Six years from now, the leading edge of baby boomers will turn 80 — roughly the age many start to consider full-service senior housing — marking a surge of significant growth for the senior-living industry. According to some industry officials, that swell will exacerbate an already-sizable challenge to staff facilities with everyone from food servers, van drivers, maintenance staff, and medical personnel, to experienced property managers.
In fact, Argentum — a national association supporting professionally managed, resident-centered senior-living communities and the older adults and families they serve — projected in 2016 that the senior-living industry will need to attract more than 1.2 million additional employees by 2025 to accommodate for industry growth and to replace current employees leaving the industry.
Some say the labor challenge is most pronounced for clinical staff, such as nurses and nursing assistants, in communities that provide assisted living, memory care, or 24/7 skilled nursing, as they compete for labor against hospitals, home healthcare, and staffing agencies. Senior-living communities run the gamut from independent living to 24/7 care, with communities containing one or more populations or, in some cases, all of them.
Senior-living leaders have responded to the labor crunch and anticipated senior tsunami by offering attractive employee benefits and engagement initiatives; special training programs for positions like nursing assistants and department directors; and by underscoring the intrinsic rewards of caring for the elderly, among others. Washington State University, driven by input from industry leaders, is developing a new major in senior-living management to help the industry respond by training its next senior community and corporate leaders.
One Eastside senior-living community — Bellevue-based Aegis Living, which has 32 assisted living and memory care communities, including in Bellevue, Kirkland, Issaquah, Newcastle, Redmond, and Mercer Island (with others under development) — has a number of positions to fill. That’s largely due to organic growth, but Aegis views the hiring challenge as motivation to focus on attributes that attract and retain top people.
“Is it difficult to hire great people? Yes,” said Kris Engskov, president of Aegis. “I wouldn’t even make the distinction between clinical and other parts of our communities. It’s not something that I’d see as such a challenge that it’s in any way impacting our growth, but, at the same time, it is (among) my No. 1 or 2 top priorities at any one time to constantly find ways to bring people into this business — and great people. So, we see it as a challenge, but we also see it as an opportunity.”
With the approaching wave of aging boomers, Engskov sees a great need for senior-living communities and workers to serve them.
Engskov said Aegis hasn’t looked at the industry’s hiring challenges as a crisis, so much as looking at the broader challenge of the approaching wave of seniors seeking assistance with everyday living, often with acute age-related issues. Boomers soon will be looking for living assistance and healthcare befitting their expectations.
“It’s very clear that so many people are going to need to come into the healthcare business,” Engskov said. “The way we’ve been viewing this is, ‘How do we really get our arms around it, quickly and really innovatively? What kinds of unique things (are we) going to need to offer to attract the best and brightest to come into this business?’”
The communities are key cogs in healthcare, even if many people don’t view the senior-living industry through that lens, Engskov said.
“We have not had a seat at the healthcare table, and that is the because we continue to be seen as housing,” he said. “We haven’t really helped people understand what we do inside those four walls, and it has everything to do with healthcare — especially as people are … coming to us later in life with more acute issues. We can take care of somebody at a fraction of the cost of a hospital or skilled nursing facility.”
Healthcare includes community and the socialization that comes with it, Engskov said, acknowledging talk about technologies being developed to allow seniors to stay in their homes longer.
Analysts in a November Wall Street Journal article suggested “aging-in-place” technologies pose a threat to growth in the senior-living industry.
But at some point, Engskov said, people need help with basic activities, which is where senior living comes in.
“The other thing people vastly underestimate is community. As you get older and you become less mobile and perhaps even a little less social, having a community and being social is critical to living …,” he said. “That is what I think we can do for people that gets underestimated many times is give them a built-in community every day, but they can still be as socially active as they’ve ever been and maybe more so. And you know, we believe that will improve their health.”
For young people, “I see this as a great career opportunity,” Engskov said of the “tectonic shifts” occurring with boomers. “Frankly … we need to make it more attractive and show people the benefits.”
Aegis, which calls itself an “employee-first company in a highly competitive healthcare market,” is focusing on nurturing employees, knowing a positive, rewarding culture translates to good customer care.
Engskov said senior living matches what many millennials seek: a cause bigger than a paycheck.
“We have got the perfect opportunity for them that not only matches their view of the world, but also is a huge societal need,” he said. “It is noble to take care of older people, and that is something that we’re tapping into in a big way. I think that is underleveraged.”
