Better Board Leadership a Must for Nonprofit Senior Living Success

From a lack of diversity among board members to old-school ways of doing business that need to change, there are a number of reasons why nonprofit senior living providers need to evaluate and potentially update their governance structure and practices.

If they don’t, nonprofits could find their market share eroded by more nimble for-profit competitors, cautions Carol Silver Elliott, president and CEO of Rockleigh, New Jersey-based The Jewish Home Family, which offers long-term care, rehabilitation, assisted living, and other services at three facilities and through a home care arm.

Elliott also is co-chair of the LeadingAge Business Strategy Council. Now in its second year, the Council is preparing to meet at the annual LeadingAge conference in New Orleans next month, where governance will be a top area of focus.


Noting that its members were seeking more research, business intelligence, and strategic guidance, LeadingAge—the largest national association of nonprofit senior care providers—created the Business Strategy Council in 2016. The Council includes about 20 people, including executives with providers as well as business partners, such as finance firms and tech vendors.

Elliott’s co-chair is Chris Bernardine, COO of Advanced Voluntary Concepts, which provides consulting on employee benefits. He and Elliott recently spoke with Senior Housing News about the challenges around governance, including the need for more education and benchmarking, and fresh perspectives in the boardroom.



Nonprofit boards include members representing the interests of the communities being served. These might be volunteers who have little or no business background.

“I’d argue it’s a huge plus to have people representing the interests of those we serve, but it makes it more complex,” Elliott said.

In other words, board decision-making for a nonprofit is not only about determining the best interests of the business, but the best interests of the community it serves. This mission-driven approach, coupled with a lack of business expertise among some board members, can lead an organization to take financial hits. While generating the biggest profit margin is not a nonprofit’s mandate, financial solvency can’t be jeopardized, either.

The solution, as Elliott sees it, is to make sure board members are up to speed on best practices and industry norms.

“I think the biggest thing is to educate, educate, educate,” she said. “The more you know about our field and where it’s going, the more we share what other organizations are doing and benchmark, the more robust a decision-making process you can have.”

New voices

Many non-profit board members have served for a long time, noted Bernardine. This can become problematic if boards become complacent or slow moving, which Bernardine has seen with nonprofit clients of Advanced Voluntary Concepts.

High-deductible health plans have become common in recent years, but many nonprofits have not updated their benefits packages, he said. They stick with expansive plans in which they are paying the majority of the costs.

“That says to me they’re not up to date on what the benefits industry is doing,” he said. “It’s an older mindset. The for-profits continue to update.”

In at least one case he can remember, a nonprofit even stuck with an expensive benefits package because the insurance broker sat on its board.

So, increasing board diversity, as well as bringing on younger people, is becoming more important, Bernardine said.

Nonprofits are realizing that the status quo is no longer viable as the industry matures and competition ramps up, Elliott said.

“There are organizations already changing the structure of their boards to acknlowedge the change in the world we live in,” she said.

Help on the way

Following its meetings in New Orleans, the Business Strategy Council plans to create resources and tools related to governance and other pressing concerns.

Last year, those resources included white papers and videos on topics such as workforce and mid-market affordability. These same topics will be under discussion again this year, Bernardine noted. The Council will divide into teams that tackle areas including finance, strategic planning, and human resources/operations.

Checklists and calculators, such as for the cost of turnover, are among the types of tools that Bernardine would like as a result of the Council’s work. Ultimately, he and Elliott hope that access to these resources can help turn even slow-moving organizations into more agile operations.

“We’re all aware of the pressures of time and the competing interests that all of us have, and the competing priorities all of us have,” Elliott said. “Where we don’t want to be is in the area of opinion pieces or high-level thought pieces. What we really want to create is a collection of tools and best practices that people already are using, and that others can use to hit the ground running.”

Written by Tim Mullaney

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