2010 ALFA Best of the Best

2010 Best Best of the By Whitney Redding A record number of entries to ALFA’s annual competition results in an elite group of award-winning companies that push resident-centered care and operational excellence to new heights i t mAy be no coincidence thAt ALL of the senior Living compAnies eArning ALfA 2010 est of the best AwArds shAre And embrAce A cor- b porAte cuLture thAt vALues And supports entrepreneuriAL big ideAs. Each of the 33 winners—a record number for the fifth annual awards program—was willing to take a risk and tackle obstacles in new and innovative ways. This year, more than half of all the winning best practices are in the resident services category, and nearly a third relate to human resources. Many of the rest have a strong human resources or resident services component. “What’s striking about many of this year’s winners is how multidimensional they are. They tie employee morale to resident satisfaction, or a commitment to resident wellness with a culture of wellness for employees,” says Richard Grimes, ALFA’s president and CEO. “These companies understand how making improvements in one area can lead to benefits in others as well.” Other take-away trends from the 2010 Best of the Best winners include: • Providers are stepping in to help seniors bridge gaps in the health-care system. Witness programs that help residents obtain veterans’ benefits, connect shut-ins with local services, offer specialized caregiving to seniors with chronic diseases, and improve communications with doctors and hospitals. • Providers view a healthy, happy workforce as being in their best interest. Multiple companies found creative ways to educate and motivate employees, using terms like “ownership” and “accountability” in the same sentence as “competitive fun” and “eye-opening experience.” • Providers are focusing on mission to remain competitive. One company spent its 14 Assisted Living executive | M ay /J une 2010 | www . alfa . org DaviD cutler

ALFA 2010 Best of the Best Award Winners › Human Resources AmericanWay Management Corp. Benchmark Assisted Living BMA Management, Ltd. Brightview Senior Living Brookdale Senior Living Castle Country Assisted Living Silverado Senior Living (2) Sunrise Senior Living Vintage Senior Living › Sales & Marketing Five Star Senior Living Emeritus Senior Living › Resident Services Emeritus Senior Living Bell Senior Living Brookdale Senior Living (3) Carlton Senior Living Country Meadows Retirement Communities Five Star Senior Living (2) Horizon Bay Retirement Living (2) Integral Senior Living MBK Senior Living The Orchards at Bartley Assisted Living Senior Living Communities United Methodist Homes/Crosby Commons United Methodist Homes/Middlewoods of Farmington Legacy Retirement Communities › Operations & Technology Emeritus Senior Living Hoffman SummerWood Community Terrace Communities www . alfa . org | M ay /J une 2010 | Assisted Living executive 15

2010 Best of the Best entire print advertising budget on polishing resident programs; another managed to demonstrate its commitment to its mission in new ways during a budget crisis. • Resident wellness is key to reducing move-outs. Water aerobics for residents with Alzheimer’s, a wellness program just for dia- betics, fulfilling lifelong wishes for residents, and regular bus runs to the local YMCA have all led to positive, measurable outcomes. Meet the ALFA 2010 Best of the Best Award winners. Category: Human Resources Winner: AmericanWay Management Corp. Portage, Wisconsin Leadership Skills Development AmericanWay is fortunate to have a stable direct-care workforce, but its challenge has been hiring administrators. President and owner Janis deets nowak is committed to promoting from within, but few qualified candidates at the three-year-old company were held on Wednesday afternoons and evenings for the conve- have emerged for the administrator positions. Meanwhile, the nience of most participants. Tellingly, some associates who were company has had difficulty finding outside candidates that fit in not working that day also chose to attend. Some participants even with the company’s egalitarian culture. offered to pay out of their own pockets for more lessons after the Nowak’s solution was to invite all employees who aspire to courses ended. leadership to sign up for a 10-month leadership development pro- Now Benchmark has deepened its commitment. The com- gram. To her surprise, more than 20 employees did. The course, pany’s learning and development coordinator, Abri brickner, is led by Nowak, covered a range of leadership topics from team- pursuing Teaching English as a Foreign Language (TEFL) certi- building to self-management. Participants spearheaded leader- fication and working with Benchmark’s organizational develop- ship projects, such as developing a volunteer program, to help ment team to create a sustainable ESL program that will certify the communities. Throughout the course, they developed a cama- its own teachers in TEFL and is free for interested associates. raderie and enthusiasm that transcended the boundaries of their By taking the program in house, Brickner says, “we’ll be able to day-to-day roles and spilled over to the rest of the community. really assess the learning level of our students and personalize The experience was eye-opening for all involved. “To take the the program to their developmental and career-specific needs.” direct-care staff and turn them into managers, one of the first steps is to help them to take control of themselves and let them Winner: BMA Management, Ltd. know they have choices to be proactive rather than reactive,” says Bradley, Illinois Nowak. By the end of the program, a position opened up and “Leading the Way” one of the graduates—a direct-care manager whose talent likely BMA Management believes there’s a big difference between an would have gone unnoticed if not for the program—got the job. effective day-to-day manager and an inspiring leader. Last year, “This leadership workshop validated to the entire staff that BMA empowered its corporate- and community-level managers their voice really does matter,” Nowak says. to take a collective step toward becoming more motivational. Through a new leadership development program called “Lead- Winner: Benchmark Assisted Living ing the Way,” managers attend relevant and stimulating quarterly Wellesley, Massachusetts presentations on key leadership topics. Participants read thought- ESL Program provoking books, hear nationally recognized guest speakers, and Like many senior living companies, Benchmark Assisted Living take part in challenging interactive exercises. Last year’s sessions employs a truly international workforce. In the Boston-Newton addressed such topics as integrating boomers, Gen Xers, and Gen area, more than 40 percent of associates speak English as a sec- Yers in the workplace, and developing personal accountability. ond language. At times, that can translate into miscommunica- All sessions are conducted in person. BMA managers also tions and missed opportunities as frontline caregivers and other sign a “Leadership Covenant” to model the BMA mission and a direct-care personnel struggle to communicate with residents commitment to lifelong learning. “We’re always out there culti- and coworkers. vating what the next piece of the leadership puzzle will be,” says After conducting an informal needs analysis, Benchmark de- rod burkett, president. “With all the complications of manag- cided to offer English as a Second Language (ESL) courses to as- ing and leading in today’s environment, we need managers and sociates who wish to improve their language skills. The primary leaders to inspire, motivate, and lead all of our staff to carry out goal, of course, was to enhance the quality of service. Last year, our mission.” the company rolled out an ESL program at four communities Since the program began, the turnover rate for executive direc- on a pilot basis. Taught by a certified teacher from the Boston tors has dropped from 22 percent to 18 percent. The program has Language Institute, two 10-week courses drew 10 students whose led to spin-off initiatives such as a formal mentoring program. In English skills ranged from beginner to intermediate. Classes keeping with one of the program’s expectations for participants 16 Assisted Living executive | M ay /J une 2010 | www . alfa . org

