Eight years ago, Enlivant was created in an effort to salvage the portfolio of Assisted Living Concepts and create a successful business. Now, the Chicago-based company is entering a new chapter as President and COO Dan Guill ascends to CEO.
Guill takes the reins at a time of intense challenges but also growing optimism. Having been hard-hit in the winter surge of Covid-19 infections, Enlivant now has completed at least two vaccine clinics across its entire portfolio of about 230 communities.
“The first, second and third thing I think of every day is Covid,” Guill told Senior Housing News.
He is spending “an inordinate amount of time” on pushing Enlivant’s teams and residents to understand that vaccination is the most important step toward creating safe environments and moving on from the pandemic.
While Guill does not use the term “mandate,” Enlivant is setting an expectation that all staff members be vaccinated, with an internal deadline of June 1. The blended vaccination rate for staff and residents across the Enlivant portfolio is about 80%, he said.
Covid might be the first, second and third thing that Guill thinks about, but it is not his only focus. He touts Enlivant’s strong culture, and he is prioritizing workforce initiatives to recruit new talent to the team, promote from within and improve retention. And, Enlivant is embarking on a comprehensive effort dubbed DIBS, for diversity, inclusion and belonging.
The provider also is relying on its dynamic pricing model to maintain rate as the whole industry enters lease-up mode to rebuild census, while contemplating how to adapt for the future.
Guill considers himself a relative newcomer to the industry, compared with some peers who have worked in senior living for decades. But, he has been with Enlivant from the beginning, and so will be bringing his institutional knowledge and familiar leadership style to the CEO role.
Guill’s road to senior living
A Fulbright Scholar with a Harvard Business School MBA, Guill took a job with private equity giant Fortress Investment Group (NYSE: FIG) in 2007. In an asset management role, he began working with Fortress-owned Holiday Retirement, where Jack Callison was CEO.
“I really admired him, we formed a close relationship,” Guill said.
In 2013, Callison was tapped to lead Enlivant, and he offered the COO position to Guill, who “jumped right in.”
While Guill seized the opportunity, it was not an easy job. TPG Capital had just acquired Assisted Living Concepts, taking the company private after a slew of issues that included a lease violation lawsuit from real estate investment trust Ventas (NYSE: VTR). The Securities and Exchange Commission would go on to sue ALC’s one-time CEO and CFO.
In other words, Callison and Guill had a massive turnaround to accomplish. They replaced all 16 of the company’s top executives, nearly all 90 corporate support professionals, and about 85% of divisional and regional operators, clinicians and salespeople across 19 states, Callison told SHN in a 2016 Leadership Series interview.
Having relocated corporate headquarters from Milwaukee to Chicago, Callison and Guill got to work on rebuilding the company, with a particular emphasis on creating a strong culture.
“Jack’s taught me a lot when it comes to operations and senior living, and frankly, just creating and building a great culture, which is one of the things that I think I get most excited about,” Guill said.
As evidence of that strong culture, he pointed to internal data showing that 97% of Enlivant’s employees say they know and understand the company’s mission, and 95% say that they know how their job directly correlates and impacts the mission.
As president and COO, Guill has been focused on the “three Ps” of purpose, people and processes. He strives to communicate in simple, clear terms and remain open to feedback, believing that strong relationships are the bedrock for success.
“I came to Enlivant because of Jack, because of relationships, because I enjoy working with people,” he said. “Those are the types of things I really value a lot, when I think about wanting to be around individuals that I truly admire, that I respect, and that we feel like we’re having an impact together.”
Leading through Covid-19
In early 2020, questions about Enlivant’s future ownership were swirling around the company. Irvine, California-based Sabra Health Care REIT (NYSE: SBRA) had acquired a 49% stake in Enlivant in 2017, with an option to buy out TPG entirely by 2021. Sabra’s leaders had indicated that instead, they might seek a new JV partner, but were biding their time.
Then, the rise of Covid-19 shifted all attention onto operations and weathering the pandemic. Enlivant experienced early challenges, including the evacuation of a community in Nebraska. But, with communities concentrated largely in secondary and tertiary markets, Enlivant was spared the widespread outbreaks suffered by providers in dense urban markets, especially in the Northeast.
However, Enlivant’s markets were hit harder as Covid-19 infection rates surged across the country in late 2020. Occupancy in Sabra’s JV portfolio fell to 71.6%, which was a 10.6% decrease, year-over-year. Same-store cash net operating income (NOI) fell 50%, compared to Q4 2019. On a sequential basis, same-store cash NOI fell 21.7% over the third quarter of 2021, and occupancy decreased by 420 basis points.
“We saw a direct correlation to sales activity and occupancy related to the broader Covid infection rates you see in the U.S.,” Guill said.
