19 Feb Workforce in Senior Living
Mike Peacock: Welcome back to Cosmic Soup. Today’s guest is a veteran in the senior living industry where he spent 23 years managing communities, directing operations, spearheading acquisitions, and organizing preopening setups for multiple ownership groups with Leisure Care, a Seattle-based senior housing management company. In 2012, he joined the Inland Group in Spokane, Washington, and was instrumental in opening and operating communities, achieving an outstandingly high level of resident satisfaction and staff development balanced with highly proficient expense control and revenue growth. Today, he is a principal consultant with us here at 3rdThird Marketing and Culinary Coach and is the founder and owner of Old Pueblo Placement Services based out of Tucson, Arizona. Please welcome to the show, Cecil Rinker, Operations Genie. Cecil, thanks for being here, man.
Cecil Rinker: Thank you, Mike, for having me.
Mike: Yeah, of course.
Cecil: I’m glad to be here.
Mike: Today, we’re going to talk a bit about operations, since you’re an expert and all. Really, we want to touch on a hot button, a burning issue of workforce.
But before all that, when you think about all the types of communities that are out there, all the communities you’ve seen, all that’s done right and all that’s done wrong, riddle me this, Batman. Imagine that you have the backing to create your own community that’s perfect for you as you age. How would it be? What would it look like? What would you design from that crazy brain of yours?
Cecil: Well, I think that, first of all, we’re looking at a generation of people who are looking at a retirement that looks different than their parents. I know I’m certainly one of those folks. I’ve been asked this question before and I’ve said before that I think that people who are looking to just enter into the retirement community setting are much more independent today. They want to remain as independent as possible. If they need a little assisted living service, they want that done privately in their home.
I think that what I would see as a model retirement community in my own mind would be where the front door of my apartment leads outside and the backdoor of my apartment leads back into the community. I know that, personally, I would like to be able to walk out of my door, get into my car, and come and go as I please. But when I want to participate in that community, the services and the activities, I could go out my backdoor and I could be a part of the community as well.
I’d like to see a community where there are a lot more young people. We have young people working in our communities, but we struggle, I believe, to bridge the generational gap. Personally, at this age of my life, 55, I like being around young people. I like to be able to talk with them and find out what’s going on in their head. I learn from young people and I believe that young people have a lot to learn from the seniors as well. I would like to see a community that is much more inclusive, that brings generations together, and provides opportunities for people to remain as independent as possible.
Mike: In your vision there, when you say that you’d like to see more young people, you would specifically like them as residents in the community as opposed to just employees.
Cecil: I could see them as residents in the community. I could see community spaces being created for young people to come and take college courses. I could see spaces being offered to groups from the city or the market area where you’re located.
As far as organizations go, there are lots of organizations, I think, that seniors still participate in. It would be easier for them to be able to remain active in organizations if they were closer by and they were easier to get to.
Yes, Mike, I believe that all of the above would be true.
Mike: What would be the incentive for somebody, a “younger person” if you will, to live in a community like that? Would that just be something where it would be set up kind of like an apartment and there just is a mix of age groups and demographics?
Cecil: I think that’s a really good idea. I believe that there are seniors out there that would like to live with younger people. I’m not necessarily saying multifamily housing where you have families with children. Although, I believe that younger children are very important in the senior communities because we are, as a society, growing very, very much so apart from our blood relatives as far as grandchildren go, grandparents living in different states, grandchildren being raised in different states. I think that there’s a need for those programs to be in there.
But as far as looking at who is living in a community, I think that we could look at how we could lower the age and give people in their 30s and their 40s who might be interested in living in a community with multigenerational people, people older than they are. I believe that we could also create opportunities where people could live in the community and maybe work at the community as well, volunteer at the community. Those are all things that I think that we could put on the table. I think that if I had all of the resources backing me, I think that we could come up with a great plan for that.
Mike: That’s pretty outside the box thinking, actually. I really like the concept. I also really like the concept of being able to have access via your front door and your backdoor to different functions of the community. If it was set up in kind of almost a courtyard fashion where everybody’s backdoors opened up to the hub of said community then, yeah, you’ve got your privacy entrance and you’ve also got your, “I want to go out and do something today,” entrance.
Mike: That’s killer. That’s a really, really great concept.
Cecil: I was asked this question about 20 years ago and, at that time, it was kind of far out there, which is now, in 2020, it’s becoming probably more of a reality than it was 20 years ago. My thought 20 years ago was that a retirement community should look like a mall that you could enter and come in and out of. The apartments, of course, would be grouped around the outside perimeters. The inside would be multiple spaces, maybe storefronts, maybe a daycare center, maybe a food court, all of those kinds of things that I might be interested in as a senior, which also might interest a younger person as well.