to serve as leaders in their market area, BMA has seen a 30 per- “Associates would rah-rah each other, cheering each other on to cent increase in contacts initiated with various elected officials reach weight-loss goals.” in 2009 compared to the previous year. Also a potential winner: Brookdale’s benefits budget, particu- larly as the company continues to take aim at reducing medical Winner: Brightview Senior Living claims through such wellness efforts. “It’s too soon to see if it Baltimore, Maryland had an impact, but it created a culture of wellness that may have Leader-Led Star Coaching been lacking in the past,” says Reid. When Brightview Senior Living evaluated its performance review process, it found some shortcomings. “The review process wasn’t Winner: Castle Country Assisted Living designed in a way that naturally allowed the stars to rise to the Castle Rock, Colorado top,” says Andrea griesmar, vice president of human resources. CCAL Charm School That finding began a fundamental shift in how Brightview Ultimately, it’s the decorum, not the décor, that defines an as- approaches reviews, moving away from a typical reactive perfor- sisted living residence as charming. Manners do matter, espe- mance evaluation that takes place on different dates for different cially when dealing with residents who grew up in an era when associates, to a more proactive “coaching” model that happens common courtesy was a prevalent cultural norm. barbara dice, all year long and culminates in a single annual review date for executive director and CEO of Castle Country Assisted Living, all associates. started noticing a few too many “teachable moments” in the way Leader-Led Star Coaching is a non-punitive process that re- team members interacted with residents and guests. “A lot of our inforces good behaviors throughout the year, offers associates team members are younger,” she explains. “They don’t realize a chance to identify their own solutions when improvement is how it can be perceived when you’re on the cell phone or the cell needed, and results in a clearer snapshot of associates’ individual phone is ringing, and how distracting that can be.” and collective performance during the annual review. Under the Rather than lecturing employees about interpersonal do’s and new paradigm, coaching is viewed as a development tool, not don’ts, Dice opted for a lighter touch. She hired local etiquette a disciplinary tool, so it empowers leaders throughout the or- guru Anthonette Klinkerman to conduct a “Courtesy Boot Camp” ganization to initiate discussions with associates using positive, for all staff. “Colonel” Klinkerman marched into each session problem-solving language. Such day-to-day coaching interactions wearing pink boots and military fatigues, and used humor to have led to better job performance and reduced the need for cor- drive home points about expressing and respecting personal rective actions. “This process gave people the tools to give feed- dignity. “It was a crash course, it was fun, it was energetic and back, to be more candid, than they ever felt they could before,” affordable,” Dice says. “The first thing she reminded us is that Griesmar adds. it’s not all about us. It’s about making our residents comfortable The change contributed to a 91 percent retention rate among in their own home. It’s not about us, it’s about them.” the highest-rated performers last year, and 100 percent reduction Thanks to “charm school,” which is now ongoing, team mem- in unacceptable ratings for associates. Seventy-three percent of bers are noticeably more comfortable in social situations. “They department directors can identify one or more individuals that have strong handshakes. They’re polite on the first meeting. They they have actively groomed for promotion using the coaching don’t run away when I’m doing a tour because they fear I’ll in- model. troduce them,” Dice adds. “Now they walk up to me and they introduce themselves.” Winner: Brookdale Senior Living Brentwood, Tennessee Winner: Silverado Senior Living The Brookdale Weigh San Juan Capistrano, California There’s the Brookdale way, and then there’s the Brookdale “Right Stuff” Recruiting Practices Weigh—and the latter has been quite a journey in the past year. The hiring process at Silverado Senior Living communities used In 2009, Brookdale Senior Living promised cash prizes to begin in a busy corporate human resources department, and for employees who joined a 12-week team competition to lose it wasn’t always expedient. “It was a typical centralized system,” weight. The initiative, modeled after the television show, “The says mark nease, senior director of human resources. Then in Biggest Loser,” was a resounding success. From frontline staff 2009, the company unclogged the pipeline and put the right to the CEO, more than 4,000 associates within 1,224 teams at tools for making smart hires directly into the hands of executive 400 offices and communities nationwide lost more than 30,000 directors and supervisors companywide. The result has been a pounds, or the equivalent of 3 percent of their total body fat. The faster, more efficient hiring process—and, ultimately, a savings greatest number of pounds lost was 96, while 247 associates lost of $1 million, due in large part to a 33 percent reduction in the 10 percent or more of their body weight. turnover rate. “We’ve now done away with almost all of our re- The company regularly fired up the competition by sending cruiters,” Nease explains. out updates on how well different teams were faring. Communi- The key to Silverado’s success has been a multi-pronged ties had fun with it, such as when a community sent fattening approach using commercially available hiring tools backed by pizzas to a rival community. Divisional and companywide win- company-centric human resources training for managers. Now ners won up to $900 each. supervisors seeking to fill a position can tap a comprehensive But in this kind of competition, of course, every “loser” was pool of job applicants through the HireDesk applicant tracking a winner, too. “Even those not out to win the competition were system. Once they find an applicant they want to interview, su- really into it,” says Kristi reid, benefits manager for the company. pervisors have been trained through a new Silverado program www . alfa . org | M ay /J une 2010 | Assisted Living executive 17

