Kendal CEO: CCRCs Must ‘Get with the Program’ and Extend Into Community

Sean Kelly hit the ground running as president and CEO of The Kendal Corporation, and he has yet to slow down since taking the reins in 2016.

Kelly has spearheaded a new vision for providing services, entering into strategic partnerships for home health services, modernizing existing communities and planning new projects that will incorporate new and unique approaches to health and wellness.

Among his ideas: continuing care retirement communities (CCRCs) must “get with the program” and facilitate residents’ seamless interactions with the community at large — including everything from local health care providers to restaurants.

Kelly shared Kendal’s progress on these initiatives, as well as what he sees are the major trends shaping the industry, during a recent interview for the Senior Housing News podcast Transform, sponsored by PointClickCare. Transform focuses on the people and ideas shaping the future of senior living.

Kennett Square, Pennsylvania-based Kendal today has a portfolio of 13 affiliated CCRCs in seven states, and the portfolio is growing. Notably, Kendal is partnering with Greenbrier Development and the San Francisco Zen Center on Enso Village, a $300 million CCRC community in Healdsburg, California that will incorporate principles of Sōtō Zen Buddhism into a senior living environment.

Another Kendal affiliate, The Admiral at the Lake in Chicago, refinanced a $202.4 million bond package, resulting in $3 million in debt service savings this year alone. The community also engaged in a strategic planning process and has just released a new plan, outlining critical areas of focus for the next three to five years.

Highlights from the interview with Kelly are below, edited for length and clarity. Subscribe to Transform via Apple Podcasts, SoundCloud or Google Play.

On the role Kendal will take meeting the demand for middle-market senior housing:

At Kendal, we are not a provider that has a stockpile of affordable housing units available to us. We have looked in certain marketplaces the possibility of affordable housing.

In the past 2.5 years, we’ve looked closely at the services and programs people have access to within our communities. We’re recognizing those services and programs are helping our residents, and our Kendal at Home members enjoy a quality of life and, by definition, enable them to access the health care system at different points than the wider world. And we’re observing that how they age is a little bit different than the folks who don’t find themselves in our communities.

We think that is because of a particular focus on care coordination, access to socialization and friends, the ability to be engaged and really … think about what is important to you and the possibility of planning accordingly what it is that you, as a resident or member of any Kendal organization, might decide to do, not just to improve and sustain your quality of life, but to keep your health.

We’re noticing that those things that people are doing to stay in good health can be made available to people who don’t have to pay an entrance fee or monthly service fees.

On CCRCs developing better home health partnerships and working with health systems on population health efforts:

In our case, that’s been our move. Over the years, Kendal [affiliates] have had a tradition for being in partnerships with various organizations including colleges and universities and, in several cases, those come along with hospitals and medical schools in the case of Dartmouth Hitchcock, that have enabled us to be pretty intentional about how we bring people in.

We’re also seeing through these partnerships that we’re running primary care practices within our Kendal communities. We’ve got these communities that have care coordination, home health, health and wellness and now primary care within our communities. Why wouldn’t we take that collection of services and programs that we know have a tremendous impact on the individual and package them in ways that would be available to the general public?

We happen to believe Kendal at Home is the perfect bridge between all of those services and programs and the wider community outside of Kendal. We’re seeing existing Kendal CCRCs that are contemplating adding Kendal at Home to their array of services that are available to Kendal residents, people on wait lists for Kendal communities and people who have no intention of moving into a Kendal community.

On how Kendal is viewing the consolidation in the nonprofit senior living space:

Kendal is a fairly unique animal in our sector. Within the Kendal structure, we don’t have as “top down” an approach to governance, management and even systems.

What we’re seeing is a move within Kendal to be much more intentional about how we leverage our scale in ways that enable us to be more consistent and even centralized in some of our approaches like health care benefits, services and programs offered through Kendal at Home, how we track occupancy and the wants and needs of our residents, satisfaction and engagement across the larger organization.

