What US News ‘Best Senior Living’ Initiative Could Mean for Consumers, Providers

Last week on Senior Housing News, we ran a story with the headline “U.S. News to Create Best Senior Living Community Rankings.” After learning more about what U.S. News is planning, I changed the headline to “U.S. News to Issue Senior Living Ratings.”

I regret using the wrong terminology initially. But, I also think that my mistake reflects some challenges that U.S. News faces in its senior living initiative.

The immediate challenge is to clearly explain to senior living providers what the plans are — not necessarily easy, when it comes to distinguishing “ratings” from “rankings,” for instance, and clarifying how the senior living effort would compare with the rankings that U.S. News creates for other sectors such as hospitals and universities. Also, some questions do not yet have answers: U.S. News is still determining some aspects of the methodology and is soliciting input from providers.

Then, U.S. News faces the challenge of producing a “Best Senior Living” resource that is helpful for consumers, which will be no small task.

I am optimistic about the U.S. News project, while offering the following observations on its current status:

— The “Best Senior Living” initiative has garnered strong initial industry support but is a work in progress

— Given the reach of U.S. News, senior living providers should be actively engaging now to shape the direction of the initiative

— Providers should consider how the Best Senior Living effort might inform their approach to operations, while keeping the focus on consumers

Ratings versus rankings

U.S. News’ basic plan involves a resident and family member survey, created by Activated Insights, that senior living providers will administer in the coming months.

Based on the results of these surveys, individual senior living communities will be placed in a particular tier — likely, there will be three tiers, with the highest scoring communities designated as “best” in their market and the next-highest tier of communities being “recognized.” Other communities will be noted for areas where they demonstrate strength — for instance, “this community is known for dining.”

There are no plans at the moment to create numerical rankings of communities, U.S. News SVP and Chief Product Officer Chad Smolinski told me. So, within the “best” communities in any given market, no community will be designated as No. 1, No. 2 and so on.

But I think there is some uncertainty and confusion regarding how U.S. News will zoom out from local ratings to regional and national levels.

After speaking with Activated Insights CEO Dr. Jacquelyn Kung, my impression was that U.S. News will create rankings (or some sort of recognition) of top senior living brands in a given region or on a nationwide basis. But U.S. News maintains editorial control of the program, and Smolinski was not definitive about this.

“There could be … but we always apply our methodology and make decisions based on what our editorial team decides is best for consumers and best using the data that we have,” he said.

I think that senior living providers with regional or national scale would like to be ranked. Phoenix Senior Living, for example, has a large presence in the Southeast, and CEO Jesse Marinko is hesitant about the U.S. News initiative in part because of the focus on individual communities.

Any portfolio of regional scale will have some properties that are higher performing while others struggle more — sometimes, due to market forces such as oversupply, which team members at the community level have little or no control over, he pointed out. However, he is confident that if considered as a whole company, Phoenix would score highly. I find it heartening that other providers seem to share his confidence in how their companies will perform — or at least, they are not letting on that they are worried about where they would stack up.

I’m sympathetic to Marinko and other CEOs who want credit for having an overall strong organization if they participate. But U.S. News’ main priority is serving consumers, and knowing that a company performs best across a region or the nation is not particularly helpful — and might even be confusing — for consumers who are living in an area where that company’s properties are lagging.

That being said, U.S. News is famous for its numerical rankings — for example, of universities, hospitals and places to live. But in many of these cases, consumers are looking at their options across the whole country, so a numerical ranking on a nationwide basis makes sense, Smolinski said.

“In the case of senior care, we expect most of those decisions are being made very much regionally, and so to begin with, there’s a smaller set of options that a family may be considering,” he said. “So, we don’t feel that it’s as important as it may be in some other areas to go the route of ordinal ranking. But again, that doesn’t mean that we won’t necessarily consider that in the future.”

Time to get involved

To their credit, U.S. News and Activated Insights are actively engaging with senior living industry leaders — including a “CEO council” of top execs from certain participating providers — to inform the methodology for this year and future years.

I think that now is the time for industry stakeholders to get involved — for example, to weigh in on how regional or national rankings could be created with fairness, so that smaller-scale operators would not be at a disadvantage to industry giants.

Here at the Argentum conference in Phoenix, I’ve heard that various other topics have also been under discussion between industry leaders, Activated Insights and U.S. News, including the creation of a consumer guide to the different types of senior living options.

I think such a guide would be essential, because educating consumers about the types of senior living seems a necessity in order to create a user-friendly Best Senior Living tool.

