The senior living industry has a golden opportunity to embrace value-based care, improve resident outcomes and save money — but more operators must be willing to take the first step.
That’s according to Jill Vitale-Aussem, President and CEO of Christian Living Communities (CLC). The Denver-based senior living nonprofit owns nine senior living communities in Colorado, and is currently evaluating growth through affiliations.
CLC was a co-founding member of the Perennial Consortium, and the organization’s residents have in recent years reaped the benefits.
“When people are well, you have less health care expenses. The benefits of that right now are going to insurance companies, Medicare Advantage Plans, or Medicare,” Vitale-Aussem said during a recent appearance on SHN+ TALKS. “More providers need to really look at … how they can participate and how it can really help them provide better services to residents.”
She added that it’s imperative that operators begin to learn more about value-based care, even when it is not their core competency.
“It’s important that we begin to learn more about value-based care and really recognize what we do and the important part that senior living plays in the healthcare system in this country,” Vitale-Aussem said. “It feels like without us participating in value-based care, we’re sitting around begging for scraps.”
As the organization looks to grow and evolve in value-based care, it is also prioritizing new staffing initiatives to boost hiring and retention, with a particular focus on training and recruiting.
We are pleased to share the recording and this transcript of the SHN+ TALKS conversation with SHN+ members. Read on to learn about:
— How Vitale-Aussem sees the value-based care opportunity and what operators can do about it
— Why CLC created its own internal staffing agency
— How the organization is growing and evolving in 2023
[00:00:05] Tim Regan: Good afternoon, everyone. I’m Tim Regan with Senior Housing News. Welcome back to SHN+ Talks. Jill, welcome. I’m very excited that you’re here today.
[00:00:43] Jill Vitale-Aussem: Thanks, Tim. I’m glad to be here.
[00:00:45] Tim: I want to start with a state of play on recovery and progress at CLC this year. I think the last time we checked in was when you came on the podcast around I think this time last year, and we talked a little bit about what you were seeing on the ground. Fast-forward to 2023, what are you seeing now with regard to things like occupancy, move-ins, and all that?
[00:01:38] Jill: We have made great progress in occupancy recovery. Really, it was 2021 and 2022. But across all communities and all levels of living, we’re just about 90% occupied. Residential living has been strong throughout, so we have an average of 94% residential living occupancy. Skilled nursing has really bumped back up. We’re getting right around 88% occupancy and skilled nursing, which is awesome.
Assisted living, 90%. Some of our memory support communities based on the market are struggling a little bit more than memory support neighborhoods of assisted living. We’re really pleased and we’re getting good leads. We actually created our own internal marketing agency during 2022. That’s really allowed us to be really focused on, really flexible with SEO and really the messaging that we want and be able to do things really quickly. That’s really helped to drive a lot of leads also, but things are going well with occupancy.
[00:02:50] Tim: Where are you still seeing pressure in your operations?
[00:03:10] Jill: Our big pressures continue to be wage escalation and the shortage of people that work in our communities.
In Denver in January of 2023, the minimum wage is $17.29 an hour here, which is high. I’m not saying whether that’s good or bad, but it has a huge ripple effect on positions all over the spectrum and outside of the Denver Metro, the actual Denver proper area. We’ve had huge wage escalation here in Denver. Affordability is a challenge here for people to find places to live in Denver, so those are big issues.
Agency usage — I’ll tell you what, our number-one goal is for 2023 to have 100% of care and services provided by our own staff. Yes, it’s about finances, but it’s also the right thing for residents. Imagine a stranger giving you a bath and all those things. Our team members have told us it’s not great working with people who are strangers in our buildings although they aren’t bad people. But we see risk issues, and we see all kinds of quality impacts too; so that’s a big focus for us. We have a ways to go but we are determined.
[00:04:39] Jill: Are you still seeing big cost inflation in your operations?
[00:05:00] Jill: The cost of gas at the pump has dropped. That was a huge issue last year. We did temporary inflation relief cards for our team members to be able to afford to get to work. Fortunately, that has gone down a bit. But there has been a huge increase in utilities. [Others include] food costs, liability insurance, property insurance. It’s everything. It’s trash removal, it’s landscaping, it’s getting your elevators fixed, everything. The prices have gone up on everything.
[00:05:48] Tim: That simply raises the bar on what you have to do at the community level. It’s like you’re attaching weights to everything. Everything just becomes a little bit more difficult.
