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ALFA Insights: Interview with Senior Living Entrepreneur and Educator, Chris Hollister

Chris Hollister, a leader and entrepreneur in the field of assisted living, has seen the industry—and its leadership—evolve throughout his extensive career. His resume includes co-founding assisted living chain Southern Assisted Living in 1995 and serving as CEO until 2006, when the business was sold to Brookdale Senior Living.

Hollister was on the boards of the Assisted Living Federation of America (ALFA) and of Residential Services, Inc. before moving to New Zealand in 2006. He lived there until April 2012 and served as chairman of Vision Senior Living, a retirement community operator based in Auckland.

Hollister’s credentials also include a fellowship at the Erickson School for Aging Studies at the University of Maryland Baltimore County (UMBC), where he has taught graduate-level courses in senior housing operations.

Now that he’s stateside once again, Hollister is co-leading the 2013 Executive Director Leadership Institute (EDLI) at the ALFA 2013 Conference & Expo, a partnership between ALFA and the Erickson School, with Evrett Benton, former CEO of Five Star Senior Living and founder and CEO of Stellar Senior Living.

The second annual EDLI program will run concurrently with the upcoming ALFA 2013 Conference & Expo in May and is open to the first 200 executive directors who sign up. Hollister called the collaboration between the Erickson School and ALFA an “exciting development” that will continue to bring people together and jump-start conversations about the senior living industry’s future.

Question: Why is there a need for leadership development and programs like the EDLI?

Chris Hollister: Assisted living started as a movement and it has been blessed to have visionary leadership from people who were mission-driven from the start to change how the U.S. and the world cares for our elders. However, for the first decade or so—around the time that Southern Assisted Living started out—it was very difficult to hire experienced folks because the industry simply did not exist before.  

A lot of people came out of social work, or had been discharge planners, or maybe they had run nursing homes or been school teachers. Back then, they didn’t necessarily have a college degree. 

Many came up the ranks, maybe as an office manager, or from the nursing side.

Now, almost everyone in the business has a college degree, and there are specific senior housing administration programs at several schools. More and more people have proactively chosen this as a career.

Q: How does the EDLI help bridge leadership gaps?

CH: Assisted living is a philosophy based on dignity, independence, choice and quality of life. It is also case management no matter how scientific you try to make it. It is highly interdisciplinary and requires a great deal of empathy and people skills as well as a range of skills in business management, healthcare, and leadership.  

Given the complexity of the operation it is rare to find someone who has absolutely every skill they need to succeed. I think the leaders in the industry have recognized this and made great strides to try to develop ongoing education and training forums that help people reach their full potential as managers and leaders.

One thing that’s the hardest to teach is empathy. You’ve got to have this solid sense of caring for other people. Historically, on our end, people are coming from more of a social work/healthcare background, and they have needed most help on the business side.

Others may need help with the concept of leadership. That’s something not only for executive directors, but also partner/managers. We’re getting calls from bigger, well-established senior living companies saying, ‘We’re glad you’re doing this. Have you thought about expanding this to other department heads?’

Q: What is the senior living industry doing to facilitate the executive development of its professionals?

CH: What I think has happened over time but accelerated in the past decade is a real focus on developing assisted living and senior care management as a profession. The Erickson School at the University of Maryland Baltimore County is a leader in this movement, and there are at least a half dozen other programs across the nation that have a similar mission.  

ALFA has stepped up to the plate by partnering with the Erickson School with which they share the common goal of raising the bar for excellence in the sector. Together they are conducting the Executive Director Leadership Institute that will run simultaneously with the ALFA Conference from May 6 to 9 in Charlotte, N.C. Last year's pilot program [which had about 50 participants] was well received and we have built on last year's success in planning this year's event.

Q: What are some noticeable ways the assisted living industry has evolved since you entered the business?

CH: Because assisted living is first and foremost about customized service to each individual, in many ways the core challenge is the same: you try to care for each person in all aspects of their life and well-being and you are only as good as how well you fulfill this core mission.