Mike: That’s fantastic. When you were talking about it, that was kind of where I was thinking. I mean I didn’t quite get the mall vision but, now that you say it like that, that exactly makes sense because that is how malls are set up with their rear service doors and their front doors to the storefronts. You can kind of get access to everything. It’s just reversed.
Mike: That’s fantastic.
Cecil: It gives the opportunity also for a retirement community or a developer to have multiple–let’s just use foodservice as an example–multiple foodservice outlets. We could have a formal dining room setting. We could have maybe even a fast-food offering. Maybe delis. Maybe bakeries.
The beauty about that is that, currently right now with the difficulty it is to find staffing in the retirement communities, you could build these spaces in a mall-like setting and you could lease the space out. You generate revenue by building a space, allowing somebody else to manage it, program it, and staff it. You’re providing a lot more choices for seniors and you are not taking on the responsibility of trying to staff all of those, if you will, satellite restaurants.
Mike: Yeah, absolutely, and that does also help subsidize the operational cost if you have people coming in, helping to kind of support the income of the building itself. You’re not having to have the facility foot all of the bills for, say, the foodservice programs or maybe the retail programs or the volunteer programs. That could all be partially paid for by people that come into the community as–I don’t know–vendors, if that’s the right word.
Cecil: Absolutely. Of course, the community would have to adopt a philosophy to allow some of the public in.
Cecil: I’ve seen that before. On a very, very small scale, we’ve opened up communities. I helped to open up communities in the past where, here in Tucson, Arizona, one of the first communities to have a liquor license opened here in 2007. When we got the liquor license, we looked at the fact that the residents would enjoy that. Maybe the family members, maybe their friends would stop by and enjoy the happy hours, the parties, and the sporting events that go on in the bar.
Then we went one step further and said, “Why not the neighborhood? Why don’t we get involved in the neighborhood, send out flyers, and tell the neighbors, ‘Hey, if you want to come in and join us for the Sunday football game and happy hour at the bar, then please feel free to come on in’?”
There’s been a big push over the past 10, 15 years to really take food service to another level, putting in a system for tracking sales, a system for charging people, a system for using credit cards. All of those things now are becoming pretty normal in our industry, so it would be a very small leap to be able to invite the public inside of a retirement community.
Mike: It really is not that big of a leap when you think about it from a logical point of view. It doesn’t seem like it would be that difficult to just kind of shift the equation a little bit. It all comes down to changing your perception of what it could be. At the end of the day, you’re only limited by your imagination.
One of the themes that I see as recurring is, “Well, we’ve always done it this way.” I hear that every day; “It’s always been this way, so why should we change it now?”
Why should we change the formula for senior living? Why should we change the formula for the kinds of food the kinds of people that we let in, or the kinds of people that the residents have access to?
It really just comes down to changing your thinking. That is where you are ahead of the curve, my friend.
Cecil: Thanks. Just to follow up on that, too, I think that when we look at operations, we’re constantly looking at ways to improve operations in the senior housing industry. What worked today may not work tomorrow. What worked three years ago may not work two years from now. What failed two years ago may work next year. I know that sounds confusing but, in our industry, we are constantly changing and trying to accommodate many different people under one roof.
An average community of 150 apartments, you’re looking at a possible 200 to 225 residents when you’re counting in the double occupancy with seniors and spouses. When we’re looking at the population, it’s everchanging. The average move-out for a retirement community is about seven people per month. Those are people who are maybe moving off to a higher level of care. Maybe they’re moving back to be closer with families. And many of our residents pass on to the next stage in life or the afterlife.
What I’m saying is that when those seven people move out, seven new people move in. They may have different ideas of what foodservice looks like. Maybe the new seven people moving in don’t want to eat dinner at 4 o’clock. They want to eat dinner at 6:30. Maybe the new people moving in don’t want to have fried chicken and fried okra and fried fish on Fridays. They want more farm to table kind of dining.
We have to constantly be thinking that our operations is everchanging as well. It can’t be stagnant. That’s why I use an example that I had a community that I was working with where there were 300 residents coming to dinner every day. They all showed up at the same time because the dining room opened up at 4 o’clock.
Cecil: That did not work and so a program was implemented where people took a time that they wanted to eat. Everybody was assigned a time and it reduced the pressure on the staff, it gave better service, and there were less wait times for meal service.
That worked beautifully for about three years and then it stopped working again. As we looked and looked and looked and tried to figure out another way, we ended up going back to the open seated dining and allowing people to come back in whenever they wanted to and that worked. It worked again for another year or so.