While that translated to a very tough end to 2020, the good news is that as vaccination rates have increased and Covid-19 infection rates have declined, sales activity has again started to pick up. Current trends make Guill optimistic about a rebound, but he is cautious in light of variables such as new strains of Covid-19, and he does not want to predict when occupancy will return to pre-pandemic levels.
Rather than prognosticating about the future or worrying too much about factors out of his hands, Guill is devoting his energy to driving vaccination rates within Enlivant’s portfolio. And that effort is succeeding; the company’s 70% staff vaccination rate is especially notable, given that no hard mandate has been put into place yet. Across the industry, only about 55% of staff had been vaccinated as of March 7, according to survey data from 69 senior living and skilled nursing providers, collected by the National Investment Center for Seniors Housing & Care (NIC).
To achieve the high rate of staff vaccination, Guill credits “a constant drumbeat of communications” about the vaccine’s safety and efficacy. The communication includes by voice, through digital media, through direct mail, and other channels, with everyone from executives to frontline workers involved. Guill also sends nightly and weekly emails to the entire company with updates on progress. Connecting leaders of communities that have been successful in vaccine uptake with communities that have lower participation rates also has helped, he said.
More transparency in pricing
With vaccination rates already high across the company and the internal June 1 date to achieve 100% staff vaccination, Guill is also thinking about how to rebuild occupancy and NOI in the coming months. In this effort, the company will rely on a dynamic pricing system that was implemented in 2019, and drove a record-high NOI margin of 26.7% in the third quarter of that year.
The system analyzes internal and external data to generate rates, which Guill describes as prices “we can believe in.”
“The industry is fairly opaque, and there are different pricing schemes,” he observed. “What we found that our customers and our employees were looking for was an ability to have a price that made sense.”
Enlivant sales team professionals now can explain the criteria behind a quoted rate. This helps build trust with consumers while establishing more predictability around pricing for the company, according to Guill.
“Our vision is to become the most trusted senior living provider, and trust is based on transparency,” he said.
Dynamic pricing has also been implemented by some other senior living providers, including Holiday. Having these systems in place could be especially important in the months ahead, as providers seek to maintain rate in a highly competitive environment. Already, some operators are reporting deep discounting in their markets, as communities try to recover occupancy lost during the pandemic.
For Enlivant, preserving margin and being able to explain its pricing to consumers is especially critical because of what Guill calls the provider’s “value-oriented” approach. With most of its communities in suburban and rural market, Enlivant strives to deliver a quality product at a fair price, rather than taking the “super ritzy” approach favored by some other private-pay operators.
While the more economical model demands greater operational and pricing discipline, it also opens up a broader consumer base, particularly as the large contingent of middle-income baby boomers ages. With this in mind, Guill is “excited” about growth, but notes that expansion is likely not in the cards until the market gains greater stability.
A focus on people
Callison’s departure from Enlivant to lead Sunrise Senior Living, effective April 1, is no doubt made easier because Guill is waiting in the wings as a successor. Indeed, succession planning and workforce development have been important priorities for the company and remain so under Guill.
“We have a very vigorous and strategic approach to talent management,” he said.
This approach begins in the hiring process. Enlivant works with outside psychologists and vendors to help evaluate candidates and make smart hires. Once people join the Enlivant team, coaching and development help drive retention and advance top talent though the organization.
Out of the last six positions at a senior vice president position or higher, all have been filled by internal promotions, Guill said. And retention — defined as the number of employees with the company at least 12 months, divided by the total number of employees — is up a little more than 6%, year-over-year. Retention has been steadily improving since Enlivant began measuring it about six years ago.
The death of George Floyd and Black Lives Matters protests last year led Guill to reflect on issues of systemic racism, and Enlivant has since launched its DIBS effort related to diversity, inclusion and belonging. The initiative is a “huge focus,” Guill said.
Among the steps taken so far, Enlivant has created a diversity council with representatives from frontline workers to executives. That council is identifying areas for closer focus and work. Enlivant has also engaged an external consultant, who has been “instrumental in helping us have authentic and tough conversations,” Guill said.
Enlivant has been benchmarking itself against companies within and outside the senior living industry. Also, some rising leaders with Enlivant have joined the Black Leadership Academy run by McKinsey. But, Guill acknowledges that the effort is just starting and the road ahead is long and hard.
“There are new ways that I personally need to start looking at things,” Guill said. “We’re all on this journey together.”
Coming out the pandemic, Guill anticipates that Enlivant will have to keep evolving to succeed in a world and industry reshaped by Covid-19.
For example, health care services and technology are more important than ever, and are areas ripe for innovation, although Enlivant is not currently “committed” to any initiatives or investments that Guill is ready to discuss.
“But I will tell you that this kind of change is good,” he said. “And I do think that we’re going to see a lot of really interesting things come up in the next couple of years, and I’m hoping that Enlivant can be a big part of that.”