Randy Bury, the CEO of the Evangelical Lutheran Good Samaritan Society, describes himself as an optimist, and he is hopeful heading into 2021. But on the question of how quickly occupancy will bounce back in senior living, he is blunt about his doubts.
“I don’t think our spigot is going to just open up again like you’re going to see in some other industries and other businesses,” he said recently on an episode of the Senior Housing News podcast, Transform, sponsored by Investors Bank.
In other words, even if a Covid-19 vaccine is widely available in senior living communities, and isolation measures are relaxed, consumers might not rush through the doors. Instead, Bury believes they will likely bide their time. They might be able to do so in part because new work-from-home policies have made it easier for them to live with adult children.
As a result, there almost certainly will be some providers in pain even at the end of 2021, he said. But he is secure about Good Sam’s position in the market, and he largely credits the 2019 merger with Sanford Health, a $6 billion health system.
Being integrated with Sanford has given the Good Samaritan Society additional resources and invaluable expertise during the pandemic, and has transformed the senior living provider from a “double-A ball club” to the major leagues, he told SHN. That’s despite the fact that Good Sam was hardly lacking in scale before the merger; the organization is one of the largest senior living nonprofits, with more than 380 locations offering services across the continuum in 24 states.
This was a hard year, so let’s start by looking on the bright side. What are you optimistic about for 2021?
I think I’m an optimist by nature. So I look ahead and first of all, I think, well, ‘21 can only be better, it’s got to be better, because we had so many curveballs in the current year.
Clearly, along with the rest of the world, we’re excited about the vaccine. I think we’re going to potentially become one of the safest locations to be in American in a few months, as long as the prioritization stays the same and our seniors get the vaccine first, along with frontline health care workers. [We should be] getting that message out and overcoming some of the negative stories we’ve endured over the last year about outbreaks in long-term care and congregate living, and the impact of the virus in those settings and really taking a negative tone. That’s resulted in a decline in our census. We’re down at least 8% or so, in senior living.
We’ve got to get consumer confidence back. We’ve got to project that message that our buildings are safe, we’ve got the vaccine.
Now, of course, that’ll depend on getting the vaccine, and we’re working hard to make sure the congregate living folks are included in the first roll out. Skilled nursing and assisted living are pretty much a sure bet. But we’ve got to make sure that congregate living folks are in that as well.
I think a lot of damage has been done to our industry. That won’t change overnight. The stimulus dollars we’ve gotten in long-term care to help bridge the financial gap this year and some in ‘21 will be great, but what happens in ‘22 if our census is still down, we still haven’t recovered, [and] there are no stimulus dollars? You know, that would be a concern.
What other concerns do you have, looking ahead to the next 12 months?
The themes are so consistent and common. Certainly, workforce is a big one for us. That’s another area where this virus has really, really hurt us. For a lot of folks, the Covid fatigue is a really real thing in our buildings, and I give a tremendous amount of credit to our workforce for hanging in there with us and with the residents through this whole episode. We’ve had buildings with significant outbreaks, and amongst staff as well. So, all of a sudden you’re short-staffed and people are helping cover for each other, so we’ve lost some workers. I think getting them back and retaining that workforce is huge.
I will tell you, we come at it from a little different perspective than most, because Good Samaritan Society about two years ago merged with Sanford Health. I can’t tell you how beneficial I believe that has been to us. Good Samaritan, just because it was a smaller size and scope than Sanford, didn’t have some of the bench strength in things like IT and HR and finance — so, in terms of workforce development, in terms of recruitment and talent acquisition, having all the systems to monitor why people are saying yes to the job or why they’re saying no, and all those backroom functions of a highly tuned HR function.
We were probably a double-A baseball club, and now we’re in the major leagues. Now, we’ve got access to tools, to talent, to the resources we really need to do a much better job of talent acquisition. Even during a pandemic, we’re still hiring as many or more people as we were a year ago. So, I think that [merger] couldn’t have come at a better time.
Can you give an example of the new approach to recruitment?
Basically, the company is divided into 10 regions. For each region, we have a dedicated HR person. So, their sole job is to make sure that region is getting what they need from HR. They’re constantly monitoring the number of applicants for positions, and job fairs, and all those things that go into a high-functioning HR position, where before, it was a little less dedicated staff to that function. We are able to take some of the tools from Sanford Health and apply those to Good Sam.
It’s not as if I want to paint a picture that Good Sam was doing something wrong. It’s just that size and scale do matter. I don’t mean to be a commercial for Workday, but Workday’s got a good solution. We’re moving all Good Sam staff to Workday in a couple of weeks. Good Samaritan probably never would have done that on their own. They just wouldn’t have the size and scale to be able to do it.
