Almost a decade ago, Health Dimensions Group began pivoting from a focus on skilled nursing to private-pay senior living. That move paid off as the company surpassed the 50-community mark earlier this year.
The company has recently expanded relationships with real estate investment trusts (REITs) including Ventas (NYSE: VTR) and Sabra Health Care REIT (NASDAQ: SBRA). Now, after an 11-property growth spurt in May, HDG is taking a well-deserved breather – at least until early 2026, according to CEO Erin Shvetzoff Hennessey.
“We need to get our systems, technology and reporting in place the HDG way, but it also takes time to build trust and relationships with the on-site teams. If you bring on too many communities too quickly, they lose the attention they need,” she said during a recent appearance on the Senior Housing News podcast, Transform.
The Minnetonka, Minnesota-based senior living provider supports its growth using three operations groups that act as integration teams to bring newly onboarded properties up to speed on sales, general operations and care coordination.
“When we get a new opportunity that comes across our desk, whether that’s an acquisition or management opportunity, we like to look at the market, and through our consulting practice, have access to just amazing market intelligence and to understand the demographics of that area,” Shvetzoff Hennessey said.
Improving staffing dynamics at local communities is a key component of getting new sites integrated into the HDG fold, as corporate office support can aid in recruitment of competitive positions like licensed care staff.
“It’s given our teams the opportunity to focus on onboarding in a relationship driven way,” Shvetzoff Hennessey said. “It’s not transactional, not onto the next thing, we’re just really coaching and mentoring and supporting these teams.”
This comes as HDG is “rethinking the way that we deliver care” as rising acuity changes dynamics of senior living operations. Technology integration has also been critical for HDG during its recent growth spurt, Shvetzoff Hennessey said.
Also In 2025, HDG, which manages 50 senior living communities across nine states, is celebrating its 25th anniversary.
Editor’s note: The following podcast transcript has been edited for length and clarity
Listen to the full episode here.
On HDG’s pivot from skilled nursing to senior living:
We made a conscious decision to move more into senior living. That shift was very intentional. Those of us who came up in skilled nursing are great at running lean businesses, caring for high-acuity patients, and navigating heavy regulation, which applies across senior care. But we also knew we needed more in areas like hospitality, culinary programs, operations, and life enrichment. We expanded into memory care and made sure we had the right team, with lots of hiring and training, to deliver excellence in senior living.
About nine years ago, we began gradually shifting our portfolio from being predominantly skilled nursing to a broader mix across the continuum of care. We still have ten skilled nursing communities, and they will always be part of our portfolio, but we’ve significantly expanded into senior housing.
We’ve been very deliberate in how we’ve grown, focusing on regional presence so our teams can be in the communities, know the staff, and know the residents. In our profession, absence does not make the heart grow fonder; we want to be there, hands-on.
We also make sure our goals align with our ownership partners by understanding their long-term plans, investment strategies, and commitment. We use a clear set of criteria when evaluating new communities so we can continue growing, but not too fast. We’ve all seen what happens when organizations grow too quickly.
We’re continuing to grow, but in markets where we know we can excel, with teams that deliver great care to residents and strong support for our staff. It takes discipline, because new opportunities come up all the time and you want to say yes to everything. But we’ve learned to stay selective and thoughtful in how we grow, and that discipline is what helped us cross the 50-community mark this spring.
On evaluating new communities to manage:
I love taking on new communities and helping our clients. Your first instinct is always to say yes, we’d love to, but then you have to take a step back and ask, ‘Should we? How are we going to do this? What’s the right path for that community and for our organization?’
We actually have a documented process that we follow, and we’re pretty open about it. When a new opportunity comes across our desk, whether it’s an acquisition or a management opportunity, we start by looking at the market. Through our consulting practice, we have access to incredible market intelligence. We study the demographics of the area, the demand for the product, and what price point makes sense. Our consulting team can go on-site, secret shop the market and really assess the long-term strength of that area for the specific product type we’re considering.
We also look closely at the local workforce. There are markets with great demand for senior housing or skilled care, but if the workforce can’t support it, that’s a major challenge. Those two things, market strength and workforce, are what we look at first to make sure we can be successful.
From there, we dive into financial performance, both current and projected. We’re pretty conservative in that analysis. We look at the scale of the operation, the resources we already have in that geography, and what we would need to add. We review how it fits within our existing regions and examine every detail closely.
We have a growth leadership team that evaluates each opportunity and then presents it to our executive team for a decision. I think many companies approach this in similar ways, but one thing that makes us a little different is that we do reference checks on our management clients. These checks focus on values, because we truly value our partnerships. Managing a community for someone is such a close relationship, and if you’re not aligned on values and priorities for residents and staff, it can be difficult.
That’s why we’ve actually said no to some partnerships when we knew the fit wasn’t right. It’s so important for us to protect our culture, our values, and the way our team works and wants to be treated. So in our final phase of due diligence, we include a reference check on our clients — and that’s something we’re proud of.
On HDG’s growth pause
We’re kind of in a pause right now. We’re rolling into October and we took on our last group of 11 properties in May. We were very planful about that, knowing we’d have several months where we wouldn’t take on anything new. We need to make sure our systems, culture and operations are fully integrated into these new communities.
