A significant number of senior living companies have implemented diversity, equity, inclusion and belonging programs in the past year, indicating that more owners and operators are “leaning in” to those initiatives to meet strategic goals, according to new industry research.

But the authors of the report about the results of the 2023 Senior Living DEIB Survey, which was released Wednesday, say it’s time for operators to focus on actions aimed at improving retention in addition to recruiting.

“Organizations should establish a holistic vision for what they are trying to achieve through their DEIB efforts,” they wrote. “It is time to move beyond the focus of just recruiting diverse talent. Companies must foster inclusive work environments that provide a sense of belonging, so that they can retain the talent that they work hard to attract.”

The survey, which continued to track the industry’s progression addressing DEIB initiatives, was conducted by Ferguson Partners and sponsored by the Senior Living DEIB Coalition, a two-year-old partnership among Argentum, the American Seniors Housing Association and the National Investment Center for Seniors Housing & Care.

Although more work lies ahead, Argentum President and CEO James Balda said that it is important to acknowledge the progress to date.

“It is exciting to note that this year’s survey showed an increase in the percentage of companies with formal DEIB programs, from 27% to 40%, which indicates a growing recognition within the industry of the importance and positive impact of promoting diversity, equity, inclusion and belonging among employees and residents,” Balda said in a statement. “A formal DEIB program is an important step to foster a culture of diversity, equity, including and belonging, which also bolsters employee engagement.”

Recommendations

The survey, however, also revealed that well more than 80% of executive positions are held by white employees, presenting a “huge opportunity” for racial/ethnic parity at the executive level with employees of color. More work also is needed at the mid-management level, with women of color leaving at twice the rate of their promotion, according to the report. 

“Senior living is about creating communities where everyone feels welcome and valued,” NIC President and CEO Ray Braun said. “The results of this survey provide us with a roadmap for furthering our DEIB initiatives and creating an industry that is truly inclusive for all.”

DEIB trends

The results also provide a market overview of how the senior living industry is addressing DEIB, according to ASHA President and CEO David Schless. 

“The data collected provides valuable insights into current industry trends, best practices and areas of improvement for those looking to further their DEIB efforts,” he said.

Survey participation increased 36% — from 44 to 60 companies — from 2022. 

According to the results, 40% of respondents have a formal DEIB program in place — up from 27% in 2022 — and 37% have implemented some DEIB initiatives or policies. In addition, 93% of respondents said they are taking steps to recruit potential employees from underrepresented groups, and 95% said they are taking steps to increase retention and promotion rates of members of underrepresented groups.

Other findings:

• The majority of organizations focus on gender (91%), race/ethnicity (98%), sexual orientation (89%) and age (83%) as dimensions of diversity.
• 73% of senior living professionals are women.
• 50% of employees are white, and 46% are people of color.
• 14% of executive management is people of color, and women make up 50% of executives.

In most cases (57%), DEIB initiatives originate in the C-suite (57%), although some initiatives are developed by the human resources department (17%) or by a dedicated DEIB committee (13%).

An executive summary of the survey results is available on Argentum’s website.

During our final session, we tried to help them pare back their goals, but they fell into the problem many companies are facing. They were struggling to prioritize and, against our advice, they felt that they needed to begin to address each item all at once. 

Senior living business leaders and companies are facing a very similar challenge in 2024, and should they fail to focus and prioritize addressing the greatest issues they face, they will soon find themselves asking how they didn’t make any headway in 2024 and what to do about it in 2025.

This can prove challenging, as these companies aim to meet immediate financial targets and operational goals while they also need to lay the groundwork for sustainable growth, innovation and quality improvement in the long term. To cut through the noise, leaders must strategically focus and prioritize the right challenge by determining its urgency over its relative standing in the hype cycle.

So, let me help with that. Here are the four challenges and their implications that leaders and companies could face that must be addressed if they are to not only survive 2024 but thrive.

