2010 alfa best of the best

14 Assisted Living executive | May/June 2010 | www.alfa.org

2010i

t mAy be no coincidence thAt ALL of the senior Living compAnies

eArning ALfA 2010 best of the best AwArds shAre And embrAce A cor-

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

DaviD cutler

Best of the BestA 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

By Whitney Redding

ALFA 2010 Best of the Best Award Winners› Human ResourcesAmericanWay Management Corp.Benchmark Assisted LivingBMA Management, Ltd.Brightview Senior Living Brookdale Senior LivingCastle Country Assisted LivingSilverado Senior Living (2)Sunrise Senior LivingVintage Senior Living › Sales & MarketingFive Star Senior LivingEmeritus Senior Living › Resident ServicesEmeritus Senior LivingBell Senior LivingBrookdale Senior Living (3)Carlton Senior LivingCountry Meadows Retirement CommunitiesFive Star Senior Living (2)Horizon Bay Retirement Living (2)Integral Senior Living MBK Senior Living The Orchards at Bartley Assisted LivingSenior Living CommunitiesUnited Methodist Homes/Crosby CommonsUnited Methodist Homes/Middlewoods of FarmingtonLegacy Retirement Communities › Operations & TechnologyEmeritus Senior LivingHoffman SummerWood CommunityTerrace Communities

www.alfa.org | May/June 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, WisconsinLeadership Skills DevelopmentAmericanWay 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 with-in, but few qualified candidates at the three-year-old company have emerged for the administrator positions. Meanwhile, the company has had difficulty finding outside candidates that fit in with the company’s egalitarian culture.

Nowak’s solution was to invite all employees who aspire to leadership to sign up for a 10-month leadership development pro-gram. To her surprise, more than 20 employees did. The course, led by Nowak, covered a range of leadership topics from team-building to self-management. Participants spearheaded leader-ship projects, such as developing a volunteer program, to help the communities. Throughout the course, they developed a cama-raderie and enthusiasm that transcended the boundaries of their day-to-day roles and spilled over to the rest of the community.

The experience was eye-opening for all involved. “To take the 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 know they have choices to be proactive rather than reactive,” says Nowak. By the end of the program, a position opened up and one of the graduates—a direct-care manager whose talent likely would have gone unnoticed if not for the program—got the job.

“This leadership workshop validated to the entire staff that their voice really does matter,” Nowak says.

Winner: Benchmark Assisted LivingWellesley, MassachusettsESL ProgramLike many senior living companies, Benchmark Assisted Living employs a truly international workforce. In the Boston-Newton area, more than 40 percent of associates speak English as a sec-ond language. At times, that can translate into miscommunica-tions and missed opportunities as frontline caregivers and other direct-care personnel struggle to communicate with residents and coworkers.

After conducting an informal needs analysis, Benchmark de-cided to offer English as a Second Language (ESL) courses to as-sociates who wish to improve their language skills. The primary goal, of course, was to enhance the quality of service. Last year, the company rolled out an ESL program at four communities on a pilot basis. Taught by a certified teacher from the Boston Language Institute, two 10-week courses drew 10 students whose English skills ranged from beginner to intermediate. Classes

were held on Wednesday afternoons and evenings for the conve-nience of most participants. Tellingly, some associates who were not working that day also chose to attend. Some participants even offered to pay out of their own pockets for more lessons after the courses ended.

Now Benchmark has deepened its commitment. The com-pany’s learning and development coordinator, Abri brickner, is pursuing Teaching English as a Foreign Language (TEFL) certi-fication and working with Benchmark’s organizational develop-ment team to create a sustainable ESL program that will certify its own teachers in TEFL and is free for interested associates. By taking the program in house, Brickner says, “we’ll be able to really assess the learning level of our students and personalize the program to their developmental and career-specific needs.”

Winner: BMA Management, Ltd.Bradley, Illinois“Leading the Way”BMA Management believes there’s a big difference between an effective day-to-day manager and an inspiring leader. Last year, BMA empowered its corporate- and community-level managers to take a collective step toward becoming more motivational. Through a new leadership development program called “Lead-ing the Way,” managers attend relevant and stimulating quarterly presentations on key leadership topics. Participants read thought-provoking books, hear nationally recognized guest speakers, and take part in challenging interactive exercises. Last year’s sessions addressed such topics as integrating boomers, Gen Xers, and Gen Yers in the workplace, and developing personal accountability.

All sessions are conducted in person. BMA managers also sign a “Leadership Covenant” to model the BMA mission and a commitment to lifelong learning. “We’re always out there culti-vating what the next piece of the leadership puzzle will be,” says rod burkett, president. “With all the complications of manag-ing and leading in today’s environment, we need managers and leaders to inspire, motivate, and lead all of our staff to carry out our mission.”

Since the program began, the turnover rate for executive direc-tors has dropped from 22 percent to 18 percent. The program has led to spin-off initiatives such as a formal mentoring program. In keeping with one of the program’s expectations for participants


to serve as leaders in their market area, BMA has seen a 30 per-cent increase in contacts initiated with various elected officials in 2009 compared to the previous year.

Winner: Brightview Senior LivingBaltimore, MarylandLeader-Led Star CoachingWhen Brightview Senior Living evaluated its performance review process, it found some shortcomings. “The review process wasn’t designed in a way that naturally allowed the stars to rise to the top,” says Andrea griesmar, vice president of human resources.

That finding began a fundamental shift in how Brightview approaches reviews, moving away from a typical reactive perfor-mance evaluation that takes place on different dates for different associates, to a more proactive “coaching” model that happens all year long and culminates in a single annual review date for all associates.