[00:05:58] Jill: Yes. And having to do higher-than-normal rate increases for residents, it causes distress for people and we feel it and they feel it. The goal is to make senior living more affordable, not less affordable. Right now with all these pressures, it’s hard to make movement in that direction.
[00:06:25] Tim: Yes. I want to talk with you a little bit about staffing here. We touched on it a moment ago. Obviously a big goal this year is eliminating agency use, you said as much.
Are you seeing other pressures in staffing?
[00:07:06] Jill: Late 2022 and going into this year, our big pain point was certified nursing assistants in skilled nursing. That was the area where wages were just spiraling out of control in the market, and we were having a hard time finding people.
We allocated significant resources to CNA wages for 2023, that has made an impact, and also home care aids. That has made an impact, adjusting those wages. A lot of times you’re like, “If you adjust CNA wages, then you have to adjust nurses and then you have to adjust managers.” It’s this huge financial ripple effect.
What we decided is why can’t we just raise up the importance of our CNAs, our direct care partners who are doing this work? We’ve seen improvement with that. We’re actually seeing the market loosen up for other positions like at our support office for people in our marketing department. Some management positions like a year ago, you would maybe get one application and now we’re being bombarded with applications. I think people seeing what’s happening with layoffs going on in our economy has impacted things.
We also did significant wage adjustments for dining services for cooks, for servers. That was necessary too to be able to bring people in.
[00:08:44] Tim: What is the unemployment rate like in the Denver area? I have heard it’s low. And I know Colorado is as well.
[00:09:06] Jill: I think it’s lower in Denver, but I’m not certain.
[00:09:10] Tim: I’ve heard that Denver in particular is a tough market for hiring
[00:09:14] Jill: It is, yes.
[00:09:16] Tim: That’s actually a great segue though into another question I wanted to ask. We started to talk about this a little bit ago, but what’s working best in recruitment and retention right now? Obviously, raising the wages this year, that sounds like that has helped. What else?
[00:09:30] Jill: We invested in our recruiting department so we centralized that. They’re recruiting for our communities and just really casting a wider net. There was a story, I think it was late last year. There was somebody who called one of their recruiters and they didn’t have access to a computer to apply for a job, which is real. I think it was somebody who hadn’t been in the U.S. very long. She met the person at the library to help them go through the process.
We’re being a lot more creative and a lot more really focused on how we help people find jobs. We’ve allocated more marketing dollars to SEO for people searching for jobs. The other thing I would say is that wage adjustments have definitely helped. Our scholarship program, that’s all funded by donors. When people get scholarships through us, through these donor funds, they stay with us. The mentor program that we have really helps. It’s culture.
When you look at our communities, they have the deepest person-directed culture, the ones that have been working with the Eden Alternative for years and years and have this culture of meaning for team members and resident engagement in owning the success of team members. When you’re doing your jobs, you don’t feel like you’re doing tasks, you feel like you’re really engaged in purpose, those are the communities where we have the best retention for sure. I always go back to culture. It makes all the difference.
[00:11:18] Tim: I remember before the pandemic there was an initiative, which was a resident and employee council that got them talking to each other and collaborating on things. That was an interesting program. I’m not sure what the status of it is like these days. Can you elaborate on that at all?
[00:11:43] Jill: Yes. That was called the Keepers Committee. Jayne Keller, who is our COO — when she was the executive director at one of our communities, she started that. We really realized that team members, when they said what they love most about their job or what they are going to miss when they leave, it’s always the residents. She was like, “Why aren’t we engaging the people that live in this community in being a part of the solution?”
I think there’s a great opportunity for family members as well. We’re all in this together. We all have the same goal. We want to get great people to work here and we want to keep them. Again, those communities where the residents own that and they show appreciation and they know our team members as human beings, those are the places where we have the best retention.
[00:12:37] Tim: You told me that CLC is not really in growth mode right now. I’m assuming that has to do with all of the hurdles out there to growth, especially with regard to development. Can you talk a little bit about growth and how you’re approaching it these days?
[00:13:06] Jill: Yes. We’re looking ahead to growth. We’re not actively building something right now. We do have a community that we are working to redevelop. The construction costs and interest rates and also the labor escalation have made that really challenging, so that’s a big focus for us. We’re looking at opportunities for affiliations with other nonprofits, acquisitions of other communities.
We’re really focused on Colorado and the Mountain states region so we get that depth in an area. That’s what we’re focused on as well as we have home care and what else can we be doing to support people in their homes. Knowing that aging in place is not the right answer for everyone. I worry about it setting people up for failure, but that there are people that we can help them stay in their homes when they want to. We’re also looking at that as well.