1. Today’s trendiest AI isn’t everyone’s best tool

Senior living businesses have arrived at a crossroads in 2024. Integrating artificial intelligence into general business practices has become an imperative and an untenable obstacle course.

Many companies are moving forward with the misguided hope that the benefits will outweigh the upfront costs, and that can be true. AI can personalize care, customize resident plans, provide predictive analytics and tell you what your budget could be next year.

Companies, however, will need to make smart choices, as not all AI models are built and, more importantly, trained, equally. Choosing the wrong model means a potential for a closed-loop input system where the model does not consider outside needs of potential future customers other than what it was trained on.

To make the most of AI, businesses should prioritize models that have transparency and ones that can help them fix their fragmented data. Siloed records, notes, charts and schedules in multiple platforms that lack interoperability means there will be limited value in the analytics from a model only able to pull from one source of data. The integration challenges are real, but the potential is transformative.

2. The demographic cliff

It’s not news to you that senior living businesses are facing the stark reality of the increasing number of potential residents and a lack of talent to care for them. As baby boomers continue to age and look to move into active-adult or various other tiered classes of caregiving, not only are the communities lacking or nonexistent, but so are the caregivers. Flexible working options and higher pay elsewhere are fueling resignations.

To address those challenges, businesses need to consider new development routes for staff and properties. Considerations for creativity in how administrative roles are staffed and developed through training and upskilling local community members is one way to start.

Long term, the labor shortage may mean rethinking on-demand workers over full-time hires. Also, there is the potential for modular construction, and investors looking to be recession-resilient could mean new forms of capital that could allow for the right-sizing of the units and technologic improvements needed.

3. Transparency versus personalization versus privacy

Senior living companies have leaned heavily on personalization to drive engagement. Data collection can provide unique offerings, especially with the advent of wearables, which can help customize meal plans, activities, amenities and medicine, but consumers and clients have begun to demand more privacy and protection of their data.

Businesses must become more transparent about where they collect data, where outside data are being used and what is done with them. If done successfully, the transparency can bolster engagement and increase communication between the residents and the communities, another potential data perk.

Equally important will be open communication on issues such as sustainability, social responsibility and employee well-being. Today’s residents and families expect more transparency. Companies that honestly address their practices and shortcomings will build trust. 

4. Inflexibility in your future direction

Operators facing these pressures often suffer from a lack of agility and flexibility in their planning. Anticipating future challenges in healthcare and demographics is crucial yet challenging, especially with limited resources, as those challenges constantly move.

Even with prioritized challenges to address, however, leaders must be open to being nimble enough to adapt their hardened three- to five-year plans while also realizing that type of planning needs to shift to become 10- to 15-year planning. This change will allow them to be ready for shifts in behaviors, to grow as digital health evolves, residents’ preferences morph and staffing dynamics shift.

Allowing for re-perception of the challenges and trends that are faced throughout the year will allow companies to be proactive instead of responsive. Most companies lack this flexibility, which ultimately means they stay the course when they need to pivot and, in doing so, become obsolete to the whims of their clients and residents.

In 2024, these challenges and trends are not just obstacles but also catalysts for innovation and improvement. For business leaders, particularly in the senior living industry, addressing these challenges head-on is not just about survival but also about thriving in an ever-changing landscape. By doing so, you can ensure sustained growth, improved service quality and enhanced operational efficiency, ultimately leading to long-term success and a positive impact on your communities.

Mark Bryan is the senior foresight manager at the Future Today Institute, an advisory firm specializing in strategic foresight aimed at driving corporate strategies that lead to long-term success and resilience. The institute partners with leaders of Fortune 500 companies, world governments and other major organizations to help them pivot, adapt and thrive in the face of disruptive change.

The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.

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New technology such as artificial intelligence recently has been deployed in healthcare to generate faster and more nuanced diagnostic tools for help with conditions such as Alzheimer’s.

An ongoing issue for senior living and care providers, however, is that these tools often fail to reduce biases against racial and ethnic minorities. That often is because the knowledge that AI and other software “trains on” pulls from data sets that often lack sufficient data on those groups.