Leader-Led Star Coaching is a non-punitive process that re-inforces good behaviors throughout the year, offers associates a chance to identify their own solutions when improvement is needed, and results in a clearer snapshot of associates’ individual and collective performance during the annual review. Under the new paradigm, coaching is viewed as a development tool, not a disciplinary tool, so it empowers leaders throughout the or-ganization to initiate discussions with associates using positive, problem-solving language. Such day-to-day coaching interactions have led to better job performance and reduced the need for cor-rective actions. “This process gave people the tools to give feed-back, to be more candid, than they ever felt they could before,” Griesmar adds.

The change contributed to a 91 percent retention rate among the highest-rated performers last year, and 100 percent reduction in unacceptable ratings for associates. Seventy-three percent of department directors can identify one or more individuals that they have actively groomed for promotion using the coaching model.

Winner: Brookdale Senior LivingBrentwood, TennesseeThe Brookdale WeighThere’s the Brookdale way, and then there’s the Brookdale Weigh—and the latter has been quite a journey in the past year.

In 2009, Brookdale Senior Living promised cash prizes for employees who joined a 12-week team competition to lose weight. The initiative, modeled after the television show, “The Biggest Loser,” was a resounding success. From frontline staff to the CEO, more than 4,000 associates within 1,224 teams at 400 offices and communities nationwide lost more than 30,000 pounds, or the equivalent of 3 percent of their total body fat. The greatest number of pounds lost was 96, while 247 associates lost 10 percent or more of their body weight.

The company regularly fired up the competition by sending out updates on how well different teams were faring. Communi-ties had fun with it, such as when a community sent fattening pizzas to a rival community. Divisional and companywide win-ners won up to $900 each.

But in this kind of competition, of course, every “loser” was a winner, too. “Even those not out to win the competition were really into it,” says Kristi reid, benefits manager for the company.

“Associates would rah-rah each other, cheering each other on to reach weight-loss goals.”

Also a potential winner: Brookdale’s benefits budget, particu-larly as the company continues to take aim at reducing medical claims through such wellness efforts. “It’s too soon to see if it had an impact, but it created a culture of wellness that may have been lacking in the past,” says Reid.

Winner: Castle Country Assisted LivingCastle Rock, ColoradoCCAL Charm SchoolUltimately, it’s the decorum, not the décor, that defines an as-sisted living residence as charming. Manners do matter, espe-cially when dealing with residents who grew up in an era when common courtesy was a prevalent cultural norm. barbara dice, executive director and CEO of Castle Country Assisted Living, started noticing a few too many “teachable moments” in the way team members interacted with residents and guests. “A lot of our team members are younger,” she explains. “They don’t realize how it can be perceived when you’re on the cell phone or the cell phone is ringing, and how distracting that can be.”

Rather than lecturing employees about interpersonal do’s and don’ts, Dice opted for a lighter touch. She hired local etiquette guru Anthonette Klinkerman to conduct a “Courtesy Boot Camp” for all staff. “Colonel” Klinkerman marched into each session wearing pink boots and military fatigues, and used humor to drive home points about expressing and respecting personal dignity. “It was a crash course, it was fun, it was energetic and affordable,” Dice says. “The first thing she reminded us is that it’s not all about us. It’s about making our residents comfortable in their own home. It’s not about us, it’s about them.”

Thanks to “charm school,” which is now ongoing, team mem-bers are noticeably more comfortable in social situations. “They have strong handshakes. They’re polite on the first meeting. They don’t run away when I’m doing a tour because they fear I’ll in-troduce them,” Dice adds. “Now they walk up to me and they introduce themselves.”

Winner: Silverado Senior LivingSan Juan Capistrano, California“Right Stuff” Recruiting Practices The hiring process at Silverado Senior Living communities used to begin in a busy corporate human resources department, and it wasn’t always expedient. “It was a typical centralized system,” says mark nease, senior director of human resources. Then in 2009, the company unclogged the pipeline and put the right tools for making smart hires directly into the hands of executive directors and supervisors companywide. The result has been a faster, more efficient hiring process—and, ultimately, a savings of $1 million, due in large part to a 33 percent reduction in the turnover rate. “We’ve now done away with almost all of our re-cruiters,” Nease explains.

The key to Silverado’s success has been a multi-pronged approach using commercially available hiring tools backed by company-centric human resources training for managers. Now supervisors seeking to fill a position can tap a comprehensive pool of job applicants through the HireDesk applicant tracking system. Once they find an applicant they want to interview, su-pervisors have been trained through a new Silverado program



called “Right Stuff” to use behavior-based interview approaches as well as health-care-focused assessment tools to screen hires more effectively.

Thanks to more consistent and objective hiring practices, Nease reports a reduction in terminations and anonymous em-ployee hotline complaints based on the wrong fit. “You have to have buy-in from the top, but more importantly, it’s how you go about training,” he adds. “If you make it optional, it’s not going to work.”

Winner: Silverado Senior LivingSan Juan Capistrano, California LOVE > FearSilverado Senior Living took steps last year to bolster its LOVE (is greater than) Fear operating philosophy through training. The re-sult has been an above-and-beyond cultural boost for a workforce that experiences daily challenges related to working exclusively with residents with Alzheimer’s and dementia.

LOVE > Fear is intended to help employees and managers stop and think about their personal mood and motivation before making decisions. It acknowledges that fear is natural when a problem surfaces, but reassures associates that Silverado sup-ports and encourages them in choosing to do the right thing, i.e., consciously make decisions with integrity and sensitivity.

