Q: I keep hearing the senior living management structure is changing. What’s new?

A: Here are several issues:

1. The complexity of the management function is increasing. Individual management contracts and entire management companies now are having to deal with a very complex, sophisticated senior housing business model.
2. Management of the senior housing continuum is becoming more complex. Due to senior consumer behavior, preferences and increased acuity, the senior living continuum frequently is subject to extensive overlap.
3. The property ownership and management company business mix is changing. Public firms and others are entering into a variety of sale/manage-back relationships with new owners.
4. Third-party management companies are necessarily developing or acquiring increasingly complex resources. Typical resources include:
   • Sophisticated systems and procedures.
   • State-of-the-art software.
   • Intellectual property.

Jim Moore is president of Moore Diversified Services Inc., a national senior housing and healthcare consulting firm based in Fort Worth, TX, that has been serving clients for 46 years. He has authored five books about senior living and healthcare, including Assisted Living Strategies for Changing Markets and Independent Living and CCRCs. Jim Moore can be reached at (817) 731-4266 or jimmoore@m-d-s.com

Q: Shelley, senior vice president / chief people officer is a new position for Ecumen. Why did you believe it was important to create it?  

A: This is a very exciting time in our field, as Ecumen works to identify innovative solutions for our customers today and in the future. When it comes to our people, we want to be laser-focused on how we can be the best possible employer.

As everyone here knows, I’m always talking about making sure that our teams have what they need to do their jobs even better. One element of this is ongoing training to consistent standards of excellence, and another is about recognizing individuals for their unique gifts and helping them grow in their professional journeys, so they choose to stay with us.

I’ve known Mel for many years. I know her strategic vision will help us do some exciting, innovative things. And her mission-focused perspective is so well-aligned with Ecumen.

Q: How many people does Ecumen employ?

A: Approximately 3,000.

Q: Does Ecumen have any unique workforce-related challenges?

A: I know that we share many of the same workforce “opportunities” with others in our field and in the healthcare field. We will continue to evolve to meet the changing needs of our customers and our workforce.

Q: Mel, what attracted you to the role at Ecumen?

A: It was a combination of many things — knowing both Shelley and [CEO Emeritus] Kathryn Roberts professionally for many years and having great respect for their leadership of Ecumen. I’m truly honored to be joining Ecumen, to work alongside this large team of dedicated people in their mission of service. 

Q: You join Ecumen from a similar position at Constellation, a collective of medical insurers and health service organizations, and also have experience as CEO and chief operating officer at Twin Cities Orthopedics and St. Croix Orthopaedics. How do you think your previous experience will benefit Ecumen?

A: Healthcare delivery is about creating an environment where people can provide the best care possible to the customers. This applies to all areas of the care continuum, and it’s something that I am passionate about supporting. Ecumen delivers exceptional care, and it is provided by highly committed and talented people. My healthcare experience provides a strong foundation for this work.

Q: Regarding human resources, in what ways is senior housing and services similar to the areas of healthcare in which you have worked, and in what ways is it different?

A: It’s similar in that both reflect a time of change, and sometimes uncertainty, in people’s lives. As care providers, we can be the constant, the stability, the assurance.

Both areas can be challenging. We need to support and recognize the extraordinary efforts being made. It’s different in that senior housing and services has not always had the visibility as a career path for young professionals.  This is changing with the dramatic growth in the field.   

Q: Do both of you envision new initiatives in the human resources area at Ecumen?

A: We’re expanding the outstanding work we’re currently doing. We want to continue to evolve to recruit and retain outstanding employees, conducting strategic workforce planning to help set the stage for the future.

Effective labor management involves far more than basic payroll applications, however. Today, operators have access to a range of sophisticated solutions to help them recruit and retain top employees, forecast scheduling needs, enhance compliance with staffing-related regulatory requirements and empower employees with real-time access to scheduling, earnings, time off accrual, training and more.

