NaCCRA Forum: Governance of CCRC/LifePlan Communit

At Bethany Village in Mechanicsburg, PA we have a nominating committee that takes nominations from residents of the five areas of residental living for each opening from their area on the Residents' Council and creates ballots that go to each of those areas. The voting is by individual resident and the candiate from each who gets the most votes is elected to the Residents' Council. The RC elects their officers from the RC members based on the bylaws. I have not seen any public campaigning in the 14 years we have been here, but there appears to be a lot of back room politicing going on.

As I posted recently under "elections" the process at Westminster Place in Evanston Illinois is similar to the one that Leslie describes. I think the RAC would be more respected and powerful and if the process were more open and democratic but I am not sure how many people agree with me.

First, I'm excited to find this organization and group. We have been at this CCRC for 2 1/2 years and the first two were pretty shut down from Covid. So, I'm just getting the lay of the land.

I have a question about Resident Association elections. Here there is a nominating committee that gathers names of people who might run for the two offices that come open every two years. Rather than try to explain a procedure I don't understand please let me insert the explanation I received from the chair of the nominating committee:

"WCBR has a sub-committee, the Nominating Committee, with the responsibility of developing the candidates for election to the Board. This committee is led by a resident chosen by the President. Committee membership is one representative from each of the 15 Areas, plus one from Catered living.

The Area Reps meet with their membership and develop a list of candidates for each upcoming elected position. This list of proposed candidates are reviewed by the Nom. Com. They contact the proposed candidates and confirm their willingness to be considered. The Com. ends up with one proposed candidate for each position and presents this to the Res. Ass’n. Executive Board. This Board must approve the recommended candidates.

There are only 4 officers of the Res. Ass’n . President, First VP, Second VP and Secretary. The By-Laws spell out that the President and 2nd VP are elected in one year and the 1st VP and Secretary are elected in the following year.

Each office is for a term of two years. 

This nominated slare of two officers is presented by the Nom. Com. at the first Res. Ass.n meeting in March. The President asks if any resident wants to add their name to the preposed slate of two officers. The vote is taken by a show of hands of those present. A majority of members present confirms the election of each candidate. 

This process is followed every year by By-Law mandates. 

I have the responsibility of providing to all residents the slate of two candidates each year. This will be done at least two weeks before the March meeting. 

I hope that this explains how the nominating and election process works. It has been done this way for many years, and I intend to conduct this year’s election in the above manner."

--------------

So, in essence the new officers are already hand-picked by the Executive Committee of the Residents Association and general members only get to say "Aye". It also means that people have been thoroughly dissected by the small group and I can only wonder how defamatory discussions might get. It also explains why a small number of men continue to be "in charge" although there are far more women.

Do other CCRCs do this? Do other Westminster-Canterburys do this.

Any information would be helpful

👍👍👍 Here's to revolutionary (and not silent) women!

Thanks for pointing me to the Mather Institute, Maura. I just visited the website and it looks like a terrific resource!

Claudia, thank you for the detailed and thoughtful reply. It does sound like Goodwin Living does truly care about Residents and works hard to keep them involved in decision-making. It seems to me that this is a critical factor in giving residents a dignified way to age and to maintain their own agency as human beings as they age. Very inspiring!

I live in the same CCRC as Claudia K and agree with everything she says, especially her last line, “Residents overwhelmingly feel the staff-resident relationship is reciprocal – we care for each other.”

We try to show our appreciation in many ways, for instance by learning names of all the staff, not easy with turnover, for instance among servers.  We greet staff when we see them.  We learn about where they are from and, for the younger ones, where they go to school and what they hope to do. We are enriched by knowing them.

We also do more tangible things.  One resident realized how expensive it is to apply for US citizenship.  She urged and negotiated and worked with management and the Goodwin Living Foundation to establish a citizenship fund, to defray the $750 cost.  The fund has been supported by resident contributions.  In the four years the fund has been in operation over 100 staff have been helped.  The program has received news coverage and we get enquiries from other CCRCs about how to replicate it.

During the pandemic the call went out to help the Foundation help our staff.  Even though they were employed, many family members lost their jobs.  Staff were given weekly grocery gift cards and many were helped with emergency funds, again funded by resident contributions.  Staff was coming in despite the risks to help us, we all felt, so the least we could do was help them.