[00:14:06] Tim: I’ve talked with other senior living operators where the idea is to do exactly what you just described, but one unintended benefit of all of this is that people just get to know who you are in the market. Maybe someone who might do home care through you for a few years realizes, “Hey, maybe I need assisted living and so I’m going to move into this community.” Are you seeing that through this program?
[00:14:34] Jill: Yes, we do. Also, we have adult day at one of our communities, and that happens also where people will go to our adult day program and then eventually move into memory support in that community. Then also people are on a waitlist because we’re full, then home care can support them also. There’s also a lot of clients in our own communities, so we’re able to keep people in their apartment homes a lot longer through homecare.
[00:15:05] Tim: I want to sort of switch topics here and talk a little bit about technology. Tech is one of those areas where I feel like my head is spinning sometimes. There’s so much cool stuff out there on one hand. On the other hand, there’s too much cool stuff out there. Is there any technology that you see that you think shows promise? What is on the horizon that you’re excited about right now?
[00:15:37] Jill: I think you’re absolutely right, there is so much out there. One of the most important things is adoption. I’ve seen many times companies investing all this money in technology that team members or residents haven’t been involved with helping to select. Then it becomes, “Remember when we had that thing we used to do here? Whatever happened to that?” It’s really important to us as an organization that we’re really careful about the technology that we use.
We do have in one of our communities a robot serving in the dining room. I’ll just say the jury’s still out on whether or not that’s actually reducing staff needs, but it is giving the team members more opportunity to be with residents in the community. What I’m excited about is artificial intelligence and video, and how that technology in particular can give people living with dementia more freedom, more autonomy while also keeping people safe. Think about people outside and not having to have someone watching you all the time.
I have a Ring doorbell. It tells me when it recognizes my husband’s face and it’s like, “Todd’s outside,” and, “Oh, by the way, somebody just picked up a package.” This tech, it’s cheap. This kind of technology is being used in retail, it’s being used in all these places. I think there’s a lot of opportunity to really find more applications for it in senior living for sure. We’re actually talking with some different organizations about what that could look like.
[00:17:35] Tim: There are a couple of tech providers out there where it’s like, with a family’s permission, there is a camera watching a memory care resident. If they fall, it can provide you data so that maybe that person does not need to go to the hospital or to the ER if they can’t describe what happened to them. Is that what we’re talking about?
[00:18:02] Jill: Yes. I think also giving especially residents with dementia the freedom to explore and be out and about. I know it’s a big topic, but how do we create inclusive dementia support for people? I think technology is going to be the answer to that. I think what you’re talking about is also really interesting. The idea of cameras on people all the time makes some people really uncomfortable, but there are also beds that can sense if this person is asleep or, is this person awake? I think there’s a lot of great opportunity to use staffing more effectively by using technology and then also promoting well-being for residents for sure.
[00:18:56] Tim: That makes sense. Keep me updated about the Servi robots because that’s a topic that I’m very personally interested in. I want to know how they’re doing.
[00:19:05] Jill: They’re really cool and the residents love it in the community. It was a big novelty when it first came out. I think they’re working well. I just haven’t seen the direct connection with reduction in laborers’ hours.
[00:19:21] Tim: Does the community do anything fun like give them names or put little faces on them?
[00:19:25] Jill: Yes, they named them.
[00:19:28] Tim: That’s great. I love that. I could probably talk about this for a lot longer, but I want to switch topics here. Before I do, I want to remind our audience that if you have any questions for Jill or comments on anything that we’re talking about, send them in and we’ll try to get to them throughout our discussion today. As a reminder, you have a Q&A window, type them in there if you want to weigh in.
Business intelligence is on this technology spectrum, if you will, but it’s a topic of its own. Collecting data, tracking it, just building all of this information so that you can use it to make decisions seems like a very big trend and a very big opportunity in the industry right now. I’m curious what you make of all of it and how you collect data and information and what you do with it.
[00:20:19] Jill: I’m really excited because I’m going to say by the end of this month, we are going to have everything implemented and rolling out. We invested in a software called PrimeView. It pulls data from payroll, it pulls data from all of our accounting systems, it pulls data from PCC, and it’s these amazing dashboards where every day you can get in there and say, “Where are we projected to be at the end of the month with revenue? What’s going on with wages?”
