We were lucky enough to interview Rose M. Saenz, whose 25+ year career is centered on serving seniors in various senior living roles from nursing care to operations to new developments. She has successfully opened, licensed and operated several assisted living and memory care communities while providing direct support and mentorship for Executive Directors. Rose is founder of RevealSol, LLC, a company providing operations consulting to senior living organizations across the US. She continues to be an advocate for the industry, serving as Workforce Development Advisor and on the Public Policy Committee with the Texas Assisted Living Association (TALA).
What are some of the key issues in care you’re observing amongst senior living operators?
The big issue with care and care delivery remains the labor pool. Operators want as much consistency as possible when it comes to care for their residents. Consistency is also good for staff — they like to know their residents. However, achieving consistency is challenging in today’s workforce environment. Recruiting and retaining frontline caregivers is hard, particularly as this generation of staff members expects more flexibility to meet needs in their personal lives. It remains a tricky balance — how do we offer flexibility to our staff, but also provide residents with continuity of care?
I’d also say that if we look 10 to 20 years into the future, another emerging issue is that the demand for healthcare workers will exceed the available population. We need to get ahead of this by attracting folks to the senior living industry and getting them into roles like LPNs, CNAs, etc.
What are you hearing from operators in terms of their strategy for growing NOI?
What I hear from a majority of the operators: Occupancy is key. Expense control is obviously relevant and required for growing NOI, but at this point it’s standard and an expected responsibility within any Executive Director’s role. I think most operators know how to tighten up on efficiencies and have already done this.
Now the focus is on the revenue side. Care revenue is a key area that I like to audit. Does your billing match the care services being provided? Are you billing correctly? Are you staying on top of your levels of care? You’ll find discrepancies all the time.
Relatedly, you should be conducting assessments quarterly to avoid acuity drift — this is common in memory care but less so in assisted living. Regular assessments ensure you’re delivering the care your residents need, documenting it, and billing for it.
What trends have you seen in terms of senior living operators and technology?
Since the pandemic, senior living operators have been much more open to adopting new technology, which is great. This is also essential as more residents and their families are demanding better tech from operators.
I think especially for larger operators that have regional management, having better information at your fingertips is incredibly helpful — there are great technology solutions out there that enable this by making care and operations data easily accessible.
Technology is also enabling a much faster pace of operations within communities. If you can do a move-in electronically, without reviewing an entire paper move-in packet in person, that really speeds things up. People are leaning into digital move-ins and e-signatures, as part of a broader digitally-enabled lifecycle that starts with using CRMs and connecting with prospects with online tools, continues with digital move-ins, and then perpetuates throughout a resident’s care experience through things like EHR platforms, and more.
As the Workforce Development Advisor and a Public Policy Committee member for the Texas Assisted Living Association (TALA), what stands out to you from the April 2023 annual conference?
Firstly, Carmen Tilton, TALA VP of Public Policy, provided an update on legislative activity that highlighted how the legislative space around senior living is heating up. One new law or bill can completely change how we operate. Right now we’re mostly seeing new bills in response to emergencies — issues like floods, freezes, and power outages. We’re also seeing a push on clinical topics within assisted living — despite our primary model being social — there’s a push for more control and regulation. This isn’t necessarily bad, in fact I think the intentions are good, but these legislative developments can squeeze operators significantly.
The other issue from TALA that stands out to me was the topic of nursing and scope of practice. This discussion sparked a lot of back and forth, and brought up a lot of questions for operators as we dug into how licenses relate to different roles, what responsibilities are and are not appropriate, where regulatory limits fit in, and more.