Prepare now for the coming shift in resident engagement

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Michele Holleran
Michele Holleran

If offering an extensive variety of activities to residents on your life plan community (formerly known as continuing care retirement community) campus is your idea of resident engagement, think again.

Notions around what resident engagement looks like these days varies widely. New findings, however, just released from Holleran, a research and consulting firm serving the senior living field, identifies four key dimensions of engagement:

  1. having a voice,
  2. well-being and security,
  3. purpose and fulfillment and
  4. inclusion and acceptance.

These four dimensions have been uncovered over the past two years by Holleran qualitative and quantitative research experts.

Having a voice

According to focus group research among older adults living in life plan communities, residents are starting to see themselves as “investors,” not merely “renters,” and they believe they deserve a say in how a campus is governed. They want full access to the board of directors.

Holleran's conversations with CEOs and executive directors nationwide reveal that when residents have issues to discuss that are not fully vetted early on or addressed to the residents' satisfaction, resident leaders often begin circulating petitions to ensure that they will be heard. What's more, many of these residents, with a substantial history of executive leadership in government, universities, leading Fortune 500 companies or small businesses, believe they are up to the task of co-managing life plan communities, especially at high-end communities, where the atmosphere is more akin to a country club than a retirement home.

This change in climate is requiring CEOs to evaluate how they will create space in their workday to listen to dissenting voices that were not as present five or more years ago. They are finding that these “vocal silents” are not all that silent. Residents want to have a voice.

“It's a new era,” said Tim Johnson, CEO of Frasier Meadows in scenic and progressive Boulder, CO. Johnson, a senior living provider veteran of 30 plus years, said his campus residents may demographically resemble the Silent Generation of seniors, but they behave a lot more like baby boomers. “They are outspoken and have a lot to say. They don't just want updates; they want input from the start,” he said.

Johnson and his leadership team make sure that many opportunities exist for that expression to surface, in the form of frequent town meetings, focus groups and an open door policy to hear the voices of the residents. He's held off on executing several key decisions because not all residents believed their voices had been properly heard. He got pushback, and he paid attention. And for the most part, he's glad he did.

“The process takes longer, but in the end, it's a better product,” he said. “I have to admit, the residents had some really great ideas to suggest that we hadn't thought of ourselves.”

Governance is another way that residents have a voice. Sometimes, however, resident councils aren't viewed as being very effective. Resident ratings of their own resident councils on campus are mixed.

According to the Holleran resident satisfaction benchmark, the largest of its kind in the field, resident councils (also called “associations” on some campuses) score a 79.9 on a 100-point scale for their effectiveness. This is one of the lower-scoring items on the Holleran resident surveys.

Beyond improving resident councils, a movement is afoot to get more resident representatives on corporate boards that govern campuses. In fact, the National Continuing Care Residents Association, in its Resident Bill of Rights, recommends that three spots on the corporate board of directors be selected and appointed by residents, and it holds that these three board members should have rights and duties commensurate with the rest of the board members.

NaCCRA's recommendation has been embraced at Kendal at Oberlin, a life plan community in Oberlin, OH. In addition, this campus' executive director, Barbara Thomas, and the corporate board of directors took the idea a step further by deciding that the best person to lead their 16-month strategic planning initiative was one of their three resident board members. This resident board member, who had more than 40 years of experience as a vice president at Case Western Reserve University in nearby Cleveland, has led the most rigorous and engaging strategic planning process in the organization's 20-plus-year history. His goal, according to Thomas, “was to make sure there were no surprises” and get buy-in from residents and other stakeholders who will support the strategic direction, not second-guess it. Like Johnson, Thomas believes that taking the extra time to solicit resident input at the front end makes things go smoother at the back end.

Reinforcing this trend of resident involvement in campus governance is a new study by the Mather LifeWays Institute on Aging that will gather information and perspectives from the staffs of life plan communities relative to the growing resident interest in operational transparency and shared decision-making. Expect that study to be released early next year.

Well-being and security

At the 2015 Ziegler Conference in Palm Springs, CA, Lisa McCracken, senior vice president of senior living research and development at the specialty investment bank, talked about the two big trends in life plan communities: hospitality and wellness.

Wellness programs are anything but new, and the self-directed health movement is becoming bigger than ever on campuses. Active seniors have embraced wellness, and many campuses believe that state-of-the-art gyms, swimming pools, walking paths and exercise programs are a must-have, no longer just a nice-to-have feature.

Guided by the philosophy that seniors should “live long and die short,” some campuses have adopted Masterpiece Living's Personal Lifestyle Inventory to assess how often residents interact with others, laugh and sleep well to help them identify the small changes and goals they wish to achieve to improve well-being and age more successfully.

Vitality360 is a joint venture of Kendal Corp. and Hebrew SeniorLife to help residents “get stronger, feel better and stay well.” The organization provides evidence-based rehabilitation services delivered by fatigue and pain specialists. The staff also consists of behavioral therapists and psychotherapists, recognizing that well-being is more than just about the physical dimension.

