Confessions of a Placement Agent: Stop Showing Off Pool Tables, Senior Living Must Sell Care

“If I could count the number of times I was shown a pool table for a family looking for dementia care, I could scream.”

These words are from the leader of a senior living placement service — the company’s agents meet with prospective residents and their families, advise them on options, and accompany them on tours of local communities.

Senior Housing News caught up with this placement agent for this installment of “Confessions.” The goal of this series is to share candid perspectives that might be hard – but helpful – for readers to hear. To encourage this level of honesty, the senior living placement agent has been kept anonymous.


Local placement agencies work directly with prospective senior living residents, meeting them in person and going with them to site visits. This is distinct from large, online referral platforms that furnish leads to senior living communities, which pay a fee if a lead is converted to a move-in. Comments from the placement agent highlighted the “placement” versus “referral” distinction, and raised some criticisms of the referral agency model.

Too often, the online referral companies are not getting to the know the prospective resident and ensuring a good match, the placement agent says.

And senior living providers themselves are often guilty of the same disregard for prospective residents’ needs, according to the placement agent. In fact, too many senior living companies appear to be the “ostriches,” the placement agent believes — they have their heads in the sand, ignoring the fact that offering health care rather than hospitality is becoming the industry’s primary mandate.


Do you work in the senior living industry? Do you want to participate in the “Confessions” series? Email me at: [email protected]. Confidentiality will be maintained for all sources for this series.

“Referral service” is like a curse word among senior living providers, it seems to me sometimes. Providers say they’re held hostage by referral companies, with no choice but to pay out large fees to secure residents. Do you consider your company a referral service, and do you have any sympathy for these complaints from providers?

There has always been an argument in the industry between using the words “referral” versus “placement.”  To me, a “referral” is a name and contact information which is predominately used by the large online agencies. The term “placement,” to me, means a completely different model which includes spending time personally with the potential resident and their families. I believe a majority of providers have far more issues with “referral” agencies than local “placement” agencies.   

I absolutely agree that they are held captive by referral agencies. The tactics that are used to obtain the names of older adults is almost fraudulent in my eyes. I never want a provider to pay two fees for one client. However, it is going to take them to come to the plate and tell the large online agencies that the smaller placement agency was the one that procured the resident. The idea of paying thousands of dollars for a name and contact information is wrong.

The only black eye I see is the one the online agencies give the providers every time they have to pay a fee that they didn’t really earn. Obtaining a name and referring them to a community that they may not have ever stepped into is not earning a fee, it is potentially putting seniors in harm’s way, and it is financially harming providers.

Related: I hear from senior living providers all the time who say they need to do a better job of reaching potential residents, so that they can rely less on third-party referral and placement services. Do you think it’s realistic that senior living providers can rely less on referral services if they up their sales and marketing game? Is that something you’re concerned about eating into your business in the years ahead?

I think that most local placement agents would agree that we don’t want to be responsible for placing the majority of the residents moving into communities. There needs to be a balanced marketplace. Providers need to market successfully on their own. However, families don’t want to be bothered by endless and countless phone calls by multiple communities.

It has become a feeding frenzy that providers have gotten themselves into simply by allowing online agencies to make it all about who gives the potential resident’s name first.

Most of the real work being done to procure an online lead is being completed by the community marketing expert. Providers should have the right to be able to compete online and, in the community, where they reside. Unfortunately, they cannot compete online, and by calling countless useless leads, it keeps them from marketing the community where they should be marketing. It becomes an endless cycle of busy work which precludes the providers from successfully marketing anywhere. One could call it a mousetrap that the online agencies have built to corner the market. However, building a better mousetrap seems impossible these days because of the dependency of needing 100 leads for a few move-ins.

Your model is for your team members to actually meet with your customers and accompany them on visits to potential senior living communities. Do senior living communities typically do a good job of connecting with your customers who visit? Are there things that they often don’t do well?

The majority of providers do an excellent job touring families. Their biggest flaw is trying to sell families their amenities first and confidence in their care capabilities second. Not to be rude or disrespectful, but no one cares about the chef or the dining room experience until the provider shares their philosophy of care first.

Providers need to understand that they are not living in a hospitality world anymore. It’s all about care now. The level of care is getting higher. Take it from me, someone who has done thousands upon thousands of tours: If you believe that the assisted living industry is all about hospitality, you see the industry from an ostrich’s point of view, head in the sand.

What do you think senior living providers misunderstand about a referral, or placement, service like yours?

