It’s been said that the Covid-19 pandemic has put much of the senior living sector back into lease-up as the battle for occupancy heats up.
Heritage Communities COO Amy Birkel knows this all too well. For the Omaha, Nebraska-based senior living operator’s 14 communities, the pandemic has turned back the clock on occupancy.
“It’s like having 14 new communities,” Birkel said during a recent appearance on the Senior Housing News podcast, Transform. “Several of our communities are at budgeted occupancy again and running strong, but some are not.”
But even as the company has looked to make up ground lost during the pandemic, Heritage’s leaders have kept their collective feet on the gas pedal. The company is nearly ready to open an expansion at one of its communities in Council Bluffs, Iowa, and is slated to start work on another community in Carrollton, Texas. All the while, Heritage added hospice to its service lines, and drilled down on resident safety and transparency.
At the same time, Birkel and Heritage’s other leaders are focused on an even more important challenge than occupancy: staffing and hiring.
“[Staffing is] the foundational piece of strong occupancy and building the reputation you want,” Birkel said.
Highlights of Birkel’s podcast interview are below, edited for length and clarity. Subscribe to Transform via Apple Podcasts and SoundCloud. The interview took place on May 10, and was edited for clarity.
On what Birkel and Heritage learned in their early days of running a Covid-19 “war room”:
That feels like a lifetime ago.
March and April of 2020, really, were about crisis management. It was daily and unrelenting; information, status, changing constantly. And so, we really had a focus of working collaboratively as a home office team to make the pandemic and what the communities were going through our day-to-day, all-day-long, into-the-evening response.
Decision-making was of the essence. When I think back to that time and what the building leadership teams were going through, they were in the trenches fighting the challenges of Covid-19. So, they needed us to have that perspective of looking at all of the pieces, making timely decisions, getting them the information and the resources they needed so they could execute. They just didn’t have the capacity and the time [to do this themselves] because of how quickly things were going.
We definitely worked to highlight other things that were going on in the community to make sure those things were being addressed and focused on. The communities needed two things from us: they needed hope, and they needed to know they were okay. So, hope and security really were the two constant things in my mind.
On how living and working in Heritage’s communities in 2019 helped Birkel during the pandemic:
That was called 13 First Days. I went to all of our 13 communities at the time and lived a resident experience.
I went through the move-in process, I had my first [experience of] walking in the dining room all alone and figuring out where to sit. And so, one of my big takeaways from that journey was that the little things are everything, and that our associates are like family.
When we went through this [pandemic], and the beauty shops were closed, at the home office our regional directors of operations and regional support teams [nonchalantly said], yeah, beauty shops are closed. And I said, no, no, no, this is a huge thing. We need to actually spend time on what else we can do. [Things like], can we hire a beautician as an associate so they’re essential and so they’re here?
I remember hearing from the residents — we would have these grand programs and all these amazing events, and they said they loved them. But a lot of times, it was the little daily consistent things they wanted us to maintain and not neglect or forget about.
As I thought about the comments residents had made to me back then, [I also thought] how the associates became such an extension of their family. And with Covid, I thought about it even more so, because that’s who they saw all the time. So, I really started to address the retention piece of this, not only because we need associates to provide our services, but also that family connection and how vital that has been.
We did a couple different initiatives. Like a lot of organizations, we did a retention bonus for a significant period of time. That was only for our non-management associates — it was for the direct care staff and the housekeeping staff and the dining staff.
We also did what we called “14 First Days,” and that 14 came from the quarantine that new residents had to go through when they moved into our communities. And so again, it was the little things in each of those 14 first days: what could we do to brighten their days and make things better? And how could they meet their neighbors virtually?
So, it definitely made me think about the smaller details.
On how the pandemic has changed senior living sales and marketing:
Heritage has always maintained a philosophy that our marketing should be a genuine reflection of what life is like in our community.
So, if you look at our website or any of our collateral, all of our pictures are our residents and our associates. And that’s purposeful. We want, when families and inquiries and guests come to our communities, that they clearly understand what they’re going to be exposed to. When our world changed last year, and it didn’t look like our website and our collateral, we updated that. We did an entire photoshoot and marketing strategy on living in a Covid pandemic world and how we still could live better.
Now as we look to 2021, in our new normal with vaccinations and the almost non-existent [number of] cases that we have, I think there’s a blend of living better, and wellness, and infection control measures. We are getting ready to start a new project, update our website, take new photos and get things updated.
But always something that’s top of mind is transparency. It’s been a common theme for us throughout this pandemic. Every organization had to make their own decisions on how to do that. And for us, it was concise, clean, factual information: Here are the challenges we’re up against right now, here’s what we’re doing to work on those and to solve those, and here’s the next step of where we’re headed.
[For prospects], the big difference is, what are your protocols, and what happens if you were to have an outbreak in your community? There is also the question of, what is the new move-in experience like? What do your visitor restrictions … look like? What are your Wi-Fi capabilities?
I also think that there are a lot of similarities [compared to before the pandemic]. While our industry, of course, went through extreme hardship, there’s a reason we’re all still here and folks continue to move in. A focus on overall wellness, and not just the health care piece, is a higher priority.
I remember visiting with a life enrichment director, just a few months after the pandemic had really hit — and she’s a fabulous life enrichment director, a very dedicated associate — but what she said to me is, ‘My job is really non-existent now.’ And I thought, oh, gosh, it’s so completely the opposite. Life enrichment is needed more than ever.
On the hitting the right balance between health care and lifestyle offerings in the post-pandemic:
We have added depth in our clinical team. I’ve added a community position where I have registered nurses that go between the communities, offering support to the leadership teams and the directors of health care in those communities.