I should add that there are three residents on the Board of Directors of the Goodwin Living Foundation. 

Our most concrete annual expression of thanks is through the resident-run Employee Gift Fund.  We have a strict no-tipping policy so each year this is our chance to show the team members how much we appreciate them.  In 2021, residents raised around half a million dollars and gave out 419 checks.  The committee that does all of this is chartered by the Resident Council.  The bank account is controlled by the committee and the checks are issued by the committee.  Note that executive leadership team; directors; administrators are NOT eligible for the gifts.

We truly feel that we are a community, not just of residents but also of all those who work here.  Respect in both directions helps make it so.

Dear "Want to Know,"

Possibly your banner is a metaphor for consciousness?

I also am enjoying and learning from these posts. I too am technically a member of the silent generation by date of birth, but my attitudinal system is more aligned with the next generation. I'm not generally silent. My expectations for retirement were to enrich my life to the fullest of my ability as I choose. I inadvertently moved into a well established facility with an old-fashioned program that pressured new residents to fit in because they knew best.

Consciousness of issues is the first step toward understanding the bigger picture surrounding any situation. This level of sharing has taught me that others are seeing/experiencing some of the same things that I am. Gathering more information from this blog helps me decide how I'm going to handle it.

Maura

This is a wonderful discussion.

I especially liked this recent statement by Maura Conry:

"These organizations started out ministering to the Greatest Generation and the Silent Generation who retired with different goals in mind. . . . . The past generations did not speak up and went with the flow. Now the Baby Boomers are here, highly educated career professionals with something else in mind as indicated in these posts."

As pointed out by Pat Kidd earlier, the generational change is mainly about the females, who with the Baby Boomer generation were the first to have some experience in running things in the wider world beyond the home.

I just checked a CCRC roster of residents: 72% female.

Vive la revolution! (Note that “revolution” in French is feminine.)

By the way, I'm a member of the Silent Generation.

Hi Donald and Pat,

The Mather Institute on Aging has a national survey report online: Transparence & Decision Making in Life Plan Communities (Resident Expectations) that will be helpful. Mather has a number of well validated studies.

A major issue is that CCRCs have government regulated services (Nursing Home, Assisted Living, Rehabilitation). Standards of practice, levels of employee education/licensure/certification strictly mandated, as are levels of care. There is a process for accountability. Independent Living typically is unregulated, except in a handful of states (last time I looked). There is a way to certify Independent Living areas but there is considerable industry resistance to do so. Independent Living is usually the entry into the CCRC, and a resident may live there for a decade or more in the unregulated part of the facility. (Of course there are some regulations depending on the state around basic operations, as for any business).

These organizations started out ministering to the Greatest Generation and the Silent Generation who retired with different goals in mind. The staff who served them did not need specialized training of any kind, and many were on the job trained. The past generations did not speak up and went with the flow. Now the Baby Boomers are here, highly educated career professionals with something else in mind as indicated in these posts. A giant shift in the service model is required, with not enough well-trained staff to pull it off.

I frequently hear that 80% of CCRCs are non-profit. If that's the case, there are probably about 1500 non-profit CCRCs in the country. I would be very interested in hearing if anyone is aware of a non-profit CCRC that is being well-managed for the future. Are you aware of any? Are the leaders of NaCCRA aware of any? The criteria I would suggest include:

I live at one of the non-profit CCRCs owned and operated by Goodwin Living (formerly Goodwin House, Inc.). I believe it can/does serve as a model of well-run, resident-focused, staff-supportive, progressive CCRC management.

1.    An administration that is truly transparent - - sharing not only "good" news about the community but willing to share bad news as well. Our administration cherry-picks information to share with residents but we never feel like we're getting the full story. Community Conversations with the administration are performative. Does everyone experience regardless of where they live? Residents hear from management (all levels) regularly at Resident Council meetings, Town Halls, and through direct communication. As I often tell prospective residents, management's clear philosophy is never say No to a resident unless it is illegal or demonstrably impossible. I believe we are provided with both good and bad news -- bad news early, before a major problem. As an example, four years ago, our CEO talked about the forecast for health care staffing issues. He made the case for raising staff pay over five years and for a plan to pay full-tuition for staff seeking to advance themselves. He explained the impact that would mean on monthly rates. Residents love and appreciate staff, so we swallowed hard and agreed that this was a good plan. Now, four years later, when the staffing issues are beginning to really hit us in the face, Goodwin Living was well on its way to reaching the pay and benefit packages that are needed.