Since the company first introduced this philosophy several years ago, its leadership team found that many associates were uncertain about how to apply this expectation on a behavioral level. “We got to a point where we heard associates saying, ‘I hear what you’re saying, but I really don’t know what that means,’” explains beth burbage, senior director of organizational develop-ment. So the company developed a comprehensive training pro-gram that both explains the philosophy and demonstrates how it applies in nine real-life scenarios. All 1,209 full-time associates have received the training and passed a subsequent exam with an average score of about 93 percent.

Additionally, since that initial training, Burbage has received plenty of anecdotal feedback that helps illustrate a new level of understanding among associates. Said one culinary director: “This may sound normal to you, but to me it’s all a new way of looking and reacting to things in my life—both professionally and personally.”

Winner: Sunrise Senior LivingMcLean, VirginiaSunrise University: Community Training KIOSKsSunrise Senior Living makes it a priority to ensure that all 33,000 employees in its more than 300 communities receive timely training that complies with state regulations and reflects com-pany values.

In the past year, Sunrise successfully piloted online orienta-tion training in 47 communities via self-contained computer learning stations called Key Instructional Online Skills-based Knowledge centers (KIOSKs). A KIOSK in each community pro-vides training, testing, and tracking customized for each team member. Thanks to the KIOSKs, Sunrise is assured that train-ing is consistent and that learners fully understand content prior to supervised skills demonstrations. Team members have 24/7 access to a self-paced training program that also prompts them to meet completion deadlines and gives immediate feedback on

test results.Since implementation, more than 55 percent of the pilot com-

munities have exceeded the corporate compliance rate of 94 percent for timely completion of orientation training, with 39 percent achieving 100 percent on-time completion. The number of hours devoted to orientation has been reduced by 42 percent, to 32 hours, resulting in substantial cost savings.

“The enthusiasm with which the KIOSKs have been received has been remarkable, reflecting our team members’ interest in learning the skills needed for their jobs and an openness to learn-ing via a new technology,” says david peete, vice president of knowledge management and education. “Our biggest challenge has been to install KIOSKs even faster to meet the demand as word spreads.”

Winner: Vintage Senior LivingNewport Beach, CaliforniaReceptionist Training ProgramAfter extensive review of recorded phone calls made to the recep-tion desks of its 21 communities last year, Vintage Senior Living concluded that one area of customer service it could not afford to put on hold was telephone etiquette. “We have the assisted living side down, as far as the health care part of it, but how can we improve customer satisfaction?” poses Lucy woolsey, senior regional sales and training manager. “We only have one chance to make a lasting impression. We as a company wanted to be sure that we were doing our part to give everyone at the front desk the right tools.”

Vintage hired a well-regarded trainer in the hospitality in-dustry to bring polish and professionalism to the front desk. All the receptionists were brought together for a daylong seminar in which they learned a new philosophy for handling calls. Re-ceptionists learned the importance of their work for engaging new business, and strategies to help callers in ways that put the customer first. “You own that call until you get the caller to the right party. If the right party is not around, you own that call to take down the right information,” explains Woolsey.

As it became evident that a higher level of customer service was evolving, Vintage also hired a wardrobe consultant to give a new look to receptionists and managers, alike. Associates now choose professional attire from a catalog, paid for by Vintage.

Category: Sales & Marketing

Winner: Five Star Senior LivingNewton, Massachusetts“Selling the Five Star Difference”Five Star Senior Living sales associates typically used to approach sales by getting referrals, asking for details about the prospect’s situation, hosting community visits, highlighting the commu-nity’s services and features, and following up. But extensive in-terviews and telephone focus groups with Five Star’s top sales performers nationwide uncovered a better way.

All sales associates, as well as executive directors, administra-tors, and regional operations team members, have learned to look at prospects in a different, more strategic light. During training sessions called “Selling the Five Star Difference,” participants learn situation-specific strategies to satisfy customers, target re-ferral sources, analyze the market, recruit their team, and frame


situations differently. The company developed a checklist based on the training’s major points so regional sales directors can track progress each quarter. “Everyone was looking at the features of the community, but when they dug down to what the [prospect] was really like, I think it really opened up the eyes of our sales force,” says mary ellen greenfield, corporate director of sales, marketing, and hospitality.

The new training and tools also accomplished another goal: to have a consistent sales process that works for all of Five Star’s diverse communities. In post-training evaluations, respondents

gave the training a score of more than 90 percent for usefulness. Five Star credits the training for helping the company retain

market share, despite the challenges of a down economy, with-out heavily discounting units. The experience also has led to en-hanced cooperation between sales and operations, and a spin-off initiative for customer service training.

Winner: Emeritus Senior LivingSeattle, WashingtonHome Visit ProgramEmeritus Senior Living has taken the practice of home visits to local seniors one step further, as in: “You don’t have to live with us in order for us to help.”

That’s the motto of the new Emeritus Home Visit Program, a complimentary service to connect seniors in the local markets that Emeritus serves with the vital health, social, and support services they need to maintain their quality of life at home. Born out of the company’s philosophy of social responsibility called “Safely Somewhere,” the Home Visit Program entails sending a range of employees to homes of at-risk seniors to check on their safety and welfare.

Many of the seniors referred to the Home Visit Program by families, church groups, senior centers, and others may never move into an Emeritus community. But that’s beside the point for Emeritus. “We know the program enhances our exposure in the local community,” says Jayne sallerson, senior vice president of marketing. “The bottom line is there are so many resources out there and a lot of families don’t know how to access them. We’re the people that help educate the families.”