CCRC Google Street View
The Admiral at the Lake, a Kendal Corporation CCRC in Chicago

We’re doing more and more together as “one Kendal” even though we are a collection of 15 or so organizations, under an umbrella that we say is a “federated” model than a typical corporate, streamlined, structured model.

We’re experiencing a lot of interest from organizations across the country that want that ability to be a part of something bigger. They understand there is a need to do that. There’s a degree of sophistication that comes from being a part of something bigger like Kendal, but there is also a great desire for folks to maintain the character of their organization and the people within it.

On what the future holds for skilled nursing within the CCRC model at large, and at Kendal’s affiliates specifically:

The regulatory environment in which bona fide skilled nursing units have to exist is onerous and really, really expensive. That isn’t problematic unto itself. However, some of the expense that relates to meeting regulations that don’t correlate to quality of care makes it more difficult when it comes to being able to afford operations or when it comes to the market being able to afford what it is that it wants to be provided in a skilled nursing environment.

I know at Kendal and across the country, if you … don’t have the built-in efficiencies and back-of-house systems to deliver skilled nursing on a large scale basis, you are [either] struggling, shutting down, selling off or converting beds to some other use.

That trend is not going to stop … For Kendal, we have three [affiliates] that have more than the usual number of skilled nursing beds. Two of them are mission-driven organizations that intend to serve poorer populations within the individual communities in which they exist. We will hold on to a number of those beds, so long as the Medicaid rules remain as they are and enable us to access that end of the market in ways we might not be able to on a private-pay basis.

In the other [affiliate], Kendal at Lexington, we made a commitment to the wider [outside] community to hold a certain number of low-income skilled nursing beds that would be available to folks who wouldn’t pass through the life plan community.

At the other Kendals, we’ve been relicensing beds, transitioning beds from skilled nursing to assisted living and different styles of memory care. We’ve been finding ourselves able to utilize resources when we change the nature of the licensing of those beds. We can hire more hands-on staff, focus in on quality measures and achieve them more readily when we’re not in an environment … spending significant dollars and oversight in meeting regulatory requirements that don’t equate to quality.

Enso Village is not being designed with any skilled nursing beds. We’ll partner with a skilled nursing provider. But even with these partnerships, we see an environment where people will be able to age in place in independent living. We want to build spaces that are adaptable to the changing needs of the individual.

On where Kelly sees technology impacting the CCRC model the most, outside of home health partnerships:

It’s already affecting us a ton. Whether it’s connectivity across our organization, between communities or even residents, it’s fascinating to me that everyone is in touch. It’s also fascinating to me that we as Kendal and as a sector continue to allow for people to have the same kinds of experiences within our organization that they had before they arrived with us.

That means we better get with the program when it comes to accessibility for all forms of media, all forms of connectivity to hospital groups and health organizations, making reservations at local restaurants, having a single credit card that gives you access to all of the programs within the walls of your campus, but also within the larger community.

[We want to] think about the space … not as a consolidated bricks and mortar community, but as a greater community that includes the culture, restaurants, and volunteer opportunities in the wider communities that surround us.

One of the biggest changes that’s going come to us through technology is our competition will be everywhere. Technology enables people to explore so much more broadly than the ways in which they used to explore. We used to look at market areas as little ZIP codes within a 10-12 mile radius of a particular location. We’re noticing, with Enso Village as an example, we’ve got people from all over the world that are aware of and signing up for [updates].

We’re noticing this all across Kendal. We’ve had residents explore communities all across the country, but they moved in with us because they were looking for a particular cultural connection — they did 90% of their research through the internet.

One last thing with technology changing everything around us: there is a much higher degree of transparency that the world is expecting. There is capability to be aware of — almost on a moment-to-moment basis — issues related to satisfaction. It keeps us on our toes but it also creates some tension as to where the resident and staff relationship begin and end.

If a Kendal resident can go online and read a review of how things are going in the dining room or in the nursing center or in the health and fitness center, from someone who visited from Des Moines, that creates tension because our residents are just as interested in making sure that we’re doing the right thing and, furthermore, that our reputation is intact.

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