The talent pool at the site level and in senior management has continued to improve. Certainly the range of care has broadened considerably since I entered the field in the mid-80s. Of course this is a result of the overwhelming success of the platform and the desire for folks to stay with us as long as they can.

There are greater resources now, and more sophistication in terms of how the industry delivers care. Memory care has emerged as a well-defined specialty within assisted living with great leaders—like Loren Shook at Silverado—who are very innovative in what they do.  

Expectations continue to be raised on the part of the consumer and I believe this will accelerate as we begin to serve the baby boomer generation. Technology and services outside of walls are things that people are spending a lot of time thinking about now, as well as the Affordable Care Act.

Q: What are some specific ways you think assisted living will change (or needs to change), especially as it relates to upcoming generations of senior living residents?

CH: I think you are going to see technology play a larger role in many areas of the business. Many ideas have been tried but I truly believe there are going to be breakthroughs and paradigm shifts in the years ahead.

The focus on containing costs and preventing readmissions that comes with the Affordable Care Act is going to completely change the way admissions and discharges are handled. I’m reading a book now called "Big Data" and that is a term you are going to hear a lot about in the next 24 months. 

The days of bringing cookies to the hospital discharge planner are over—the entire world of healthcare is going to be measured and become much more quantitative. This will tend to help the larger or at least more sophisticated players who have the talent and resources to respond effectively to these changes.  

Q: You mentioned the idea of measuring outcomes and collecting data. How much of a role will this have in the assisted living space? Will the concept of penalties for high readmissions spread from hospitals to skilled nursing to assisted living?

CH: It’s absolutely going to be a factor, and it will spread to assisted living. The larger companies in this company and the leaders are very well aware of those, and are already taking steps to deal with this.

We used to go around to hospitals and doctors’ offices and bring them cupcakes. It was a nice thing to do, but the reality is, now they’re going to be looking at standard deviations for falls and trying to understand how this community has a good or better track record compared to other communities in the area.

We will still serve residents one person at a time but we are going to be held more accountable for measurable outcomes.

Q: With memory care expected to become an even greater need (according to Prof. Victor Regnier, who says up to 80% of future assisted living residents may have cognitive impairments of some sort), how do you think this will be addressed within assisted living, especially in terms of staffing and training?

CH: I would think Prof. Regnier is probably right, looking at the epidemic of Alzheimer’s disease and the expectation that some form of dementia will affect about half of those over age 85.

When I was a kid, the only way you could talk on a screen was on The Jetsons. Now, there’s the Internet and [things like] Skype. You can alleviate loneliness and social isolation through the Internet. There are robotics and different technologies, such as automated medicine dispensers, that allow people to stay in their homes if they want to.

It’s different if you have cognitive impairments. You can’t stay at home if you can’t prevent yourself from wandering out on the street.

When I started Southern Assisted Living 1995, we decided to have memory care within our assisted living building, and to train in a very proactive way. It was considered a very radical concept at the time. We saw something that was going to evolve into a big part of assisted living. I think people will need to spend more time and training dollars [for memory care]. It’s going to impact design, too: As well as you think you have it, it’s not easy to retrofit assisted living into memory care.

Q: What are some dangers facing the industry, and how does leadership factor into the evolution of assisted living?

CH: Complacency will be our enemy. We need to be thinking about new business models. I don’t think the baby boomers are just going to want to move into their parents’ senior living community. They’re going to have their own ideas. The people who are incumbent in the industry now—if they don’t stay on their toes, there could be new entrants to the sector who develop things and take the lead. It may not even be within walls, it may be more service-oriented, delivering care to people in their homes.

There are a lot of big changes coming, but the industry has always had great leadership.

In New Zealand, it’s such a small country, you’d think they talk more, but in a way they talk less. There are only three to four providers, and they get paranoid about trade secrets. 

The U.S. is so enormous—someone from Texas versus a Seattle provider is not really worried about their market getting stolen. People are open to share ideas, and it’s really positive for the sector.

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