Care aides, marketers, housekeepers, and maintenance em-ployees are among the Emeritus envoys who conduct visits, as-sess the situation, and help with everything from arranging for “Meals On Wheels” to doing odd jobs around the house. “What’s most surprising is the sense of pride from the employees,” Saller-son adds. “They see the impact on local seniors. It’s the right thing to do.”

Category: Resident Services

Winner: Emeritus Senior LivingSeattle, WashingtonNortheast Division Dining ContestWhat began as a contest to create a little buzz during Dining Services Month at Emeritus Senior Living ended up taking on a life of its own. This was one contest where the process was the winner.

In October, the 60 communities in the company’s Northeast division earned points for completing a series of tasks designed to enhance the fine dining experience and foster collaboration in the communities for the best interest of residents. “It was an opportunity to spark an interest in dining services,” says steve sacco, divisional dining services director.

Participants earned points for demonstrating quality dining services, improving employee education and recognition, getting resident feedback, and collaborating with activity departments and memory care departments on creative, resident-centered 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.

By the end of the month, Sacco had received hundreds of e-mails, faxes, and photos documenting events large and small. In all, more than 1,000 employees received training at 165 in-services; about 90 percent of the dining departments collaborated with other departments on food-based activities; 70 percent of communities made a visible improvement in the dining envi-ronment; and 30 communities used dining services to attract media attention.

Three winning teams won cash prizes to make purchases for their dining programs.

Winner: Bell Senior LivingGreensboro, North CarolinaResident Retention/Bell Ringer ProgramIn the past, whenever a new resident moved into a Bell Senior Living community, the job of helping that person settle in and find the services they needed fell to the director of resident ser-vices and whichever associates happened to be working that day. “It was very reactive,” explains rosalyn watson, a regional direc-tor of clinical services.

Meanwhile, the regional team would hold regular conference calls with local communities regarding resident care, but those tended to focus mainly on residents whose health was at risk. Any resident who had settled in, but was quietly dissatisfied, was at risk of falling off the radar.

To shine a light on the needs of those residents, Bell created its Resident Retention Program. The goal was to empower every as-sociate who observes a potential satisfaction problem to intervene and communicate information. When transitioning into a com-munity, new residents are assigned a “Bell ringer” to advocate for their needs during the first 30 days. Executive directors host a monthly activity with new residents and families. Associates keep a weekly retention log, with triggers to identify potential losses and retention interventions.

Bell ringers report on their assigned residents each morning, including the outcome of any retention interventions they found

All sales associates as well as executive directors,

administrators, and regional operations team members have learned to look at prospects in a different, more strategic light.



necessary. “The major key ingredient is that every associate or team member is part of the process. It’s not just the CNA, it’s everyone. It’s the housekeeping staff. It’s the dining staff. Every-one communicates with the Bell ringer,” says Watson.

Winner: Brookdale Senior LivingBrentwood, TennesseeOptimum Life: Cross Train Your BrainEach year, as part of its ongoing Optimum Life wellness program, Brookdale Senior Living highlights a different aspect of wellness in its programming. Last year, the company took the show on the road, partnering with the nonprofit Institute for Optimal Ag-ing for a public awareness campaign called “Cross Train Your Brain.” In six major markets from Los Angeles to Raleigh, North Carolina, Brookdale hosted an auditorium of people and brought in local medical experts, led by the company’s own expert, in-ternist and geriatrician Dr. Kevin O’Neil. Speakers focused on the importance of brain fitness for residents and nonresidents, seniors and non-seniors. During the free, all-day symposiums, participants learned about the importance of exercise, emotional health, and social engagement for brain health, and participated in fun breakout sessions such as ballroom dancing.

“It’s not about Alzheimer’s, per se. It’s about the latest re-search about the brain, and how it can be supported through life-style factors. There are certain things you can do over a lifetime to reduce the risk of Alzheimer’s,” says carol cummings, manager of Optimum Life Wellness Programs. “It was hugely popular. In

every place where we did it, we were at capacity and had waiting lists of people who wanted to come.”

“Cross Train Your Brain” educated and engaged prospects and strengthened relationships with professional referral sources, while facilitating partnerships with academic and medical experts in major markets for the company. The campaign also featured special activities for residents throughout the year.

The initiative “helped to establish ourselves as experts,” Cum-mings says. “We’re still getting requests to do those programs.”

Winner: Brookdale Senior LivingBrentwood, Tennessee“We Say Yes” ProgramThe new “We Say Yes” program is a dining services initiative at Brookdale Senior Living communities that ties resident satisfac-tion to associate morale.

This program requires dining services associates at one com-munity to use positive phrases when communicating with resi-dents and guests. For example, if someone asks for an item that is not on the menu, the first answer should be: “Let me check on that for you.” If the item is not available at all, the associate is authorized to come up with a positive solution, such as to offer a similar substitute. “We were looking for ways to empower our associates and at the same time find ways to say ‘yes,’” says Joska hajdu, senior vice president of dining services.

Notably, residents are incorporated into the success of the pro-gram. As part of the initiative, dining services associates wear

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badges that say “We Say Yes.” Whenever a dining services associ-ate is caught in the act of providing exceptional service, residents are encouraged to present them with performance credit in the form of a gold leaf sticker that is added to their badge, akin to a generous restaurant tip. For every 10 performance credits, the dining associate becomes eligible for a reward.

