Kendal COO: Senior Living Industry Needs More Consumer Transparency, Diverse Leadership

Now is as good a time as ever to build a more diverse senior living industry.

Just ask Marvell Adams Jr., who took the COO role at The Kendal Corp in 2018. Although the pandemic is necessitating new and creative ways to source talent, it’s also breaking down some barriers standing in the way of more diverse leadership. For instance, while in pre-pandemic times a community or company could have made the argument that they were hamstrung by physical proximity to their local labor and leadership pool, that is no longer a valid excuse in the age of remote conferencing and social distancing.

Adams also foresees that consumers will expect and deserve more information about their senior living options. The government’s five-star rating system for skilled nursing has its flaws, but it has created a “go-to” tool for consumers to use, he pointed out.

“I think prospective residents and their families are going to want to understand [things like]: what are your infection rates? What are your sanitation and cleaning protocols? How do you keep residents safe there? What is your percentage of individuals that have been vaccinated against normal influenza, and then once a vaccine comes online for the coronavirus, what percentage of your staff and business have been vaccinated?” Adams said during a recent appearance on the Senior Housing News podcast, Transform.

In his capacity as COO, Adams has worked to safeguard the Kennett Square, Pennsylvania-based organization’s residents and associates from the virus. All the while, he has continued to help the organization source new talent — a task that is more important, yet more challenging, than before the pandemic began.

Highlights of Adams’ podcast interview are below, edited for length and clarity. Subscribe to Transform via Apple Podcasts, SoundCloud or Google Play.

On dealing with Covid-19:

It certainly has not been easy.

Some of the reports that people are seeing about nursing homes and other aspects of how Covid-19 has really ravaged our industry, I can’t say we’re experiencing it to that level. Most of our communities are currently Covid-free, and many of them have been Covid-free this entire time. We have had some communities that have had a handful of cases.

The main thing we’ve taken some reassurance in is that, in the cases where we’ve had a community with maybe one or two Covid cases, they’ve been able to contain it and prevent the spread from happening. So, that’s been very helpful. But all of the other aspects of the pandemic, we’ve certainly experienced just as much as everyone else: stress among our staff, difficulty of trying to combat isolation amongst residents, being able to make sure that we have the revenue and the funds we need to be able to PPE and to potentially pay hero pay.

We’re a multi-state, multi-site organization. We’re across several states with 13 communities, one of those being an at-home program. So, a state-specific plan does not work for our entire system. What Maryland is doing obviously may be very different than what Ohio is doing, and very different than what New York is doing. For Kendal, being able to support the affiliates — but also have an awareness of their state regulations, what’s allowed and what’s being done — is a big part of the challenge. Operationally, it’s been difficult because we [in the U.S.] don’t have a national strategy. So, we have really had to customize and look at how we can support each affiliate based upon what their state is doing or not doing.

Beyond that, we’ve had very good success in obtaining PPE. When the pandemic started, we had just started to move toward a different strategy around procurement, and ensuring that we could really bring together all the volume-buying power that we had across the system and drive prices down. We have a specific member of our team, Ben Butler, our director of culinary procurement, who is sourcing PPE, procuring it, getting it shipped in and then sending it out to the affiliates as they may need it.

That has been a great success for us because not once did we have a community short of PPE. Not a single time has someone tried to reach for a gown, a glove, a mask, and not have one. In the very beginning, certainly people didn’t really know what the protocols were. We’ve really had a great deal of success, and have been working to find ways to help other providers in sourcing PPE. In one instance, we actually were able to help a local hospital that was adjacent to one of our campuses get some PPE, because they had some difficulty sourcing it.

For those states where we have one community where the state itself was administering the test — Maryland was one of them — we didn’t need to provide that much support. But we did take an approach that we want to make sure that no matter what, everyone has some sort of option for a partner to do testing with, whether they’re going to be doing testing with the state or not.

We identified a handful of partners that all of our affiliates could reach, to be assured that they could get testing materials sent to them in order to do swabs, send them back and get a pretty decent turnaround time. For us, surveillance testing has been helpful to find asymptomatic individuals that may be out there. We had a low for a bit where the testing was just surveillance testing, but we weren’t having any positives pop up. Since then, we have seen a little bit of a spike as colleges and universities have opened back up.

We have partnerships with Dartmouth-Hitchcock in Hanover, New Hampshire. We have a partnership with MedStar Health, which is a pretty significant non-profit hospital system and provider in the Mid-Atlantic. In New York, we have providers who have partnerships with the Mayo Clinic. [We have partnerships] even in other areas, where there is a close relationship with a hospital and acute-care provider. In those instances, we can rely upon them for their infrastructure for testing. That certainly has been helpful, particularly as we’ve helped residents who live on our campus go to the hospital, to come back to our campus as safely and as quickly as possible by having that partnership with the hospital.

