A few weeks ago I participated in an executive round table where a group of about 30 leaders talked about a number of issues and opportunities in the senior living space.

By Steve Moran

While at the Masterpiece Living Lyceum a few weeks ago I participated in an Executive Round Table where a group of about 30 leaders talked about a number of issues and opportunities in the senior living space. The group included for-profit and not-for-profit leaders plus a number of other experts and the discussion was led by Dan Hermann of Ziegler.  


The consolidation discussion mostly centered around the not-for-profit sector but has some application to all of senior living. The consensus of the group seemed to be that single site CCRCs (or not-for-profits) are going to continue to have a very difficult time thriving or even surviving with two possible exceptions:

  1. If they are in the top two in a given marketplace

  2. If they are in a rural marketplace, which means effectively they in the top two

I am not so sure I buy it.

The Benefits

The benefits — at least on the surface, particularly for CCRCs — is obvious: fewer CEOs, CFOs, and other corporate overhead staff. Beyond that, multi-site organizations have the resources to hire various subject matter experts, allowing them to increase their level of sophistication.  

The Downsides

If you own a single CCRC, you do everything yourself. You don’t have corporate HR, Nursing, Food Service, Physical Plant people, Finance people and more expensive CEOs or COOs. You also have no layers of middle management. Those things all add to cost and complexity.

The Real Problem

There are many dozens of single site not-for-profits and a few multi-site not-for-profits. Most are resistant to consolidation. As the discussion went, the sense was that there were two reasons: top leaders who would lose their jobs — which means income and influence — and boards who would also lose influence. I completely concur with this description but think the problem goes deeper.

The hard truth is that — whether single site or multi-site — the performance of the organization is tightly coupled with the quality of the leadership. What I see is that when a single site is struggling, it has much less to do with the size of the organization than with how good the leader of that site is. The questions are these: Are they learning? Are they thinking? Are they asking hard questions? Are they looking at new ways of doing things?

To Struggle or Not Struggle

Senior Living is not an easy business. There are a ton of moving parts. There are some large organizations that are not doing very well.  

For one reason:  Poor Leadership.

There are some small organizations out there that are doing great.

For one reason: Good Leadership.

I am not anti-consolidation at all, and — in point of fact — I think in many cases consolidation is a great idea that can serve residents and team members well. At the same time, it can very easily result in the depersonalization of a business that is, by its very nature, all about relationships.