The program spurred friendly competition for gold leaves, gen-erated better service, and made associates more directly account-able for their actions. Resident satisfaction increased 36 percent after implementation. Now other departments and communities 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: Brookdale Senior LivingBrentwood, TennesseeExperiences of a Lifetime As part of Brookdale Senior Living’s Optimum Life program, the company is committed to helping residents and employees live life to the fullest in six wellness areas—physical, spiritual, emo-tional, social, intellectual, and purposeful. But nothing explains this philosophy more clearly than any one of several videos on the company’s Web site, including a clip (www.brookdaleliving.com/pettit-experience-of-a-lifetime.aspx) of resident Jean Pettit.

The video shows Pettit jumping out of an airplane from 13,000 feet in a tandem skydive. She was one of seven Brookdale resi-dents who had a lifelong dream fulfilled through an Optimum Life initiative called Experiences of a Lifetime. Residents were selected based on submissions that explained how their lifelong dream tied back to the six areas of wellness.

In addition to fulfilling dreams, Experiences of a Lifetime was a trendsetter on several levels, from breaking stereotypes about seniors and senior living to energizing a wellness culture, to mak-ing for memorable marketing. “It had a powerful effect on the company, but you have to tell the story to get people to understand it. You can’t just say, ‘Go live an optimum life,’” explains sara terry, vice president of Optimum Life. “By telling the story, you provide a roadmap for others.”

Winner: Carlton Senior LivingMartinez, CaliforniaAdvanced Caregiver Training ProgramLike many providers, Carlton Senior Living has had to turn away prospective residents who would have been a good match for a community, except that they had an advanced chronic disease. People in certain markets may have had to consider nursing homes “who didn’t really need to be there,” says shannon dentel, RN, director of risk management.

Thus a niche was born. To serve the needs of seniors with Parkinson’s, diabetes, multiple sclerosis, or other long-term conditions, Carlton needed specialized caregivers. This led to the company’s first Enhanced Assisted Living community—the Carlton Crown Plaza of Sacramento, which features 24-hour nursing services. All the associates who work at the community have received certifications from the Advanced Caregiver Train-ing Program. ACT training exceeds state training requirements and provides continuing education on select diseases. Caregivers learn how to recognize and observe changes, provide immediate action when necessary, and report what they see. They learn to distinguish better between subjective and objective observations.

“We’re really training caregivers to be proactive with their care, instead of reactive,” Dentel explains.

ACT caregivers are able to participate more in the overall de-velopment of resident care plans. According to Dentel, that has translated into superior care and lower staff turnover among ACT participants (just 17 percent during the first year of operation). “An important goal is that our employees feel valued by [getting] the proper information to understand the how’s and why’s of their jobs,” she adds. “They get a lot of recognition when they go through this program.”

Winner: Country Meadows Retirement CommunitiesHershey, PennsylvaniaVeterans Benefits AssistanceWhat started as a small gesture by a sales manager to help one long-time resident apply for Veterans Administration (VA) ben-efits has turned into a free and highly valuable service for many residents of Country Meadows Retirement Communities.

Since last September, marketing software manager eileen Kutzler has filed 15-20 new applications per month on behalf of veterans and veterans’ spouses who each qualify for up to $1,644 in monthly benefits. The process is onerous; applications are up to 23 pages long and involve about eight months of back-and-forth communication with the VA. “What’s really difficult is to know what to gather, what the VA is looking for. There are a lot of things I’ve learned that the VA wants that aren’t on the form,” Kutzler explains. “And it’s not just the once-and-done initial ap-plication; they have to recertify every year.”

Many residents had been unaware of the benefit or had given up on the cumbersome process. While residents can find a third party to help them through the process, Kutzler sees advantages to providers taking it on. “We have a vested interest in making sure these applications go through the VA, that they get the mon-ey, and that we’re in it for the long haul,” she says.

Call that what you will—good customer service, good market-ing, or good for retention—but families helped by Country Mead-ows have their own terms for it. “I do hear the words ‘godsend’ and ‘blessing’ many times,” adds Kutzler.

Winner: Five Star Senior LivingNewton, Massachusetts“Fall Prevention Is Everybody’s Business”Fall prevention in senior living often is seen as a clinical respon-sibility. Nurses are the experts, after all, and they develop suitable care plans for at risk residents.

Yet, in her position as a regional health director at Five Star Senior Living, bonnie thomas, rn, noticed that falls throughout her 19 communities tended to occur anytime, anywhere, and in the presence of anyone. Therefore, she reasoned, fall prevention must become an area of expertise for all staff. “Really, everyone needs to be as involved as a nurse,” she says. Thomas is passion-ate about preventing falls; her own mother died after falling and hitting her head. “I had a real vested interest that no one else either died or suffered,” she explains.

The result was a pilot project called “Fall Prevention Is Every-body’s Business … Not Just Clinical!” Thomas invited all nursing and activity directors in her region to a two-day kickoff event, where each pair presented a creative idea for decreasing falls.



Each attendee went home with a binder of all 19 ideas to imple-ment. Among them: An employee scavenger hunt to see who can identify the most fall risks in the community; “clinics” to assess eye wear and safe footwear; competition between communities for the least falls; and a partnership with pharmacies to assess medications that could be contributing to falls.

Both the number of falls per month and the number of falls resulting in injury have dropped at participating communities.

Winner: Five Star Senior LivingNewton, MassachusettsBridge to RediscoveryThe success of Five Star Senior Living’s new Bridge to Redis-covery dining services program shows that it is possible to give residents with dementia more control in the dining room—and ensure they eat good foods and eat enough.

The company’s dining directors confirmed that residents with Alzheimer’s could enjoy a good meal as much as other residents. The challenge was coaxing some to pay sufficient attention to eating a nutritious, balanced meal. Indeed, to minimize meal-time complications, many memory care programs predetermine menu selections for residents. “Typically, there aren’t any choices offered. It is assumed it would be too confusing for them,” says raymond helou, regional director of food and dining.