When people come to HDG – and these particular communities were rebranded as Dimensions Living – it takes time. I always say you have to win their minds and their hearts. We need to get our systems, technology and reporting in place the HDG way, but it also takes time to build trust and relationships with the on-site teams. If you bring on too many communities too quickly, they lose the attention they need.
So we’re still in that pause. I think we’ll bring on some new properties in late fall or early in the new year. These last few months have been really enjoyable. It’s been fun getting to know the new communities, their leaders and residents, and it’s given our teams time to focus on onboarding in a truly relationship-driven way. It’s not transactional or rushed. We’re coaching, mentoring and supporting these teams.
The last 15 communities we brought on were handled by our new transition team. We actually have three operations teams at HDG. The transition team focuses on new communities joining the management portfolio. We developed it about a year ago because bringing on new communities is very different from operating existing ones.
When this team comes in, they roll out new brands and systems, host meet and greets, visit all three shifts and hold welcome ceremonies. There’s swag, balloons—it’s a celebration. It’s very different from our consulting operations team which handles turnarounds and receiverships. In those cases, we’re focused on keeping the license, the lights on and the residents safe.
Then we have our stabilized assets operations team which manages communities that are already performing well. They focus on ongoing quality improvement—getting from 90% to 95% occupancy or from four-star to five-star quality. It’s about fine-tuning, which is very different from onboarding or turnaround work.
All three teams use the same systems and processes but have different leaders and portfolio sizes. This last group of 15 was managed by the onboarding team which is interdisciplinary—operations, clinical, financial, culinary and human resources, everyone working together to onboard these new communities. It’s been great to watch that team in action, and once they finish this phase, they’ll be ready for our next group of assets before handing them off to our permanent operations team where they officially become part of the HDG family.
On maintaining REIT relationships:
Not a secret at all, it’s really about having the right partners. Someone asked me a couple of months ago how I sleep at night working with REITs, and I said, I sleep just fine. You just need to work with the right partners. They’re great. We don’t have any problems.
We have about 16 ownership groups, and two of them are REITs, Sabra and Ventas. They’re great relationships, and each of us brings something unique to the table to make it work. We started our relationship with Sabra many years ago through a triple net lease at a community in Texas. We now have another lease with them in Wisconsin, and we also manage five communities for them in an RIDEA structure, which isn’t a triple net lease but a third-party management agreement.
It’s been an awesome relationship. Sabra brings technology and pilot programs to us, like their newest one with robot vacuums. They vet and invest in our communities and help implement these programs. They bring real estate, capital and technology, and we bring our operating model and brand. We’re better together, and it’s a true partnership.
We also started working with Ventas a little over a year ago, and that’s been another great relationship. Those are all third-party management arrangements across 15 communities in Wisconsin. Ventas is a great organization to work with, and they bring incredible resources. They share industry insights, data and tools that help us operate more effectively. They bring broad knowledge, and we bring market-specific experience, so it’s a strong balance.
Those relationships are really important to us, and I see them expanding over the next few years. We’ve been so fortunate to have such a wide variety of ownership groups. My business partner Amber and I are owners of some assets ourselves, and we also work with cities, counties, the VA, private equity groups, not-for-profits, religious organizations and hospitals. So many different partners trust us to run their senior care organizations.
Looking back over 25 years, those partnerships have been really special, both with our management and consulting clients. One of our management agreements is 25 years old. We’ve known these people a long time, and it’s been a lot of fun.
On lessons from growth:
That really came from experience. Bringing a new community into HDG is never the same. They’re all different. Some will be with us long-term and just need a name change, some come on temporarily during a receivership, and others are in between. We realized we can’t treat them all the same. We needed different teams with different skill sets, and that was a huge learning—understanding that operations aren’t just operations. It’s more nuanced. Those dedicated teams came directly from that realization.
Another big learning was how critical the on-site teams are to a successful transition. A transition involves technology, systems and data, but at the end of the day, it’s about making sure on-site teams have what they need to do a great job. Do they have the right staffing, marketing support and care resources? Focusing on those leadership teams has been a major priority.
Over time, we’ve also learned the importance of streamlining operations and systems. You can’t change everything to the HDG all at once, it’s too overwhelming. But using consistent technology partners and KPIs helps roll things up in a more streamlined way.
And finally, retention is huge. We have over 90% retention during transitions, which we monitor closely. When teams turn over too much, you lose progress. We’re very intentional about making sure these teams feel connected to us and the organization, and that those relationships are built right away.
On how staffing has evolved in senior living:
I think while most of our communities are doing really well with staffing, there are still some areas where it’s really difficult. It’s not great everywhere. We have markets that have bounced back and are doing wonderful but others are still struggling, especially rural areas where there simply aren’t enough people. Even if you recruit and retain everyone, the workforce just isn’t there.
I was an ED in a very rural community in Iowa many years ago, and about eight or nine years ago we started centralizing recruiting. That was a huge change for us. We brought our recruiting team into our Minneapolis central office where they handle postings, recruiting, scheduling interviews and screening candidates. It’s all done by the HDG team. That allows the on-site teams to focus on what really matters, meeting candidates, making final decisions and onboarding new hires.