Approximately 25% of nursing home residents are non-white, according to a 2019 study. And only 12% of assisted living residents are not non-Hispanic white individuals, according to the federal government.

To help address this issue, a new tool that attaches to a smartphone is designed to screen for Alzheimer’s in a way that avoids typical racial biases. 

The attachment accounts for racial disparities not by skin tone, but by eye color. That’s because pupil-based diagnosis, or pupillometry, is easy to generate via light and imaging, and such eye coloration often correlates with skin tone. 

The device, which was developed by engineers at the University of San Diego, essentially is a filter that makes it easier for smartphone cameras to capture measurements of the pupil’s movements and dilations. 

Beyond even removing explicit racial bias, the goal of the smartphone attachment is to make Alzheimer’s diagnostic tools accessible for everyone, the researchers stated, adding praise for smartphone technology.

The attachment is being designed to work on any smartphone, and the next phase of development will include making the device easier to use for older adults, the researchers said.

“The high plasticity of smartphone applications allows for continued ingenuity in providing new and different stimuli,” the study authors stated. “The smartphone can be programmed to provide a wide variety of visual or auditory stimuli for a pupil response task.”

Although the smartphone attachment is not commercially available yet, the researchers indicated that their prototype could be “improved and simplified for low-cost production.”

“Our commitment to rigorous environmental, social and governance practices supports the growth of our successful enterprise built on serving the needs of a large and growing aging population,” Cafaro said in a press release issued in conjunction with the report.

In 2022, Ventas became the first healthcare REIT to commit to net zero operational carbon emissions and since has built and implemented detailed decarbonization plans to meet its goal by 2040, according to the report. 

“Our carbon reductions are primarily driven by improvements in energy efficiency and renewable energy procurement,” the company said.

Ventas encourages collaboration, “recognizing individuals for their unique strengths and continually enhancing employee resources, all while upholding a strong commitment to an equitable and inclusive environment that celebrates diversity in all its forms,” according to the report.

The REIT said that it is committed to “best-in-class corporate governance and transparency” as its board of directors advances their objective of creating long-term, sustainable stakeholder value.

The REIT has earned global recognition and numerous awards for its ESG efforts:

• The No. 1 listed healthcare REIT in Global Real Estate Sustainability Benchmark assessment since 2017.
• Received the 2023 Energy Star Partner of the Year Sustained Excellence in Energy Management Award, the program’s highest honor, and ranked among the top 15 Energy Star certifiers of 2022.
• This is the company’s fourth consecutive year on the Dow Jones Sustainability World Index, representing the top 10% of global companies based on long-term economic, environmental and social criteria and sixth consecutive year in North America.
• This is the company’s fourth consecutive year on the Bloomberg Gender Equality Index.
• Ventas was a Bronze Award Winner in Nareit’s 2022 Diversity, Equity and Inclusion Awards.
• The REIT is a seven-time winner of Nareit’s Leader in the Light Award, recognizing companies that demonstrate superior sustainability practices.

Ventas said that it also is working to mitigate the risk and effects of any disruption from cybersecurity threats and data breaches. Employees receive training and testing on cybersecurity protocols throughout the year.

LeadingAge has released a new tool for members that helps outline the myriad technology solutions aimed specifically at workforce needs for aging services providers. Cost implications are included.

The tool, named “Unlocking Workforce Technology Solutions,” is designed to help members with a “map” of the tech market, breaking down solutions by what aspect of staffing a particular tool is aimed at, such as scheduling or workforce training. 

With senior living and care operators dealing with ongoing staffing challenges, new technology within healthcare is frequently aimed at addressing workforce issues, either by making existing care more efficient or directly aiding the staff to ease administrative burdens. 

The LeadingAge report, which was released earlier this month, covers six categories, detailing how to find and implement various solutions under those umbrellas:

• Recruitment and retention
• Diversity, equity and inclusion
• Education and training
• Workflow efficiencies
• Robotics
• HR tools

The report also is designed to help providers address the cost of implementing certain technologies and how to find funding. Its primary authors were Scott Code, LeadingAge CAST vice president, and Jenna Kellerman, LeadingAge director for workforce strategy and development.