Then we were back into a situation where it wasn’t working.
It really was not that the idea or the implementation of a new operations for food service was wrong. It was right at the time. Then things changed. People change. People left and new people moved in. We had to change course and we had to adapt to the new folks there.
Mike: Yeah, and as far as the demographic changing, as far as ages of residents and things like that, you’ve also got administration changes that are coming from different generations who grew up with different ideas about food and operations. People that are running the show now have had a different perspective on things.
I did want to ask you. How did you get involved in the senior living industry? What was your catalyst for wanting to do this?
Cecil: Well, I used food service there as an example. That’s how I entered into the senior housing communities. It would have been 1994. Up until that point, most of my time was spent working in hotels and fine dining.
I thought that would be the career for the rest of my life. But, as it turns out, I had an opportunity to go help a retirement community here locally in Tucson. They needed help with their food service. I was able to go in and bring some ideas and things that were carryovers from the hotel restaurant industry.
I watched the senior housing community from that time, which was called “restaurant-style dining.” From a batch cooking perspective, everything was made ahead of time. It was plated and it was served by servers, but it was still a buffet. Basically, you were steam table cooking a lot of different foods and then plating them up and sending them out in a restaurant-style setting.
The leap from restaurant-style to, “Why can’t we just be a restaurant?” was really kind of a lightbulb that went off that was really something that was standing there right in front of us. It all came back to when we were developing. How did we develop those kitchens? How did we build those kitchens? What did we use for standard equipment?
Once we made that leap and started putting in the things that allowed our teams and the food service department to make breakfast to order, to expand lunch offerings, to expand the dinner menus, and make a steak when somebody ordered the steak instead of cooking up 15, 20 steaks and then serving them out. Obviously, we know the steak is probably getting tougher by the minute when you’re waiting for somebody to order it.
Those are all things that I think were important to make that leap.
Mike: It’s clear that you’ve really dedicated your life to this business. Do you see yourself; this is you now, this is what you’re going to do forever, for the rest of your life?
Cecil: I believe so. That was an epiphany I had not too long ago when I really started to reflect and look at my life as a whole. I was one of those kids who, at 12 years old, I wanted to be at grandma’s house all the time and that did not change.
My grandparents died when I was 16, but I spent an exorbitant amount of time with both of them, hanging out with my grandfather, taking trips in the truck around country roads and visiting his old friends at country stores, to staying up later than my bedtime as a kid playing dominos with my grandmother and her friends and my great-grandmother. I was fortunate to have her until I was 19 years old. Then I left.
After everybody passed and I left Virginia and moved to Arizona, I found myself working in a hotel here in Tucson that’s pretty well-known, at least in the state, called the Arizona Inn. The Inn had a reputation of repeat guests that came back and had been coming there for over 40 years, so their clientele was in their 70s and 80s.
When I left the Inn and entered the industry in 1994, there was very little difference in the clientele that I was already serving. I did some home healthcare when I was younger as well, and I just found that I am most comfortable with people who are a lot older than I am.
I feel like there is a connection that I have with folks. Maybe it was because I was born and raised in a small town. But it is easier for me to communicate with seniors and I feel a great amount of empathy for what it is that they’re trying to accomplish in their older years because I can see myself wanting to have as much as I possibly can in those last years as well.
Mike: Sure. Well, clearly, you’ve got a passion and a love for this industry. If we’re going to get real for a second, though, it does face a ton of challenge operationally and then you also touched on what we’re going to talk about as well, which is difficulty in keeping some of these places staffed or getting quality applicants. What we’re talking about is workforce. What are some of these problems that you’ve encountered in terms of workforce in the industry?
Cecil: Well, I think that when I look back at my career, there was always that struggle to keep the foodservice department staffed in the front of house because mainly we were using the younger generation, a lot of high school kids, maybe some college students. They were serving in the dining room. A lot of times, the kids would come in. They would work in the summer months when they’re out of school. There was always a big push to talk to kids right before the school season to say, “Are you going to drop down to part-time? Are you going to continue working?”
A lot of parents wanted their kids to leave that summer job because they wanted them to focus on their studies, which is very understandable. But we face that every year, so we got really creative. Maybe a student can only work one day a week.
Maybe the parent says, “Okay, you can work Saturdays or Sundays. You can work the weekends, but you can’t work during the week.” We would try to get ahead of that months or weeks before the school year would start. Those were some of the biggest difficulties we had.
