Memory care is a complex, hands-on line of work where caregivers, residents and their families form close bonds. But at scale, maintaining a level of quality in memory care is easier said than done.

Having a presence spread across multiple communities is a double-edged sword. With scale comes additional resources and support, typically from a corporate support center or back office. On the other hand, executing on high-quality memory care services across an entire portfolio is easier said than done, with many moving parts that can derail even the best-laid plans.

For some of the largest senior housing operators in the country, the challenge is balancing autonomy and standardization and navigating both the need to offer personalized memory care services with the need for continuity in quality and standardization across a large portfolio. Operators must often rely on communication and supporting regional leadership to ensure benches aren’t stretched too thin. Larger companies also deal with initiatives gaining traction quickly.

“In a big company, it’s a big ship to turn,” said Life Care Services (LCS) Vice President and Director of Health Services Sharon Maguire. “Getting traction on programs, even though you may have the best idea and the best people contributing to it … is really challenging.”

The LCS family of companies is based in Des Moines, Iowa and operates a portfolio of more than 130 life plan and rental communities that include about 2,500 memory care units.

But if senior living is more akin to a cruise ship than a dinghy, there are also operational advantages in driving such a large boat, according to Arbor Company Vice President of Memory Care AJ Cipperly. Atlanta, Georgia-based Arbor operates approximately 1,000 memory care units across a portfolio of over 40 communities.

Having the resources at-hand can lead to potential benefits on things like food and supply costs, and leveraging data and pilot programs across communities to measure outcomes can improve operations and care.

“The advantages are having more resources, certainly financial resources, personnel resources, more bench strength,” said Arbor Company Vice President of Memory Care AJ Cipperly during the recent Senior Housing News BRAIN event in Washington. “We’re able to have subject matter experts as discipline leaders to really lead initiatives like memory care engagement and clinical resident care.”

Gaining traction

LCS has a proprietary memory care platform, Heartfelt Connections, and the company’s leaders implemented a scorecard to track site visits, tracking company priorities with communities being awarded bronze, silver or gold levels of compliance. That allowed LCS to define its memory care standards and gave management “better traction” in executing key components of its memory care program, according to Maguire.

“We took something that we perceived as a challenge to help move toward more consistency and better execution of what we really want to see happening every day,” Maguire said.

Scale allowed LCS to get clear branding and messaging out regarding its memory care program thanks to efforts by sales and marketing teams. While continuity might be a good thing across a brand overall, Maguire noted that communities need flexibility in certain areas to appeal to local audiences.

One example of local community flare is an LCS community running a chicken coop on campus, something that not every community has.

“That element of programming around that chicken coop helped that local flavor come alive,” Maguire said. “So this ability to localize a national standard is critical, but this brand is important to us.”

As a way to instill a sense of cohesion among different services, Arbor created a service vision that defines what the company wants their memory care communities to look like and how to function. Instead of controlling them to a tee, Arbor offers each community room for creativity. That fits the company’s specific goal of meeting customers where they are at in their respective markets to boost leads, visits and move-ins.

Arbor allowed communities to use the same vision: “We Create Home.” But they instructed the leaders to translate that for their communities, resulting in a colorful melange of practices that ranges from. dedicated staffing and consistent staffing assignments, to more welcoming physical and community layouts for residents.

“How our community does that in Atlanta may be different than how our community in Texas does that,” Cipperly said. “As we’re executing on that vision, and that guiding principle, we’re meeting that standard.”

Staffing, leadership key to continuity

While a corporate office can launch a brand, it’s the employees at the community level that ensure rollout and standards are met. That’s why it’s important to be “empowering those who are training at the community level,” Maguire said.

The LCS Heartfelt Connections memory care program would not be possible without the on-site training provided by community staff to new employees. That led LCS to add elements to the branded program, increased training to support leaders and increase buy-in from staff.

“This ability to localize a national standard is critical,” Maguire said.

Cipperly said by getting staff on the same page, Arbor is able to allow its memory care program “to have a voice.” In the past eight months, Arbor has been able to allocate resources to build out new roles once there were perceived gaps in staffing.

“Being able to have a seat at that table to talk about how the decisions that are being made are impacting our memory care neighborhoods, and our memory care customers is really important,” Cipperly said.

After seeing a high rate of turnover among memory care directors, Arbor created Cipperly’s position. That started “reframing the onboarding” for memory care directors and how they are trained. For the last nine months, Cipperly has helped empower local community staff and offers in-person training to make stronger connections, rather than issuing directives from a corporate office.

A similar effort is also underway for LCS, with the company in the process of “reconfiguring” areas within its org chart to support regional staff like Maguire. That’s where the company’s corporate resource team comes in. Made up of individuals at the community level, the resource team is the “star performers” in various areas and is designed to cover all areas, not just memory care.

“The folks can offer coaching, on-site support and they’re plucked from the community for a period of time and are kept in touch by corporate team involvement with steering committees.”

A memory care steering committee fills the gap of a national memory care director, and allows for new opportunities and collaborative contributions in a positive, supportive environment for staff, Maguire said.

Even at scale, Cipperly said memory care programming wouldn’t be possible without a “person-centered approach” with residents and families demanding personal connection. She added that operators need to be aware of what types of memory care communities they are starting, and be intentional with the spaces they create.

“The question is: are we creating communities that our future residents want to move into, and you need to look at your product, and if the answer is no, you’ve got work to do,” Cipperly said.

In the near future, Maguire said she believes that Medicare Advantage plans will “change our world” of memory care, and larger operators have a “great opportunity” to be part of that conversation.

“Large operators really can make an impact here by looking at you know, being in network, looking at cost and risk sharing, as well as moving that continuum back toward the home,” Maguire said.