After years of focusing on workforce initiatives and restructuring relationships with capital partners — and while still battling through the Covid-19 pandemic — Holiday Retirement’s leaders now have their sights firmly set on improving the resident experience.
“For an industry that talks a lot about our employees and residents, we don’t make a lot of investments in that area … we’re more heavily invested in the real estate side,” CEO Lilly Donohue told Senior Housing News.
Holiday is setting out to change that, including through investing in a resident experience platform that will allow for connection and communication among residents, family and employees.
Winter Park, Florida-based Holiday is the largest independent living provider in the United States, with a portfolio of 261 communities.
One overarching goal for Holiday is to collect and analyze more resident data, in order to better customize their experiences to their interests and goals. The result should be higher customer satisfaction and longer length of stay, along with more efficient and cost-effective operations.
Meanwhile, Holiday is continuing its Covid-19 vaccination efforts. After independent living providers were shut out of the Pharmacy Partnership for Long-Term Care, Holiday launched a grassroots effort to provide vaccine access to residents and staff. Now, the company is focused on increasing vaccination rates and making sure the vaccine program is sustainable longer-term.
Laying the groundwork
Donohue, who became CEO of Holiday in Jan. 2016, considers herself a relative newcomer to the U.S. senior living industry. But, she has already led Holiday through several notable changes and challenges.
For instance, Holiday transitioned from triple-net leases to a management agreement with its major real estate investment trust partner, New Senior (NYSE: SNR). Holiday also switched to management agreements with Ventas (NYSE: VTR) and Sabra (Nasdaq: SBRA) and amended its leases with NHI (NYSE: NHI).
And in 2017, the provider transitioned away from a long-time practice of having “live-in managers” at every community, toward a more traditional staffing structure.
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Since that time, the company has been pursuing a multi-year strategy to bring down turnover and increase workforce engagement, Donohue told SHN.
“It’s really been a very thorough process with action plans and growth plans and career ladders,” she said.
As part of that effort, Holiday was the first senior living provider to partner with Great Place to Work and Activated Insights, to start up the annual Best Workplaces in Aging Services list that is published in Fortune.
Over the last three years, Holiday’s scores have earned the company certification as a Great Place to Work. Certification is achieved with a score of 70, and Holiday’s current score is 79. Thanks in part to the Great Place to Work effort, Holiday’s community turnover has declined more than 20%.
As further evidence of the progress made, Donohue pointed to the fact that during Covid-19, Holiday never had more than 170 employees who were not working, and more than half of those were dining staff younger than 18 years old. This is despite worker engagement falling on an industry-wide basis as the pandemic stretched on, and commonly reported instances of workers quitting or taking extended time off due to fears of infection, new family-related demands or other factors.
“We had real engagement during Covid,” she said. “You can’t actually do the safety protocols when people don’t come to work.”
With the intense focus on workforce paying off, the company can start to elevate the customer experience.
“Now that we have retention and engagement, we can actually make it happen,” Donohue said.
Changing the story on aging
A key initial step toward the goal of improving the resident experience is Holiday’s work with tech company Cubigo, to invest in a platform dubbed Holiday365. The system rolled out to 26 Holiday communities on Oct. 1, 2020, and the entire portfolio has now started the adoption process.
Holiday365 is an integrated platform that includes features such as online resident chat rooms and activity sign-ups; maintenance or other service requests; structured communication channels allowing operators to send messages to residents and families; digital signage and an in-room TV channel; and integrations with other software to consolidate products and data.
One basic function of Holiday365 will be to solicit more information from residents about their interests, and gain more visibility into what programs, activities and services are more and less in demand.
Holiday365 can also auto-populate other activities that residents might be interested in, based on what they — or residents with a similar profile — have already engaged with on the platform.
As one example, a leader at a Holiday community in a northern state saw through the system that residents expressed a lot of interest in nature-related activities and opportunities, but there were few on offer given the winter weather, VP of Resident Experience Shawn Richard said on a recent webinar hosted by Kisaco Research.
“She couldn’t take people outside, but she brought in virtual events that would be nature-related, to hit that high expectation inside the resident base,” he said. “That’s not something we would have realized before.”
The vision is that by utilizing Holiday365, activities coordinators shift away from leading and participating in a single activity at a time, and become facilitators of a greater variety of options that are more closely tailored to the resident base of any given location.
An activity room at the community might still be the hub, but there might now be four or five different small-group activities occurring at any given time rather than one single activity, Richard said.
Donohue hopes and believes the system will also raise the bar on the types of activities on offer.
“I’m looking for more provocative, interesting activities, not just bean bag baseball and bingo, even though those do really well,” she said. “I love the idea of having 261 communities, and in one, it’s bean bag baseball experts, and in another one it’s biology experts.”
Having more data should have multiple business benefits, Richard and Donohue explained.
For instance, Holiday historically has given all communities of similar sizes the same budget for resident experience-related costs. With Holiday365, the company should have more visibility into communities where resident engagement is high and where engagement is lower, Richard said. Dollars can be reallocated to support the high engagement, while company leaders can work with the other communities more closely to drive up engagement.