On the pandemic’s effect on resident preferences, sales and marketing:

The idea of a lunch-and-learn with 100 prospective residents is no longer there, but that doesn’t mean we aren’t having events. We’re continuing to have pretty significant virtual events that I suspect we may want to keep going even after the pandemic starts to subside.

For instance, [we held] a spectacular virtual prospect event for the entire Kendal system. We normally could not have done that for more than maybe 100 or so people on-site in an auditorium or at an offsite location. But in this instance, we were able to reach hundreds of prospective residents in their homes, and provide them with information that was pertinent to them, and that also allowed us to showcase the types of protocols and precautions that each of our communities take. That has actually resulted in prospective residents either not changing their plan to move in … [or to] move in sooner.

Say what you will about the CMS star rating system. For good or for bad, it became the single primary source of information for consumers looking for nursing homes that have a high quality of care, good staffing, good survey results, things like that. That is a well-known go-to, and it provides a look of what type of care and what type of nursing home you’re dealing with.

So, you expand that to senior living, and I think prospective residents and their families are going to want to understand [things like]: what are your infection rates? What are your sanitation and cleaning protocols? How do you keep residents safe there? What is your percentage of individuals that have been vaccinated against normal influenza, and then once a vaccine comes online for the coronavirus, what percentage of your staff and business have been vaccinated? I think that type of information is going to be so critical as people make their decisions.

I think consumers are really going to need to be reassured. We know how to do infection control, but it’s usually behind-the-scenes for consumers. So, I think this becomes, post-Covid, a very standardized way of consumers judging and seeing for themselves. [They will ask questions like] what type of community am I considering? Are they taking infection control as seriously as I want them to? Are they successful, as one might hope, in keeping residents, staff and others safe?

On hiring during the pandemic:

It is very difficult.

We looked at hero pay. Staff are doing the work in order to care for those residents that may have Covid, or may have had an exposure to it. There’s a risk associated with that. It’s not a risk that can’t be controlled and mitigated, but you’re asking something of them that perhaps is a little bit of a higher mark than what we previously did. Having an additional dollar amount for their hourly wage … that has been helpful.

Our approach within our communities is focused on meeting people where they are, and understanding their challenges. Someone who is a single parent with two kids that are in elementary school during this pandemic has a hugely different challenge than someone that may be nearing retirement and lives alone. It doesn’t mean that the risk that they’re exposed to is less, but the challenges of getting to work on a daily basis are very different.

We don’t want to give you preferential treatment, but we do want to understand what some of those challenges are, because they can be unique. And, how do we help them surmount those? In some ways, that has been infrastructure that already existed [before the pandemic]. For instance, we have Kendal communities that have daycare on site. In most instances, those daycares shut down temporarily, but have come back online to provide that type of support needed for staff members and their families. 

We want to be able to understand what someone’s challenges are — even if it means that they are dealing with financial challenges because a loved one or a partner has lost their job, and we’re referring them to employee assistance programs. It’s about being able to recognize you have resources, talking to them about their insurance benefits so that they understand, should they have a health event, these types of things will be covered, and also giving the reassurance that we’re going to be here, and each day that you come back, we’re going to keep showing up as as well.

On the need for the senior living industry to speak out about social justice:

I think Sean Kelly’s speaking out — and speaking with the voice of the entire Kendal system — was a great example of showing staff, residents and board members that we understand. And not only do we understand, but we recognize we have a lot still to learn. 

I think it would be spectacular for other communities, CEOs, leadership, board chairs, to put out public statements that say, ‘We understand the challenges that exist for people of color, and we understand that our communities thrive on diversity.’ Our communities do better when people of color are a part of our resident communities, our staff communities, and our board communities so that we can have a shared understanding of each other’s unique talents, but also the difficulties that may exist for one particular group. So, yes, I would love to see more of that.

And there will be more and more opportunities for engagement around this, and for potentially CEOs and other key stakeholders and communities to speak out with a strong voice, and recognize that Black, indigenous and people of color play such a huge role in the work we do every day. As such, we should do all we can in ensuring that their lives are respected, that their lives are seen as important, and that their lives matter.

On the need for more diversity in industry management:

Many communities — Kendal communities and those outside of Kendal — have a significant number of people of color that are working as CNAs, as nurses, as housekeepers, as dietary aides, cooks, you name it. The significant gap is when you talk about senior leadership, and that, across our industry, is very rare. It’s very rare for someone like myself — a Black male — to be the chief operating officer of a top senior living provider.