That’s in part due to the persistent consumer confusion between nursing homes and senior living, as well as the fact that independent living, assisted living and memory care communities will all receive separate, individual U.S. News ratings — even if all three levels of care are being provided under the same roof. One possible comparison to this approach is U.S. News’ Best Law Firms, which rates individual law firms across their various practice areas.

I played around on the Best Law Firms website for 10 minutes, and I struggled to grasp its intricacies. I think in creating the Best Senior Living tool, U.S. News would benefit from industry input to balance being informative and being straightforward.

I’ve also heard that senior living executives are interested in whether the Best Senior Living website will include some sort of lead-generation feature.

I think providers’ obvious interest here is in diffusing some of the power of A Place For Mom. But there’s a delicate balance to strike, in order for the U.S. News ratings to be seen as a consumer-friendly tool versus a portal into being aggressively sold a senior living product. And if the Best Nursing Homes approach is an indication, the choice might boil down to selecting a referral partner to connect with U.S. News’ ratings: the Best Nursing Homes site includes a phone number that readers can dial, which will connect them with Caring.com.

Still, I do think the U.S. News effort holds some potential to seriously compete with existing third-party referral platforms. U.S. News not only has a large readership but is highly rated by search engines. I just Googled “Best Hotels in Phoenix,” and the first non-ad link is to U.S. News’ “25 Best Hotels in Phoenix.”

The reach of U.S. News is one more reason why I think senior living providers should get involved now in shaping the approach to creating Best Senior Living, which has the potential to be the most influential industry ratings even as the field grows more crowded with the likes of J.D. Power and other organizations.

A consumer focus, an industry tool

Several senior living providers — including some industry behemoths like Brookdale, Sunrise and Holiday — already have gotten involved and will take part in the inaugural Best Senior Living ratings.

Atlanta-based The Arbor Company also will take part. The company believes that the U.S. News ratings will be a helpful tool for consumers, but CEO Judd Harper also is excited about gleaning information from the resident and family member surveys in order to improve operations.

Harper believes there will be a lot for Arbor to “celebrate” when the survey results come in — but also thinks that if particular communities do not rise to the top tiers in their markets, the surveys will create an opportunity for improvement, and he is not too concerned that these teams will be discouraged or de-motivated.

“I think the data and the information we’re going to get … is going to be invaluable to our teams on how do we get better, where do we need to focus our energies and efforts,” he said.

While more hesitant about taking part in the first year of the ratings, Phoenix’s Marinko also said he is attracted to getting the data and being able to zero in on where to focus improvement efforts.

Any participants in Best Senior Living will gain some valuable information, but providers also have the option to make these surveys into their sole, annual resident and family member surveys. Doing so comes with additional costs but also benefits, in terms of the data produced and how that information is “sliced and diced” — including features such as easily segmenting survey findings for different ownership groups, Kung said.

I think that larger providers are also pushing for the regional and national rankings (or ratings) so that they can tout any success they achieve, not only for external marketing purposes but workforce recruitment and morale.

Consider the case of U.S. News’ Best Hospital rankings; like senior living consumers, many hospital consumers are tied down by geography, not able to travel long distances to receive care at hospitals with the highest national rankings.

“This is absolutely meant to be consumer-facing, but what we’ve learned from the research is that consumers don’t really use these rankings to decide where they’re going to get care,” Melissa Riba, director for Research and Evaluation at University of Michigan’s Center for Healthcare Research & Transformation, told healthleaders.

Doctor referrals, family and friend recommendations and geography are the biggest drivers in hospital choice, she said, noting that U.S. News acknowledges this. Still, the publication does issue numerical national hospital rankings.

“The biggest ‘wows’ actually come from within the industry,” Riba said, about the reaction to those rankings. “I work at the University of Michigan. We are ranked No. 5 on the list and U of M was very proud of it, and immediately circulated the news in our internal newsletters. It was up on the website within milliseconds of being released. It’s a point of pride.”

Achieving and maintaining that pride is so important, some hospitals do “teach to the test” and make changes explicitly with the goal of improving their ranking, Riba said. Taking this approach can lead to genuine quality improvement, although one danger is that organizations simply game the system, or make changes that lead to improvement on paper but not in reality. The press has spilled a lot of ink over ways that universities, in particular, game the U.S. News rankings system.

There is a lot still to be determined about the Best Senior Living initiative, but if it focuses providers on meaningful quality improvement, I think it will boost the industry. However, all stakeholders should keep a consumer-centered focus, Smolinski urged.

“I think as long as we all stay focused … on the goal of assisting consumers with their decision making, and not an overemphasis on any given accolade or designation, then we’re focused on the right things,” he said.