“Managing labor in senior living is a multidimensional issue because it requires a solution that can efficiently manage day-to-day concerns [and ideally help] companies determine proper staffing levels based on current community acuity levels,” notes Trish Cole, chief operating officer and general counsel at Medtelligent Inc.

Experts agree that the key to better labor management is effective capture, utilization and dissemination of valuable data, and customizable and user-friendly technology solutions that facilitate widespread, simplified adoption.

“Current labor management technology reduces waste, decreases payroll error and also [enhances] a facility’s position in the market in terms of being an ‘employer of choice,’” says Susan Reese, DNP, MBA, RN, CPHIMS, chief nursing executive / director for Kronos Inc.’s Healthcare Practice Group. She points out that almost half of employees surveyed by The Workforce Institute at Kronos wish their workplace technology performed like their personal technology, whereas almost one-third of healthcare employees feel that outdated processes and technology make their jobs more difficult — two factors that make smart labor management solutions a wise investment.

RECRUITMENT DONE RIGHT

A key benefit of today’s labor management solutions lies in its ability to help drive top talent to available positions and build a quality candidate pool for future employment opportunities.

According to Martha Abercrombie, product marketing strategist for HealthcareSource (formerly Vikus), optimal labor management begins with hiring the right people faster, keeping them longer and then fostering their growth along with that of the organization.

“With 75% of directors of nursing services citing staff shortages as their most challenging job duty — and the demand for healthcare labor on the rise — it’s critical for organizations to invest in both recruiting and retention efforts,” she says. “With increasing staff vacancies and overworked employees, it is tempting to just keep filling open positions as quickly as possible rather than slowing down and fixing the real problem, which just might be the hiring process itself.”

SMARTER SCHEDULING

Once quality employees are hired, it’s essential that operators assign the best employee for the job and not put too big a load on them, which can negatively affect care and resident and employee satisfaction. Fortunately, today’s sophisticated labor management tools can help mitigate risk, facilitate better care and maximize productivity, as well as revenue.

Gustavo Sapiurka, senior vice president of affordable and senior markets for RealPage, explains that the data captured by robust information technology solutions can take the guesswork out of scheduling and planning through the use of business intelligence, metrics and predictive analytics. Proper use of captured data can help providers determine when and where the most labor-intensive tasks are taking place, he says, and over time, can help operators better assess their future staffing needs based on census and trends with move-in and move-out dates. When more data are captured in labor management solutions and then proactively monitored and evaluated, organizations potentially can even foresee how many emergency department visits related to falls might be coming, for example, based on specific resident averages, metrics and characteristics. This information then can help operators make necessary care and scheduling changes to reduce those risks.

“Understanding the data is very important,” Sapiurka says. He pointed out that executive directors and regional managers are, perhaps, best suited for evaluating data and monitoring trends to better manage labor, occupancy changes and care needs. “You need to go through the data and normalize [them]. As you get more sophisticated in understanding, you can use [them] to project future needs.”

Predictive scheduling solutions also can lend themselves to greater visibility with staffing-related regulatory compliance. Staffing tools can help ensure that employees are receiving proper breaks and taking breaks in adherence to the organization’s policies and labor laws, Reese notes. And because labor levels at senior living communities fluctuate based on staff illness, vacation and other variables, “an advanced forecasting solution can help reallocate labor as needed to avoid open or unfilled shifts on the schedule,” she reasons.

Labor management technology’s artificial intelligence and machine learning capabilities offer increasingly advanced benefits to end users. According to The Workforce Institute, 82% of employees worldwide see an opportunity for AI to improve their jobs and would welcome AI in the workplace if it simplified or automated time-consuming internal processes, helped better balance their workload, increased fairness in subjective decisions or ensured that managers made better choices affecting individual employees.

“It’s worth exploring the intelligent capabilities now available to empower managers with real-time, strategic labor data and engage employees with AI-driven, self-service features to streamline scheduling and requests,” Reese says.