Now, we’re looking at every department that’s struggling. We have low unemployment rates. We have a growing number of people entering the senior housing market, moving into the senior housing market. They are coming in. They’re younger. They have more demands. We have a lot more people on assisted living services.
As a placement service agent here in Tucson, I really thought when I started my business seven years ago that I would be working with independent folks who were like, “I’m ready to sell the home. I don’t want to do the lawn care anymore, and I want to go have a lifestyle that affords me no household chores and more time to go golfing, to take trips, and to go see my family.”
What the reality has been is that I would say 80% of my clients have a great need. It’s just not a need of, “I can’t care of my home anymore.” It’s a need that I need help with my medications. I need help with bathing. I need help with dressing. I need help with transfer.
That has put a lot of the tilt into the model from a mixture of independent and assisted living into a lot more assisted living, which requires a lot more care staff. I see that as being our biggest struggle facing the industry now is having enough people to provide the care for the people living with us.
Mike: Do you think the problem is in getting the people in the door or retaining them once you’ve got them there?
Cecil: I believe that those are both correct.
Cecil: We have to be really good at recruiting. Then once we get people, we get good people, we have to work to keep them there because, again, we’re all vying for the same pool of caregivers and there are not enough caregivers to go around. As more retirement communities are being built because we know, statistically, that we don’t have enough beds or apartments to fill the demand that’s coming.
Cecil: That’s one aspect. The idea that once we have the caregivers in the community, we’ve done a good job up front as far as making ourselves an employer of choice, a great place to work where staff feels supported and they’re not being burned out, how do we keep them there with us? I think that that’s where a lot of the industry struggles.
I think that once they have somebody in the door, we can’t go revert back to old ways saying, “Okay, well, they got a job. They’re not going to leave this job.” People are leaving jobs at an alarming rate nowadays.
I think that a lot of the industry says people are leaving for money. There’s always going to be a segment of people that’ll job hop for $0.50 more an hour. But for the majority of people, if they feel valued, if they feel like their work is something that they can go home at night and feel good about, if they feel supported in their own families through their employer, I believe that that is key to retaining high-quality staff.
Mike: Sure. Sure.
Cecil: When I say, “How do you as an employer make a difference in an employee’s life and how do you connect with their families?” it’s a fine line to travel. You don’t want to cross a personal line but you need to be aware enough of what’s going on in your employee’s lives and what’s important to them.
You need to help them to be able to keep those important moments, if you will, intact and allow them the opportunity to not miss something. That could be anywhere from a granddaughter’s first play at school, a mother’s son’s first T-ball game. Those are all things that, when you get to know your employees and you have a relationship with them, you’ll know these things. Once you know something about someone and what’s important to them, if you can create an environment where you’re not allowing employees to miss those moments, they will become much more dedicated to you as an employer.
Mike: Yeah. For sure. Environment is definitely a huge factor. Coming from the restaurant business myself, I think one of the environmental factors that leads to employees either being stressed out or not being comfortable is when facilities, restaurants, communities, whatever we choose to call them, when they use their labor as kind of a tool to leverage their profit and then you end up with companies that just cut their labor forces to skeleton crews. Then the employees that are there, they’re super frustrated because they don’t have any support. They’re always under the gun. I think it often stems from owners and operators putting a percentage goal as part of their budget rather than really looking at their operations and seeing if that fits their budget before they move forward with their plans. Do you agree with that?
Cecil: I do agree with that. I agree with that and I would add to that, too, is that, as operators, we tend to sometimes focus on the numbers–
Cecil: –of our operations. Of course, we have to keep our eye on the numbers. We have to be profitable. We have to be able to maintain the communities and we have to maintain proper staffing.
When we look at managing by numbers entirely, we miss a lot of the opportunities. As you said, when you’re cutting staffing to make those numbers, that’s not going to work out in the long-term. It’s very short-sighted.
I think when we look at our employees and we think about what it is that needs to be done to improve revenue, there are other ways to take a look at that. When you’re meeting your numbers, there’s either spend the money and look at opportunities to grow revenue through new programs, new revenue sources that residents and their family members would see a value in and want to pay for.
I believe that’s the way to go because, when you start thinking about laying off employees, how many of those employees come back, especially in this market? If you lay somebody off today, they’re going to have a job by the afternoon and you’re not going to get that employee back. Well, I shouldn’t say you’re not, but….
Mike: In all likelihood, yeah.
Cecil: High probability you’re not going to get that employee back. Then if somebody really took a look at the numbers and what it costs us to recruit, what it costs us to get those people in the door, to get them oriented, to get their uniforms, to get them to fit into the community, that could be six solid months of training, getting that person comfortable, and getting them in a position where they could be successful in their jobs. If we look at cycling those people through and we’re constantly training, recruiting, and hiring, we’re spending an exorbitant amount of money doing that when it doesn’t take much to create a culture where the employees feel supported and, in return, can support each other.
