Ascension Living has been on the move lately.
In August, 2017, Ascension Living’s parent organization, Ascension, acquired Presence Health, the largest Catholic health system in the state of Illinois. The deal added 21 senior housing communities to Ascension Living’s portfolio, which today stands at 51 locations in 12 states and Washington, D.C.
The integration of Presence comes at a time of a transformation for Ascension. While the St. Louis-based nonprofit health system has a network of 153 hospitals, it appears to be shifting away from hospital care to population health management, and at the same time expanding its presence in the communities it serves.
With that as the backdrop, Senior Housing News caught up with Ascension Living CEO and President Gayle Trupiano to talk about how the faith-based provider plans to further integrate into the larger health system, where its growth priorities are, and its areas of operational focus such as staffing, where the company has managed to reduce its voluntary turnover by double digits.
SHN: How did you get into senior living?
Trupiano: It is an interesting story. I was at Ascension as the vice president of performance excellence for almost 15 years. I served in a capacity where we were advisors to the acute care side on a variety of topics. We covered efficiency, process improvement, lean training, financial improvement and strategic consulting. We did a little bit of everything but the revenue cycle. My experience within the larger Ascension family has allowed me to be in every location in Ascension on the acute care side.
In September, Dr. [Patricia] Maryland asked me if I would consider moving into the CEO role for Ascension Living. She felt my clinical and operations background would be a great fit for moving Ascension Living forward, so that it is a strong component of the continuum of care. I said yes after some thoughts and prayers.
Ascension Living’s portfolio grew quite a bit right before you took the helm, through the Presence deal. Is there a typical kind of Ascension Living senior housing community?
I would say no. We have brought together several sponsors of Ascension facilities. Part of our strategy going forward is ensuring we have the right portfolio and service line mix to meet the current population’s needs, as well as future ones.
We have three CCRCs, two very large ones in Tennessee and Milwaukee, [both called] Alexian Village. We have independent living and assisted in some locations, and we have skilled nursing and assisted living in other locations. What we’re looking at is what the need will be going forward. Nationally, the skilled nursing occupancy has continued to go down. Our occupancy stays above the national average.
We are looking at how we change our assisted living portfolio to include more memory care, as an example, because that’s a growing unmet need. And, we’re looking at what is the right mix of skilled nursing beds to assisted living where we don’t have independent living.
It’s a new era in how people want to be cared for. One of our strategies is going to be, how do we keep people at home longer? We have a program called Live at Home, where we help keep people at home, healthy, and cared for so that they can stay there as long as possible before choosing to move into one of our facilities. We’re looking at, how can we expand that considering many people want to stay home as long as possible.
What are your plans with senior housing going forward? Any plans to grow that side of Ascension Living?
What we’re looking at right now is, do we have the right services in markets where we have acute care facilities? With markets where we have acute care but we don’t have an Ascension Living facility, we want to add those services and partner with our acute care location to make sure we are offering the community a complete continuum of care.
We’re also looking at adult day care offerings within our portfolio. We believe we may need to have more than what [we currently do]. We also want to repurpose some of our facilities so they become assisted living and memory care. We have developed a memory care program that we are implementing as a standard. This program will be utilized as we expand memory care in more markets.
I’ve always thought people have looked at senior care as a place, a destination. I believe it is more than a place to go for long-term care. Our communities are where people come for short-term stays, whether that be for respite care, transitional care, short-term rehab, or adult day care. We also want to support small standalone communities, and where it’s appropriate, bring them into Ascension Living. Sometimes, that may be an acquisition, sometimes it’s connecting them with the right people. We’re trying to look at the population, what the needs are in each community, and what’s unmet.
What do you see as the biggest opportunities within the senior living industry today?
One of the biggest opportunities we have are our associates. How we treat our associates, the culture they work in, the way we recognize them, that’s the key to having successful care for our residents. We continuously work to improve our culture. We look at wage adjustments, providing the education and the ability to move up in the organization. And we’ve really been focused on that.
By focusing on our associates, we’ve been able to reduce our voluntary turnover [by 44.67%] since July of last year. Our goal is to continue to push that number down. We believe having a stable workforce, again, improves the quality and experience for the residents.
Is there a lot of for-profit competition, and is it a challenge for non-profits like Ascension Living to respond to for-profit competition?