Five Star Senior Living has made a series of dining services changes to promote more choices and greater independence while enhancing residents’ appetite. Main courses are now served “butler-style”; residents can see the choices and point to the one they want. The platters are then placed on the table for residents who are capable of helping themselves to seconds, “family-style.” The ingredients, ambiance, snacks, and hydra-tion practices have been updated in accordance with the latest research. For example, the china was changed because studies show that people with advanced Alzheimer’s eat and drink more when using brightly colored dishes.

The residents responded well, reacting as if eating at the family dinner table, or with friends in a restaurant. Residents’ appetites have improved; weight loss has been re-duced, as has reliance on supplements—in some cases, by up to 50 percent.

Winner: Horizon Bay Retirement LivingTampa, FloridaSMILE ProgramNo matter how well organized and beneficial the activities pro-grams may be, it’s not enough to post them on the calendar, hand out flyers, and make a general announcement. “It doesn’t work that way,” confirms Jim concotelli, vice president of resident programs at Horizon Bay Retirement Living.

Residents might skip an activity for a variety of reasons. They might not be feeling well. They might not be socially inclined. Then again, “some of it is because of very simple things, like hearing and mobility. Some of it is they weren’t paying a high level of attention or got involved in their TV programs. Some of it is forgetfulness,” explains Concotelli.

To increase awareness and participation, Horizon Bay started SMILE, which stands for Schedule, Motivate, Invite, Listen, and

Escort. SMILE is a collaborative effort by all community staff to encourage residents to become more engaged in community life. Through SMILE, communities systematically track participation levels, identify residents who attend the least number of activi-ties per week, and set goals to engage them. All staff members receive training that focuses on listening to residents and com-municating with them about their preferences. Staff members talk up planned activities and actively offer to help residents with any barriers, such as mobility, that might discourage them from participating.

As a result, overall group participation has increased; as many as 70 percent of the least engaged residents in one community attended three or more activities in the first week.

Winner: Horizon Bay Retirement LivingTampa, Florida“Your Story Continues Here”Horizon Bay Retirement Living has a care standard that formally acknowledges the importance of making new residents feel wel-come, and addresses the standard during regular training. But beyond that, there used to be a great deal of variability in how communities put that standard into practice. “You’ll have com-munities that do a great job with it, if there’s a member of the leadership team that values the new resident experience enough to put the process in place,” explains Jim Concotelli, vice presi-dent of resident programs. “Without a system in place, things

can fall by the wayside.”To foster consistency, the company launched “Your Story Continues Here,” a thorough new resident

welcome program developed by a taskforce of employees. Components include a special wel-come during the initial community visit; a final apartment inspection before move-in; personal-ized welcome signs, gifts, and welcome card; an interview to determine the resident’s interests,

a community orientation with staff; and a “Meet Your New Neighbors” social event with current resi-

dents. Another important element is the involvement of a resident-run welcoming committee, which assigns

the new resident a “Welcome Ambassador” to escort them to their first meals and activities. Regional directors interview new residents during community visits to ensure the practices were implemented.

The key to success has been training and communication—there’s a resident handbook, a staff manual, a checklist to follow, and collateral materials. It’s also important to make the protocol easy to implement. “We really tried to simplify it so each step is very easy,” adds Concotelli.

Winner: Integral Senior LivingCarlsbad, CaliforniaDining by DesignIt used to be that some Integral Senior Living communities of-fered only two lunch choices daily, and sometimes no alternative menu either. Thanks to Dining by Design, the company’s recent overhaul of dining services, the quality and consistency of the dining experience at all of its 30 communities recently leaped forward. If a resident at any Integral community doesn’t like the chef’s dinner choices one night, she may peruse an alternative


menu. If she’d prefer to eat at 2:30 in the afternoon or at another off-hour, the goal is to be ready to give her a full meal.

“Resident satisfaction—that’s the goal,” says pari manouchehri, executive director of Quail Ridge in Grass Valley, California. “Din-ing services in this industry is really, really important. For a lot of people who come in to inquire about our building, the first thing they ask about is food.”

To get to where it is today, a taskforce of corporate, regional, and community employees developed comprehensive standards with resident input. Training is extensive, including for executive directors. Among the improvements: A focus on fresh produce; a healthy, standardized alternative menu; attractive marketing collaterals; signature items to help with marketing; comment cards for diners; and—a resident favorite—expanded hours for anytime dining.

One prospect who had moved from one community to an-other because of food sensitivities finally found a home at Quail Ridge after visiting for lunch every day for a week. “It was such a simple thing, but for her, it was a huge deal,” says Manouchehri.

Winner: MBK Senior LivingIrvine, CaliforniaMBK Diabetes Wellness ProgramMBK Senior Living is proving that the words “diabetes” and “well-ness” can be compatible, even for residents who need insulin injections three times a day.

About 10 percent of MBK residents are insulin dependent. Last year, MBK launched a diabetes wellness program that ex-tended the company’s ability to support residents with advanced diabetes and took a wellness approach. The emphasis of the mul-tifaceted program is to empower residents to manage their illness better and improve their quality of life. The program is compre-hensive, covering meal choices, exercise programs, weight and blood pressure monitoring, monthly “healthy feet” monitoring by a podiatrist, smoking cessation support, assistance with doc-tor appointments to manage and monitor blood glucose levels, monthly courses through the American Diabetes Association, and more. Each diabetic resident is offered a diabetes wellness journal that includes a step-by-step guide to managing the disease and a log for monitoring daily progress, which can be brought to doctor’s visits.