I truly believe that, given the opportunity, employees want to be able to help each other if there’s a system and a community that’s fostering that kind of behavior. An example would be, I was working at a community a couple of years ago and it was a difficult day. Somebody had called in because it was a single mom. They had a child who was sick with the flu or some kind of cold. Daycare would not allow them to come in.
She had to call off from work. I’m sure this employee did not want to call off from work. I’m sure she didn’t want to miss the day and the pay, but other alternative do they have?
Instead, the manager I was working with at that community calling and saying, “Look, I’m really sorry that your child is sick. I’m going to do the best I can here to have your shift covered. Do you have time to make some calls with some of the other people? I’ll start making calls. Let’s make this a team effort to make sure that we can support you because you’re not having a good morning, and we can still make sure that we’re covered so that our residents get good care.”
It’s been said a long time ago and I learned this a long time ago, at Leisure Care, actually, where there is an emotional bank account and we have to be able to make deposits in our employees’ emotional bank account and make sure their needs are met because then when our needs are there and we need them to come in, we’re more apt to get a positive response when we ask for help. But you can’t just keep taking and taking and taking and piling more shifts or asking somebody to stay for that double shift because somebody else didn’t show up. You can’t keep doing that and never giving back something because you’re going to emotionally drain that bank account and, sooner or later, that employee is going to be burned out, not feel supported, and they will leave.
I think, really, people who are in the mindset to work in senior housing, the want to give good care. They want to do a good job. They like being around seniors. If you don’t like seniors, you’re not going to be in this industry.
When we cut down the time for them to have compassion and caring and understanding with our residents, we make them feel not so good about their job either. I believe that that is something else that we need to address because, as a person now who works not only in large facilities, I work with a lot of smaller communities. I work with very small care homes.
I’m seeing a lot of caregiving staff that I’ve known who have worked in our local market in larger communities for a long time and now they’re working in smaller care home settings. I’m kind of scratching my head at that because I’m like, “Are the care homes paying more?” In fact, I found out some are competitive. Most are not paying more. Most don’t have any benefits.
I started asking some of the folks that I’d run into when I go to these small care homes, like, “Yeah, you know, I saw you at ABC retirement community last year. When did you make the move? Why did you make the move?”
Every single person I encountered said the same thing. “I have ten residents here. I have more time so when Margaret is upset this morning, I can spend a little extra time with her. We can talk about something and get her mind off of it. I can have a good conversation and maybe help her emotionally.”
When you look at what’s going on in the large communities, we have been on a timetable for a long time. We have now looked and analyzed assisted living to the point where it’s like, “Well, it takes eight minutes to perform this task, six minutes to perform this task, and five minutes to perform this task.” We cold our caregivers accountable to that.
Now, you’ve got a caregiver that’s going in to do a five-minute task, which may be to help somebody button-up, get dressed, tie their shoes, get their hair combed, and get ready for the day. If that person is upset, having a bad day, or might not be moving as fast as they normally do because of arthritis, rheumatism, backache, sciatic nerves, or whatever the case may be, now he or she has to spend 18 minutes with that person. Now, they’ve just missed the person next door. They were supposed to be there 15 minutes ago.
Now, we have set a caregiver up to fail for the rest of the day because now every place she goes, she’s going to be late or hears she’s going to be late. They’re going to have residents who are going to be upset and they’re going to go home at the end of the day feeling not so good about the job they did that day and it’s not really their fault.
I’m seeing that the caregivers who have made the leap out of the large communities are doing so because they go home feeling better at the end of the night that they have more time to provide not only hands-on care but emotional care. They can actually be there for someone who is just really having a bad day.
Mike: That sounds to me, in terms of not just a timeline, but it sounds like if we’re to meet these timelines then it really is just the fact that there’s just not enough people to perform that job on the payroll at any one given time.
Mike: Well, thank you, Cecil. I definitely appreciate getting your opinions on the very complicated topic of workforce management. We can spend so much more time talking about this but there is a ton of other cool stuff we’re going to want to dig into.
For now, we’re going to take a quick break. Let’s call this Part 1. When we come back, we’re going to tie up our conversation about workforce and move into the equally challenging world of operations. Tune in to the next episode to hear Part 2 of my epic discussion with Cecil Rinker, Operations Genie, and get the 4-1-1 on how to identify and overcome those nasty operational challenges. Stick around.