So, there really are a couple different approaches that we are taking, and see that others could potentially take as well. One is recognizing that there’s no switch to flip that could make communities’ senior leadership or any other parts of its board more diverse overnight. It just does not happen that way.

When you’re talking about where there is a need for increased and improved diversity and cultural competency, that needs to start way sooner than you know, when someone is 10 or 15 years into their career. You really have to start back when they’re students. And so how do we get more students of color into this industry? How do we support them? How do we recognize that someone that is Black, indigenous or a person of color may have a different experience and may have a different path to senior leadership than someone that is white?

For us, that means investing in LeadingAge’s summer enrichment program, which we’ll be launching next summer to be able to focus on bringing Black, indigenous and people of color into internships with senior living providers with a very high focus on those individuals. The purpose is, one, having regular access and engagement with the senior leaders of an organization — not just the directors and vice presidents, but the COOs and CEOs and CFOs in organizations. One of the more unique parts of the program is anyone who participates and has an intern come through the summer enrichment program makes a commitment to go through some type of racial sensitivity training so that we can be assured that they will do all they can to have an inclusive environment when that intern shows up. Another way we’re doing this is by ensuring that person has a mentor who is a person of color outside of the organization that they’re interning with.

The challenge for us is, if we’re talking about diversity and improving diversity across our system, we really have to consider how we do that in a way that is authentic. Just being able to say, ‘Okay, yeah, we just did this training so we’re good,’ or ‘We sent out a letter, great,’ — I don’t think that’s what we’re talking about. I think we really are talking about recognizing what the challenges are for people of color to be a part of our organizations as residents, staff, or board members. And then, how can we remove those barriers? Because at the end of the day, if an individual looks to engage with the Kendal community and they are a person of color, if they do not feel that the organization is inclusive, the diversity piece will never get there. Do they have the license to be able to speak up and say if something is uncomfortable, or if something is not inviting for them? Many times, that comes down to trying to have the position become culturally competent.

And if you are in certain parts of the country, it may be very difficult to have someone join your organization at any level that improves the diversity of the organization. But that doesn’t mean that the community can’t improve its cultural competency so that they have a better understanding of different cultures, so that they have an ability to be more inclusive, and that they are welcoming so that, as diversity increases and improves across different geographies, that community will be ready to invite and welcome in that type of diversity.

One of the things that Covid has provided us, though, is this: You have boards of Kendal communities, and all LeadingAge communities and other not-for-profits, that are most likely meeting virtually. If a board says, ‘You know, we really can’t find individuals willing to join our board who are Black, indigenous or people of color — or, they’re not in this area, they can’t come to the board meetings.’ Well, for the last nine months, most organizations have not had board members be in the same room. They’ve been on Zoom, they’ve been on Skype, they’ve been on WebEx. And so to me, that has shuttered away the excuse, the barrier to diversifying their board. Right now, I’m in Baltimore, Maryland, and in serving a community here, there’s no reason that I could not recruit a board member that is from Los Angeles, that is from Seattle, that is from Houston, that is from New York City, that is from Miami, Florida.

On how Kendal is preparing for the potentially hard months ahead:

Every single one of our communities is preparing as we normally would for the traditional flu season, with staff members and residents getting flu shots. Before the pandemic, our staff members needed to wear a mask during flu season if they did not get the flu shot as a means to mitigate the risk of exposure. So, when we’re talking about a flu season plus the coronavirus, that means to us that our protocols that we’ve had during the pandemic need to stay strong and consistent. Our traditional flu season protocols need to come online, and we need to be hypervigilant about the vaccines for the traditional flu and making sure we have good coverage for our staff.

Some of this is looking back to some of the practices we had when we knew a lot less about Covid, learning from those experiences and preparing accordingly. For instance, PPE: We are making sure right now that we are in a position to say, as we enter November, that we will be in a good position to have an ample and sufficient supply of PPE through the winter.

But also, I think we have to look at what it means to continue with the protocols we have while finding ways to break down barriers to eliminating isolation among residents, and finding ways to continue to be supportive of staff in keeping their stress levels managed and reduced wherever we can. We’re continuing to keep ourselves in a position to be nimble, as well as finding ways to continue to move forward and not trying to get back to what we had.

We want to get to a position of being better than we were before, so that we can really feel assured that, if there’s another pandemic, if there’s another novel virus, that we don’t see the level of disruption that we see in 2020. This is a new way of doing business for all of us. And I say shame on us if we don’t learn the lessons that we’ve seen before us in the last few months, and ensure that we have the best outcomes for our business staff and board members and others going into 2021.

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