We know how challenging hiring can be. You might have ten people apply and five interviews where two show up and one stays. We want the on-site teams focused on that one who stays. The other nine we handle centrally by keeping them in our network, doing background checks and managing the setup process. Centralizing recruiting has been a game changer because it gets the best candidates quickly to our communities so the teams can focus on hiring and retaining great staff.
What I want our on-site teams focused on are the things we can’t do for them at the corporate office. We see ourselves as a support center for our communities. The on-site teams should be focused on having enough staff to care for residents, maintaining occupancy and providing quality care. Everything else we can centralize, including insurance, benefits, billing, recruiting, revenue cycle and even social media.
Now all our communities have to do is snap a photo of an activity or event and send it to our social media team. We handle the captions, releases and posting. We want them to focus on being present and enjoying those moments while we take care of the rest.
That approach has been a huge help in retaining staff. By removing administrative tasks from the communities we let people do what they came to do, take care of people. We handle the admin.
On recruitment changing with resident acuity:
I always say, ‘We work in skilled care. You can’t scare us.’ We’re used to high acuity, lower margins and a highly regulated environment. We still have 10 skilled communities in our portfolio. Some are campuses and some are standalone, but when you walk through our senior living communities, there are also a lot of high-acuity residents, and that’s how it should be. We want people to choose a care setting they love and be able to stay there through the end of life. That should always be the goal.
There will always be a need for skilled care and a place for people who need that level of support. But as people live longer and have more complex health needs, we have to ask what we can do in our settings to help them stay and receive great care. That comes down to nursing. We need nurses who are well-trained and well-supported. For many nurses, that challenge is exciting because they get to build strong relationships while also handling higher acuity care.
For us, it’s about recruiting great nurses and giving them the tools and training they need. The shortage of caregivers and nurses is concerning for everyone. I felt such relief when LPNs were included in the staffing mandate discussions, because they are truly the backbone of nursing in skilled care and senior living. They do incredible work, and leaving them out of those calculations was a huge oversight.
As we look at LPNs, RNs and nursing assistants, we’re thinking about how to keep growing their skills. Maybe nursing assistants become medication aides. We need to continue educating caregivers to do the work only humans can do, while letting technology, AI or automation handle what can be done elsewhere.
It’s about rethinking how we deliver care and making sure our most valuable work happens at the front line. We need to make the jobs of those who bathe, feed and care for residents easier by giving them the right training and tools. Anything we can centralize, automate or outsource helps. We’re already using robot vacuums for corridors and dining rooms so our teams can focus on resident spaces and public areas.
For nurses, technology like audio documentation can give them more time with residents and more time for assessments. It’s never going to be all or nothing, but we have to think creatively about how to address higher acuity efficiently. Do we have enough people? Do we have the right technology? Because looking ahead, there are going to be a lot of people to care for.
On technology integration to support operations and growth:
I think it’s a big piece, but I also think we’re always continuing on that journey. We’re working with our AI Task Force to understand how we can use new technology and robotics. One of our biggest projects right now is around data integration. As every operator knows, there’s so much data coming at us from every system—financial systems, EMRs, EHRs—it can feel overwhelming.
We’re focused on pulling that data together and making it easier to make decisions. We’re working on a large ERP project to streamline data and improve clinical dashboards. The goal is to make information easier to access for frontline teams and reduce the amount of reporting that on-site teams need to send to the corporate office. Anything we can pull automatically helps us make faster decisions and gives our teams more time to focus on residents.
Technology has been a huge part of what we’re doing, and I think over the next few years it will be an even bigger opportunity for HDG. There’s something new and exciting every day, which can be overwhelming, but our focus is on smart evaluation, thoughtful training and using data in a meaningful way
On future outlook and the company’s next 25 years:
I feel like the last 25 years have gone by in the blink of an eye, but things have changed so much. When I think about the next 25, I imagine more growth and unprecedented demand. We’re going to have a lot of people to care for, and it will be our responsibility to do a great job providing high-quality, lower-cost care. Everything we do has to support a sustainable health care system.
For HDG, I see continued growth and a consistent focus on quality. We’ll keep expanding our consulting services and growing our communities. In consulting, we’ve already served around 1,300 organizations, and there will be more of that. I expect new service lines, more technology and more work in home and community-based care.
What I don’t want to change are our values. We’ve stayed true to our five core values for 25 years, and I don’t see that ever changing. I don’t want our culture to change, and we will never move outside of senior care. That’s where our passion is, and as we grow, our focus will always be on seniors.
It’s exciting to think about the future. Many of us have been together for 15, 20 or even 25 years. It’ll be fun to look back on what we’ve accomplished and forward to what’s ahead. I hope the next 25 years bring more of the same—growth, new team members, great care and a continued commitment to our mission.
This is an incredible time to be in senior care. We’re stepping into this demographic moment with a wonderful company and a great team, and we’re ready to take full advantage of it.
The post Health Dimensions Group CEO: Our Focus on Senior Living Has Unlocked New Growth Opportunities appeared first on Senior Housing News.
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