Culture change in senior living

Designing for emerging resident-centered values requires buy-in from management, but can mean a competitive edge in the long run.

When it comes to senior living, culture change is much more than a buzzy catchphrase. It represents a new way of conducting resident care and a new way of living for residents in a senior living environment. It requires reversing the age-old, top-down, nursing-focused senior care model.

Empowerment, that’s what residents and staff want today. They want a style of management and operations that allows for a staff- and resident-centered facility. Under the old nursing model and values, residents tended to feel institutionalized and restricted to a lifestyle tied down to accommodate a nurse’s or manager’s schedule. Properly done, change encourages management and staff to shift their focus from number crunching exercises to resident care.  The new culture engages and empowers staff and residents to improve their satisfaction and well-being.

This type of culture change isn’t just a trend. It’s a sustainable and long-lasting transformation that can generate a better revenue stream when stakeholders agree to it. In my view, the environments that don’t foster this change will continue to focus too much on staff efficiency, maintenance costs and profit margin rather than on staff satisfaction and resident care.


Reorienting focus and operational values is required to transform a senior living environment from the institutional model to person-centered care. Setting this new course requires an educated management company/operator that understands that important choices are made at every level from custodial to nursing and administration. It requires strong leadership.

Inevitably, some management companies say ‘No way, I’m not paying for that. Number one, it’s too expensive and number two, it’s a liability issue.’ This is a natural reaction to a new attitude about senior living, but those concerns can be addressed by looking at resident-centered culture as a long term investment. But getting everyone on board can be quite a challenge.

For example, I’m currently interacting with a developer / operator who owns four assisted living communities. He tells me his traditionally-oriented management company is restricting him and not allowing him to effectively reshape the culture in his environments. He wants an operation that’s totally resident-centered; providing residents a choice of what and when they want to eat, better dining experience and options, choices about when they should be bathed, freedom for residents to interact with the outside community, flexibility of activities and schedule and so on. However, because his management partner is focused primarily on boosting profit margin and lowering risk, he cannot make the necessary adjustments. The operator and manager will likely continue to struggle over a strategy to achieve growth.

An educated management team will continue to emphasize budget and profit appropriately, but in the new model, it will see numbers in the context of the long-term benefits brought about by a new attention to resident care. Embracing this progressive paradigm can potentially impact marketability and growth of a senior living facility.

When facilities successfully change their culture, word gets out to the surrounding community. Resident parents will tell their adult children, “This place is fantastic. They let us have happy hour from 4 to 6, they’re letting us go skydiving, they’re taking us to the beach every other weekend.” And so on. In turn, their adult children will share this experience with their peers and other competing communities will hear. As word spreads, reputation builds.

Culture change is about educating investors, developers, operators, and management about the value of designing from within. People matter. Residence and staff choices matter. Understanding their needs first can create a successful and sustaining environment. Rather than force residents to fit in a particular envelope, refocused senior living requires us to start designing from the inside-out. It’s giving the residence and staff empowerment so that they have choices, and don’t feel oppressed by rules, regulations and an obsession with profit margins. This transformation is taking place across sectors of the senior living environments including assisted living, memory care and skilled nursing.

Thinking and designing around the emergent resident-centered culture and values in senior living isn’t just progress, it’s very likely what’s going to sell.

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