Our satisfaction surveys are going to link into that. Our satisfaction surveys that we do, CMS Five-Star ratings are going to be in there. Everything we need to know will be there and it’s not just, “Hey, here’s what happened.” It’s, “Hey, here’s what’s happening right now today,” so we can make quick adjustments and really adjust things to get where we need to go. We’re really excited about that.
[00:21:29] Tim: One of the things I’m excited about that I’ve heard of is using all of this data plus artificial intelligence to help determine, for instance, whether a resident is better-suited for AL or IL. Is that similar to what you’re talking about too?
[00:21:57] Jill: That isn’t part of this project that we’re working on right now. Do you mean in terms of how much the person might be needing in terms of assistance in AL for care levels?
[00:22:08] Tim: Yes. I’m just curious because I’ve heard this percolating as I’ve worked on stories.
[00:22:17] Jill: I’m going to make a note to ask about that, so thank you.
[00:22:19] Tim: Yes. Let me know. [laughs]
[00:22:22] Jill: I will.
[00:22:23] Tim: You just answered this question a little bit, but what specific metrics are you very keen on tracking? Just generally, what do you look at to make sure that I have my pulse on the company’s financial health?
[00:22:40] Jill: Of course, the big drivers of financial health are occupancy and staffing. I think that of all the areas where senior living has done a really good job, it’s understanding the pipeline of lead generation to conversion from lead to tour and tour to move-in. We always keep a very close watch on that and are really looking at how we can better measure the human resources metrics for how many applicants you need to get to fill one position or what your interview-to-job offer ratio looks like. We’re still working through some of those things.
What we’re looking at, in addition to overall team member retention, is 90-day retention. A trend we saw was that we were losing people in their first 90 days. We really track that and agency usage every day. What’s going on with that? We actually created our own internal community staffing department for our skilled nursing communities. All of them manage all of the staffing. Rather than calling an agency, they’re able to say, “Oh, hey, Tim from this community isn’t working. He can come over and work at the other community.”
Then of course equality impacts so many things, so what’s going on with our mock surveys? We do monthly satisfaction surveys with a percentage of residents. Then we started doing the culture value assessment last year through Drive, Denise Boudreau-Scott’s group.
Instead of employee satisfaction, it measures what are my personal values, what are the current values of Christian Living Communities, and what I want to see as values here. It gives you all this amazing information to see where you’re out of alignment. It’s led to amazing conversations. Again, I think we have to go deeper than satisfaction, so we keep a really close eye on those things as well.
[00:25:11] Tim: What do you make of the utility of some of these third-party survey providers out there? It seems like this could be a great badge of quality for your community. On the other hand, there are so many of these awards that, as a consumer, I have trouble understanding what they all mean sometimes.
[00:25:49] Jill: That’s a really good question. I think having a badge that says you’re the best of something helps, but what really makes an impact is word of mouth. It’s who’s telling someone they should come work here, who’s saying, “Oh, you should really move in here,” that I think really matters. We get regular awards through our satisfaction so we work with the Pinnacle survey. We get awards through that and we’ve had Great Place to Work but I think there are so many of them that people are confused.
[00:26:21] Tim: Yes. I want to talk with you also about the middle-market, a topic that comes up on basically every TALKS that we have these days. When I say the middle market, I should define this. We’re not talking about affordable senior housing. We’re talking about the folks known as the “forgotten middle.” These are folks that make too much or have too many assets for true affordable senior housing, but not enough to afford senior housing as it is today.
How are you thinking about that demographic, the middle market; and what do you make of that opportunity?
[00:27:14] Jill: That’s one of our goals with this redevelopment we’re working on is creating more middle-market residential living. We work with Senior Housing Partners, part of Presbyterian Homes.
It really takes looking at your building and making sure that you’re building a great building, but with a cost that is effective and can drive those rates. Then staffing models are really important, as well as amenities. It’s hard right now to make things work, at least from what I’m seeing with interest rates and construction costs, and a wage escalation makes it harder and harder.
One of our communities, Clermont Park in Denver, has all the different elements, which is really interesting. Life plan apartment homes, HUD, and what are really middle market rental apartment homes. When you get that whole mix together, it’s really interesting in terms of culture and it creates a really dynamic community. It also can help somewhat with spreading out the costs over different areas of the campus.
The other thing that’s kind of interesting is what’s happening with [2Life Communities’ Opus project] in Boston, and I’m following it very closely. They are creating a model where you need less staff because the residents are volunteering in that community.