RISK REDUCTION

The shift toward computer-based labor management solutions is helping operators mitigate risk on numerous fronts. Not only are manual spreadsheet-based approaches inefficient, they are not secure because information easily can be manipulated or deleted and also can give inaccurate information through slight formula mistakes, Cole says.

“Computer-based solutions help eliminate risk because the system is backed up and numerous people are usually trained on usage, so the tasks can be fairly easily picked up by someone new,” she adds.

Interoperability and integration capabilities lie at the heart of effective, efficient labor management data capture and compliance, allowing operators to manage the entire employee lifecycle — from punch to payroll — with a single solution, as opposed to multiple stand-alone systems. A single solution that unifies labor management with human capital management capabilities, such as payroll, talent acquisition, on-boarding, core human resources and performance management, will offer operators the biggest return on investment, Reese says.

One Michigan-based nonprofit senior services provider with almost 700 clinical employees working across four locations experienced firsthand the challenges associated with a mix of disparate automated and manual scheduling, timekeeping, attendance and payroll systems. Not only were the systems used at Holland Home inefficient and costly to maintain, they made regulatory compliance a struggle, prevented managers from regularly accessing employee time data to avoid unnecessary overtime, and provided no real-time visibility into employees’ accrued time.

After adopting the Kronos for Healthcare automated workforce management suite, Holland Home was able to use a centralized scheduling model to build schedules behind the scenes based on budget. The centralized scheduling department creates schedules for clinical staff for assisted living, skilled nursing and hospice by using a staffing model that indicates the number of registered nurses, licensed practical nurses and nurse aides needed for each unit and shift; that information is built into the Workforce Scheduler. If an employee calls off, any central scheduler can send an open-shift request to a suitable replacement because the solution’s integrated human resources module tracks employees’ skills and certifications and indicates which employee has the right skills to fill an open shift.

Additionally, Holland Home was able to use automated tracking and reporting of regular and contract staff hours, which supported compliance with Affordable Care Act payroll-based journal reporting requirements and provided managers with real-time access to employee accrual balances, as well as daily overtime reports.

“Now we can see overtime by person and look at the schedule census to determine if overtime was needed,” says Doug Himmelein, vice president of human resources for Holland Home. Through efficiencies and a reduction of payroll and scheduling staff, Holland House saves $100,000 in wages annually.

EMPLOYEE EMPOWERMENT

Labor management tools don’t just streamline operational efficiencies for managers; they also give employees at-a-glance access to schedules, time cards, earnings, time-off accrual balances and even training and certification information and resources. Many of today’s solutions allow easy access to the information from a mobile device, which further boosts efficiencies and employee satisfaction.

Additionally, integrated labor management solutions can enhance employee engagement through strategic surveys and e-learning tools and tracking capabilities. “Every time a new employee is added to the HR system, they are entered into the learning system, as well,” Sapiurka says of RealPage’s senior living solution. Staff can be trained and kept up to date on company policies and processes and remain compliant with regulatory requirements such as the Health Insurance Portability and Accountability Act.

Senior living communities choose to partner with a company to manage pharmacy services for many reasons. One is the growing problem of polypharmacy. Another is the increase in adverse medication events and the negative publicity it brings.

This is why medication management is a growing concern among families of community residents.

Jennifer Hardesty, Pharm.D., FASCP, chief clinical officer and corporate compliance officer for Remedi SeniorCare, says it’s a topic that arises during virtually every conversation between a community’s sales and marketing representative and the prospective resident. Of course, licensing and fee structure can determine what kinds of medication management a community can provide, she warns.

“Assistance with medication management and administration can be one of the top reasons prompting a move into a senior living community,” she says. “A senior or their family may no longer be able to self-manage their medication regimen. The stress of prescriber communication and delivery to worrying about the administering and monitoring of the medications can adversely impact the quality of family relationships.”