We also added someone to really look at policy and procedure to then, down the line, determine if we are prepared as our market potentially changes or as consumers’ needs change. Our philosophy is similar to what I mentioned before: wellness — mind body and spirit — and a protection of resident rights.
There is an ethical dilemma on protecting resident rights, while not infringing on other resident rights, through people’s lifestyle choices. In full transparency there were times throughout last year that I felt like all I heard was, ‘Don’t. You can’t do that. Don’t do this. Don’t go there. Don’t.’ And there wasn’t a lot of ‘Here’s how.’
It would have been easy to get lost in that health care piece alone. So, general wellness and well-being had to be a bigger shift. And I needed my clinicians, my health care team, to get that right, to really understand that we weren’t moving health care and the clinical piece down at all, we were just making sure it wasn’t the only thing we were worried about. And that’s why I mentioned the life enrichment piece, and the socialization, and how we needed to work just as hard to make sure our folks were connected with their family through technology, and then with each other. Senior living is still a community.
So, yes health care has changed a little for us. Our focus, our conversations, I would say are better now.
On what Heritage is seeing with regard to the ongoing Covid-19 recovery:
Certainly, our markets are in lease-up. It’s like having 14 new communities. Several of our communities are at budgeted occupancy again and running strong, but some are not. When you were averaging six to eight move-ins a month before, now, you need to be doing more than that.
The silver lining is: it’s coming. The inquiries, month after month, continue to go up. The tours and folks coming in and seeing the community, [it] all falls in line with the deposits. And again, folks need us. They understand what happened to our industry, everyone saw it. It was highlighted every time we turned around. I feel why Heritage is steadily coming back is because of the commitment to our core values, even when it was hardest.
On whether staffing will be an even bigger challenge than occupancy in the future:
I’m in the camp of being concerned.
We’re fortunate in that we build our own communities, the owners build beautiful buildings, but that really doesn’t matter unless we have the right associates. So to me, it’s the foundational piece of strong occupancy and building the reputation you want.
I’ve reordered our human resources department. I actually took one role, director of human resources, and split it in two so that director of talent management is a separate role. Then I pulled that totally out of HR, and now I have talent management as its own department with a great emphasis on sales and marketing.
We market and we sell to our inquiries and our families, and we showcase our lifestyle. I need to have that same mentality and strategy to showcase the associate experience. I have so many great opportunities to do joint marketing — we’re at events promoting different things. We need to look at [hiring] with the same mindset, and that this is a referral source for employment, too.
Word of mouth, that’s where your best associates come from. I just can’t emphasize how much I have seen that benefit when we’ve taken the time instead of taking dollars and throwing it and at job postings. So, that’s one thing. If I’m bringing in a new role, I am showcasing the associate journey.
We also did some smaller things that I think are meaningful. We started an employee giveback program. It’s a wholly separate non-profit for our associates who are going through personal hardship or unexpected challenges. They can apply for a grant, and we have a board that reviews that and then we write the check for rent, or their utilities or their car payment or even just to pay for the new tires. It’s a small but very personal way that we can help associates through and I think that speaks to our core values of how wellness and living better is a priority for us as well.
Another small thing is we went to an on-demand pay option. So, you don’t necessarily have to wait two weeks to get your paycheck. If things are a little challenging at home right now and you want to draw that out, that can be done up to five times in a pay period. So again, it was paying attention to the small things. Just like on the resident side, those small things can really make a difference.
We’ve also opened up our home office for a couple different entities to come in and use it as training facilities. When Covid hit, a lot of the medication aide instructors, the CNA instructors, or the CPR instructors, they lost some of their environments. Or if they were at the hospital and in different conference rooms, folks didn’t want them to come in. So we turned that around and said, ‘Would you want to come in and use our training room?’ These are essential folks that still have to go on and get their education.
So every weekend, there’s a different class going on here. And it’s a great opportunity then for us to highlight what we do and potentially be an employer for those folks.
But I watch my open positions just as closely as I watch the occupancy reports.
On what lies ahead, both for the industry and for Heritage:
Attracting and retaining that workforce … has to be a priority for every leader at every community, and for every leader at the home office here. It’s recognition, it’s appropriate wages and benefits, it’s creative benefits, it’s on-site potential health care assistance and bringing resources to them, it’s career pathing. I just think it’s moved much higher up the list, and it will be a focus for senior living.
There are of course folks that won’t be with us forever. And that’s okay. Let us be your first job, and then go tell everybody about what a great experience that was.
For me, when I think of the future of the senior living, it’s a different way of almost recruiting and marketing the associate journey, what that looks like at your community and owning it, and then measuring that on the outcome.
Another area [I’m watching] is the increase of technology needs. We just saw that completely change for us this last year. It’s just become such a vital part of our overall operations, and I think that will continue to magnify.
We opened a community in the middle of the pandemic, like a lot of providers did. We opened our community in Nebraska, our 14th community, in December. We start construction on our first community in Carrollton, Texas, in about another month or so. And then, we’re opening another community here in just another month, which is a huge addition to a current property that we have in Council Bluffs, Iowa. So we’ve kept our feet on the gas pedal.
We’ve diversified a little bit. In 2017, we added home health, and we’re in the beginning stages of adding a hospice service line. The goal is, as we build and go into now four different states, we’ll have our home health and hospice service available to all of those communities in the different cities and states.
Heritage’s future is bright, it’s hopeful, it’s optimistic, it’s honest, and we’re just going to keep working hard and doing the right things because people need us.
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