The latter has outlined a “ladders and lattices” approach to training and retaining long-term care employees, arguing that staff needs to be given tools to learn new skills, and opportunities for advancement within an organization. 

LeadingAge has been a vocal critic of national nursing home minimum staffing mandates proposed by the Centers for Medicare & Medicaid Services. As part of a statement this month on the high cost of implementing such a rule, LeadingAge President and CEO Katie Smith Sloan called the proposal “impossible to implement” due to the lack of available workers. She added that “regulations and enforcement, even with the best intentions, just can’t change the math.” 

LeadingAge will be discussing the new tool at its annual meeting next month in Chicago.

CHICAGO — Creating a diverse, equitable and inclusive workplace where employees have a sense of belonging isn’t just the right thing to do; it’s also good for the bottom line.

That’s the message shared by the senior living executive members of a panel at the 2023 National Investment Center for Seniors Housing & Care Fall Conference, who discussed how to effectively provide opportunities to enhance employee morale, increase productivity, improve resident satisfaction and outcomes, and contribute to an organization’s bottom line, all under the auspices of creating DEIB — diversity, equity, inclusion and belonging — programs. 

Based on employee surveys and focus groups, Trilogy Health Services President and CEO Leigh Ann Barney said that senior living and care workers view DEI as a higher priority than does the rest of the general population. That isn’t surprising, she added, considering that healthcare workers get into the industry to help people. 

But companies and organizations have to put the work into creating a culture that not only will attract new workers but also will appeal to consumer demands coming with the baby boomers, who are a more diverse group and are looking for communities where they will feel comfortable.

“Our industry is at a crossroads,” Barney said. “We’re going to see more diversity from our residents and their needs and what they’re looking for. We need that same diversity of thought in our leadership in the industry so we’re prepared for that.”

Moderator Sarah Dirks, Pinnacle Quality Insight vice president of business development, shared results from a survey done with Great Place to Work that revealed senior living and care organizations are losing 85% of staff members each year, costing an average of $275,000 in net operating income. New hire turnover is the highest, comprising 40% of that number.

Barney said that DEIB is not a sprint, but a journey. Trilogy sought outside help from a local university and other organizations to assess its employee demographics through surveys and focus groups. Then the company turned to their employees to lead efforts to achieve their DEIB goals. 

“We wanted to build it into the fabric of what we already have at Trilogy,” Barney said. “We wanted to enhance what we already did.”

For Trilogy, the effort turned into employee resource groups that focus on what employees wanted DEIB to look like within the organization. Under executive sponsorship, the groups communicate about a specific topic to create efforts to help other employees and residents.  Employees took ownership of the effort, which has led to a 77% retention rate among workers who participate in a resource group.

Part of Harrison Street’s DEIB focus is on emotional health organizations, which Jill Brosig, managing director and chief impact officer, said ties back to critical needs — to be accepted, important, included, respected and secure. That focus, collectively, she said, creates an emotionally healthy organization that attracts a more diverse workforce and helps with retention.

Measuring success

Barney said that the measure of success of DEIB is earning the trust of employees to participate. When employees see that their feedback is being used to improve offerings and not as a punishment, then they are more willing to share those data. And sharing the results — along with an explanation of how those results led to change — will affect turnover rates and lead to a more stable employee base.

“You do these things because it’s the right thing to do and it helps you provide better care for your residents, but there is a financial impact to it and you can measure that out through your metrics,” Barney said. “Building that trust, letting the team know this is something important to the organization, you are going to start small and roll it into the fabric of what you are already doing and be consistent.”

The “elephant in the room,” Brosig said, is the current societal pushback against DEI.