Few marketed services scream safety more than medication management. “Advertising smart medication management systems promotes the wellbeing of the residents and their families,” says Patricia Howell, RN BSN, WCC, CFCS, clinical support manager for McKesson Medical-Surgical Extended Care. “These systems take the burden off family members having to manage the medications.”

Consider just the task of getting a list of a resident’s meds. Having a responsive medication management provider offers a great deal of peace of mind in the event of an emergency or an upcoming physician office visit, says Trisha Cole, COO of Medtelligent.

Accuracy is another buzzword.

“Simply having medication management services is part of the table stakes,” says Andy Brigant, vice president of pharmacy sales for PointClickCare. “Facilities that do not have medication management capabilities may risk being viewed as unable to grow with residents as their care needs progress. With constantly evolving, strict regulations governing medication administration and pharmacy dispensing compliance, it’s vital that providers create and maintain accurate records.”

Joe Kramer, vice president of sales and marketing for Geri-Care Pharmaceuticals Corp., believes “the first and best option to market to prospective residents or their gatekeepers is your facility’s low Medication Error Score. Numbers don’t lie, and once they see how diligent your facility is in ensuring residents take the correct medication at the right time, you have already earned their trust.”

Speaking of trust, having a geriatric pharmacy specialist on staff who is available to answer clinical questions goes far in instilling confidence, says Sarah Barker, Pharm.D., general manager of Montgomery Pharmacy for Turenne PharMedCo.

“When a resident makes the challenging decision to move into a senior living community, they and their family should have assurance that they are turning over the management of medications to a trusted team,” says Courtney Oland, president of Guardian Pharmacy of Maine. “Savvy operators choose their pharmacy partners carefully to meet this need.”

The trust also extends to operators themselves, who must have confidence in the clinical expertise of their pharmacy partner. Although not required by law in many non-skilled senior living settings, clinical oversight by a skilled senior care pharmacist can make the difference in the quality of life of residents and in turn, increase satisfaction with the community, Oland adds.

Another big issue is the high cost of drugs.

“Moving into a senior living community often changes the landscape of finances for the resident — they may go from owning a home to paying a monthly rent. Changing pharmacy providers can bring on uncertainty about ongoing medication costs,” says Libby McDonald, RN, senior vice president, account services, for Remedi SeniorCare.

For those residents coming from a hospital stay or departing home for any other reason, continuity is a topic near and dear to many families. Few things would imbue ease of mind among family members more than having a trusted pharmacy services provider that handles these changes for a living.

“The family wants to know that it will be a smooth transition behind the scenes, but most importantly, that their loved one won’t be without their medications,” McDonald says.

Medication errors are among the biggest gaffes during transitions, and the leading cause of trips back to the hospital.

Continuity is a major focus in provider-pharmacy services relationships, according to Chad Worz, Pharm.D., BCGP, CEO of the American Society of Consultant Pharmacists. “Operators are realizing that the cost of unmanaged patients is high: lower census, held beds while the patient is in the hospital, higher staff requirements in care and the ability to differentiate service level versus competitors are factors that more than justify the addition of a senior care pharmacist and specialized pharmacy.”

THE HOT BUTTONS?

This is the age of 24-hour everything, and that could not be more common, yet essential, than in the pharmacy services and senior living worlds.

“Five years ago, as a general rule, assisted living communities preferred partnering with smaller, local long-term care pharmacies because the relationship was strong and the needs of the residents were less from a medication perspective,” Cole says. “Now communities are seeing higher-acuity residents and have the need for around-the-clock services to attract and retain residents, so even though they still seem to prefer the smaller, local pharmacies, those pharmacies have not transitioned to supporting that.”

Packaging and delivery are another must-have. The greater the options and flexibility, the better.