2010 Best of the Best called “Right Stuff” to use behavior-based interview approaches test results. as well as health-care-focused assessment tools to screen hires Since implementation, more than 55 percent of the pilot com- more effectively. munities have exceeded the corporate compliance rate of 94 Thanks to more consistent and objective hiring practices, percent for timely completion of orientation training, with 39 Nease reports a reduction in terminations and anonymous em- percent achieving 100 percent on-time completion. The number ployee hotline complaints based on the wrong fit. “You have to of hours devoted to orientation has been reduced by 42 percent, have buy-in from the top, but more importantly, it’s how you go to 32 hours, resulting in substantial cost savings. about training,” he adds. “If you make it optional, it’s not going “The enthusiasm with which the KIOSKs have been received to work.” has been remarkable, reflecting our team members’ interest in learning the skills needed for their jobs and an openness to learn- Winner: Silverado Senior Living ing via a new technology,” says david peete, vice president of San Juan Capistrano, California knowledge management and education. “Our biggest challenge LOVE > Fear has been to install KIOSKs even faster to meet the demand as Silverado Senior Living took steps last year to bolster its LOVE (is word spreads.” greater than) Fear operating philosophy through training. The result has been an above-and-beyond cultural boost for a workforce Winner: Vintage Senior Living that experiences daily challenges related to working exclusively Newport Beach, California with residents with Alzheimer’s and dementia. Receptionist Training Program LOVE > Fear is intended to help employees and managers After extensive review of recorded phone calls made to the recep- stop and think about their personal mood and motivation before tion desks of its 21 communities last year, Vintage Senior Living making decisions. It acknowledges that fear is natural when a concluded that one area of customer service it could not afford problem surfaces, but reassures associates that Silverado sup- to put on hold was telephone etiquette. “We have the assisted ports and encourages them in choosing to do the right thing, i.e., living side down, as far as the health care part of it, but how can consciously make decisions with integrity and sensitivity. we improve customer satisfaction?” poses Lucy woolsey, senior Since the company first introduced this philosophy several regional sales and training manager. “We only have one chance years ago, its leadership team found that many associates were to make a lasting impression. We as a company wanted to be uncertain about how to apply this expectation on a behavioral sure that we were doing our part to give everyone at the front level. “We got to a point where we heard associates saying, ‘I hear desk the right tools.” what you’re saying, but I really don’t know what that means,’” Vintage hired a well-regarded trainer in the hospitality in- explains beth burbage, senior director of organizational develop- dustry to bring polish and professionalism to the front desk. All ment. So the company developed a comprehensive training pro- the receptionists were brought together for a daylong seminar gram that both explains the philosophy and demonstrates how it in which they learned a new philosophy for handling calls. Re- applies in nine real-life scenarios. All 1,209 full-time associates ceptionists learned the importance of their work for engaging have received the training and passed a subsequent exam with new business, and strategies to help callers in ways that put the an average score of about 93 percent. customer first. “You own that call until you get the caller to the Additionally, since that initial training, Burbage has received right party. If the right party is not around, you own that call to plenty of anecdotal feedback that helps illustrate a new level of take down the right information,” explains Woolsey. understanding among associates. Said one culinary director: As it became evident that a higher level of customer service “This may sound normal to you, but to me it’s all a new way of was evolving, Vintage also hired a wardrobe consultant to give a looking and reacting to things in my life—both professionally new look to receptionists and managers, alike. Associates now and personally.” choose professional attire from a catalog, paid for by Vintage. Winner: Sunrise Senior Living Category: Sales & Marketing McLean, Virginia Sunrise University: Community Training KIOSKs Winner: Five Star Senior Living Sunrise Senior Living makes it a priority to ensure that all 33,000 Newton, Massachusetts employees in its more than 300 communities receive timely “Selling the Five Star Difference” training that complies with state regulations and reflects com- Five Star Senior Living sales associates typically used to approach pany values. sales by getting referrals, asking for details about the prospect’s In the past year, Sunrise successfully piloted online orienta- situation, hosting community visits, highlighting the commu- tion training in 47 communities via self-contained computer nity’s services and features, and following up. But extensive in- learning stations called Key Instructional Online Skills-based terviews and telephone focus groups with Five Star’s top sales Knowledge centers (KIOSKs). A KIOSK in each community pro- performers nationwide uncovered a better way. vides training, testing, and tracking customized for each team All sales associates, as well as executive directors, administra- member. Thanks to the KIOSKs, Sunrise is assured that train- tors, and regional operations team members, have learned to look ing is consistent and that learners fully understand content prior at prospects in a different, more strategic light. During training to supervised skills demonstrations. Team members have 24/7 sessions called “Selling the Five Star Difference,” participants access to a self-paced training program that also prompts them learn situation-specific strategies to satisfy customers, target re- to meet completion deadlines and gives immediate feedback on ferral sources, analyze the market, recruit their team, and frame 18 Assisted Living executive | M ay /J une 2010 | www . alfa . org