“It’s the right thing to do, but we have to demonstrate why it’s the right thing to do,” Brosig said, adding that research exists showing that the more diverse a group is, the richer the thought and the better the performance. “I don’t want anyone to think we’re doing this to hit a quota or check a box. We’re doing this because it’s the right thing to do, and we want to make sure everyone has an equal opportunity.”

Barney advised attendees to take some initial steps and use internal resources to start building DEIB into an organization’s culture.

“There is a real need to do this — not just as an organization but for our industry as a whole to continue to be successful and to grow,” Barney said. “It takes time and effort; it takes intention, but it doesn’t take a lot of resources.” 

The NIC Fall Conference lasts through Wednesday.

The agency said the plan also commits the EEOC to supporting employer efforts to proactively identify and address barriers to equal employment opportunity, cultivate a diverse pool of qualified workers and foster inclusive workplaces. One of the areas of focus will be discrimination, bias and hate directed against religious minorities, racial or ethnic groups and LGBTQI+ individuals.

“Through the [strategic enforcement plan’s] effective implementation, the agency will continue to advance equality and justice for all in workplaces across this nation, even as significant challenges remain,” EEOC Chair Charlotte A. Burrows said in a statement. 

Updates to the existing enforcement plan include priorities related to the protection of workers affected by childbirth or related medical conditions in addition to pregnancy, including through the new Pregnant Workers Fairness Act and other laws. Additionally, the agency’s changes include a focus on employment discrimination associated with the long-term effects of COVID-19, as well as technology-related employment discrimination, including discrimination that may occur through employers’ use of artificial intelligence and machine learning for human resources functions such as job postings, the application process and hiring.

Also, the agency said that the plan is meant to preserve “access to the legal system by addressing overly broad waivers, releases, nondisclosure agreements or nondisparagement agreements when they restrict workers’ ability to obtain remedies for civil rights violations.” 

The EEOC said that the process for developing the enforcement plan was a collaborative, bipartisan effort by working groups of staff members from its headquarters, field offices, commissioner’s offices and union. To obtain public input, the EEOC hosted three listening sessions that focused on racial and economic justice, vulnerable workers and other issues related to the agency’s current strategic enforcement priorities. 

“We are grateful to the public — especially to those who participated in our listening sessions in Buffalo, New York, Washington, DC, and virtually, for their engagement and investment in the development of the [strategic enforcement plan]. This plan will help guide the agency’s work for years to come,” Burrows said.
The strategic enforcement plan works with the strategic plan for fiscal years 2022-2026, published in August, by establishing substantive law enforcement priorities, the agency said.

Growing up Black in the Jim Crow South of the 1940s and 1950s, Friendship Village of Tempe resident Rosemary James is very familiar with the effects of prejudice in American society. Today, she’s using her personal and professional experiences to teach others how to become allies for marginalized communities. 

“I’m an educator who wrote content, developed and conducted workshops for much of my career,” James said. “So I put all of those skills to work again, but in the area of racism, racial justice and equality.”

At her church, James shared her diversity, inclusion and equity presentations to great success. Afterward, she decided she wanted to test it out somewhere closer to home. 

“Through my church, I wrote content and designed workshops dedicated to diversity and inclusion,” James said. “It began to change the culture of our congregation, so I thought I would bring that to Friendship Village of Tempe.” The Arizona continuing care retirement community is managed by Life Care Services.

The church presentation quickly turned into a two-day resident workshop on DEI at Friendship Village. The event was so successful that James was invited to share the same training with 50 employees at LCS’ corporate headquarters in Des Moines, IA, during the company’s August leadership conference. 

James has completed two resident workshops for the community, has a waiting list for a third workshop and is working with the community’s leadership team to adapt the training for employees. By sharing those presentations, she hopes to encourage more people to become allies in the fight against prejudice. 

“People here have been willing to put themselves in an uncomfortable position, and to experience and learn how they can be more proactive at interrupting racism when they experience it in their lives,” James said. “It takes an extra special effort to say something in these difficult situations, so whatever you say needs to come from you even if it’s as simple as stating ‘what you just said made me feel uncomfortable.’”

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