ADVICE FROM THE EXPERTS

Here are some quick insights for those senior living providers considering or knee-deep in arrangements with pharmacy services companies:

Be as broad as possible with service offerings. Senior living residents prefer it, experts say. High on the list are electronic records technology and innovative dispensing methods — two “wonderful tools that help people manage their medications,” Worz says. Yet, although they improve staff efficiency and save money, they are only tools. “Good pharmacy service and a good consultant pharmacist go hand in hand and ultimately are not very expensive. Shorting one side of the management system or the other opens the door to more risk and higher cost for both the operator and the patient. Good utilization of both services ensures a healthier and less costly patient population.” Never miss the opportunity to tell residents they always have a choice, however.

Don’t oversell or overpromise. “An organization’s advertising needs to be honest and transparent about what they can offer, as well as any challenges related to medication management that they’re currently addressing. Otherwise, they may face legal challenges,” Brigant says.

Cole agrees. “My advice to communities marketing these kinds of services would be to stick to the facts and not overpromise,” she says.

Don’t dilute the clinical image of the partnership. “Most providers are attempting to provide a more homelike and social model of care,” Howell says. “This model of care isn’t always realistic when there are people who require more help with their medical needs, such as medication administration.

Finally, ensure the partnership is a good fit. “In deciding what type of medication service you are going to promote, operators also should consider, first, who will be administering the medications; and second, how often those medications would potentially be changing,” Hardesty says. “Choosing a medication management system that fits your community well can make medication procurement and administration a safer, quicker, more effective process for staff and residents.”

As the association observes its first anniversary, Ader counts more than 400 members in his organization, which suggests to him that senior living community operators are taking food quality and service excellence very seriously. As someone who has worked with providers and food service contractors, Ader says he started the association because there has been a noticeable gap in connecting providers with food service resources.

“So we took a leap of faith in thinking that if there was a need, they would come,” he says. “Now our growth and evolution is progressing quickly.” Lou Boudreau, senior vice president of operational excellence at Unidine, agrees that quality food service is a timely revelation for senior living operators.

“As the industry expands and evolves to accommodate the growing aging population, we are seeing a proliferation of new senior living housing being developed,” he says. “For these communities, a standout dining program isn’t just ‘nice to have.’ It is a must-have in to attract and retain residents in this competitive marketplace.”

Boudreau says Unidine is committed to being “agilely responsive” to two parallel trends affecting senior living operators — younger, vibrant residents who seek elevated experiences, and residents with complex health issues.

“Resident demographics are evolving, and with that comes changing expectations that we need to meet,” he says. “These discerning residents are retail-minded and expect dining experiences that are nothing like the conventional dining of senior living communities of the past. We are seeing that our commitment to scratch cooking, healthful offerings and passionate hospitality culture resonates strongly with them and aligns with their existing food experiences and service expectations.”

BE CONSISTENT

Many components make up a quality food service program: locally sourced ingredients, imaginative dishes, professional preparation, attractive dining environment and a “fun” approach to meal time. One aspect supersedes all of them, however, Ader says.

“Consistency,” he says. “That one is the biggest. If you have consistency in your food and what you do, that’s the ultimate.”

Comprehensive training is another essential aspect of a quality food service program, Ader says, because the senior living environment “is not a restaurant, which just focuses on the food. No … for us, there is much more to consider.”

Variety and choice are other critical pieces of the food service puzzle, because they enhance resident choices to create an overall positive experience, Ader says.

One more ingredient in the equation is something that may get overlooked when trying to present a high quality program: food optimization.

“A big reason for high food costs — especially in smaller communities — is improper utilization of food resources,” he says. “Manage portions so that there is little left over at every meal.”

CREATING AN EXPERIENCE

Food service contractor Sodexo has implemented forward-thinking programs across the senior living continuum, working closely with operators to ensure that each resident has a memorable experience with each meal.

As Vicky Kriczky, director of marketing and sales for Frederick (PA) Living observes, “Food brings our community of residents together.” The dining program at the community “is not just about providing meals, but about delivering an exceptional experience that engages all the senses — from delicious aromas to modern atmospheres to opportunities to engage with fellow residents,” she says. “In fact, it is common to see residents pushing tables together to enjoy their meal as a group.”