I think there are opportunities. I’m really excited to see what happens with that and how we think differently about residents. We’re going to do a pilot in one of our communities to really promote, hey, here are these jobs that are open or these things that you would want to do. Particularly dining and other things like that. The thing is we have people that can’t afford senior living, we have a staffing crisis, and we have people that need meaningful purpose in their lives. All that comes together for me in a little different model. I think that’s exciting. I think where things get really hard is trying to figure out middle-market assisted living. We’re going to crack independent living before we crack the assisted living affordability, I think.
[00:30:29] Tim: We’re getting a little bit off-topic, but I want to share with you a vision that I have for the future. If you have any thoughts on it, great. If you don’t, no worries either. I’ve brought this up in other TALKS as well.
I wonder if looking down the road, folks that need middle-market services aren’t going to look at active adult communities and say, “This maybe isn’t what I need. If I could afford something else, I might maybe move into IL, but this is well within my budget, I can afford this. I’m going to move in here and try to stay here as long as I can.”
For the residents, obviously, if you can afford it, that’s great. But to me, that doesn’t seem like it’s really solving the problem. It’s just pushing it down the road a little bit because eventually these folks, if they live long enough, may not be able to live in that setting anymore. Again, that’s what I wonder about. What will happen in the future if active adult becomes the de facto middle-market choice?
[00:31:30] Jill: I think that’s really interesting. Then think about if you’re choosing to go live in a community at maybe a younger age and you have all those benefits of community living, you’re probably less likely to need higher levels of care because of all the social determinants of health. You might have cracked our whole problem, Tim.
[00:31:53] Tim: [laughs] If you see me getting into the business at some point, that’s your indication that I’ve cracked the whole problem. For now, I’m staying a journalist.
Value-based care, that’s another big trend. Another huge opportunity, but kind of a nebulous topic. When I say the phrase value-based care, it does not always seem like people think about the same things, but it’s a big topic. Lots of opportunities there. Can you talk about how CLC is working to integrate into that value-based trend? I also remember the Perennial Consortium and your involvement in that.
[00:32:50] Jill: CLC is part of a provider-owned Medicare Advantage Plan. Also, we’re looking at opportunities for ACO participation. I think when we talk about value-based care, it’s really about the value that senior living brings to the healthcare system. I know Lynne Katzmann talks about this a lot. She’s the one who’s taught me really all about this. People who aren’t socially isolated, being in an age-positive environment, having meaningful purpose in your life, continuing to grow and learn — all those things keep people well.
When people are well, you have less health care expenses, the benefits of that right now are going to insurance companies, Medicare Advantage Plans, or Medicare. Medicare Advantage Plans are growing so much every year in participation in that. Being part of an ACO or working with a provider-owned Medicare Advantage Plan or being an owner in one gives you the opportunity where those cost savings can come back to your community. You can use those savings to help pay for wages and keep the cost to the resident lower and lower. I think it’s something we absolutely have to continue looking at.
When you look at the growth of Medicare Advantage Plans, the squeeze that’s happening with what they will pay for reimbursement for skilled nursing, it’s a growing issue and it’s really causing financial distress, especially for providers that have skilled nursing as part of their mix. We had a special needs plan for the first year of the plan, and then we added an MAPD plan so that independent living residents or anybody who’s eligible for Medicare could also join the plan. I think it’s really important and I think more providers need to really look at this, how they can participate and how it can really help them provide better services to residents.
[00:35:40] Tim: I was at a LeadingAge. This was before the pandemic, probably 2018. But there was a really interesting panel I sat in on about getting into value-based care and some of the first steps. I’m curious, maybe you don’t have to give us first steps, but if I’m an operator and I’m saying to myself, “This is obviously very important, but I don’t know what to do.” What would you tell them?
[00:36:09] Jill: I would do research and talk with organizations that are doing this. There are a lot of different levels of engagement you can have. There are different risks and rewards that you can look at. I would talk with other organizations that are involved in this and do a lot of research and just evaluate what’s going to bring you the best opportunity.
It’s not our core competency, right? Managed care isn’t. But it’s important that we begin to learn more about value-based care and really recognize what we do and the important part that senior living plays in the healthcare system in this country. It feels like without us participating in value-based care, we’re sitting around begging for scraps. You know what I mean? To get more of, as Lynne says, a seat at the table; it will serve us, well.
[00:37:06] Tim: Yes. I was thinking exactly of Lynne’s words about having a seat at the table. I know she likes to talk about that, and it’s a great analogy.