2.    An administration and board that actively solicit input from residents and openly and honestly address the input they receive. Does anyone feel they are clearly heard and responded to? Management here is extremely responsive to any resident comments. They always encourage us to drop into any office to talk about concerns, to email or phone at any time. Residents frequently are surprised that management responds evenings and weekends to messages that residents have just sent. As residents who like and respect our staff, we are learning NOT to send non-urgent messages then because we want the staff to relax and have downtime.

The Resident Council Chair and Vice Chair meet at least weekly with the Executive Director (ED) to talk about anything that affects or concerns residents. The ED also provides a report to the Resident Council at its monthly business meeting and to the entire community at the monthly Town Hall. Residents are also free to visit or contact the COO to discuss anything concerning operations and community life.

3.    An administration and board that puts forward a detailed long-range strategic plan for the future, laying out the challenges (e.g. demographic changes, increased competition, declining appeal to younger seniors) and drawing clear, data-supported lines from those challenges to proposed tactics. This is Business 101 but I can say that in our community that doesn't happen. I don't believe that either our administration or our board have the skill sets needed to do this and do it well. So, we're left with a capital improvement plan minus any vision for the future. Is there anyone who lives in a CCRC where they feel the future of the community is being seriously considered and planned for? In 2019, a portion of a Town Hall presented presented residents with the outline of a newly approved strategic plan. (Our resident voting member of the Board of Trustees -BOT- was a full, active member of the Board committee that developed the plan over more than a year.) Residents at our community had a lot of questions and concerns about the plan. The Resident Council appointed one of its members to be a Liaison to the Strategic Plan. The liaison called meetings to include any resident with concerns or interest. Everything that transpired in those meetings was written up and presented to our Chief Strategy Officer who also met with the liaison. The initial plan was vague, and over time, as it became less vague, residents made their views known. One of our big concerns was with the word Diversity. Residents supported the corporate goal of finding ways to reach out to people with fewer financial resources than we have through expansion of services, but we also wanted diversity within our resident population. Over nearly two years, the Strategic Plans goals were expanded to include both kinds of diversity. Residents continued to push for measurable Sales goals that would achieve the population diversity we wanted. Residents also did not feel that putting reports about the Strategic Plan within a Town Hall offered enough time for adequate questioning and understanding of where things stood and were headed. We requested two community meetings a year be entirely focused on the Strategic Plan. We wanted advance knowledge of which parts of the Plan would be addressed and we wanted reading material in our Library to study beforehand. That is how things have gone forward.

4.    A board that includes residents and is curious about what is going on in the CCRC community. Our board discourages resident board members (2) from attending or participating in Resident Association meeting and sharing anything that's going on with the board. Are there folks in NaCCRA who feel the board understands the community? In addition to our one voting resident member of the BOT, the chair of the Resident Councils (we have two CCRC communities) attend and report to Board meetings. Most Board Committees (where all the real work is done) have resident members – some voting and some contributing. BOT members have been invited to participate in Zoom meetings of our Spiritual Life Committee (engaged in a multi-year spiritual/philisophical exploration of racism, identifying and overcoming barriers that minority residents might face in considering living in our CCRC). In the Before Times (pre-Covid) BOT held their meetings at the community and ate in our dining room. There was no significant interaction with residents. Twice a year at our Semi-Annual Community Meetings, the chair of the BOT and our CEO are invited by the Resident Council to provide an overview of the last six months, what problems they are currently facing, and what they are focused on for the next six months. Our CFO meets with our Resident Finance Committee to look at all the financial reports and answer residents’ questions. Annually, the CFO gives an hour presentation of the budget and explains any changes to our monthly fees as well as discusses the long-range financial stability and prospects for Goodwin Living. 

5.    An administration and board that recognize Residents are their customers and that without our money they would not exist. Does anyone live in a CCRC community where this is recognized? The management philosophy at Goodwin Living is that staff is working in the residents’ home (vs. residents taking up space in their offices). Residents overwhelmingly feel the staff-resident relationship is reciprocal – we care for each other. 