At Garden Spot Village in New Holland, PA, the primary mission of the food service program is “to enrich lives … that includes delivering a high-quality dining experience that exceeds residents’ expectations,” says Chief Marketing Officer Scott Miller. “The high value that today’s senior living community residents place on their dining experience has escalated dramatically in recent years. They are looking for the authentic flavors they’ve tasted in traveling the world, as well as farm-to-table freshness and options to customize their meals.”

INNOVATIVE TRENDS

One of the Senior Dining Association’s missions is to research current food service trends and report their findings to members through published articles. Among their findings are innovations such as farm fresh ingredients, destination dining, fast casual, college model and chef-driven meal preparation.

Destination dining is “a newer concept, where you have a dining room for specially themed meals, like intercontinental dining, steakhouse fare or Chinese flair,” Ader says. “The college model is a brand of marketplace, like a food court with different stations. Some communities have even installed touch-screen point-of-service kiosks.”

Boudreau considers developing new programs for senior living communities “a crucial priority” for Unidine.

“Consider for a moment the university student or corporate experience and the dining programs created for those demographics,” he says. “We hope to translate those successes and learnings into the senior living experience, with the correct modifications and appropriate elements.”

For senior living residents, dining isn’t just about early bird dinners, but about the experiential factor, Boudreau says.

“From poolside cooking and Hibachi grills to chef’s tasting menus and craft cocktails, these worldly residents expect their communities to have multiple retail-style dining experiences beyond the traditional sit-down dining room,” he says. “Retail-oriented dining, such as pubs, bistros, coffee bars, healthy fast-casual options and to-go service, are available to cater to their needs and wants.”

Additional branding opportunities, such as providing house-branded coffee and signature cocktails, give communities a valuable competitive advantage in the marketplace, Boudreau says.

Tara Ober, vice president of communications and resident life at Brethren Village in Lititz, PA, says Sodexo’s chef-driven program has generated much interest and engagement from residents and their families.

“Our chef’s innovative menus help drive our brand and identity among peers and a strong waitlist for our community,” she says. “Inspired by the rising popularity of celebrity chefs, people are eager to try new and interesting tastes.”

Responding to the trend for freshly prepared, made-to-order food, the Brethren Village Center Bistro features multiple stations, including a pizza oven, sandwich and salad station, grill and chef’s daily specialties.

“Our residents and other customers enjoy talking directly with the chefs who are preparing their meals, offering both customization and socialization,” Ober says.

MORE VEGGIE OPTIONS

Health, wellness, nutrition and vegetarian options have become increasingly important to senior living residents, and communities are responding accordingly.

At Laurel Circle in Bridgewater, NJ, the community’s philosophy is “healthy life services,” and the food service program accurately reflects that stance, says Sara Miller-Philpott, director of marketing.

“Sodexo is proud to source nearly 90 percent of produce from local farms, enabling chefs to build creative menus around what’s in season,” she says. “Local sourcing aligns with our priority to provide healthy and fresh food to the Laurel Circle community.”

With more vegetarians and vegans among senior living residents, communities are searching for the freshest produce available. Garden Spot Village, for instance, has installed a 4,600-square-foot aeroponic greenhouse on its property to ensure true farm-to-table produce.

The movement toward healthful meals makes perfect sense, and companies such as Sodexo are making it a priority, says Ray Torres, senior director of business development.

“Good nutrition is key to a healthy lifestyle,” he says. “With more seniors taking control of their health with gluten-free, keto and other dietary programs, chefs must know how to provide excellent food that meets food preferences and intolerances.

“Chef demos provide a terrific way for residents to try new dishes, learn about ingredients and see how their meals are cooked — all creating an enjoyable activity that keeps them mentally active and healthy,” Torres adds.