That is a great question. I believe the biggest thing that providers misunderstand about our services is that our tour to move in percentage absolutely destroys the online agencies. If the providers stopped using online agencies tomorrow, they would see that the local placement agents could actually place more residents overall. The problem is, many of the local placement agents have simply stopped doing business with a lot of the large providers because they can’t get paid for their efforts.

What are your biggest pet peeves in working with senior living communities?

That one is easy. Touring with a family, closing the deal, and then be told that an online agency gave the resident’s name and phone number eight months ago. There is no other industry in the world that operates like this. The monopoly power of the online agencies can only be shifted if the providers are willing to stand up to them.

What do you hear from consumers when it comes to choosing a senior living community? Do they have common complaints about providers or points of confusion — what do you think senior living providers aren’t understanding about their customer base?

Personally, I believe that providers are too worried about starting their tour than they are about getting to know who the consumer is first.

As local placement agents, we have closing rates well into the 80% mark. I believe a lot of that has to do with us not “selling” a service, but listening to the customer’s needs first. If I could count the number of times I was shown a pool table for a family looking for dementia care, I could scream.

Too many providers perform the same tour every time rather than listening first, and tailoring their tour around that specific family. I believe this goes back to the hospitality model.

Families wish that the community marketing people could connect as we do with our families. The provider who can master that would close every family that walks in their doors.

Do you see any patterns in terms of what types of senior living communities make the best impression on potential residents? Do locally owned communities outshine corporate chains, do nonprofits outshine for-profits, do memory care communities do a better/worse job than independent living or assisted living, etc.?

I think it is interesting that you didn’t mention residential homes. Larger communities could take a lesson from them regarding connecting with families. We work best with those who work best with our families and us. I don’t think it is a national or local phenomenon. It is more of who connects the best. Families will choose the “feeling” of a place over the “looks” of it every day of the week.

Providers who train their caregivers to interact with residents and families during the tour always do better. It is amazing how many great caregivers never make eye contact with a touring family. Families notice subtle things like this. There are no sides when it comes to connecting with families. National, regional, non-profit or for-profit. It is all the same. What is different is the people inside, and no one entity has mastered it consistently.

What about your competitors in the senior living referral business, would you say you have a generally positive relationship with competitors, or is there friction? Are there any common business practices in the senior living referral sector that you would like to see changed?

Another great question. In the past, relationships were downright brutal. However, over the past few years, major changes have occurred.

The National Placement and Referral Alliance (NPRA) was formed about 18 months ago to bring competitors together and to help change the industry with a positive, pro-family, pro-disclosure and pro-provider goal. The consensus of members is that families should have the right to inform the provider which agency helped them during their search. Simply sending a name and a phone number is very disturbing and outdated in an industry that is about care.

The only friction is between the online agencies and the local agencies, with the providers and the families caught in the middle. Local agencies never want providers to pay double fees, nor do we want families to go unserved, so we work for free, while the provider pays the agency who gave them a phone number first. The family gets serviced, and the provider loses another local agent for future placements.

I believe in the end, local agents and the providers will join forces and demand that families’ needs should be what is important. Instead of signing agreements that force providers to pay for services that aren’t really services, they should be focusing on what is best for a client. I think that sometimes the families are the losers in this “friction.”

I can tell you, my lowest moment in my long career was when a VP of Sales for a major provider told me, “I don’t pay you to offer families a better experience, I pay you to fill my beds.” Statements like that sum up the friction and the pressure providers experience living in the world between the online and local agencies.

Do you foresee any changes to the senior living referral landscape in the years ahead? For instance, we’ve seen a Medicare Advantage provider, Aetna, start to offer referral services/consultations as an insurance benefit to seniors. Do you see the competition ramping up; what is keeping you up at night from a business perspective?

I see the placement industry growing up and reaching adulthood. With the NPRA’s help, national certification and massive changes in health care, I see local professional agencies becoming members of the continuum of care. I see us fully involved with insurance companies and health care systems all the way up to the C-suite.

The only thing that keeps me up at night is large providers feeling like they have to end all agreements with all agencies to take control of their leads. Getting rid of the baby with the bathwater doesn’t solve the problem in this case. Getting rid of the dirty water while keeping the clean babies is truly the answer. I am beginning to see this happening in the industry with some large providers refusing to renew their agreements with online agencies, while keeping agreements with local agencies and larger franchise systems who are truly local at the same time.

Whatever happens, it must be in the best interest of families. We all have to remember they aren’t just leads, they are someone’s parents, spouse, grandparents and relatives. Their experience matters more than a head in a bed, and the provider who takes that to heart will win it all.

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