situations differently. The company developed a checklist based on the training’s major points so regional sales directors can track Category: Resident Services progress each quarter. “Everyone was looking at the features of the community, but when they dug down to what the [prospect] Winner: Emeritus Senior Living was really like, I think it really opened up the eyes of our sales Seattle, Washington force,” says mary ellen greenfield, corporate director of sales, Northeast Division Dining Contest marketing, and hospitality. What began as a contest to create a little buzz during Dining The new training and tools also accomplished another goal: Services Month at Emeritus Senior Living ended up taking on a to have a consistent sales process that works for all of Five Star’s life of its own. This was one contest where the process was the diverse communities. In post-training evaluations, respondents winner. In October, the 60 communities in the company’s Northeast division earned points for completing a series of tasks designed All sales associates as well to enhance the fine dining experience and foster collaboration in the communities for the best interest of residents. “It was an as executive directors, opportunity to spark an interest in dining services,” says steve administrators, and regional sacco, divisional dining services director. Participants earned points for demonstrating quality dining operations team members have services, improving employee education and recognition, getting resident feedback, and collaborating with activity departments learned to look at prospects in a and memory care departments on creative, resident-centered different, more strategic light. food-related activities. Each week, Sacco posted the scorecard as well as photos of what various communities had done, which fired up the competitive fun. gave the training a score of more than 90 percent for usefulness. By the end of the month, Sacco had received hundreds of Five Star credits the training for helping the company retain e-mails, faxes, and photos documenting events large and small. market share, despite the challenges of a down economy, with- In all, more than 1,000 employees received training at 165 in- out heavily discounting units. The experience also has led to en- services; about 90 percent of the dining departments collaborated hanced cooperation between sales and operations, and a spin-off with other departments on food-based activities; 70 percent of initiative for customer service training. communities made a visible improvement in the dining environment; and 30 communities used dining services to attract Winner: Emeritus Senior Living media attention. Seattle, Washington Three winning teams won cash prizes to make purchases for Home Visit Program their dining programs. Emeritus Senior Living has taken the practice of home visits to local seniors one step further, as in: “You don’t have to live with Winner: Bell Senior Living us in order for us to help.” Greensboro, North Carolina That’s the motto of the new Emeritus Home Visit Program, Resident Retention/Bell Ringer Program a complimentary service to connect seniors in the local markets In the past, whenever a new resident moved into a Bell Senior that Emeritus serves with the vital health, social, and support Living community, the job of helping that person settle in and services they need to maintain their quality of life at home. Born find the services they needed fell to the director of resident ser- out of the company’s philosophy of social responsibility called vices and whichever associates happened to be working that day. “Safely Somewhere,” the Home Visit Program entails sending a “It was very reactive,” explains rosalyn watson, a regional direc- range of employees to homes of at-risk seniors to check on their tor of clinical services. safety and welfare. Meanwhile, the regional team would hold regular conference Many of the seniors referred to the Home Visit Program by calls with local communities regarding resident care, but those families, church groups, senior centers, and others may never tended to focus mainly on residents whose health was at risk. Any move into an Emeritus community. But that’s beside the point resident who had settled in, but was quietly dissatisfied, was at for Emeritus. “We know the program enhances our exposure in risk of falling off the radar. the local community,” says Jayne sallerson, senior vice president To shine a light on the needs of those residents, Bell created its of marketing. “The bottom line is there are so many resources Resident Retention Program. The goal was to empower every as- out there and a lot of families don’t know how to access them. sociate who observes a potential satisfaction problem to intervene We’re the people that help educate the families.” and communicate information. When transitioning into a com- Care aides, marketers, housekeepers, and maintenance em- munity, new residents are assigned a “Bell ringer” to advocate ployees are among the Emeritus envoys who conduct visits, as- for their needs during the first 30 days. Executive directors host sess the situation, and help with everything from arranging for a monthly activity with new residents and families. Associates “Meals On Wheels” to doing odd jobs around the house. “What’s keep a weekly retention log, with triggers to identify potential most surprising is the sense of pride from the employees,” Saller- losses and retention interventions. son adds. “They see the impact on local seniors. It’s the right Bell ringers report on their assigned residents each morning, thing to do.” including the outcome of any retention interventions they found www . alfa . org | M ay /J une 2010 | Assisted Living executive 19

2010 Best of the Best necessary. “The major key ingredient is that every associate or every place where we did it, we were at capacity and had waiting team member is part of the process. It’s not just the CNA, it’s lists of people who wanted to come.” everyone. It’s the housekeeping staff. It’s the dining staff. Every- “Cross Train Your Brain” educated and engaged prospects and one communicates with the Bell ringer,” says Watson. strengthened relationships with professional referral sources, while facilitating partnerships with academic and medical experts Winner: Brookdale Senior Living in major markets for the company. The campaign also featured Brentwood, Tennessee special activities for residents throughout the year. Optimum Life: Cross Train Your Brain The initiative “helped to establish ourselves as experts,” Cum- Each year, as part of its ongoing Optimum Life wellness program, mings says. “We’re still getting requests to do those programs.” Brookdale Senior Living highlights a different aspect of wellness in its programming. Last year, the company took the show on Winner: Brookdale Senior Living the road, partnering with the nonprofit Institute for Optimal Ag- Brentwood, Tennessee ing for a public awareness campaign called “Cross Train Your “We Say Yes” Program Brain.” In six major markets from Los Angeles to Raleigh, North The new “We Say Yes” program is a dining services initiative at Carolina, Brookdale hosted an auditorium of people and brought Brookdale Senior Living communities that ties resident satisfac- in local medical experts, led by the company’s own expert, in- tion to associate morale. ternist and geriatrician Dr. Kevin O’Neil. Speakers focused on This program requires dining services associates at one com- the importance of brain fitness for residents and nonresidents, munity to use positive phrases when communicating with resi- seniors and non-seniors. During the free, all-day symposiums, dents and guests. For example, if someone asks for an item that participants learned about the importance of exercise, emotional is not on the menu, the first answer should be: “Let me check health, and social engagement for brain health, and participated on that for you.” If the item is not available at all, the associate is in fun breakout sessions such as ballroom dancing. authorized to come up with a positive solution, such as to offer “It’s not about Alzheimer’s, per se. It’s about the latest re- a similar substitute. “We were looking for ways to empower our search about the brain, and how it can be supported through life- associates and at the same time find ways to say ‘yes,’” says Joska style factors. There are certain things you can do over a lifetime to hajdu, senior vice president of dining services. reduce the risk of Alzheimer’s,” says carol cummings, manager Notably, residents are incorporated into the success of the pro- of Optimum Life Wellness Programs. “It was hugely popular. In gram. As part of the initiative, dining services associates wear NCRI IS THE ONLY WOMAN OWNED, ISO 9001 QUALITY CERTIFIED, CLASS A COMMERCIAL CONTRACTOR, AND FULL SERVICE RESTORATION IN THE WORLD. AS A GLOBAL LEADER, NCRI HAS PROVIDED OVER 38 YEARS OF IMPLEMENTING FREE COMPREHENSIVE PRE-DISASTER PLANS. � EVERY SECOND COUNTS EMERGENCY SERVICES “PLEASE CONTACT US OFFICES & AFFILIATES FOR YOUR COMPLIMENTARY SITE ASSESSMENT. SEE OUR ARTICLE 1.800.598.6274 ON EMERGENCY IMMEDIATE RESPONSE FIRE . SMOKE . WATER . STORM . MOLD . DAMAGE PREPAREDNESS PLANNING!” 24 HOURS A DAY, 365 DAYS A YEAR PATRICIA A. EASTER WWW.NCRICAT.COM PRESIDENT MENTION THIS AD AND RECEIVE THE ALE SUBSCRIBER DISCOUNT 20 Assisted Living executive | M ay /J une 2010 | www . alfa . org