Since the program was piloted, MBK has retained 100 percent of insulin dependent residents who previously would have had to be discharged to a higher care provider, and there has been a 50 percent reduction in diabetic complications such as foot ulcers. Since many diabetic residents also have other health concerns, residents have appreciated the tools to keep the diabetes in check. “Because of the program, their blood sugars are more consistent, which means the resident is enjoying a happier, healthier day,” says danielle morgan, vice president of operations.

Winner: The Orchards at Bartley Assisted LivingJackson, New JerseyCare Management ProgramProviding seamless care for residents can be challenging. In ad-dition to monitoring the sometimes subtle changes in residents’ needs, which must be noted and communicated to everyone in-volved in providing care, there is the issue of keeping families and

outside medical providers in the loop. Without adequate prior communication about a resident’s condition, the recommenda-tion to increase service levels for a resident can come as a shock for families.

The Orchards at Bartley Assisted Living last year implemented its new Care Management Program to keep residents, family members, staff, and outside providers on the same page about the progression of a resident’s health. From the time they move into the community, new residents, their family members, and personal physicians are introduced to periodic care management meetings with the wellness director, dementia program coordina-tor (if applicable), activities director, dietitian, social worker, and executive director.

The meetings, held at least once every six months, set the tone for open communication and establish trust in the care and the caregivers. “Residents who are able to participate feel like we understand their needs, and families feel they are being kept abreast of the resident’s condition,” says Joanne ryan, vice presi-dent of administration. Last year, meetings took place for more than 80 percent of new residents and for more than 60 percent of residents overall.

Through a relationship with a geriatric fellowship program at a local teaching hospital, the Care Management Program also is supported daily by physicians-in-training.

Winner: Senior Living CommunitiesCharlotte, North CarolinaWAVESModerate exercise has been shown to alleviate symptoms associ-ated with dementia such as anxiety, wandering behavior, confu-sion, and lack of appetite. Yet residents with dementia often do not have access to the same exercise opportunities as other residents.

Senior Living Communities has taken advantage of the heated indoor pools at their communities to experiment with an aquatic-based exercise class specifically for residents with dementia. On-site wellness coordinators lead training sessions for residents, who each are accompanied into the water by their primary care-giver. The training consists of a variety of slow, methodical, low-impact aerobic exercises.

The program has reaped many benefits. In the first five months, for example, participants experienced a 17 percent av-erage increase in lower body strength, and notable improvements regarding mobility and agitation. It also has provided a bonding experience for residents and their caregivers, as they must rely on each other in the water.

At first, Senior Living Communities piloted the program in only one community to determine how residents would respond. Now the program is expanding to the company’s other communi-ties. “We hope other companies will steal the idea and use it to develop innovative programming for their residents,” says Katie huffstetler, director of public relations.

Winner: United Methodist Homes/Crosby CommonsShelton, ConnecticutTransitions of CareAccording to the National Transitions of Care Coalition, danger-ous and even life-threatening consequences can result when health professionals fail to adequately communicate about an in-



dividual who has been transferred from one provider to another, or when it is assumed that individual will relay all the pertinent health information.

Last year, Crosby Commons Assisted Living Community’s nurs-ing team formed a taskforce to bridge such communication gaps. They devised a system to ensure each resident’s health-care infor-mation will go wherever they go—with the resident’s permission.

Now, whenever a resident interacts with outside providers, the community provides the resident and health-care professionals with a packet describing demographic and insurance informa-tion; a current list of medications; recent nursing notes; infor-mation on the resident’s living situation; and the services that are, and are not, available to them at the community. Residents also receive a Transitions of Care Resource Manual that lists lo-cal and regional health-care resources. When a resident moves out, Crosby Commons provides a transition letter detailing care techniques that worked for that resident.

These efforts have led to improved continuity of care for residents. “Enhanced communication and collaboration among hospitals, home care agencies, rehabilitation facilities, and as-sisted living communities assure resident care needs are ad-dressed in a timely manner,” says Lee waskow, director of health services.

The experience also deepened the community’s relationships with local hospitals. “They tell us they wish other assisted living communities frontloaded them with this information,” Waskow says. “It allows them to expedite the care.”

Winner: United Methodist Homes/Middlewoods of FarmingtonFarmington, ConnecticutFitness ProgramAt Middlewoods of Farmington assisted living community, exer-cise classes involving balance, stretching, sitting exercises, and small weights have been offered regularly for years. But focus groups with residents revealed a demand for enhanced fitness options. Since the building was too small for a fitness room, Ex-ecutive Director carlene rhea was struck with a thought: What about the local YMCA?

Located just 10 minutes away, the “Y” was just the solution Middlewoods of Farmington needed “It’s a fabulous facility,” Rhea says. The community paid for a group membership and started offering complimentary rides to the gym during off-peak hours twice a week. Usually 6-8 residents, including some who use walkers, make the trip. Some are drawn by the heated pool with a ramped entrance. Others spend time participating in ex-ercise classes or using fitness machines. Each participant is re-quired to sign the YMCA’s standard waiver, and YMCA assistants help the seniors as needed.

Meanwhile, Activity Director ginny brown arranged for out-side instructors to teach more varied classes, such as bellydanc-ing, at the community. Additionally, about a dozen residents and staff members have formed a year-round walking group, led by the community receptionist, and have set a goal to participate in a fundraising walk for breast cancer this spring.


