportunities for continued growth.
“It’s not a life of pampering [they want],” she said.
This is a transition that has been happening across the industry, albeit gradually, Kelly said. And it is a trend that he believes will gather momentum moving forward. Kelly’s organization — Kennett Square, Pennsylvania-based Kendal — includes 15 affiliate CCRCs totaling 3,629 units, and ranks 14th on the 2020 LZ 200 list.
Residents move to senior housing because they want to be part of a larger community, and to reduce feelings of isolation. The design and programming of senior housing campuses can facilitate that, but often feel forced and inauthentic.
Kelly believes what providers offer within the walls of a senior housing community needs to be as authentic as what a resident might find walking down the street – whether it is a coffee shop or restaurant, or a library setting.
“We have to make the internal spaces of our places authentic, so that people don’t feel like they’re walking into a retirement community … That’s a culture shift,” he said.
Reinventing staffing
Recruiting and retaining quality workers remains a pressing challenge, and is forcing nonprofit and for profit operators to confront some harsh realities about how the industry views hiring.
“It’s about time we honestly and truly re-evaluated the whole model,” Kelly said.
He believes that Covid-19 highlighted inefficiencies in the current workforce model, and showed how the industry has not capitalized on the myriad platforms and partnerships that can support frontline workers and make their jobs easier.
Throughout the pandemic, Kendal offered a range of benefits and compensation packages that have had positive impacts on workforce recruitment and retention. With Covid-19 gradually receding, it will be nigh-impossible to return to a pre-pandemic status quo.
“We can understand that the work being done by these people, that we’ve decided for the first time to call ‘heroes’, has always been done,” he said.
Employee wellbeing will play an essential role in how the Evangelical Lutheran Good Samaritan Society revamps its staffing model, Vice President of Finance Eric Vanden Hull said. The Sioux falls, South Dakota-based provider operates 142 communities – including 53 CCRCs – and ranks second on the 2020 LZ 200.
Good Samaritan struggled to keep facilities adequately staffed and relied on agency contracts to maintain proper workforce levels before and during Covid-19. As part of its affiliation with Sanford Health, the provider is looking to leverage economies of scale to create a more data-driven focused recruiting team and better aid in employee retention.
Additionally, Good Samaritan recognizes the competition for talent from other industries, and intends to be more flexible from a pay and benefits perspective to attract new talent.
One challenge Vanden Hull sees is the company’s payer mix; 70% comes from government sources with set annual rates, making it harder to compete for new workers.
“Efficiency is just something in the industry that we’ve really got to look at,” Vanden Hull said.
CLC is already exploring ways to improve hiring and retention and is enlisting leadership, frontline staff and residents in its efforts.
The provider is hosting learning circles at its communities. Workers have universally said the best part about their jobs is interacting with residents, and Vitale-Aussem sees an opportunity for residents to actively recruit potential candidates to communities.
“Imagine residents actively involved in making sure that people are happy at their job and want to stay,” she said.
Building new service lines
Expanding non-campus services and launching new segments during the pandemic was one of the more notable trends in the nonprofit space expedited by the pandemic.
Over the past 18 months, a growing number of nonprofit providers turned to home- and community-based services as a way to diversify revenue streams while meeting a potentially larger demand for services delivered to people in their own homes.
Kendal’s home health care services arm, Kendal at Home, has been around for 10 years, but the segment experienced substantial growth in the past year. In October 2020, the line entered the Massachusetts market through its Lathrop Retirement Communities affiliates in Northampton and Easthampton, with further plans to penetrate the greater Boston area.
Kelly sees even more opportunities for further penetration of specific markets. Some of the services offered within Kendal affiliates have proven beneficial to positive health outcomes, and these could be delivered to seniors where they live, even outside of Kendal campuses.
“That’s just the beginning. There is more to come,” he said.
Vitale-Aussem plans to spend the remainder of 2021 and 2022 laying the groundwork to expand CLC’s home care division to support seniors across the socioeconomic spectrum. CLC has not decided on what that might entail, but the provider does recognize the market potential if it can provide a solution.
CLC is studying a range of options to bridge the gap. One, in particular, is through the implementation of Ibasho principles to community and home health settings. Translated from Japanese, Ibasho means “a place where you can feel like yourself.” Ibasho cafes are intergenerational community hubs created and managed by elders. Vitale-Aussem envisions the concept as tailor-made for senior care.
Whatever model CLC adopts, she expects home- and community-based services to be a cog in the greater machine.
“Home care will be part of it,” she said.
Good Samaritan has a home health segment and is exploring providing virtual care, Vanden Hull said. Sanford Health recently announced a $300 million initiative to transform rural care delivery, in which virtual care will play a significant role.
The initiative will connect Good Samaritan locations to primary care providers and medical specialists, in an attempt to provide better health assessments and outcomes while reducing costs and resources related to transportation.
“It is where things are going to change in the future,” he said.
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