badges that say “We Say Yes.” Whenever a dining services associ- “We’re really training caregivers to be proactive with their care, ate is caught in the act of providing exceptional service, residents instead of reactive,” Dentel explains. are encouraged to present them with performance credit in the ACT caregivers are able to participate more in the overall de- form of a gold leaf sticker that is added to their badge, akin to a velopment of resident care plans. According to Dentel, that has generous restaurant tip. For every 10 performance credits, the translated into superior care and lower staff turnover among ACT dining associate becomes eligible for a reward. participants (just 17 percent during the first year of operation). The program spurred friendly competition for gold leaves, gen- “An important goal is that our employees feel valued by [getting] erated better service, and made associates more directly account- the proper information to understand the how’s and why’s of able for their actions. Resident satisfaction increased 36 percent their jobs,” she adds. “They get a lot of recognition when they go after implementation. Now other departments and communities through this program.” are borrowing the concept. As Hajdu puts it: “It’s really difficult to walk around with a badge that says ‘yes’ and then say ‘no.’” Winner: Country Meadows Retirement Communities Winner: Brookdale Senior Living Hershey, Pennsylvania Brentwood, Tennessee Veterans Benefits Assistance Experiences of a Lifetime What started as a small gesture by a sales manager to help one As part of Brookdale Senior Living’s Optimum Life program, the long-time resident apply for Veterans Administration (VA) ben- company is committed to helping residents and employees live efits has turned into a free and highly valuable service for many life to the fullest in six wellness areas—physical, spiritual, emo- residents of Country Meadows Retirement Communities. tional, social, intellectual, and purposeful. But nothing explains Since last September, marketing software manager eileen this philosophy more clearly than any one of several videos on Kutzler has filed 15-20 new applications per month on behalf of the company’s Web site, including a clip (www.brookdaleliving. veterans and veterans’ spouses who each qualify for up to $1,644 com/pettit-experience-of-a-lifetime.aspx) of resident Jean Pettit. in monthly benefits. The process is onerous; applications are up The video shows Pettit jumping out of an airplane from 13,000 to 23 pages long and involve about eight months of back-and- feet in a tandem skydive. She was one of seven Brookdale resi- forth communication with the VA. “What’s really difficult is to dents who had a lifelong dream fulfilled through an Optimum know what to gather, what the VA is looking for. There are a lot Life initiative called Experiences of a Lifetime. Residents were of things I’ve learned that the VA wants that aren’t on the form,” selected based on submissions that explained how their lifelong Kutzler explains. “And it’s not just the once-and-done initial ap- dream tied back to the six areas of wellness. plication; they have to recertify every year.” In addition to fulfilling dreams, Experiences of a Lifetime was Many residents had been unaware of the benefit or had given a trendsetter on several levels, from breaking stereotypes about up on the cumbersome process. While residents can find a third seniors and senior living to energizing a wellness culture, to mak- party to help them through the process, Kutzler sees advantages ing for memorable marketing. “It had a powerful effect on the to providers taking it on. “We have a vested interest in making company, but you have to tell the story to get people to understand sure these applications go through the VA, that they get the mon- it. You can’t just say, ‘Go live an optimum life,’” explains sara ey, and that we’re in it for the long haul,” she says. terry, vice president of Optimum Life. “By telling the story, you Call that what you will—good customer service, good market- provide a roadmap for others.” ing, or good for retention—but families helped by Country Mead- ows have their own terms for it. “I do hear the words ‘godsend’ Winner: Carlton Senior Living and ‘blessing’ many times,” adds Kutzler. Martinez, California Advanced Caregiver Training Program Winner: Five Star Senior Living Like many providers, Carlton Senior Living has had to turn away Newton, Massachusetts prospective residents who would have been a good match for a “Fall Prevention Is Everybody’s Business” community, except that they had an advanced chronic disease. Fall prevention in senior living often is seen as a clinical respon- People in certain markets may have had to consider nursing sibility. Nurses are the experts, after all, and they develop suitable homes “who didn’t really need to be there,” says shannon dentel, care plans for at risk residents. RN, director of risk management. Yet, in her position as a regional health director at Five Star Thus a niche was born. To serve the needs of seniors with Senior Living, bonnie thomas, rn, noticed that falls throughout Parkinson’s, diabetes, multiple sclerosis, or other long-term her 19 communities tended to occur anytime, anywhere, and in conditions, Carlton needed specialized caregivers. This led to the presence of anyone. Therefore, she reasoned, fall prevention the company’s first Enhanced Assisted Living community—the must become an area of expertise for all staff. “Really, everyone Carlton Crown Plaza of Sacramento, which features 24-hour needs to be as involved as a nurse,” she says. Thomas is passion- nursing services. All the associates who work at the community ate about preventing falls; her own mother died after falling and have received certifications from the Advanced Caregiver Train- hitting her head. “I had a real vested interest that no one else ing Program. ACT training exceeds state training requirements either died or suffered,” she explains. and provides continuing education on select diseases. Caregivers The result was a pilot project called “Fall Prevention Is Every- learn how to recognize and observe changes, provide immediate body’s Business … Not Just Clinical!” Thomas invited all nursing action when necessary, and report what they see. They learn to and activity directors in her region to a two-day kickoff event, distinguish better between subjective and objective observations. where each pair presented a creative idea for decreasing falls. www . alfa . org | M ay /J une 2010 | Assisted Living executive 21