The focus on fitness also has helped marketing efforts. “When we say we have a ‘Y’ run twice a week, people’s eyes always light up,” says Rhea. More importantly, she adds, the number of resi-dents involved in exercise increased by 25 percent last year.

Winner: Legacy Retirement CommunitiesLincoln, NebraskaEnrichment Committee/CoordinatorHere’s an intriguing strategy for what to do with a $250,000 advertising budget for three communities in a tough economy: Spend the money on existing residents instead.

That’s what Legacy Retirement Communities did when it decided to forgo traditional promotional strategies last year and reinvest the money in programs. “We weren’t at a shortage of leads, we were at a shortage of closing those leads,” says greg Joyce, director of sales and marketing. “The writing was almost on the wall that the best thing we could do is increase word of mouth, and the best way to increase word of mouth is to focus on programs.”

So as the company turned its attention to the leads it had, it 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-dents’ individual needs and created programs accordingly. The company started a separate wellness department. Even marketing events were tailored to include residents; a “Chef Fest” culinary open house drew 1,200 attendees.

It was not easy to let go of traditional advertising as a means to boost the bottom line. “Today it makes perfect sense. Two years ago when we thought of it, it seemed so scary and uncharted,” Joyce explains.

In terms of customer approval, last year was “by far” the com-pany’s most successful in its 15-year history, Joyce adds. Overall resident satisfaction was 98 percent, while occupancy was at or near 100 percent with a growing waiting list.

Category: Operations and Technology

Winner: Emeritus Senior LivingSeattle, WashingtonE&Me Intranet SiteOne consequence of the 2007 Emeritus-Summerville merger was the less-than-perfect merger of approximately 10,500 forms, manuals, and other documentation. To achieve greater consis-tency in communication and systems among its 316 communi-ties, Emeritus Senior Living recently launched a new employee intranet site called E&Me.

E&Me includes every department in the company and allows senior management to connect with each community. It allows two-way communication for news and announcements through a feature called “Chatter.” It also provides easy access to all manu-als and documentation (reduced to 3,500), which are now easy to update. Plus, new communities can access all these company resources for speedier assimilation.

What many employees value most about E&Me, which was developed by an in-house team of experts, is how user-friendly it is. “That’s been one of the advantages,” says Lori Loucks, direc-tor of policies and procedures integration. “We organized it into

who’s who

Contact information for members in this article.

› Abri brickner, [email protected]

› beth burbage, [email protected]

› rod burkett, [email protected]

› Joan carney, [email protected]

› Jim concotelli, [email protected]

› carol cummings, [email protected]

› shannon dentel, [email protected]

› barbara dice, [email protected]

› mary ellen greenfield, [email protected]

› Andrea griesmar, [email protected]

› Joska hajdu, [email protected]

› raymond helou, [email protected]

› Katie huffstetler, [email protected]

› greg Joyce, [email protected]

› eileen Kutzler, [email protected]

› Lori Loucks, [email protected]

› pari manouchehri, [email protected]

› danielle morgan, [email protected]

› robert murano Jr., [email protected]

› mark nease, [email protected]

› Janis deets nowak, [email protected]

› david peete, [email protected]

› Kristi reid, [email protected]

› carlene rhea, [email protected]

› Joanne ryan, [email protected]

› steve sacco, [email protected]

› Jayne sallerson, [email protected]

› sara terry, [email protected]

› bonnie thomas, [email protected]

› Lee waskow, [email protected]

› rosalyn watson, [email protected]

› Lucy woolsey, [email protected]

functional systems and how they work in the community, rather than just having a bunch of disconnected documents that you have to put together yourself.”

So far, intranet site traffic is up 50 percent compared to the company’s old intranet system. The number of hits to key pages continues to increase, showing that staff is starting to rely on it. When the subject of E&Me came up during one of senior man-agement’s town hall meetings with staff, the audience broke into spontaneous applause.

Winner: Hoffman SummerWood CommunityWest Hartford, ConnecticutRecession Survival StrategiesWhile in the final phases of a community expansion last year, Hoffman SummerWood Community was faced with a challenge. It had nearly doubled its occupancy, and now it had to continue providing quality care to more residents as costs continued to escalate.

Joan carney, executive director, met with department heads and board members to brainstorm ways to keep costs under con-



Strategictrol while still providing top-notch resi-dent care and services. “We looked at how we could do things differently,” Carney explains, not just about how to cut costs.

Among the changes: Residents, family members, and volunteers were tapped to conduct activities, leading to a noteworthy increase in the number of new programs and corresponding attendance. The community restructured its care fees to

be more flexible and affordable to more residents, leading to a 35 percent increase in the number of residents using assisted living services. An energy audit resulted in an estimated 61 percent return on in-vestment after the implementation of the findings. Several new apartments were innovatively designed for flexibility—giving residents the option of a studio or one- or two-bedroom apartment, without

the need to change apartments. Offering complimentary trial stays to prospective residents resulted in a 100 percent con-version rate.

During this time, SummerWood earned a 94 percent approval rating in resident satisfaction surveys. Notably, all respondents said they would recommend the community.

Winner: Terrace CommunitiesNew London, New HampshireTerrace Communities OnlineTerrace Communities offers an intriguing model for how a small regional provider can engage residents, families, employ-ees, and prospects through the creative use of social media.

As early as 2008, Terrace was devel-oping 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 in-volved early and lead the way,” says robert murano Jr., chief operating officer.

Currently up and running at terrace-communities.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 mem-bers can interact and participate.

TCO has grown steadily in members and traffic. To date, more than 8,000 peo-ple 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 communi-cation across the company’s seven com-munities, 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 an-other 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 [email protected].

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