Hi Donald,

I frequently hear that 80% of CCRCs are non-profit. If that's the case, there are probably about 1500 non-profit CCRCs in the country. I would be very interested in hearing if anyone is aware of a non-profit CCRC that is being well-managed for the future. Are you aware of any? Are the leaders of NaCCRA aware of any? The criteria I would suggest include:

1. An administration that is truly transparent - - sharing not only "good" news about the community but willing to share bad news as well. Our administration cherry-picks information to share with residents but we never feel like we're getting the full story. Community Conversations with the administration are performative. Does everyone experience regardless of where they live?

2. An administration and board that actively solicit input from residents and openly and honestly address the input they receive. Does anyone feel they are clearly heard and responded to?

3. An administration and board that puts forward a detailed long-range strategic plan for the future, laying out the challenges (e.g. demographic changes, increased competition, declining appeal to younger seniors) and drawing clear, data-supported lines from those challenges to proposed tactics. This is Business 101 but I can say that in our community that doesn't happen. I don't believe that either our administration or our board have the skill sets needed to do this and do it well. So, we're left with a capital improvement plan minus any vision for the future. Is there anyone who lives in a CCRC where they feel the future of the community is being seriously considered and planned for?

4.A board that includes residents and is curious about what is going on in the CCRC community. Our board discourages resident board members (2) from attending or participating in Resident Association meeting and sharing anything that's going on with the board. Are there folks in NaCCRA who feel the board understands the community?

5. An administration and board that recognize Residents are their customers and that without our money they would not exist. Does anyone live in a CCRC community where this is recognized?

I would love to find a community that's firing on all cylinders to use as a model for how this happens.

Dear Pat Kidd:

Yours is a very familiar tale, and you are spot on. Our CCRC has an additional burden of having originally started as a retirement site for clergy so that we are the lower cost provider in a competitive market with the additional burden of having a cohort of residents who are financially stretched thin with a very slim reserve to meet the current crisis of funding. We have a Loving Care Fund to cover such shortfalls, but these residents are proud and strongly resist applying to use this fund. The future is not a happy one as all CCRC's are facing funding shortfalls of unanticipated amounts. Monthly fee increases are being anticipated with fear and dread.

Leading Age publishes several articles for its members you may find useful. I encourage membership in this professional organization as well as a state organization for residents of CCRC's if you have one. This post-Covid era is bringing about many changes at an unprecedented pace. Even as "aware" residents coming from various business backgrounds, we will have to be flexible, as well as CREATIVE in our approach to demanding the services we paid for in our Life Plan contracts, and in our monthly fees.

May I stress that no one knows what the future holds. My prediction is that there will be a large movement to age in our homes in the CCRC's with a corresponding decrease in utilization of the SNF beds. Those beds may well be divested of their classification and reimagined into another category. I see the successful CCRC running their own elder support agency, and possibly servicing those in the surrounding community as well. The CCRC will invest heavily in supporting aging residents will new and as yet unimagined technology that helps them to keep mobile into advanced years. Look at what iPads, iPhones, I-watches. insulin pumps, hydration centers, scooters and new mobility devices and other inventions beyond my ken have produced in the last five or ten years. (The Holter Monitor I wore two weeks ago for two weeks had no wires, no visible source of power, and was smaller than a deck of cards.) The Green House Project has brought us a new model for Memory Care. What could it do for the CCRC model?

Your analysis is spot on. CCRCs are experiencing a demographic change that they are ill prepared to understand, much less handle. The industry started out as the nursing home industry, complete with the paternalistic attitudes familiar to medical model systems. Most of them, later on, added an independent living part to appeal to younger and possibly healthier clients. There is a huge difference between a patient (medical model) and a resident (strengths model) client.

Ageism is alive and well in the United States and other cultures worldwide. It's not realistic to assume that that attitudinal system might not be a factor here, even for those who struggle against it.

This forum is exactly on target with issues that are systemic to the industry. Those of us from corporate, medical, government, social service backgrounds understand how these systems can offer services (perks, promises, expectations, supports, etc.), then make the process of getting them so burdensome that most give up. Residents Councils, though effective in a number of ways, still fail miserably in others.

My hope is to continue this illuminating forum to explore this theme, which I've been researching for ten years. The issue is complex as it relates to societal attitudes, social system structures, business, and on and on. I'm ready to share, and social workers never really retire.

