Creating a culture of engagement in senior living

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Michele Holleran
Michele Holleran

Senior living organizations across the United States face three big challenges:

  1. Becoming the employer of choice in their region,
  2. Attracting younger, more vibrant seniors and
  3. Creating a campus where both employees and residents feel they have meaning and purpose.

All three of these challenges can be addressed successfully by creating what I call “A culture of engagement.”

Creating a culture of engagement on campus requires a comprehensive approach, and it usually doesn't happen quickly. In fact, organizational culture gurus believe it takes an average of seven years to change a culture.

I believe it can happen more quickly if some key success factors are in place — employees and residents are already “satisfied” with campus life, the executive leadership team and managers lead the way by demonstrating engaged behaviors, and there is an active and on-going initiative to develop or enhance resident engagement.

Are employees and residents satisfied?

I have long made the case that “satisfaction” is not enough when it comes to campus health. But it is a great start. That's because neither employees or residents are going to get “engaged” unless they are first satisfied.

A campus needs to attend to the basics — those elements of campus life that contribute to satisfaction. For employees, that is a competitive wage and benefit package, on-time and meaningful performance reviews and a feeling that management is fair to them and others.

For residents, it means satisfaction with their living quarters and amenities, confidence that the campus is financially stable and the opportunity to enjoy good to excellent food and service.

Think of satisfaction as being the lower rungs on psychologist Abraham Maslow's Hierarchy of Needs, where the basic needs are being met, both physiological and safety needs. If all the basic needs of both employees and residents are being met, then a campus can begin tackling engagement — human needs identified on the upper rung of the hierarchy, including belonging, esteem and self-actualization.

Until those bottom-rung needs (measured by satisfaction factors) are being met, it is difficult to meet the top-rung needs (measured by engagement factors), and it is the top-rung needs that contribute to a feeling of engagement — the igniting of passion for living and working. These top-rung needs are similar for employees and residents and are met through acceptance, appreciation, trust, mutual respect, friendship, purpose and meaning, using one's strengths and gifts, feeling a connection to mission and achieving personal fulfillment.

To ensure that the lower-rung needs are being met, surveys and other feedback mechanisms are helpful. Some campuses are now doing “pulse” surveys to get a more frequent read on whether the basics are in place.

Holleran measures satisfaction and engagement of both employees and residents and has benchmarks for both sets of survey factors. According to the Holleran national benchmark, which contains 150,000 cases, here is where life plan communities are missing the mark on lower rung needs (as measured by satisfaction factors):

Employees:

  • I am paid a competitive wage (only 56.9% agree)
  • Communication is good (only 56.2% agree)
  • The workload of my team is distributed fairly (only 61.8% agree)

Residents:

  • Convenience/availability of parking (only 65.9% agree)
  • High food quality (only 73.2% agree)
  • Availability of after hours/weekend non-emergency medical services (only 69.8% agree)

As a field, we need to pay attention to the basics before we have a shot at creating “engaged campuses.” Once we've addressed the lower-rung needs of both employees and residents, however, the foundation is strong to address the higher-rung needs.

Are your leaders and managers engaged?

It often has been said that employees don't leave their organizations, they leave their bosses. This is especially true in senior living, where teams rely on each other and their supervisors for support in highly stressful jobs.

Because senior living employees must be skilled in relationship-building as well as task functions, they need even more support. Although many jobs allow employees to hide behind a phone or a once-and-done interaction with a customer, senior living involves the creation of long-term relationships with residents, in a face-to-face, real time, intimate setting.

When employees feel overwhelmed with these interactions, they look to engaged supervisors to help them through rough spots. Non-engaged supervisors are the number one threat to a campus' culture.

The Holleran national benchmark, which catalogues supervisor engagement at hundreds of life plan communities, shows that 58% of supervisors in senior living are engaged — this compares favorably with corporate America, where only 35% of managers are engaged. That's the good news.

But we still have 42% of supervisors who are not engaged, and that spells trouble, leading to high turnover and burnout rates.

An important strategy is to see how many of your campus' supervisors are engaged and find ways to keep them engaged. Offer strategies to encourage engagement — facilities and resources to keep them physically and mentally fit, time and opportunities to create strong partnerships with other managers and their own teams, rewards and recognition so they know they are appreciated, and growth opportunities such as leadership development experiences. Once the supervisors are engaged, you've won more than half the battle, because they will, in turn, empower and encourage the hearts of their subordinates.

Once your campus has the reputation of employing supervisors who are skilled relationship-builders, it will become an employer of choice. Although it is true that salary, benefits and good working conditions attract better workers, it also is true that good supervisors are the real key to enhancing recruitment and retention. Leaders and managers sometimes go “in and out” of engagement, but generally they fall into one camp or the other and often stay there. That's because a lot of engagement is based on intrinsic motivation — the love of the work and the natural connection an employee has to a campus.