Furthermore, the first six months are of critical importance to winning over new residents — if they are not engaged in that timeframe, they are at high risk of moving out. Holiday365 should help improve the move-in process by enabling community leaders to more easily connect newcomers with people who share their interests, Richard noted.
Donohue believes that most senior living providers, including Holiday, recognize the importance of quickly engaging new residents, and she is looking to drive engagement over time by getting more visibility into residents changing interests and goals, and how their preferences for different types of activities might shift.
Achieving this should drive longer overall length of stay, and using technology like Holiday365 should also help staff, who too often only glean information about what will engage residents by asking them in conversation, or when residents speak up.
“Sometimes you gravitate toward the noisiest customers,” Donohue said, noting that this is of course not the smartest way to drive engagement across the board.
Holiday365 is only part of the larger push to improve the resident experience. Another component will be resident surveys, which Holiday has developed with the help of Great Place to Work company Activated Insights.
Donohue wants to see these survey scores improve over time, and believes that this will translate not only into longer length of stay but will build the brand reputation of Holiday and create more robust sales pipelines.
“I need to get my existing residents to be the best marketers,” she said.
Big-picture, the drive toward enhanced resident engagement is about “changing the story on aging.”
Noting that she has two children who are college-aged, Donohue said she wants older adults to be as excited about senior living as young adults are about going to college, considering that both offer the chance to meet new friends, move into a new environment and have new experiences.
Vaccine progress and Covid-19 performance
Holiday is not the only provider that is prioritizing efforts to elevate the resident experience. For example, Juniper Communities is also working on changing the paradigm of senior living activities, pushing for more meaningful options that involve greater integration with the community at large.
Efforts like these could be crucial as the senior living industry moves forward following the Covid-19 pandemic. Providers not only need to rebuild occupancy but regain consumer confidence, all while navigating an increasingly complex market — with potential disruption on the horizon from players like Amazon (Nasdaq: AMZN). Amazon in the past has proven particularly disruptive for industries that do not prioritize the customer experience, CB Insights noted in a report on the technology giant’s health care strategy.
Independent living has faced a particular challenge in pushing toward recovery, having been left out of the Pharmacy Partnership for Long-Term Care, which has been the main route for assisted living providers to get priority access to Covid-19 vaccines.
“We were super disappointed that we were de-prioritized,” Donohue said. “In typical Holiday style, we recognized quickly that we were not going to get anywhere with that process, and we said let’s shift, pivot and go grassroots, and figure it out.”
She and other leaders at the corporate support center joined in that effort, writing letters and emails and picking up the phone to call local and state-level organizations and businesses such as grocery chain Albertson’s, making the case for why they should make vaccines available to Holiday residents and, in some cases, workers.
Today, 100% of Holiday communities have vaccine access and a second round of doses will be completed within weeks, Donohue said. About 80% of residents and 50% of staff have been vaccinated.
The next phase of the vaccination effort is to increase uptake, with a target of 70% staff participation, and to ensure longer-term access to the vaccines.
Donohue is proud of the progress that Holiday has made on vaccinations, and is also pleased with how the company performed throughout Covid-19. Early in the pandemic, concern swirled around independent living, with fears that residents might move out en masse to avoid family visitation restrictions, and that demand for communal living might be dramatically dampened.
But the sector has held up well, and Donohue believes that independent living proved its value in keeping people safe while also offering more support than older adults had if they were living at home alone.
“At Holiday, we’ve been able to retain better census, as well as profitability … we’ve significantly outperformed other sectors,” she said.
While Donohue declined to share exact occupancy or profit margin figures, publicly available numbers from New Senior — which had about 100 Holiday communities in its managed portfolio as of Q4 2020 — back up her assertions.
Occupancy in New Senior’s managed portfolio stood at 81.3% in the fourth quarter, compared with an average senior housing occupancy that quarter of 80.7%, according to National Investment Center for Seniors Housing & Care (NIC) data. The difference is even starker when compared to assisted living occupancy, which stood at 77.7%. However, the New Senior portfolio’s occupancy was lower than average independent living occupancy as tracked by NIC, which came in at 83.5%.
On the financial side, 2020 same-store cash NOI was down 5.4% on a year-over-year basis for New Senior’s IL portfolio. That compares to same-store NOI being down 33.8% for the senior housing operating (SHO) portfolio of Welltower (NYSE: WELL), using the REIT as a rough proxy for the industry due to the size of its SHO portfolio, which includes 514 properties and a blend of care levels. The cash NOI margin for New Senior’s IL portfolio was 39.1% in Q4 2020. The NOI margin for Welltower’s SHO portfolio was 23.3% for the quarter.
Donohue credits the years of building up the workforce for the company’s ability to maintain relative stability throughout the pandemic, and now she is “super excited” to move forward and is focused on turning the vision for Holiday’s future into reality.
“We want to be a customer-obsessed business — it’s one thing to say it, and another to do something about it,” she said.