Maura Conry, MSW, LCSW (inactive)

Pharm D (retired)

Wow. Pat, you nailed my thinking as I am now in our 8th year of living in our current CCRC (NC) with 3.5 years at a previous one (TX) that didn't work out. Your way with words and the content was so impressive that I copied it to give to our new Executive Director (female). She will assume the role upon the mid-August departure of the current Exec Dir --- a young man who is about 12 years younger than she. Our about-to-be Exec Dir came to us 3 years ago as the Health Care Administrator and has reported to this departing Exec Dir. She has a one-way commute to get here from her home in a larger city to our west. That larger city is the location of a larger CCRC that just acquired us one month ago, purchasing us from our non-profit hospital system owner. That larger CCRC has managed us for the last 5 years, until we became "theirs" last month. When that larger CCRC needed to hire a new Health Care Administrator, our coming new Exec Dir passed up that promotional opportunity that would have given her a 12-minute commute, asking to be considered for the open Exec Dir position here. She got the job. I can only hope she knows what she's getting into, but since she and her wife are raising two small children, I'm hoping she's "progressive."

I stepped into the role of RA President a year ago to complete the elected president's term. A meeting between the RA Pres and the coming new Exec Dir is a must; however, we've had to reschedule our initial "let's talk turkey" meeting efforts that began when it was announced that she got the job ---- largely due to the recent unhooking from the previous owner and hooking up to the new and preparing for her new role. I have to be patient.

As a leading-edge babyboomer female who chose not to have kids, I needed to choose an institution for future life changes. As a retiree from the corporate world, I quickly picked up on the differences between the generations on the female side as I became part of the communities. Not to criticize those coming here in the well-established, comfortable roles of being provided for .... since they largely fulfilled the roles expected by social norms -- fulltime homemakers, deferring to spousal preferences. If they worked outside the home, it was usually the typical nurse, secretary, teacher. I can't complain, since I was raised by one.... I definitely flummoxed my own mother with my marching to a different drumbeat.

It is very challenging to work with a management team of the "old school." Some of us involved with acquisitions (either being acquired or being the acquirer) try to point out potential pitfalls and areas of needed pre-planning, only to be ignored.... ESPECIALLY if it comes out of a female mouth.

So I thank you again for your most insightful and well-written observations. How true. How true.

I am looking for a good attorney. Is there some way we can communicate in private?

I am one of those women CCRC residents Pat Kidd was talking about and I know how to do stuff including finding an attorney.

Regarding our Residential Advisory Council (RAC):

1. It is not clear what RAC sees as its mission. Does RAC represent residents? Does RAC represent the CCRC. See if you can answer these questions after reading the attached Minutes of the July 20, 2022 RAC meeting. Much of what is in the RAC Minutes is repeated via other channels.
2. One has no way of knowing how RAC members voted. Residents lack necessary information for electing or ousting RAC members.
3. Residents who present a contentious issue to RAC receive a private, anonymous reply. The issue doesn't get reported in RAC Minutes.
4. RAC elections are tightly controlled. They don't provide an opportunity to question candidates. An Election Committee presents the same handful of questions to candidates for written answers that are posted for residents to view.
5. Public, televised RAC meetings with the Executive Director require written questions prior to the meeting. These questions may or may not get addressed at the meeting.
6. Residents have no good way of knowing if other residents share their concerns and teaming up with others to lobby for shared concerns.
7. RAC should lobby to bring back resident comment cards and the annual survey of residents.

Speaking as an engineering management consultant, and having worked in the U.S. and countries from Russia to Africa to Indonesia for international aid agencies, our RAC has considerable room for improvement.

I'm realizing my post didn't address Resident Councils (the theme of this thread). The reason I didn't and instead went directly to the Administration/Board is that they want to push the Resident Council into a "cruise director" role (overseeing a plethora of committees) and tend to dismiss any issues of substance that come to them from the Council. We had a very proactive Council last year, that provided a detailed report on resident concerns about the future of the community, which has basically hit a stone wall with the Board/Administration. Concerns about the poor quality of communication between the Council and the Board have basically been dismissed by the Board. So, the Council is basically toothless unless we start to see some change on the part of the Board/Administration.