“If you come to Aegis, we’re going to show you a career, not just a job,” he said. “Not everybody wants that; I understand that. But the ones who are (the) best and brightest, you want to keep them; you’ve got to show them how to get there.”
Aegis, in early 2019, launched Aegis University, a new career-development and training program aimed at helping employees at all levels improve leadership skills and advance their careers within the company, it said in an email.
The program kicked off by selecting and training care director candidates interested in advancing to director of operations. The eight-month training program includes classroom training, job exposure, and assignments to test learning and readiness for a new role. Other training will cover a variety of positions and functions — from marketing director to Certified Nursing Assistant (CNA) certification, and more. Aegis will launch a company-run CNA training certification program in early 2020, the email said.
Farther south in the state, Tacoma-based LeadingAge Washington — which represents not-for-profit and mission-driven organizations dedicated to improving the aging experience of more than 50,000 older Washingtonians needing safe and affordable housing or healthcare in community and licensed residential settings — hopes to alleviate some of the clinical staffing crunch at member communities. It plans to launch a four-week course in early 2020, pending state approval, to train people to become Nursing Assistant Certified (NAC), said Laura Hofmann, director of clinical and nursing facility regulatory services for LeadingAge. NAC is equivalent to Certified Nursing Assistant (CNA).
Coursework will occur online, with hands-on clinical training at a member community. Tacoma Lutheran Retirement Community will pilot the hands-on training for the LeadingAge-run program managed by Hofmann. Students who earn their NAC can then work anywhere.
“It is a big problem,” Hofmann said of the clinical staffing shortage plaguing not just senior living, but home health, hospice, and other healthcare organizations.
Olympia-based Koelsch Communities — which has 32 communities in eight states, including 10 in Washington and three more under development in Puyallup, Bellevue, and Kirkland — has found it important in a tight labor market to respond quickly to prospective employees. It, too, has found the competition more acute for CNAs and nurses.
“Part of the challenge we face as an industry is nurses and caregivers often don’t even understand the geriatric opportunities or have any sense of connection to that,” said Benjamin Surmi, a gerontologist and director of people and culture at Koelsch, which offers independent and assisted living, memory care, and respite and hourly care.
One message that’s difficult to convey in the geriatric field is that nurses and caregivers have more power to make quality-of-life changes and dramatically impact people’s lives, unlike hospitals, where doctors have most of the life-changing power, he said. In senior-living communities, a nursing intervention can make all the difference in somebody walking or eating again, or laughing and enjoying life instead of staying in bed all day, Surmi added.
“Simply providing quality nursing interventions can radically change someone’s life and can change their whole family’s life because now family can perhaps interact with their loved one in a whole new way and they have grandma back,” he said. “And you don’t have to be a doctor, you can be a nurse or caregiver to do those things.”
One strategy Koelsch has used to attract CNAs at some communities includes creating partnerships with CNA training schools to conduct students’ clinical training at a Koelsch community. Oftentimes, students end up applying for jobs at the community after experiencing connections with residents and the company’s culture, Surmi said.
In another effort to build CNA and nursing staff, and to equip them for success working with sometimes challenging behaviors in memory care, Koelsch has gone outside the U.S. to tap evidence-based training used throughout Europe and Japan. Koelsch has flown in trainers from Portugal who conduct intensive staff training under an outcome-based program called Humanitude. Within four days of training, staff are changing the lives of people with challenging behaviors — such as refusing to eat or shower, or hitting — that make it difficult for caregivers to work in some memory care settings, Surmi said. Koelsch has piloted the program three times and plans to roll it out in other communities, starting with one in Longview and another in Fresno, California.
“Many caregivers simply do not get that training when they leave CNA school,” he said. “There’s no wonder why they leave, because they aren’t equipped, they don’t have the tools; and, so part of my perspective is that if you can equip your front-line staff with the tools they need to be successful, you’re going to have people who actually are going to stay and you’re going to have long-term employees.”
Koelsch plans to bring Humanitude experts to Seattle next spring to do educational workshops with area doctors, social workers and nurses to increase awareness of the modality and its tools.
Koelsch in 2019 also changed its entire orientation experience for every employee, moving beyond just paperwork and videos.
“We decided we wanted to create an experience where, when folks come to work and their first day on the job, or first couple weeks on the job, they get to experience our culture,” Surmi said.
That includes exercises where they meet residents and build relationships with them, learn their life stories, get to know one another and their executive director in a deep way, plus games and other efforts to help them understand Koelsch’s culture, he said.