I’m going to jump around here to another question I have. This is something that’s near and dear to my heart. I’m very passionate about it. DEI, diversity, equity, inclusion. I know that you’re a champion of this too. This is obviously another big topic and it’s a place where I think a lot of operators are scratching their heads and wondering, “Where do I start? It’s important, but what do I do?”
I want to get into some of this, but what is your top take on all of this? What does it mean to you and to CLC? I’ll ask you in a moment to talk about how maybe you can turn thoughts into words, but let’s start with just what this means to you and to CLC.
[00:37:55] Jill: It’s really important to me and to my organization, to my board of directors that we focus on this, and for a number of different reasons. It’s what people expect these days. The newer generation, people looking for jobs are expecting that you’re doing some of this work. We’ve got great amazing diversity in our direct care partner workforce. Then it’s just like every organization, you go further up and you see that diversity really starts to dissipate over time. It’s really important that we look at that and work around that.
Then there’s also LGBT inclusion, which really matters. When I think about this, it’s our team members, but it’s also the residents.
When you use terms like DEI, it triggers political beliefs, it triggers walls going up, and, “Oh, now you’re advocating for this and that.” It really can create division. We have a workgroup that’s been working on this for a couple of years now, and we really determined this is really all about belonging. It’s really about being honored, included, recognized for your individual identity. I’ve talked to so many people and asked, “Do you think that this person with this identity should feel like they belong here at CLC?” “Yes, of course.” “Oh, okay then.” People get that. Belonging is so much more of a human word than the phrase DEI, which people attach things to.
We actually added a new value called “we belong,” and it is about the things you traditionally think about with DEI. It is also, for older people; dementia inclusion, it is inclusion of people living with frailty who need walkers and wheelchairs, and if you have a continuum campus, who live in skilled nursing who oftentimes are pushed to the side. It’s about all of that too. It’s pretty big here, the scope of it all.
[00:40:32] Tim: I’m glad that you mentioned folks with dementia in that. I was actually having a discussion last week about the various ways here in Chicago that I personally felt that the city could be more friendly to people that are living with dementia and other forms of Alzheimer’s.
[00:40:48] Jill: I would suggest going beyond friendly to inclusive. I had somebody tell me that once, that the phrase ‘age-friendly’ felt like a pat on the head versus really engaging me.
[00:41:08] Tim: I’ll have to update my language. Thanks for sharing that. That’s a great perspective.
The second part of that question — which I think that you answered — is how do you turn those thoughts into action? A lot of operators that I talk to I sense that they struggle with this part. They have committees, they talk about the need to do this, but then when it comes down to it, it’s like a training that happens three times a year or something like that. That doesn’t seem like that’s the best way to approach this. Do you have any thoughts about turning words into action?
[00:41:46] Jill: Yes. We had a lot of starts and stops here too at CLC. We hired a consultant to work with us who could really help us move things forward. We started a workgroup, a committee of team members from our communities. We meet with them once a month. At first, it was leadership. The magic happens with our direct care partners and the people in our communities. We meet regularly. One of their reasons for being is to hold leadership accountable. Right now, we’re working on how we bring this to our communities and how we operationalize this in our communities. Then the other really important thing is what metrics. How do we measure if we’re really getting anything done?
I think investing in having somebody help has been really good for us. And engaging team members in this, because they are going to hold us accountable, which is really good, and they should. Then resident engagement, too, because they will also.
Again, that’s where I see this really taking off: When it’s at the community level, and team members and residents are working together. There’s a lot to do. For me, it helped me to just be like, “This is new and I don’t know what I’m doing, and we’re going to make mistakes and it’s okay. As long as we are one, you don’t have to know what the whole path is. You can lay the path as you walk it and that’s okay.”
[00:43:29] Tim: Sometimes I’ll hear the intergenerational conversation as part of all of this. I think there’s a lot of good thought behind this, which is the idea that if you help build these more organic communities where people support each other and belong and feel like they belong, that this kind of stuff will just organically happen. Do you share that thought?
[00:43:54] Jill: Yes, I think so. There has to be intention because if things just organically happened, then we wouldn’t have ageism in our society. There’s old people and young people and everybody living together, and we still have all this generational bias. I think there has to be intention around it.
[00:44:19] Tim: I want to ask you another question here. Every year, we do these senior living executive forecasts where we try to get a cross-section of folks to weigh in on what to expect for the year ahead. There was a very interesting response from HumanGood CEO, John Cochrane, who was also on TALKS a few months ago. He talked about the need to pivot away from crisis mode.