2010 Best of the Best Each attendee went home with a binder of all 19 ideas to imple- Escort. SMILE is a collaborative effort by all community staff to ment. Among them: An employee scavenger hunt to see who can encourage residents to become more engaged in community life. identify the most fall risks in the community; “clinics” to assess Through SMILE, communities systematically track participation eye wear and safe footwear; competition between communities levels, identify residents who attend the least number of activi- for the least falls; and a partnership with pharmacies to assess ties per week, and set goals to engage them. All staff members medications that could be contributing to falls. receive training that focuses on listening to residents and com- Both the number of falls per month and the number of falls municating with them about their preferences. Staff members resulting in injury have dropped at participating communities. talk up planned activities and actively offer to help residents with any barriers, such as mobility, that might discourage them from Winner: Five Star Senior Living participating. Newton, Massachusetts As a result, overall group participation has increased; as many Bridge to Rediscovery as 70 percent of the least engaged residents in one community The success of Five Star Senior Living’s new Bridge to Redis- attended three or more activities in the first week. covery dining services program shows that it is possible to give residents with dementia more control in the dining room—and Winner: Horizon Bay Retirement Living ensure they eat good foods and eat enough. Tampa, Florida The company’s dining directors confirmed that residents with “Your Story Continues Here” Alzheimer’s could enjoy a good meal as much as other residents. Horizon Bay Retirement Living has a care standard that formally The challenge was coaxing some to pay sufficient attention to acknowledges the importance of making new residents feel wel- eating a nutritious, balanced meal. Indeed, to minimize meal- come, and addresses the standard during regular training. But time complications, many memory care programs predetermine beyond that, there used to be a great deal of variability in how menu selections for residents. “Typically, there aren’t any choices communities put that standard into practice. “You’ll have com- offered. It is assumed it would be too confusing for them,” says munities that do a great job with it, if there’s a member of the raymond helou, regional director of food and dining. leadership team that values the new resident experience enough Five Star Senior Living has made a series of dining services to put the process in place,” explains Jim Concotelli, vice presi- changes to promote more choices and greater independence dent of resident programs. “Without a system in place, things while enhancing residents’ appetite. Main courses are now can fall by the wayside.” served “butler-style”; residents can see the choices and To foster consistency, the company launched “Your point to the one they want. The platters are then Story Continues Here,” a thorough new resident placed on the table for residents who are capable welcome program developed by a taskforce of of helping themselves to seconds, “family-style.” employees. Components include a special wel- The ingredients, ambiance, snacks, and hydra- come during the initial community visit; a final tion practices have been updated in accordance apartment inspection before move-in; personal- with the latest research. For example, the china ized welcome signs, gifts, and welcome card; an was changed because studies show that people interview to determine the resident’s interests, with advanced Alzheimer’s eat and drink more a community orientation with staff; and a “Meet when using brightly colored dishes. Your New Neighbors” social event with current resi- The residents responded well, reacting as if eating dents. Another important element is the involvement at the family dinner table, or with friends in a restaurant. of a resident-run welcoming committee, which assigns Residents’ appetites have improved; weight loss has been re- the new resident a “Welcome Ambassador” to escort them to duced, as has reliance on supplements—in some cases, by up their first meals and activities. Regional directors interview new to 50 percent. residents during community visits to ensure the practices were implemented. Winner: Horizon Bay Retirement Living The key to success has been training and communication— Tampa, Florida there’s a resident handbook, a staff manual, a checklist to follow, SMILE Program and collateral materials. It’s also important to make the protocol No matter how well organized and beneficial the activities pro- easy to implement. “We really tried to simplify it so each step is grams may be, it’s not enough to post them on the calendar, very easy,” adds Concotelli. hand out flyers, and make a general announcement. “It doesn’t work that way,” confirms Jim concotelli, vice president of resident Winner: Integral Senior Living programs at Horizon Bay Retirement Living. Carlsbad, California Residents might skip an activity for a variety of reasons. They Dining by Design might not be feeling well. They might not be socially inclined. It used to be that some Integral Senior Living communities of- Then again, “some of it is because of very simple things, like fered only two lunch choices daily, and sometimes no alternative hearing and mobility. Some of it is they weren’t paying a high menu either. Thanks to Dining by Design, the company’s recent level of attention or got involved in their TV programs. Some of overhaul of dining services, the quality and consistency of the it is forgetfulness,” explains Concotelli. dining experience at all of its 30 communities recently leaped To increase awareness and participation, Horizon Bay started forward. If a resident at any Integral community doesn’t like the SMILE, which stands for Schedule, Motivate, Invite, Listen, and chef’s dinner choices one night, she may peruse an alternative 22 Assisted Living executive | M ay /J une 2010 | www . alfa . org

