Staffing 'Nightmares' Changing Senior Housing Site Selection, Design

Senior housing facilities are locked in competition to attract workers from a meager pipeline, and the issue is affecting where the next generation of projects will be built.

Since the pandemic began, long-term care facilities have been at the center of some of the pandemic’s most difficult challenges, including finding ways to stop viral spread in dense communities and limiting contact while still providing essential services and care.

One of the most acute results of those challenges has been senior housing's labor shortage. Between June and September last year, 99% of nursing homes and 96% of assisted living communities said they were dealing with staff shortages, and the vast majority said the situation had worsened during the study period, according to a survey by the American Health Care Association and National Center for Assisted Living. 

Ikeogu Imo, senior vice president of multifamily lending and neighborhood investments at the D.C. Housing Finance Agency, said he doesn't see resident demand for senior housing looking dramatically different post-pandemic, but as a lender charged with investing the public’s money via bonds into sound housing projects, he said the rising costs associated with labor keep him up at night.

"Right now, everything seems to be balancing out, but one of the pain points for us is the staffing," Imo said at Bisnow’s senior housing event last week. "If there's anything that gives me nightmares right now about senior housing, it's staffing."

With the industry continuing to hemorrhage workers as demand for its services is expected to rise, senior housing providers have been forced to get creative in finding ways to lure staff into open positions. In many cases, that means changing the calculus on where senior living communities should be built.

Employee attraction and retention is something Bobby Zeiller, vice chairman and co-CEO of Silverstone Senior Living, is thinking about before he even settles on the site for a new community. 

Silverstone has a scorecard with dozens of items that it uses to evaluate potential sites, but one factor that has become increasingly important to Zeiller and, down the line, investors, has been access to transit for workers.

"That might seem a little counterintuitive to a senior population, however, the biggest issue that we see coming up is accessibility to labor," Zeiller said. "Being close to a Metro station where we can pull from a larger pool of employees and a larger pool of associates is so critical to being successful."

Mather LifeWays, a Chicago-based nonprofit that operates three senior living facilities around the country, placed a high value on Metro accessibility for its fourth. The nonprofit is planning to open a new facility in Tysons in 2023, and it received a $300M construction loan to get the 378-unit project underway last year.

But even Mather has had to go back to the drawing board when designing its facilities, consulting with designers to consider how the two-tower development could be safer and therefore more attractive to residents — but especially to potential staffers.

Morgan said the opportunities available to workers in the industry have changed dramatically as a result of the pandemic. She noted many of the frontline workers in the industry that used to work two jobs now only need to work one as wages have shot up. 

"Everything has changed," said Gale Morgan, senior vice president of sales at Mather. "Everyone now has a choice of 100 places to work."

Besides higher pay and more flexible hours, Morgan said Mather is also redesigning locker rooms to include natural light and considering offering its employees partial access to the residents' gyms. She also said Mather is offering shuttles to pick workers up from transit stops to simplify their commutes.

“We really have made a lot of adjustments. I wish I could say that led to full staffing. It still hasn’t, and so we’re still challenged,” Morgan said. “But that creativity has been helpful.”

Even architects have been dragged into the staffing challenge. Janet Meyer, principal at BCT Architects, said she has had multiple discussions with senior living clients about ways to improve the experience of their employees through site design.

"Now that staff are almost as equal [as] bringing in your residents, let's design for both of them," Meyer said.

Seniors have also appeared increasingly willing to adopt new technologies, especially in the realm of communications and health monitoring systems. Multiple panelists at the event spoke about their increased use of technology, especially touchless tech that keeps surfaces clean and other smart home technologies that simplify living experiences for residents.

Morgan said that to help maximize efficiency with limited staff, Mather has begun piloting a robot at one facility that follows wait staff around and returns dishes to the kitchen.

Others in the industry also appear ready to embrace technology in a way they wouldn’t have before the pandemic, especially as contact between staff and residents becomes a greater concern.

Over the past 20 years, robotics have become much more user-friendly for senior living applications, said Sharon Ricardi, president of Northbridge Advisory Services and managing director of HallBridge Partners.

“I was involved with some [robotics] in beta testing 20 years ago and it was a disaster, but they are sophisticated now,” Ricardi said. “As long as we remember that we have to save the high-touch for the resident-and-aide and resident-and-nurse interactions… there are lots of places that we can take the touch out, and that’s where robotics should come in.”

John Braley, vice president of business development at Delos, which created the WELL Building Standard, said interest in meeting the standard by providing cleaner air has skyrocketed during the pandemic.

Braley said that ESG investors are also beginning to incorporate wellness into their portfolios, which could be a windfall for senior living communities looking to demonstrate high standards in their facilities for residents and workers alike.

“There are certain parts of the country and certain spaces that we’re seeing where actually union contracts with their population have started to require certain things like clean air,” Braley said. “Who would have ever imagined that a union would have to write into an agreement that they needed to have clean air, not just for the residents and so forth, but for their population?”