I liked that a lot because I sense that that’s what a lot of people in the industry are doing right now: Going from the crises of the last three years to hopefully the beginning of the growth or continuation of growth of the years to come. Do you have thoughts on that or examples of how CLC has made a similar pivot from crisis to growth or opportunity?
[00:45:05] Jill: Yes. I think John is spot on. We’ve been actually thinking about this a lot and talking about this a lot here at CLC. We were in crisis mode for almost three years, right? I feel like now we’re finally getting to a place where we’re out of that, but our brains were retrained during that time.
We were forced to take in information from a place of fear and from a place where there were really dire outcomes with what was going on with Covid. We had to make quick decisions and we had to tell everybody what to do. Our brains very much have been trained to be very reactive and I believe our organization has been trained to be directive.
One of the things that has happened with that is that I think we’ve created dependence at our community level on our support office and helplessness. We’ve created frustration for them because when you have an amazing executive director or a sales and marketing director, they don’t want to work in a place where people are telling them what to do. There’s been frustration from that place because all of a sudden, we were like, “We have to tell you everything you need to do.”
We’re really focused on moving back to being a support office, creating those conditions for empowerment at the community level, and the clear KPIs and your goals. It’s an attitude of: “You know what? You figure out how to get there. If you’re not meeting them, we’re going to come in, but you know what you’re doing.” By doing that, we free ourselves up as organizational leaders to do the work we’re supposed to be doing, which is thinking about the future and developing our organization further. That’s been a big shift.
I think there’s still a little we have to nudge ourselves back to that place even more. Over probably the last five, six months, I have felt us pick our heads up and say, “Now what?” It’s really just been survival for a couple of years and we have to retrain our brains and the way we do things so that we can move forward.
[00:47:37] Tim: Yes. Personally, these days with all of my working from home, I need to retrain my brain to leave my house. [laughs]
[00:47:43] Jill: Right. You get into a rut for sure. It’s just the way it is.
[00:47:49] Tim: Yes. Exactly. We have a little bit under 15 minutes left, and we’re approaching the last leg of our discussion here. I wanted to remind our audience if there’s anything that you wanted to weigh in with now is the time to speak. I want to talk with you about the future and just generally about what we can see next out of CLC.
I remember you had said last year that you were returning to CLC’s nonprofit roots and that that was a big focus for you. Now we’re a year away from that. What does that mean here in 2023 to return to those roots? How are you doing that or how are you already there?
[00:48:37] Jill: In the last two years, we were managing communities in seven states and had multiple partners that we worked with who were really good people. We really realized that we needed to really re-center the organization. There were issues with efficiency and being all over the country and there were also questions of who we really are and where we really want to go as an organization. That’s why it was very intentional that we have nine communities that we own or manage here in Colorado. We are still working with some for-profit organizations.
We’re really focused on making sure there is cultural alignment, that the things that matter to us matter to you and really focusing on nonprofit and very, very mission-aligned for-profit opportunities. I feel like we’re CLC. Not that it was bad, but it’s just we’re more back to who we are. I look at it as creating a really strong foundation from which we can now grow.
[00:50:10] Tim: Absolutely. We’ll talk about the avenues for growth. I think you had mentioned earlier affiliations and some other things. Before we do that though, how do you think senior living demand is going to play out over the next 12 months? Or maybe another way to ask that is what are you at CLC preparing for?
[00:50:51] Jill: We are very much seeing demand back where it was. Skilled nursing has been the most recent where we’ve really been able to get occupancy back up in skilled nursing. I think we’re going to continue to see strong interest in senior living. With life plan communities, the housing market impacts all of that. We really haven’t seen a big drop-off. We’ve got strong wait lists and I’m feeling really positive.
[00:51:50] Tim: Let’s talk about growth a little bit. You mentioned affiliations earlier. What avenues of growth are you looking at? Maybe rehash some of that stuff, and then how might we see CLC grow next?
[00:52:05] Jill: We’re looking at affiliation opportunities with other nonprofits, we’re evaluating if communities for sale come up, especially in Colorado.
Again, it’s really how we serve people in their homes. There’s a lot of exploration going on right now, I would say. Within the last year, we really refined what we were looking for. What are our geographic limitations? What makes sense? What doesn’t make sense? Otherwise, you’re chasing things all over the place, and that’s not a good use of resources. We really spent our time really refining what that looked like.