For us, the other benefits are things you don’t necessarily think of. Something like a global pandemic comes along. We have a weekly incident command meeting that connects all entities of Sanford Health at the same time on a video conference. Good Samaritan, we find ourselves in a position with our chief medical officer, Dr. Greg Johnson, he’s at our table. But because we’re part of an acute health care system, we’ve got infectious disease physicians and all the chief medical officers from the hospital side, from the clinic side — we’ve got all that collective expertise and the ability to ask questions. To be able to tap into that vast resource of a $6 billion health system has proven to be a huge advantage to us.
What are your top priorities for 2021?
Consumer confidence. We have to convince the public that our buildings are safe places to be.
Visitation requirements, all those things, have worked against us. They were necessary, we had to do them, but the public doesn’t like it, the residents don’t like it, and neither do we. Nobody likes it. That’s created this perception that once you go in, you’re isolated.
I think there will be a pent-up demand, but I don’t think it’s going to come back — again, we see both sides of this. We see what happens on the acute care side. They stopped elective surgeries for a lot of good reasons. Now, many of them started to do elective surgeries again, and when they open up the spigot, those surgeries come right back in. The person that needed their hip done six months ago, they still need it done today. I think in our business, there’s a lag. It’s going to be a lagging indicator. People are not going to rush right back into our doors, because in many cases, they don’t necessarily have to. They can stay at home or live with family members another few months. I don’t think our spigot is going to just open up again like you’re going to see in some other industries and other businesses. I think there’s going to be a lag while people kind of wait and see what’s going on in these facilities. “Are they still having outbreaks? I’m just going to bide my time a little bit.”
That lag hurts not only us, it hurts the whole industry. There’s going to be a lot of really hurting organizations out there, for sure, at the end of ‘21. Because this is not going to rebound that quick, I don’t believe.
Any sense of whether demand will come back sooner for assisted living versus independent living?
We’ve wrestled with that exact same question sitting around our table. I kind of feel like, tell me which one you want me to argue, and I think I can make a run at it. Because I don’t know.
If you look at it from senior housing, those people are more independent and, just logically, if they want to delay, you’d think they could delay longer. At the same time, I think the pandemic itself, with more and more people working from home, I think it’s actually assisted some families in being able to take care of senior members of their family a little bit easier. Because if they’re working from home, it’s a little bit easier to have mom or dad in the house, and kind of keep an eye on them and provide basic services they need. Maybe it’s pretty easy for them to delay a move into assisted living.
So, I don’t know. I think it’s all speculation right now. I sit on the AHCA [American Health Care Association] board. There’s been a lot of discussion about this very topic around that table. Like I said, I think pick your argument, you can make it. I don’t think we’re going to know for sure until we get into this, in ‘21.
In terms of the vaccine rollout, how do you plan to operationalize that, how are you working with pharmacy partners?
The AHCA board had a call at [CMS Administrator] Seema Verma’s request, probably a couple months ago now, where she wanted to talk to us about the rollout of the vaccine and the different methodologies to it. I was really proud of the organization because to a person we all said, we will support whatever is the fastest way to roll this vaccine out to seniors. If it’s a government partnership, if it’s the government, whatever’s fastest.
She talked about the potential, at that time, CVS/Walgreens methodology. I’m really happy with that methodology. I think it takes out some levels of complexity in terms of, you’re not dealing with 24 separate state agencies. We’ve already established good communication with Walgreens and CVS. I don’t want to oversimplify this. Rolling out this vaccine, it’s huge … I’m comfortable, at this point, that I think the rollout is going to go well. We’ll have bumps in the road. But I’m glad the rollout in long-term/senior care is being done the way it is. More on the SNF side, we’ve seen all the different states come up with different rules, different ways of doing things during Covid, different regulations, different requirements. Frankly, it creates a lot of confusion and chaos when you’re trying to run a company that has operations in 24 different states. So, to narrow it down and say CVS and Walgreens, this is how we’re doing it, I’m optimistic about it. I think a lot of really smart people have worked really hard at it.
Going back to the benefits of being part of Sanford, any advice or further information that could be helpful to other senior living providers considering closer integration with health systems?
I’ll declare my bias, because I’ve been part of an integrated health care delivery system for pretty much my entire career. So, I’m a believer in system-ness, and that the more integrated you are, the better off you are. I think we’ve seen hard evidence of that in the Good Sam/Sanford merger.
For example, hospitals being full in our market and needing to get discharges out the door quickly. Because we’ve got Good Sam facilities in or near a lot of those communities, especially in the Upper Midwest, the medical centers will tell you how beneficial it’s been to have Good Samaritan as a colleague, as somebody working for the same company, sitting at the table troubleshooting.
We opened up three wings of an unused facility in Arthur, North Dakota in short order, 24 additional beds, just to take discharges out of the Fargo, North Dakota medical center. That would never have happened if we were two separate companies. Good Sam on its own just wouldn’t have been able to have enough confidence that that would work, financially. But being part of an integrated system, we could open up and staff those 24 beds and take discharges, because we knew it was the right thing to do for patients and residents, and it helped the flow of patients through the medical center.
More and more, I believe long-term care companies start to partner and look at acute care partners. The benefits are there.
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