RUI President: We’re Building More Scale After Doubling in Size, Taking First Management Agreement

It’s been a big couple of years for senior living operator Retirement Unlimited (RUI).

The Roanoke, Virginia-based operator at the start of the year announced it had doubled in size following taking management of seven Florida communities. Sullivan and RUI also this year pivoted from a growth strategy based solely on new development to one that also includes acquisitions, and took on their first-ever management contract.

The moves grew the company’s community portfolio from just seven in 2021 to 19 — and the company isn’t done growing there.

Looking ahead, RUI President Doris-Ellie Sullivan has her sights set on growing the company’s regional presence from Virginia to Florida.

“We want to make sure that our regional vice presidents of operations, our nurses, our plant operations [teams] … , and some of those folks can get to all their buildings by car,” she said during a recent appearance on the Senior Housing News podcast, Transform. “That’s kind of the scale and kind of strategic plan that we’re looking for.”

Doris-Ellie Sullivan grew up on a farm in Northern Michigan and served in the U.S. Army where she became a nurse. And she is bringing that organizational discipline to the senior living operator.

“What I’ve learned from the military, especially work ethic, go-time, obviously helped us a lot during Covid, to activate and deploy troops,” she said.

Highlights of Sullivan’s appearance on Transform — including retention, diversity, management and more — are included below. Her comments have been edited for length and clarity, but her full conversation is available in podcast form on Apple Podcasts and SoundCloud.

On the company’s evolving growth strategy

RUI is actually 40 years old — it started in 1982. And we also had a large sister company called Medical Facilities of America, which had 42 skilled nursing facilities that were sold in 2021. That meant that we had a lot of, you know, capital in a very distressed market and we want it to grow our senior living. And we’ve never not grown from the ground up.

Since I’ve been on board, we built four buildings which brought us up to 10 total in Virginia. So, we are looking to develop and we have three developments currently in the works.

But we also are looking at the opportunity for acquisition and I think it was Covid-19 and construction prices.

It is a much better deal to find a building in the location where we want to put our programs and our branding in than it is to build something new.

We set out and … changed our strategy plan. Instead of building everything from the ground up, [we] blend that with some acquisitions. We also, for the first time, have opened ourselves up to some third-party management agreements. That will eventually bring us into other states so that we can create regions and create scale at a faster pace.

Regional Growth

We’re a very formal company — everybody in the community wears a uniform. You’re greeted at the door by somebody in a full suit with a scarf or a tie. This is for everybody including executive directors.

So for us, we feel that Virginia down to Florida just makes sense in terms of regionality. And we do believe in regional oversight pods so that our team can deploy to the community by car, especially in the air travel climate we currently live in.

We want to make sure that our regional vice presidents of operations, our nurses, our plant operations [teams] … and some of those folks can get to all their buildings by car.

To maintain this kind of culture throughout multiple regions, consistency is key. In a flat, autonomous organization like ours, you need trust and validation. To that end, we give our team the tools to ensure that they’re set up for success.

On improving occupancy in the new portfolio

Currently, we’ve had the Florida portfolio for eight months. I think that it’s been a work in progress — establishing our teams and getting the culture in place including our signature programs.

For us, those programs are a differentiator. They are born and bred in Virginia and include our quality care program. And with my background in nursing, we strongly prioritize clinical care and believe that financial success will follow.

Installing our culture and the support needed for our signature programs into the new communities has been a challenge. But, that makes the successes exciting. It’s great that the residents are going to have a better purposeful life. But, more importantly, you know that the team members are going to be taken care of.

That’s what I would say we’re working on. Getting the alignment of census, margins and clinical care that we have in our Virginia communities to the Florida communities.

Everybody wants us to get [to our desired margin] tomorrow. But, we are very strategic about it.

We really believe in the month-over-month improvement system. When you dive into strategic business plans that are in 90-day increments or in years, it gets overwhelming.

And people need wins, right? That could mean wins at the community level, the department level, or at the regional level and above. So we really believe in the month-over-month incremental improvements, measurable goals that we can.

One of the things that we have is our [Leader Effectiveness Measure] goal system, our leadership, is a pillar system that the same goals roll all the way up to me so everybody is aligned in their goals and everybody is incentivized by those same alignments.

Our most important thing, when we look at everything, is not how we are going to get to where we need to get to in December, but what we are doing in September to have a good September. And then in October, did we have a better October than we did in September? And I think that month over month, actively managing trust and validation is key to success.

How farm life and the military impact her leadership style

What I’ve learned from the military, especially work ethic go-time, obviously helped us a lot during Covid to activate and deploy troops. I really dug in. And there are a lot of folks on our leadership team that work that have military backgrounds.