menu. If she’d prefer to eat at 2:30 in the afternoon or at another outside medical providers in the loop. Without adequate prior off-hour, the goal is to be ready to give her a full meal. communication about a resident’s condition, the recommenda- “Resident satisfaction—that’s the goal,” says pari manouchehri, tion to increase service levels for a resident can come as a shock executive director of Quail Ridge in Grass Valley, California. “Din- for families. ing services in this industry is really, really important. For a lot of The Orchards at Bartley Assisted Living last year implemented people who come in to inquire about our building, the first thing its new Care Management Program to keep residents, family they ask about is food.” members, staff, and outside providers on the same page about To get to where it is today, a taskforce of corporate, regional, the progression of a resident’s health. From the time they move and community employees developed comprehensive standards into the community, new residents, their family members, and with resident input. Training is extensive, including for executive personal physicians are introduced to periodic care management directors. Among the improvements: A focus on fresh produce; meetings with the wellness director, dementia program coordina- a healthy, standardized alternative menu; attractive marketing tor (if applicable), activities director, dietitian, social worker, and collaterals; signature items to help with marketing; comment executive director. cards for diners; and—a resident favorite—expanded hours for The meetings, held at least once every six months, set the tone anytime dining. for open communication and establish trust in the care and the One prospect who had moved from one community to an- caregivers. “Residents who are able to participate feel like we other because of food sensitivities finally found a home at Quail understand their needs, and families feel they are being kept Ridge after visiting for lunch every day for a week. “It was such a abreast of the resident’s condition,” says Joanne ryan, vice presi- simple thing, but for her, it was a huge deal,” says Manouchehri. dent of administration. Last year, meetings took place for more than 80 percent of new residents and for more than 60 percent Winner: MBK Senior Living of residents overall. Irvine, California Through a relationship with a geriatric fellowship program at MBK Diabetes Wellness Program a local teaching hospital, the Care Management Program also is MBK Senior Living is proving that the words “diabetes” and “well- supported daily by physicians-in-training. ness” can be compatible, even for residents who need insulin injections three times a day. Winner: Senior Living Communities About 10 percent of MBK residents are insulin dependent. Charlotte, North Carolina Last year, MBK launched a diabetes wellness program that ex- WAVES tended the company’s ability to support residents with advanced Moderate exercise has been shown to alleviate symptoms associ- diabetes and took a wellness approach. The emphasis of the mul- ated with dementia such as anxiety, wandering behavior, confu- tifaceted program is to empower residents to manage their illness sion, and lack of appetite. Yet residents with dementia often do not better and improve their quality of life. The program is compre- have access to the same exercise opportunities as other residents. hensive, covering meal choices, exercise programs, weight and Senior Living Communities has taken advantage of the heated blood pressure monitoring, monthly “healthy feet” monitoring indoor pools at their communities to experiment with an aquatic- by a podiatrist, smoking cessation support, assistance with doc- based exercise class specifically for residents with dementia. On- tor appointments to manage and monitor blood glucose levels, site wellness coordinators lead training sessions for residents, monthly courses through the American Diabetes Association, who each are accompanied into the water by their primary care- and more. Each diabetic resident is offered a diabetes wellness giver. The training consists of a variety of slow, methodical, low- journal that includes a step-by-step guide to managing the disease impact aerobic exercises. and a log for monitoring daily progress, which can be brought The program has reaped many benefits. In the first five to doctor’s visits. months, for example, participants experienced a 17 percent av- Since the program was piloted, MBK has retained 100 percent erage increase in lower body strength, and notable improvements of insulin dependent residents who previously would have had to regarding mobility and agitation. It also has provided a bonding be discharged to a higher care provider, and there has been a 50 experience for residents and their caregivers, as they must rely percent reduction in diabetic complications such as foot ulcers. on each other in the water. Since many diabetic residents also have other health concerns, At first, Senior Living Communities piloted the program in residents have appreciated the tools to keep the diabetes in check. only one community to determine how residents would respond. “Because of the program, their blood sugars are more consistent, Now the program is expanding to the company’s other communi- which means the resident is enjoying a happier, healthier day,” ties. “We hope other companies will steal the idea and use it to says danielle morgan, vice president of operations. develop innovative programming for their residents,” says Katie huffstetler, director of public relations. Winner: The Orchards at Bartley Assisted Living Winner: United Methodist Homes/Crosby Jackson, New Jersey Commons Care Management Program Shelton, Connecticut Providing seamless care for residents can be challenging. In ad- Transitions of Care dition to monitoring the sometimes subtle changes in residents’ According to the National Transitions of Care Coalition, danger- needs, which must be noted and communicated to everyone in- ous and even life-threatening consequences can result when volved in providing care, there is the issue of keeping families and health professionals fail to adequately communicate about an in- www . alfa . org | M ay /J une 2010 | Assisted Living executive 23

2010 Best of the Best dividual who has been transferred from one provider to another, Winner: United Methodist Homes/Middlewoods or when it is assumed that individual will relay all the pertinent of Farmington health information. Farmington, Connecticut Last year, Crosby Commons Assisted Living Community’s nurs- Fitness Program ing team formed a taskforce to bridge such communication gaps. At Middlewoods of Farmington assisted living community, exer- They devised a system to ensure each resident’s health-care infor- cise classes involving balance, stretching, sitting exercises, and mation will go wherever they go—with the resident’s permission. small weights have been offered regularly for years. But focus Now, whenever a resident interacts with outside providers, the groups with residents revealed a demand for enhanced fitness community provides the resident and health-care professionals options. Since the building was too small for a fitness room, Ex- with a packet describing demographic and insurance informa- ecutive Director carlene rhea was struck with a thought: What tion; a current list of medications; recent nursing notes; infor- about the local YMCA? mation on the resident’s living situation; and the services that Located just 10 minutes away, the “Y” was just the solution are, and are not, available to them at the community. Residents Middlewoods of Farmington needed “It’s a fabulous facility,” also receive a Transitions of Care Resource Manual that lists lo- Rhea says. The community paid for a group membership and cal and regional health-care resources. When a resident moves started offering complimentary rides to the gym during off-peak out, Crosby Commons provides a transition letter detailing care hours twice a week. Usually 6-8 residents, including some who techniques that worked for that resident. use walkers, make the trip. Some are drawn by the heated pool These efforts have led to improved continuity of care for with a ramped entrance. Others spend time participating in ex- residents. “Enhanced communication and collaboration among ercise classes or using fitness machines. Each participant is re- hospitals, home care agencies, rehabilitation facilities, and as- quired to sign the YMCA’s standard waiver, and YMCA assistants sisted living communities assure resident care needs are ad- help the seniors as needed. dressed in a timely manner,” says Lee waskow, director of Meanwhile, Activity Director ginny brown arranged for out- health services. side instructors to teach more varied classes, such as bellydanc- The experience also deepened the community’s relationships ing, at the community. Additionally, about a dozen residents and with local hospitals. “They tell us they wish other assisted living staff members have formed a year-round walking group, led by communities frontloaded them with this information,” Waskow the community receptionist, and have set a goal to participate in says. “It allows them to expedite the care.” a fundraising walk for breast cancer this spring. 24 Assisted Living executive | M ay /J une 2010 | www . alfa . org

