Greystone’s Tim Mallad moderated a hospitality panel at this year’s Greystone Management Symposium. Joining Tim were Executive Director Sam Guedouar of The Amsterdam at Harborside, a CCRC in Port Washington, N.Y., and Phil Jacobs, administrator of skilled nursing at The Buckingham, a CCRC in Houston. Both Sam and Phil came to senior living from the hospitality industry. Below is an abridged transcript of their thoughts on how best to transfer hospitality concepts to continuing care retirement communities.
Tim: How is working in a high-end retirement community similar and dissimilar from the hotel experience?
Sam: The residents I have are very accomplished. The expectations are extremely high. They want a four-star chef, they want a great experience on a daily basis, they want to be cared for, they want to be known on a daily basis, they want their community to be clean, the landscaping to be great. It’s no different from hotels. The hotel people want to see that during the couple days of their stay; the residents want to see it for the rest of their lives. In our community, a CCRC, you are the keeper of the promise. The promise that you deliver is that everything is going to be impeccable. You have to ensure that it’s delivered, it’s maintained, and it’s sustained for the rest of their lives. The reason why it’s a little bit different is that the residents are more vested. Hotel guests are not vested. They come in for two days, then they’re out. For residents, it’s their home. Every day we come in and do the work, making sure we do a great job and come back the next day to do a better job.
Tim: Phil, when we were putting these questions together, you shared that you had a family member who was receiving health care and you found certain things lacking. What from your hospitality experience have you been able to incorporate in health care on a day-to-day business?
Phil: I think one of the biggest things that we fail to do in health care is focus on the belief that we’re selling at the forefront. Disney really capitalizes on this point. When customers go to Disneyland, they have a certain notion of what to expect from their vacation. We do not look at going into health care as a vacation. One of the biggest things that people do not have in health care is an understanding that this is going to be a good experience, a positive experience. When they come into our independent living or assisted living side, they have a preconceived notion of what’s going to happen if they ever end up in skilled nursing. What have we done to challenge that, to ensure that what our people have told them on the front end is going to be carried through all the way to the end? When you walk into Disneyland, you’ll see that construction areas are blocked off. There are signs that say, “We don’t want our mess to ruin your vacation.” That mess sometimes could be our staff, it could be our people who prevent families from getting proper communication. Hospitality is not just walking into a room and seeing something pristine and prestigious. It’s also how those services are carried out when residents and family walk in and enjoy the experience.
Tim: Sam, You managed leadership of a very large community that was experiencing a slow fill. You had to introduce some concepts that weren’t always the most popular. Can you talk about managing those expectations when you are in a slow fill and you’ve had to implement some things that would be considered experimental and new for residents?
Sam: When I walked in, it was not a good situation. Today, I feel comfortable that we are doing very well. When we started the hospitality approach, everybody looked at me like, “What is this guy doing? Let’s maintain. You’re rocking the boat.” I wanted the team to understand that we want the residents to feel special. We want to make memorable experiences. Every day I want residents in the community to say, “I’m going to start living today,” because we’re having themed dinners, themed wine tastings. We did chef’s tables, which everybody liked, and it was so full that we had two chef’s tables on a weekly basis. Two months ago, we did trivia, employees against residents in the lobby, and it was so well received that we’re going to do it again. There was a lack of connection to our residents. I had some team members who did not have the hospitality gene. The hospitality gene is people who care naturally. So I went back and looked at the people who are going to serve the residents. We had people in the back of the house that had great personalities, but they were hidden in the back. I brought them up front and put them at concierge. I moved a couple of managers in food and beverage who didn’t do much with the residents and put them up front. They are community strengths, and I made sure they were there to take care of residents.
Tim: Skilled nursing is a heavily regulated environment. How difficult is it to achieve things from a hospitality perspective? How have you overcome regulatory challenges?
Phil: The key people in health care are the nursing staff. We challenge our nurses with the responsibility of being understanding, being proactive, caring for our residents, but also dealing with families. How many nurses go through hospitality training before they go on the floor? It doesn’t happen. The hospitality concept is not there, so what we need to do in health care is ensure that we bring that hospitality element and that education. Most of the time when nursing staff are faced with a question, they’re told to send it to the administrator, send it to the executive director, send it to the nursing director. That’s not the best answer, because we’re diverting the responsibility of an immediate need to a later time. That’s not what families want. They think at that point that the nurse or staff is not competent to handle such things. We need to invest in the people who are dealing with our residents immediately so they’re able to bring that hospitality to them. How do we do that? We do in-services, spend time, show our staff what types of reactions we want them to have when they’re faced with the most troublesome questions.
Tim: I have found as a frequent hotel guest that when I have an issue or complaint the hotel will give me 5,000 points and hope I go away somewhat resolved. In our environment, when you get a complaint or get an issue that may be chronic or unusual, how do you handle that complaint from a CCRC perspective?
Sam: The art of listening, that is the No. 1 thing. You have to be a listener first, and you have to act on plans and follow up. When I came into The Amsterdam, I put out a lot of comment cards and encouraged residents to give me feedback. I was visible 6 hours a day, and I was a magnet for all the complaints. You have to pay attention, it’s very important. And you have to follow up. The follow-up is key. We have a 9 a.m. meeting every day and we talk about issues. What have we resolved? Tell us about what happened yesterday. Anything we need to know about? And then when it comes to town hall, they give me a list of things. I write them down, then the next time when I go to town hall, I can say, “Fixed, fixed, fixed.” It’s always the follow through that makes the confidence, the trust. The residents are active. They want to do a lot of things every day. Problems will happen every day, and we have to expect that.