I think there’s a challenge for the industry as a whole that comes from us getting overbedded in some markets with assisted living and independent living. And what happens is, we find our competitors coming in and then lowering the first two or three months’ rent so that people will move in, but then the rates go up. It’s difficult to compete with that. The one differentiator we have is, as a Catholic, mission-driven organization, we have an environment we create that people want to live in. That has helped us.
We’ll never be able to chase that dollar, and I don’t think we want to. We want to provide the right product at the right price, and provide an experience that the residents want.
The baby boomers are coming. By most estimates, they’ll start retiring into senior housing en masse by the mid-2020s. How is Ascension Living preparing for this influx of seniors?
One of the things we have to do is understand what their experiences are going to be. They’re going to very different. They’re going to want to have access to Wi-Fi. They’re going to want to stay at home longer, and then when they go to a community, they’ll make the choice to go into a CCRC where they can be in independent living and enjoy all the activities. And if they can’t do that, then how do we support them living the life they want to live? Their choices are going to be much different, and we have to adjust as an industry.
We’re looking at how we can use technology and leverage it more to support seniors. Also, how can we use that technology in their home, and keep them at home longer? We’re looking at it from a holistic approach.
[On the culinary side], we have ongoing surveys of what they’d like to eat. What choices? What time of day? With our partner TouchPoint, we have also had chef classes in our communities, where the chef comes out and helps seniors prepare meals, and teaches them new things about the dietary balance they should have.
We do fun things. We sometimes have little jazz bands come in and make it part of the food experience, so it’s not just sitting at a table eating, but interjecting things that make that mealtime memorable and enjoyable. And it helps encourage socialization, to ensure more people come and sit and enjoy food together. We as an industry also need to get to more intergenerational living. We haven’t done it yet, but I have wanted to try in one of our communities where we have some college students that live there and provide services. Maybe they’re a musician that plays during dinner.
We need to be creative. We need to be thinking differently about how we can enrich seniors’ experiences, which will attract people to come live in our communities, both young and at a point in their life when they need it.
We’ve witnessed new interest in senior living providers linking up with health systems. Specifically, the acquisition of HCR ManorCare by nonprofit health system ProMedica could be a sign of things to come for senior housing and care. It seems like Ascension is ahead of the game in this respect, in that you are a health system with senior care communities. Can you tell me about your plans to integrate the two sides of the organization?
In Waco, Texas, we have a skilled nursing facility and a CCRC there, right on the campus with Providence Hospital. The synergy there between the two is outstanding. Our administrator attends the leadership huddles on the acute care side weekly. The medical director discusses medications for our residents.
We are very integrated in several of our markets. We’re promoting integration of leadership and promoting integration through communication to ensure we’re providing the best services to support residents and patients, and to ensure they’re in the right location for their level of care.
I think that’s the future when it comes to working with acute care. In markets where we don’t have senior living, we are working to either build or acquire, and then integrate into that market in a way that’s effective for the acute care side, in a way that meets their needs and meets their populations.
Our goal is not to be present in every market, but to be sure that continuum of care exists in a quality manner.
Generally, why is it advantageous for a health system and a senior living community to exist under the same roof, so to speak?
It provides a higher quality of care. And the continuum of care is not just about quality, it’s about social services, it’s about leadership, it’s about care of the individual. We are focused on person-centered care.
Because we’re the same family, I believe we can have better insight, and are able to work with those caregivers to transition their patients into a senior housing setting in a more effective manner. If there are needs or issues that need to be addressed for residents once they come into our community, we can still connect with an acute care facility. And, from a spiritual care perspective, we all share the same mission and vision for Catholic health care.
I think health care is difficult to navigate for everyone, acute care or in a senior living setting. The more we can provide coordinated care, communicate in one voice, and simplify the process, the better we can serve residents. That is a huge piece of why there is an advantage to be under one umbrella.
What are your main priorities in leading Ascension Living? Is there something specific you want to achieve, or a target you want to hit by the time the so-called “silver tsunami” arrives?
We have to be known as the most integrated senior organization in the country so that we can provide the highest quality of care and the best experience.
We need to be thinking differently. We need to include the person in our conversations, and in their care, in an active way. It’s about their spiritual care, it’s about their emotional support, their socialization. We need to have a vision for senior care in this country that’s about how, through dignity and respect, we keep people at home as long as possible if that is their desire, or we take the best possible care of them when they’re our residents.
We have a lot yet to do in our industry to get to that point. We have to change how we think and how we approach what we do. We’re going to get more creative.
This interview was edited for length and clarity.
Written by Tim Regan