The focus on fitness also has helped marketing efforts. “When functional systems and how they work in the community, rather we say we have a ‘Y’ run twice a week, people’s eyes always light than just having a bunch of disconnected documents that you up,” says Rhea. More importantly, she adds, the number of resi- have to put together yourself.” dents involved in exercise increased by 25 percent last year. So far, intranet site traffic is up 50 percent compared to the company’s old intranet system. The number of hits to key pages Winner: Legacy Retirement Communities continues to increase, showing that staff is starting to rely on it. Lincoln, Nebraska When the subject of E&Me came up during one of senior man- Enrichment Committee/Coordinator agement’s town hall meetings with staff, the audience broke into Here’s an intriguing strategy for what to do with a $250,000 spontaneous applause. advertising budget for three communities in a tough economy: Spend the money on existing residents instead. Winner: Hoffman SummerWood Community That’s what Legacy Retirement Communities did when it West Hartford, Connecticut decided to forgo traditional promotional strategies last year and Recession Survival Strategies reinvest the money in programs. “We weren’t at a shortage of While in the final phases of a community expansion last year, leads, we were at a shortage of closing those leads,” says greg Hoffman SummerWood Community was faced with a challenge. Joyce, director of sales and marketing. “The writing was almost It had nearly doubled its occupancy, and now it had to continue on the wall that the best thing we could do is increase word of providing quality care to more residents as costs continued to mouth, and the best way to increase word of mouth is to focus escalate. on programs.” Joan carney, executive director, met with department heads So as the company turned its attention to the leads it had, it and board members to brainstorm ways to keep costs under con- raised the bar on dining services to include five-star menu style dining, national recognition for the chefs, and special events. A new enrichment committee and coordinator focused on resi- who ’ s who dents’ individual needs and created programs accordingly. The company started a separate wellness department. Even marketing Contact information for members in this article. events were tailored to include residents; a “Chef Fest” culinary › Abri brickner, abrickner@benchmarkquality.com open house drew 1,200 attendees. › beth burbage, bburbage@silveradosenior.com It was not easy to let go of traditional advertising as a means › rod burkett, rod.burkett@bma-mgmt.com to boost the bottom line. “Today it makes perfect sense. Two years › Joan carney, jcarney@hoffmansummerwood.org ago when we thought of it, it seemed so scary and uncharted,” › Jim concotelli, jconcotelli@horizonbay.com Joyce explains. › carol cummings, ccummings@brookdaleliving.com In terms of customer approval, last year was “by far” the com- › shannon dentel, shannon@carltonseniorliving.com pany’s most successful in its 15-year history, Joyce adds. Overall › barbara dice, barbaradice@castlecountryassistedliving.org resident satisfaction was 98 percent, while occupancy was at or › mary ellen greenfield, mgreenfield@5sqc.com near 100 percent with a growing waiting list. › Andrea griesmar, agriesmar@sheltergrp.com › Joska hajdu, joskah@brookdaleliving.com Category: Operations and Technology › raymond helou, rhelou@5sqc.com › Katie huffstetler, khuffstetler@senior-living-communities.com Winner: Emeritus Senior Living › greg Joyce, greg@legacyretirement.com Seattle, Washington › eileen Kutzler, ekutzler@countrymeadows.com E&Me Intranet Site › Lori Loucks, lloucks@emeritus.com One consequence of the 2007 Emeritus-Summerville merger › pari manouchehri, quailridgeed@islllc.com was the less-than-perfect merger of approximately 10,500 forms, › danielle morgan, daniellemorgan@mbk.com manuals, and other documentation. To achieve greater consis- › robert murano Jr., rmurano@terracecommunities.net tency in communication and systems among its 316 communi- › mark nease, mnease@silveradosenior.com ties, Emeritus Senior Living recently launched a new employee › Janis deets nowak, jannow@amwelcome.com intranet site called E&Me. › david peete, david.peete@sunriseseniorliving.com E&Me includes every department in the company and allows › Kristi reid, kreid@brookdaleliving.com senior management to connect with each community. It allows › carlene rhea, crhea@umh.org two-way communication for news and announcements through › Joanne ryan, jryan@bartleyhealthcare.com a feature called “Chatter.” It also provides easy access to all manu- › steve sacco, ssacco@emeritus.com als and documentation (reduced to 3,500), which are now easy › Jayne sallerson, jsallerson@emeritus.com to update. Plus, new communities can access all these company › sara terry, sterry@brookdaleliving.com resources for speedier assimilation. › bonnie thomas, bthomas@5sqc.com What many employees value most about E&Me, which was › Lee waskow, lwaskow@umh.org developed by an in-house team of experts, is how user-friendly it › rosalyn watson, rwatson@bellpartnersinc.com is. “That’s been one of the advantages,” says Lori Loucks, direc- › Lucy woolsey, lucy.woolsey@vintagesenior.com tor of policies and procedures integration. “We organized it into www . alfa . org | M ay /J une 2010 | Assisted Living executive 25

2010 Best of the Best trol while still providing top-notch resi- be more flexible and affordable to more the need to change apartments. Offering dent care and services. “We looked at how residents, leading to a 35 percent increase complimentary trial stays to prospective we could do things differently,” Carney in the number of residents using assisted residents resulted in a 100 percent con- explains, not just about how to cut costs. living services. An energy audit resulted version rate. Among the changes: Residents, family in an estimated 61 percent return on in- During this time, SummerWood members, and volunteers were tapped to vestment after the implementation of the earned a 94 percent approval rating in conduct activities, leading to a noteworthy findings. Several new apartments were resident satisfaction surveys. Notably, all increase in the number of new programs innovatively designed for flexibility— respondents said they would recommend and corresponding attendance. The giving residents the option of a studio or the community. community restructured its care fees to one- or two-bedroom apartment, without Winner: Terrace Communities New London, New Hampshire Terrace Communities Online Terrace Communities offers an intriguing model for how a small regional provider can engage residents, families, employees, and prospects through the creative use of social media. As early as 2008, Terrace was developing what essentially became a public- facing, private social network. “We knew early that social networking would be useful for us and that this was where the world was heading. We wanted to get involved early and lead the way,” says robert murano Jr., chief operating officer. Currently up and running at terracecommunities.groupsite.com, Terrace Communities Online (TCO) provides a way for members to easily connect, chat, and share information, photos, files, events, videos, and other media using tools like a group blog, discussion fo- rums, e-mail blasts, calendars, and more. The public can eavesdrop, but only members can interact and participate. TCO has grown steadily in members and traffic. To date, more than 8,000 people have made 20,000 visits to the site with 46,000+ page views. As of March 31, there were 142 members, 159 blog posts, 105 discussions, and 1,059 photos on the site. TCO helps to centralize communication across the company’s seven communities, educate prospects and families, and give a competitive marketing edge. The site also has received high-profile praise on the social media blog, Mash- able.com. “It works on so many levels and I think we’re really just scratching the surface,” says Murano. “It gives us another way to engage, communicate with, and support residents, families, and other stakeholders.” ❏ Whitney Redding is a contributing writer to Assisted Living Executive. Reach her at wredding@alfa.org. 26 Assisted Living executive | M ay /J une 2010 | www . alfa . org

2010 ALFA Best of the Best

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2010 ALFA Best of the Best — Document Transcript

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