It is important to identify those managers who are disengaged, either actively or passively, and to work out a plan of action. For some managers, that will mean exiting the organization.

Once your workforce is engaged, it permeates the entire campus.

Culture, simply defined, is “how a place feels.” The feel of a campus often is dictated by how engaged the staff are in their work — how passionate and compassionate workers are about what they do each and every day. Staff engagement is the “tipping point” for prospective employees when they are choosing between two campuses, with all other things being relatively equal.

The engagement of the resident population on most campuses is a reflection of the staff engagement — the two are intimately intertwined. Together, staff and resident engagement conspire to create an engaged campus.

Make sure your leaders, both executive staff and frontline supervisors, are exhibiting engagement behavior. Spell out those behaviors in writing and ask them to commit to practicing them. Importantly, hold them accountable to those behaviors, and use a 360 degree leadership assessment tool to ensure that those behaviors are experienced by the supervisor, direct reports and peers of each leader.

Is there an active resident engagement initiative taking place?

Life plan communities, in a quest to attract younger and more vibrant resident populations, also need to work on facilitating a good experience for residents by giving them a voice to express opinions and concerns, as well as enhanced opportunities for well-being, personal fulfillment and meaningful connections.

Many seniors today have a different expectation level than their predecessors who hail from the silent generation. Younger members of this generation are not so silent, and the lines between those who grew up in a World War II America and the Vietnam Era are blurred.

Today, campuses are trying to attract those in their 70s at a time when the average age of entry into a life plan community is 82.

Younger residents expect and demand a different experience than their older counterparts. They often want to express their opinions freely, question the administration on its decisions, have representation on the board of directors and see their resident councils taking meaningful action.

They also expect up-to-date fitness and wellness offerings and are much more self-directed when it comes to physical and mental health. Life on campus should offer purpose, meaning and connection.

An engaged resident population sees itself as co-creator of positive campus culture. On those campuses where this desire is squelched or paid “lip service,” relations between residents and administrators become strained. There are many campus environments where this strain is taking the form of protests, petitions and demands to interact with corporate boards of directors.

Holleran has developed a one-of-a-kind resident engagement survey that indexes how well a campus supports successful aging, based on four domains. These domains include voice (engagement with the campus), connection (engagement with others), fulfillment (engagement with life goals) and well-being (engagement with health and wellness).

A wealth of literature shows that these four domains are associated with minimizing disease and mortality, reducing risk and accidents, slowing cognitive and physical impairment and increasing life satisfaction. By focusing on all four of these domains and facilitating a truly engaging campus environment for residents, senior living organizations can reduce costs, maintain and improve the well-being of residents and thrive as both a community and a business.

What are the markers of an engaged campus?

You can actually “feel” how engaged a culture is on a campus. Markers signal high engagement, based on trust, respect and an openness to dissenting opinions. You know if a campus is engaged by:

  • How you are greeted by people as you take a tour or walk the halls.
  • The amount of laughter and interaction between residents, between staff and residents and among staff.
  • The degree that residents create their own activities as opposed to having an activities coordinator create the activities.
  • The acceptance of residents who have disabilities and special needs in dining and common areas.
  • The number of “listening posts” created by administrators to hear from staff and residents.
  • Open and courteous debates about issues and welcoming of all perspectives.
  • Effective communication systems to keep everyone updated on what is happening in the community.
  • High participation in programs that emphasize well-being.
  • Active resident councils that meet often and carry out meaningful work.
  • Regularly executed satisfaction and engagement surveys, with feedback openly shared with staff and residents.
  • High participation in volunteer activities by staff and residents.
  • Innovation in all things large and small.
  • A sense of appreciation and gratitude among most members of the community.
  • Supervisors who regularly encourage the hearts of those with whom they work.
  • Stability of the core staff and leadership team.

Creating an engaged culture is not a function of an ace human resources or resident activities director. Although those positions can facilitate policies and programs that contribute to such a culture, it is the frontline supervisors who hold the key to campus engagement. They are the ones who have the ability to inspire and motivate staff members so that staff members inspire and motivate residents.

Pay close attention to this group, and do everything possible to train them, support them and develop their full potential.

Michele Holleran is founder and CEO of Holleran, a full-service community engagement research and consulting firm with offices in Pennsylvania and Colorado. She can be reached at michele@holleranconsult.com.

McKnight's Senior Living welcomes guest columns on subjects of value to the industry. Please see our submission guidelines for more information.

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