[00:52:45] Tim: I know that obviously with life plan communities, you cover the whole care continuum, but is there a rung of that ladder that you think you’ll be particularly focused on in the future?
[00:53:12] Jill: Yes. Life plan communities are our sweet spot. We’re really good at life plan. We’re really good at a lot of things. If you look at anything with the staffing situation, then you lean more toward the opportunities that don’t require a lot of staffing. Independent living with very limited services, those kinds of opportunities, there’s a lot less risk and a lot less volatility of the impact of wages and labor pressures on that. Those are focus areas. We’re not going to go and buy skilled nursing right now. I can tell you that.
[00:53:53] Tim: Or launch an active adult division tomorrow?
[00:53:57] Jill: We’ll see what comes.
[00:53:58] Tim: Yes. [laughs] I’ve been hearing a lot of that answer on that specific question.
If you had the power, let’s say you have a magic wand, you can wave it and change one thing about the senior living industry, what are you going to change and why are you going to change it?
[00:54:18] Jill: Oh, it’s my favorite question. If I could wave a magic wand, I would have senior living providers follow the evidence. I think we think we’re following the evidence a lot of the time, but here’s the thing. We are so focused on, and I’ve seen this shifting a bit, but creating these environments, hospitality heavy come in, we’ll do everything for you. Investing in all of these amenities and services. Those things are important, but they’re one piece of it. If you go back to studies that– I think it was ASHA that did the “Make them Feel at Home” study — it was really all about how the amenities and food only matter so much, but what really matters is feeling at home. What drives feeling at home is having meaningful relationships and feeling like you have control over your environment and things like that. The most recent ASHA study was all focused on how important purposeful living is to consumers. I feel like we’re perfectly positioned for that because we are very focused on what we call the citizenship model. Rather than seeing people as customers, you’re citizens, you have an active role to play, you’re part of something.
Then the other research is about what we need to live a long and happy life. I have never seen one piece of evidence that says you need a life of leisure. It’s not out there. What it does show is you need meaningful roles, you need meaningful purpose, you need to truly belong, so going back to that DE&I work. You need to continue growing and learning and need to be in an environment that pushes back against the negative views of aging.
All that evidence is out there. I think it points to community and I think it points to doing our own work inside our own heads because all of us have ageist beliefs and ablest beliefs when it comes to dementia and frailty. If we really dig into the research, it guides us in a different direction than where we are right now. It really guides us to creating cultures of inclusion and belonging and meaningful purpose. I’m seeing it happen, but I’d love to see more of that.
[00:56:45] Tim: I’ve been talking to folks over the last few weeks about the utility of this. Are you familiar with this ChatGPT or these other chatbot programs?
[00:57:15] Jill: I just used it for the first time the other day and it was amazing.
[00:57:19] Tim: Yes. I write fiction on the side sometimes and I was playing around with this, and it’s very powerful and very interesting. As I was playing around with this, I thought, “I could see this having some utility in senior living.” I don’t know what the utility would be. Maybe in marketing or maybe as a chatbot on a company’s site. Is that on your mind in a similar way?
[00:57:43] Jill: Yes. Absolutely. My brother’s in a totally different field, but he was talking about what if that type of technology overlaid the data you have in your organization, and you can, say, ask questions and it can pull out that information you need to make business decisions. Like where am I generating the most profit? It’s mind-boggling what is happening. I think there are opportunities, we just need to figure out what they are. What do you think?
[00:58:21] Tim: What I think is there’s probably a lot of utility to this, but I think there’s a little bit of a dark side to some of this too. When I say dark, I don’t mean that there’s going to be some robot that’s going to take over the world. What I mean is — I was just reading a story about a different chatbot, Microsoft’s Bing, which is a rival to ChatGPT. There are all these stories out there about how this chatbot is having emotional breakdowns because people are asking it specific questions. It’s wild.
So I do see this as a powerful tool if you use it right, just like any other powerful tool. I think this will probably have some utility somewhere. I’m very excited to see how it plays out. I’m just a little bit nervous it’s going to take my job, [laughs] but that just means I’ve got to be the best dang editor I can and beat those computers.
All right. This has been a lot of fun. I think we’re about out of time. Jill, I just want to thank you again for coming on this program. You’re always a pleasure to talk with. Thank you for coming on SHN+ Talks. Thank you for CLC of course for making this happen.
[00:59:44] Jill: Thank you, Tim. I really appreciate it.
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