Heritage Communities COO: Senior Living Ops Must Focus More on ‘Little Things’

Heritage Communities COO Amy Birkel wanted to learn more about her company’s residents and what they go through every day, so she packed her bags and lived among them.

For 13 days in August, she lived and slept in all 13 of Heritage’s communities throughout Nebraska, Iowa and Arizona. During that time, Birkel ate with residents, played cards and participated in activities with them.

What she learned during this initiative were a lot of little things, though not unimportant things. Birkel gained a new understanding of the issues a new senior living resident might be grappling with, including the loss of identity, social isolation and a long list of new and sometimes confusing rules — all of which are easily dismissed by executives who are focused on top-level metrics like occupancy or total revenue.


That knowledge will be important to Heritage’s operatings going forward, particularly as the Omaha, Nebraska-based provider looks to grow and expand its operations to Texas. In addition to the 13 that Birkel visited, the company has two communities under active construction, and ultimately plans to grow to 30 to 35 communities in the years ahead.

Senior Housing News caught up with Birkel on her first day back at work to talk about what it was like spending 13 days in all 13 of the company’s communities last month, and how that journey will inform her decisions as COO going forward.

The following interview was edited for length and clarity:


On why she did the “13 First Days” initiative:

The 13 First Days idea actually came from a vendor that reached out to us that wanted to work on product research. They asked to spend some time in one of our communities to get to know residents a little bit more, ask some questions about the product, even spend the night so they could talk to as many residents as they could.

I was impressed by that, really wanting to hone their craft, by the folks that use it. So much so that I came back and I said … gosh, this outside vendor is taking such an interest in our residents, why don’t we do that? I’ve worked in senior living for over 25 years. I had the fortunate opportunity to, in my younger days, work as a dining server and a CNA and a medication aide and in sales as an executive director.

In all that time, through all that experience, I have never sat on the other side of the apartment. I have never been the new kid walking into the dining room. I’ve never gone through the move-in process on the other side of the desk.

As we continue to steadily grow as a company, as we build new communities, we implement new services and amenities, as we work so hard to understand what our residents want and what’s the best thing for them, maybe this perspective is something we need to experience ourselves.

On the risk of losing a sense of identity when moving into senior living:

I experienced a fraction of what our folks do, and I understood that through the process. I was obviously not a true resident in the sense that I wasn’t living with a disability and going through this at the same time. I didn’t just move from my home or lose a spouse. All of that was in the back of my mind.

But in a small way, I experienced the same emotions that our residents do. I missed my family. I felt lonely. I’m as extroverted as they come, but I had moments where I didn’t know how to fill my time.

I could easily see what our residents are going through, and how they might feel about losing a little bit of their identity, or the transition into senior living. That’s why those associates are so important to those residents. They see them more than their family. Those associates mean the world to them.

I did not anticipate really getting to feel that personally. I was surprised that I walked away with some of those same feelings. This was not easy. It takes a lot of courage some days to walk out of that apartment or walk back into the dining room.

On a new appreciation for the “little things” in how a community operates:

Little things are huge things.

As operators, the little things may seem as, ‘Yeah, we’ll get this fixed.’ And to us, it may not be so important. But to the residents, the little things are everything. Part of the reason for that is that they have more time. You and I don’t have as much time to just sit and enjoy some of the pleasures in life.

For example, we have beautiful pianos in our communities. One community in particular has their grand piano in the dining room. There is a resident there that played for her church for years. And she comes down and plays every morning.

So I listened to her. And she noticed me and smiled and she said, you know, the keys stick on this piano, it needs to be tuned and there’s a lot of humidity in this room. I could tell, to her, that it was so important. She’s made this her purpose, to provide this music to the community.

I could easily see where, as operators, … sometimes that can get lost in the shuffle of our to-do list. And so, I think sometimes we need to pay attention to the little things. They’re more important than we think.

On better communication and bring respectful of privacy:

Another takeaway is communication. Specifically, communication on the little things and being respectful of residents’ days and privacy.

A handful of times, there would be a repairman outside my window, on the roof, and it would startle me. I thought it would have been nice to know we’re going to have a repairman in the building at 10 a.m. working on air conditioning, or whatever. Or, we’re going to stripe the parking lot so everyone needs to move their cars, versus someone telling me to move my car right now.

I think it’s about respecting that we work in these residents’ homes. We go home, but they’re there all the time. So, we really need to understand the communication piece of that.

On avoiding the “bait and switch”:

Another thing I noticed that was interesting was, while I did not go through the selling process … I could see how a family or a new resident could feel like how they had gone through this wonderful selling process where the community learned so much about me, but then when you sit down with the operators, you hear a lot of rules. You hear a lot of, ‘Nope you can’t do this.’ I could see where it may feel like a bait and switch, unintentally, because you’re working with different people who are concerned with structure, and operations and efficiency.

I found it interesting when there would be a rule or policy, and I would question why we did this. I couldn’t always get an answer and I certainly couldn’t always get the same answer.

For me, what that means is, when we put a policy and a rule in place with a clear objective, are we then still getting that, months after we put that into place? Are we measuring that? Are we looking back and saying, yes, the value of that objective is worth more than the challenge we might have by enacting it. But if we’re not looking back and measuring that … then we just have rules to have rules that don’t always make sense. And at the end of the day, who is it affecting? The people that live there.

So, I completely understand. I am all about order and planning and structure. But the rules better make sense and I better be able to explain it.

I think sometimes we just lose sight in because we’re in such a hurry. But sometimes, the best use of our time is listening to folks with open minds. It’s really listening to their perception, because they have a unique thought on this and how it affects them.

On how this experience will inform her work as COO:

My first plan was to share it with my senior leadership team. And then, I want to share it with our executive directors and their management teams. I want to talk about it in an open dialogue.

What trends did we see, and then what is most important to us moving forward? Is it new initiatives? Is it revamping some things we’re doing? Are some things building-specific? I’m pretty early in the conversation yet to have a formal plan for you. But what I can tell you is, I have information I would not have known to this personal level had I not experienced it.

I have an obligation to look at our residents and associates and say, I was one of you, what is most important to you and how do we execute on that moving forward? On a small scale, I personally need to spend more time listening. There is just something different about hearing things one-on-one. And not only from residents, but from associates, too.

So, I think opening up some different communication venues, where folks can reach me and I can respond back to them, are some good opportunities for us to look at.

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