Tim: Just from an observer’s standpoint, an anecdote from your community, sometimes our culture is a culture of “no.” It’s easy to say the regulations say “no” or the policy says “no.” If you don’t want to get a resident wound up, then saying no as a first thing is probably the worst thing to do. Hotel folks, you give a series of options versus saying no off the bat. I had an employee approach me and say, “Things are so much better here now that we’re able to say ‘maybe,’ or ‘yes,’ or ‘how about this?’” I think the resident or the family is better pleased with the answer, so just a good observation. Phil, I have a question for you, what’s the financial impact of good and poor hospitality, and could poor hospitality affect your RUG scores?
Phil: The problem that people face most when they check into a skilled nursing center is the admission process. When we look at the admission process, if it’s not what they want it to be, that could harm length of stay. People look at wanting to leave immediately. That could be within the first 24 hours or the first 7 days. The hospitality component comes through by ensuring that the admission process is warm and welcoming. One of the things we do is an admissions meeting where we have the team there to meet with the family and answer initial questions. They want to know what’s going to happen to them while they’re here. If we’re not there to answer those questions accurately, that could shorten length of stay. During the time that they’re in the actual health center, if they do not feel warm, if they do not feel welcome, if they do not feel that this is the place they want to be, I’ve always noticed their participation level decreases. When your participation level decreases, what ends up happening? We drop from doing 144 minutes in a daily therapy session down to 100. Did that resident have the potential of doing 144 minutes? Absolutely. But they do not want to be in an environment that is not conducive or at least not welcoming to what they were expecting. So what do they do? They shorten their ability to partake in what’s required for them to get better. It’s not just about a RUG level. But if they’re not receiving proper therapy, they go home and they end up back in the hospital. And it’s not just because of our skilled abilities; it’s because of hospitality.
Tim: How do you transform a reactive culture into a proactive culture?
Sam: Empowering the employees. We have meetings constantly with managers and supervisors and other key employees who want to make a difference in the residents’ lives. And a couple of employees came up with great ideas. We took all resident birthdays and I had my assistant send them as a calendar invite. Now every manager has a calendar invite come up with resident birthdays for that day. It’s promoted throughout the managers and employees. Also, we do anniversaries. That information goes to our dining room, so my dining room manager has that information for the day. When we have anniversaries, we customize a cake with the first letter of the couple’s name. And these ideas are coming from employees: “How about we do this? How about we do that?”
Phil: Proactivity for me is: What are you going to look for in order to combat issues that are going to come later? We have a program called our “angel” program. The purpose of our angel program is to visit our residents on a continual basis. I divvyed up the skilled center into certain groups of rooms, and I’ve assigned a manager to each one of those residents. So each manager has about five residents, and their role is to go to see those residents at least three times a week and report back to me as a group and look at the needs and the concerns of the residents — not when they are expressing them, but before they feel the need to express them. Give them the opportunity, the venue, to express what is wrong and then look at it on a global level. The managers, the staff themselves, need to be able to embrace a resident and say, “Is everything okay? Is there anything that we can do better?” Do this before something grows and festers and becomes a greater problem than it actually is.
Tim: Sam, can you walk us through your three Ps approach?
Sam: We started it about three weeks ago. The first “P” is property walk. We created this little booklet, and we went around and took pictures of certain areas. I took the community and divided it into 15 areas. An employee might own the dining room and the library — that’s their area to walk twice a day to make sure that the set and stage are correct. Everyone has a booklet that shows them what the dining room is supposed to look like, what the library is supposed to look like. They can make changes, but if there’s anything major they can go to the concierge and put in a work order that has to be done the same day. It rotates on a monthly basis. The second “P” is physical activity. I want the mangers to participate twice a month in a physical activity with the residents. You can do Tai Chai, you can walk, you can do yoga, you can do aqua fit if you want to jump in the pool. I wanted my employees to connect with the residents on a personal level. Next week I’m doing line dancing. The last “P” is personal touch. I took all 195 residents and divided them. Every manager and supervisor has 12 or 13 residents that they own and they have to call once a month. The call has no script. You say, “Hi, how are you doing? Is there anything I can do for you?” I just want them to be able to find gaps and bridge those gaps and really connect on a personal level.
Tim: Phil, how can hospitality bridge the gap between the triangle of residents, employees and management?
Phil: We look to ourselves to hire people in management roles, but are they suited to deliver the type of hospitality that we expect? We hired them based on their skills from before, but how many times do we interview people based on their hospitality skills. We assume sometimes that because they are managers or have management skills that they also possess the ability to deliver hospitality. That’s not always true. You have to lead by example, but the question is: “What is the example?” Have we as directors shown hospitality to our managers so that they’re able to lead from that example? Your staff will mimic their manger’s behaviors. If your manager is out there chastising, breaking down the staff and ranting and raving on the floor or even behind closed doors, your staff will conceive that as acceptable behavior. And our customers are not just the residents. Disney, when he focused on his model of how he wanted to start off Disneyland, he focused on his employees. When you walk into Disney, you see name badges that are huge. The first name of the employee is written in big bold letters, and what comes underneath it? Where they grew up. Disney wanted to let each employee know that you are somebody when you walk in this place every day for work. One of the things that we’ve implemented at the Buckingham is that every time we hire an employee, that person comes to me for an interview on hospitality. I never go through their résumé. I just want to see how this person interacts with me and why they want to be in this type of environment. After that, I have the employee come into the morning meeting. Why? Because management needs to know employees by name. It’s not nurse so-and-so who was at the station the other day. She has a name. If you don’t recognize people by name, you’ve already lost a huge element of hospitality. When your managers walk through the building and your people do not feel that the managers know them, they’re not going to feel important in your building. When people don’t feel important, they will transpire that back to the residents and the resident families. It’s important to understand the concept that your employees fall on the forefront of the hospitality realm, but it’s only going to be as strong as your managers understand that concept, too.