Quality Systems are Senior Living Silver Bullet

In senior living, a company’s brand is reflective of its reputation, not only in the eyes of consumers and their families, but to state regulators as well. Operators who have gone the extra mile to polish their brands through the use of various quality measurements have seen tangible successes in their operations.

Whether it’s maintaining a specialized audit process to measure quality across one’s own communities, leveraging technology or striving for accreditation, private-pay senior living providers have been able to move the needle when it comes to driving occupancy, enhancing care and increasing resident satisfaction, said a panel of CEOs from some of the nation’s largest senior living companies during a conference in October.

Auditing for quality


“The intersection of quality in senior housing—quality of experience, quality in delivery of care, quality in services—a focus on that not only is the right thing to do but can, in fact, materially impact performance,” said John Moore, CEO of Atria Senior Living, during the National Investment Center for Seniors Housing & Care annual conference in Chicago.

The Louisville, Kentucky.-based Atria operates 151 properties across 29 states in the U.S. as well as 29 communities in seven Canadian provinces. In total, the company oversees 21,184 units in its portfolio.

To drive operations across its communities, many of which are located in states where Moore said there is a “very high” degree of regulatory scrutiny—New York, Pennsylvania, Texas, California—Atria relies on what it calls Quality Enhancement (QE) tools to run audits on its communities.


One of those tools is a 12 “quality enhancement” directors, which consist of nurses, executive directors, culinary service personnel, among other staff involved in operations at Atria’s tasked with working in the QE program. This team does two unannounced quality audits at every Atria community each year.

The results speak for themselves, Moore said. When Atria started its QE process in 2004, the company had 4.7 deficiencies per state survey. In 2014, that number has dropped to just 1.2.

The QE program tracks core indicators that run the gamut across all aspect of Atria’s business, including areas like food service and first impressions, for example.

“We track every aspect of what it means to run a building in the right way that matches our policies and processes,” Moore said. “You can’t turn dials if you don’t have consistency across the business.”

Brand cheerleaders

Information systems that track various operating metrics are essential for senior living providers to not only enhance the care they deliver, but to also strengthen brand recognition, said Brandywine Senior Living President and CEO Brenda Bacon.

“Quality equals your brand and brand is one of the most important things that leads to the success of your business, and that leads to your financial results,” Bacon said.

Brandywine, headquartered in Mount Laurel, New Jersey, operates 27 properties—24 operational with three currently under construction—located predominantly in high-income, primary markets on the east coast near Interstate-95. The company’s annual revenue per occupied room (REVPOR) is about $7,000 per unit, and its portfolio has an average occupancy of 92%.

“What’s important to consider is, as we look at the data, we have to know what data we’re measuring and why we’re measuring it, because that can quickly get away from you,” said Bacon. “You also have to think about how you communicate that data to your workforce and who’s the audience for our quality measures.”

Brandywine, like Atria, carries out yearly on-site surveys at its communities by the company’s corporate and peer team, tracking similar operating and clinical metrics. All recorded metrics are then included under Brandywine’s Center for Leadership and Service Excellence, which is included in the company’s proprietary database, ALVIN, which was built in 2003 to track quality measurements across all business operations.

Systems that record quality evaluation and improvement is both an offensive and defensive measure for senior living providers to protect their brands, Bacon said.

“It protects your brand from being the victim, reduces dissatisfaction from families and employees, and creates cheerleaders for your brand,” she said. “The efforts you put into measuring quality and doing something about what that says is going to lead to strong consensus, price growth, happy residents, families and referral sources. And that drives financial success and access to capital.”

Accredited for success

For other operators, like Senior Resource Group (SRG), gaining accreditation is a clear indication of a company’s focus on quality. The Solana Beach, California-based provider has received CARF accreditation at each of its 18 communities, with some properties already on their fourth accreditation surveys, said Wick Peterson, executive vice president at SRG.

“Accreditation has long been recognized as the quintessential demonstration of an organization’s commitment to quality,” Peterson said.

CARF International, as an independent, non-profit accreditor of health and human services, assists providers in meeting international recognized organizational and program standards. The accreditation process is ongoing, as it’s meant to signal to the public that the provider is committed to continuously improving its services.

SRG’s occupancy of stabilized properties is, on average 98.5%—all of which now compete against each other to see who have have zero deficiencies in quality standards, Peterson said.

In a reference to Moore’s previous comments about certain regulatory “battleground states” for senior living, Peterson noted that earning accreditation can be especially important in states like California, where there’s an “onslaught of regulation and surveillance going on.”

Facilities eligible to apply for CARF accreditation may do so via the organization’s Aging Services Program, which accredits assisted and independent living, dementia care, continuing care retirement communities (CCRCs), nursing homes, adult day services, case management as well as home and community services.

CARF surveys, however, are not easy to attain but they do pay off, Peterson advised. A provider begins the process with an internal examination of its business practices, then requests an on-site survey that is conducted by a team of practitioners selected by CARF, usually trained professionals experienced in the industry of the provider seeking accreditation.

During the survey, providers must demonstrate they they conform to a series of internationally recognized CARF standards, and based on the results, CARF then prepares a written report of the provider’s strengths and areas for improvement. If a provider sufficiently demonstrates its conformance to the standards, then it earns CARF accreditation, however, the process doesn’t end there.

After receiving the report, providers must submit what is known as a Quality Improvement Plan (QIP) to CARF to show that they are addressing areas for improvement, if any. Additionally, each year during the term of accreditation, the provider is required to submit a report to CARF documenting additional improvements it has made.

“We’re dealing with savvy families and we believe accreditation signifies the highest quality standards of our organization,” Peterson said. “It also puts us well-positioned in the ACO world and we can demonstrate quality outcomes and show well-below average re-hospitalization visits.”

Punchline pay-offs

Driving quality in senior living is a big theme for all providers, both private-pay and not-for-profits, especially as organizations further carve out their roles within the greater healthcare and post-acute landscape. Developing quality systems can be the X-factor to enable providers to stand out among their competition and can undoubtedly lead to greater operating efficiencies, but it’s a long haul.

“The punchline of this is that all of this stuff seems like hard work and extra work, but it sells rooms and it drives rate—and helps you sleep at night,” said Moore.

Written by Jason Oliva

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