At August Health, we have the privilege of speaking with senior living operators every day. These conversations have evolved significantly over the past 3 years, as we’ve witnessed operators emerge from addressing COVID-related emergencies in 2020 to new learnings and perspectives for the years ahead. As we navigate the path to post-COVID recovery and resilience, future-minded senior living leaders are seeking more than a return to pre-pandemic norms. They are envisioning a future that prioritizes care and operational excellence fit for the next era of senior care. 

While NOI remains the north star metric for tracking the financial viability that allows for quality care, few communities can easily report and forecast on NOI’s contributing factors. The pandemic further underscored the importance of transparency and data-driven decision-making for maintaining a high standard of care. Yet so many communities still lack the necessary systems, insights, and support required to both deliver quality care and thrive as businesses.

The NOI spiral consuming your leadership team

There are many talented, highly experienced leaders in Senior Living, but they are often overloaded by daily fire drills. Leaders are short on time and resources to dedicate to planning for the future of their staff and community. There are four major challenge areas at the root of this day-to-day overwhelm.

The staffing challenge: the pervasive juggling act of onboarding and training new staff, retaining existing staff, and managing the financial overhead to do so, all while trying to build a positive work culture and improve personalized care.

The acuity challenge: operators are falling behind in tracking (and billing for) the increasing care being delivered as resident acuity increases. At scale, this phenomenon results in care risks and revenue gaps.

The technology challenge: a deficit of purpose-built solutions for the distinct workflows within the Senior Living industry. Existing software is often hard to use, which results in staff spending too much time on paperwork and hunting down information.

The data challenge: as staff lack user-friendly software to document care information, the result is poor or incorrect data for operational leaders.

These four interconnected challenge areas are all factors that directly affect operating income. When these challenges are feeding into one another, there is a negative compounding effect we think of as an “NOI Spiral”.

When a community doesn’t have the right tools and processes in place, and their team isn’t getting assessments in or charting incidents appropriately, it creates a suboptimal work environment and compromises the quality of care — especially for a population with rising acuity. If the staff don’t have the tools they need and don't feel confident they are set up for success, they will leave their jobs for other opportunities and leave their community further behind. 

With every challenge area continually fueling an NOI’s spiral’s momentum, escaping the spiral can feel impossible.

Moving from NOI spiral to virtuous NOI cycle

While the challenges of the NOI spiral are very real, the opposite is also true. If you can feed a negative feedback cycle with the wrong systems and processes, you can create a virtuous cycle with the right ones. 

A future exists where your assessments are being updated quickly, you have all the data you need to make strategic decisions, your people trust the care systems and are able to deliver the best possible care in a fulfilling work environment. All of a sudden you have a community that is attracting and retaining high caliber staff that deliver excellent care, with income increasing as a result.

Care Smarter, Not Harder

To thrive in the face of challenges, successful senior living leaders are embracing a holistic approach that prioritizes both care and operations.

Staffing: a positive work culture is fostered in which staff members feel valued and empowered to provide the best care possible

Acuity: appropriate care levels are understood and the right support system and staff for residents needs is provided

Technology: user-friendly tools enable staff to focus on care, maintain compliance, and understand the needs of the community.

Data: quality data is collected and leveraged for making proactive decisions around care and operations

Post-pandemic challenges present an opportunity for senior living communities to reimagine their operations, care models, and technologies for the future. By caring smarter, not harder, and developing a virtuous NOI cycle, communities can overcome staffing challenges, adapt to rising acuity levels, and ensure their financial sustainability.

Additional resources

At August Health we’re passionate about helping solve care and operational challenges in the Senior Living industry. We’ll be talking more about these challenges and solutions in future blog posts here on, as well as upcoming webinars, white papers, and more.

To get started, you can watch the recording (or get a quick recap) of our webinar on staff engagement and retention in 2023 and beyond.

To learn about the August Health modern EHR platform and how it’s helping communities like Westmont Living and Koelsch Communities create virtuous NOI cycles, you can request a personal demo below.

August Health

August Health