Mather Lifeways is collaborating with the University of Arizona on a project called Thrive (not to be confused with LeadingAge's Thrive initiative), which brings together the expertise of school educators, gerontologists and industry leaders to adapt existing successful programs from other fields to meet the unique needs of older adults, thereby allowing for implementation of varied and sustainable programs for resident engagement and wellness.

Security is a dimension of resident engagement that surprised researchers at Holleran. As one resident eloquently shared during a focus group session, however: “How would anyone expect a high level of engagement on campus and with other residents if we were too afraid to leave our houses or apartments?”

Purpose and fulfillment

Residents today no doubt would appreciate hearing these words as they enter a life care community for the first time: “We welcome you to use your talents, skills, interests and gifts to make our campus an even better place to live.” Even if these words are shared, it is another matter to make them come to life so residents feel a sense of purpose and fulfillment.

Campuses all over the country are striving to make it happen, however. Kendal at Oberlin in Ohio rightfully is proud of its Grandparent Reader program, whereby low-income children read to a resident one on one, offering a unique and beneficial intergenerational experience at local elementary schools. One Kendal resident has taken on the job of creating a volunteer clearinghouse that helps track and measure the effect of resident volunteers who give their time and talent to more than 80 community organizations outside the campus walls.

And as with many campuses these days, Kendal is finding that it is better to let the residents direct their own social activities than to hire staff to do so. More and more resident-directed activities are organic in nature and allow seniors to determine how they would like to spend their time finding purpose and meaning.

Back at Frasier Meadows in Colorado, the residents even started their own brewery. Although no marijuana-growing operations are yet on campus, it's our bet that CEO Johnson won't be surprised when the request comes his way.

In addition to volunteering on and off campus and creating resident-driven activities, older adults at life plan communities are starting to crave just that — their own life plans, outlining the goals, aspirations, bucket lists and desires that they'd like to achieve for fulfillment in the last years of their lives.

Successful aging — a term used widely but with no consensus definition — in the future will depend as much on finding a sense of purpose as on physiologic and mental well-being. The staff at Mather Lifeways in Evanston, IL, have coined a term that encapsulates this search for meaning by residents: “repriorment.” Employees are trained to work with residents to find pursuits that are unique and meaningful to them as individuals, fostering boundless opportunities for personal satisfaction and fulfillment.

Inclusion and acceptance

The fourth dimension of resident engagement is inclusion and acceptance. This dimension has relevance at a variety of levels and manifests itself in a desire by residents to be welcomed on campus for exactly who they are. For some residents, that means not being ostracized because they are frail and need a walker to ambulate. For others, it means to freely express affection to a gay partner.

The concept of inclusion also relates to racial and economic status. A focus group participant living in a rural Mississippi life plan community stated: “I've been fighting my whole life to be treated equally. It was not my intent to spend the last decade of my life continuing the fight.” Happily, she reports that she feels fully accepted on the campus where she lives and has no regrets about moving there, despite the fact she is in the minority.

It is important to make visitors feel included and accepted as well. Some residents interviewed by the Holleran researchers stated that, on occasion, staff members have seemed annoyed by the presence of and questions from family members. Extending a warm welcome to family members on campus speaks volumes about the culture of an organization.

The idea of inclusion and acceptance intersects with the first dimension of resident engagement — having a voice.

“I'd like to be able to express my point of view, even if it is not what most of the others on campus happen to believe. I don't want to be attacked because my beliefs are different. Hell, we are all entitled to our individual opinions. That's what makes this a free country,” stated one resident who was interviewed about resident engagement.

Conclusions and recommendations

The shift in nomenclature from CCRC to life plan community still is in its early stages, and the adoption of a new mindset toward resident engagement is moving in tandem with that shift.

The idea that residents want a say, seek well-being and security, crave purpose and fulfillment, and desire inclusion and acceptance is not revolutionary per se, but combining all these dimensions under the banner of resident engagement is an important paradigm that senior living providers ought to consider embracing. Engagement is not one or another of these elements; rather, it embodies all of them, according to Holleran's research findings.

Providers can create a culture of engagement that allows resident populations to flourish by adopting a dozen practices:

  1. Include residents in decisions that affect their lives early in the process.
  2. Create a variety of channels for resident feedback to be heard.
  3. Strengthen the role and responsibilities of the resident council/association.
  4. Add resident representation with voting rights to the corporate board.
  5. Adopt a formal well-being program such as Masterpiece Living or Vitality360.
  6. Recognize that well-being is multidimensional and includes good mental health. Support the mental health of residents through counseling, stress management, spiritual offerings and other resources.
  7. Don't overlook the obvious. Make sure your residents feel safe and secure on campus.
  8. Develop an inventory of resident talents, skills, interests and gifts, and put that inventory to use.
  9. Invite residents to create and manage their own life plans that outline goals, aspirations, bucket lists and activities that are fulfilling to them individually.
  10. Encourage and organize volunteering efforts both inside and beyond the campus walls.
  11. Assess how inclusive your campus is perceived to be by residents and family members.
  12. Encourage full acceptance of all residents through policies, practices and behaviors.

Michele Holleran is CEO of Holleran, a research and consulting firm with offices and staff in Pennsylvania and Colorado. She may be reached at michele@holleranconsult.com. Visit the Holleran website at www.holleranconsult.com.

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