Also being a nurse, I donned scrubs and worked in our communities, especially our hardest-hit Covid communities, to ensure our line staff knew I was not going to ask them to go into any community that I wouldn’t go into myself.

Scrubs are way more comfortable than my suit and heels, so I would like to wear them all the time. It is actually an interesting story — at our Heatherwood community [in Burke, Virginia], the CNAs and the nurses wanted different scrubs, they wanted the kind of scrubs that have the elastic bands on the ankles. After working shoulder-to-shoulder with them on several shifts, the next week, we got a whole box of new scrubs. And they were my first team to try those out and change our uniform. It transformed our whole entire line staff uniform because of that experience, and because of the feedback from our team members on site.

We feel our leadership team is like the Navy SEALs, although I was in the Army, and the Army Rangers are great. We are not so bogged down in red tape or bureaucracy that we can make decisions pretty quickly and move pretty quickly.

I lead autonomously. When we have things that just don’t make sense, or things that can be more efficient … we’re a very work-the-problem kind of organization. Once we get that solution, let’s implement it and not take 10 weeks talking about how we’re going to implement it.

So, that probably comes a lot from nursing, the military, or maybe me growing up on the farm — I’m not quite sure where that comes from.

I had a fantastic upbringing. Our farm was harness racing — sulky carts, horse racing — so horses were not for pleasure, they were our business. There were four generations of that. We were flanked by Amish farms, so we learned a lot about a family-based community.

And I truly believe in that community involvement. From four o’clock in the morning until nighttime, it was full-time. There were no sports for me growing up.

I think that gave me my work ethic. If you don’t finish your work, you don’t eat. And so that’s a whole different lens to look through. College was not in my picture as I came from several generations of farmers. So when the army came to my high school, looking for army nurses, I raised my hand and said “Okay, this is my opportunity to do something completely different than anybody in my family ever has.”

On recruitment, retention and worker wellbeing

I really think that community colleges are the key. Not to do a commercial — and they probably should come find me — but the ECPI of the world, those private colleges that can somehow fast-track a nurse, a CNA, a culinary team member, much faster than the traditional community college or the four-year universities. To get the workforce and get the supply and demand, we really have to relook at the way we’re training the workforce because we run a restaurant, a health care community and a country club.

As far as the money question that everybody has, it’s interesting. Chick-fil-A here in Roanoke, they posted a sign that said $18. This is Roanoke, Virginia. We don’t have a Costco, so you know how small we are.

We have to ensure that the compensation, the package, is not only there, we need to make sure that we’re communicating that package. For example, we match 401(k), and we have really worked hard to ensure that our line staff understands that we want them in five years to leave with a little nut, or in 10 years — however long they work for us.

And we feel that the value of communicating the whole compensation, our health insurance, is extremely affordable because we’re self-insured. We want healthy team members. We want you to go to the doctor, we want you to have health insurance, we want your family to have health insurance. For us, it’s been a focus on that compensation package, and making sure that we’ve redeployed all of our resources to ensure that everybody understands the total compensation.

We’re very fortunate in Virginia that we don’t use agency [staffing]. In Florida, we are down to one building using agency.

For prospective nurses looking at what they can earn with a labor agency compared to our pay, we want them to understand how much more weight our total package carriers are beyond just the hourly rate.

For example, we’ve created a PowerPoint presentation that compares me to a hypothetical 24-year-old and shows how that person’s 401k will be worth more than mine down the road. We show the grids that explain that when a company matches 401k, it’s free money. We show how many hours someone would have to work to make $1,000 tax-free.

Another great example we use to prove this point is our own team members. Because we have such a long history (40 years), we have some very long-tenured team members who have participated in the 401k. We show real-life examples of say a housekeeper who has been with us for 15 years or a CNA who has been with us for 12 years.

We have a server who has been with us for 35 years … her 401k is enormous. That example highlights how not everybody’s career trajectory is the same and that you can make a good living, and have a great culture and a great work environment, but you can also have a little nugget in savings.

On the need to be more inclusive of women in hiring

In a TED Talk, I remember hearing that we, as a people, raise boys and girls differently. We raise our girls to be perfectionists and polite. We raise our boys to be brave.

The TED Talk cited a report by Hewlitt-Packer, in which they found that a male will apply to a job if he meets just 60% of the requirements, but a female will only apply to a job if she meets 100% of the job requirements.

And that observation made me think we need to change some of the verbiages of our job postings and the way that we advertise them. And, obviously, we need to teach our women to be braver and to be more risk-takers from that standpoint. But, we are a female-dominated industry, especially at the front one staff level and the community level.

We really started really looking at the way we’re advertising and how[we can] make sure that we’re not taking ourselves out of the mix just because there’s one bullet point that a female [doesn’t match up to]if it’s their way of thinking that they have to check all 100% boxes.

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