“That’s been really cool,” Surmi said. “We call it Happiness 101 because our mission statement is we create happiness by providing the finest living experiences anywhere.”
WSU Steps in to Help
Washington State University is doing its part to train the next generation of senior-living leaders with plans to offer a full major in senior-living management in fall 2020 through the Carson College of Business’ School of Hospitality Business Management.
About 10 years ago, Aegis officials and other industry leaders began helping WSU develop a program to train future senior-living leaders to get a head start understanding the complexity and intensity of operating buildings and communities in the industry. The effort began with a training program in one class, an elective course called “Introduction to Senior-Living Management” that’s part of WSU’s hospitality program. In early 2018, WSU added an online, on-demand noncredit-bearing certificate program for the introductory exposure to the industry.
The new major goes further. Offered through WSU’s newly named Granger Cobb Institute for Senior Living, the major will include core business classes — the degree will be a business degree in hospitality — plus additional coursework in human development education to instill a broader knowledge about the aging population, said Nancy Swanger, who’s on the front lines of developing the major’s curriculum. Almost every college on WSU’s campus will offer curriculum input, including fields of psychology, sociology, aging and human development, construction management, interior design, and more, she said.
Swanger is scheduled to become associate dean and founding director of the Granger Cobb Institute for Senior Living on Jan. 1, transitioning from the role of associate dean and director of the School of Hospitality Business Management in the Carson College of Business. The Granger Cobb Institute is housed in the Hospitality School in Pullman.
The plan is to offer a Bachelor of Arts in Hospitality Business Management, with a major in senior-living management, which would be available at all WSU campuses, including Everett, Swanger said. The major will address senior-living management that includes independent living, assisted living, and memory care, but not 24/7 skilled nursing care, which is more of a medical model, she said. However, nursing faculty, including a gerontologist and other WSU medical professionals, are contributing to curriculum development, she said, noting assisted living and memory care facilities include nurses and nursing aides.
Many boomers retiring today won’t consider senior-living facilities until their 80s, but WSU wants to help the industry prepare, she said.
“When the boomers really put the demand on, we want to be at the front of the pack helping solve these workforce challenges and others as well,” Swanger said, noting a “real concern” among operators to groom future property leaders.
WSU’s operations-focused program will train students to become the next leaders and operators of senior-living communities. But as hospitality program majors, students also are required to have 1,000 hours of paid industry experience exposing them to entry-level and front-line roles through internships or other arrangements. The hope is students would transition upon graduation into a management-training position, she said.
“The thing about this project is, it impacts every human that’s breathing — everybody that’s alive; if you’re breathing, you’re aging — and there’s only one way to escape aging, and it’s not a good one necessarily,” Swanger said. “How do we make that better? That’s the goal.”
Competition and Opportunity
Bill Pettit, president of Seattle-based R.D. Merrill Co. — which operates 33 Merrill Gardens senior-living facilities in eight states, including Washington, where it has eight Puget Sound facilities that include communities in Kirkland, Seattle, Renton, Burien, Auburn, and Tacoma, and a future property in Sammamish — has been involved in the WSU planning and also sees a great opportunity in the industry.
Merrill Gardens offers independent living, assisted living, and memory care. About 65 percent of its population is in independent living, and 35 percent uses assisted living and memory care services, for which care aides and licensed nurses are available.
“Even today, so many of the positions that we are competing to fill are talented people in marketing; care, certainly, across the board from caregivers to nurses; food and beverage operations; even to physical plant maintenance because the low level of unemployment and the amount of job growth has left us competing for people with other industries,” Pettit said.
That competition includes construction trades for building and physical plant maintenance personnel; restaurants and hotel and hospitality companies for food and beverage workers; and the hospital industry, urgent care, and home healthcare for caregivers, care aides, and nurses, he said.
“It doesn’t make any difference today which technical skill we have working in our industry; we’re finding almost direct competition amongst industries for the similar type of talent, and that’s just going to get more intense as we see the number of seniors double toward 2025,” Pettit said.
That underscores the importance of working hard to care for good people, make them feel appreciated, and demonstrate to them the opportunities available with the company in the future in order to retain them, he said.
With the growth in seniors seeking senior housing and need for additional staff to handle them, Pettit sees ample potential for workers entering the field.
“It’s a time when I’ve never seen more opportunity in the industry to build a career than we have at this point in time and over the next 15 years,” he said.