Meet Terri Cunliffe, president and CEO of Covenant Retirement Communities, a longtime senior living provider dating back to 1886. Cunliffe began with CRC in 1988 as a community administrator and took the helm as CEO in 2015. Now with 15 communities in 10 states, the company has made strides in its approach to technology, navigating the ACO landscape and inspiring its staff over time. We sat down with Cunliffe to learn about what drew her to senior living in the first place, how CRC made it through the post-recession CCRC downturn, and why it’s always a good idea to have a Plan B.
Spotlight on Technology
Today, do you think the industry is doing a good job of investing in technology in general?
I think that, like us, everybody is investing more, just because of the role technology is playing right now. I will say that I think it’s challenging for people. We’re a big provider, so we can invest in a robust technology and IT department. We’re really focused now on moving a lot of our applications to the cloud, better security, getting away from the 8-bazillion server-based applications.
As far as what types of technology are you investing in today, what do you think is going to help propel your organization into to the future?
HR [technology]. This Workday platform where people are clocking in on their iPhone instead of a time clock. They walk in, they take their device, they clock in once it hits our wireless and they’re on the clock. Giving people access to their PTO hours, being able to online request time off…those things will improve our efficiency; [they] demand less manager time for missed punches and puts more responsibility on the employee.
Does technology help those managers, too?
Yes. I think that you know some of the other areas of technology, obviously LifeConnect, our EHR…we’re spending a lot of time right now integrating our systems; we probably have a total of 30 different applications, so [we’re] integrating and building interfaces to reduce the number of applications people have to touch, and reduce the number of clicks per employee. It takes their time, and things are feeding back and forth. [For] our payroll system, we went from very, very manual—lots of manual activities—to completely automated. I think we’re looking at taking every workflow, looking at what is manual in that workflow and committing to really automating that so you can improve efficiency. The more time they spend away from a desk and out in front of the people, the better the service is.
Tell me about how you got into senior living.
I started out in college as a piano major, went through two years of that and decided I couldn’t make a living. [I] was at John Brown University, then went to University of Minnesota Duluth. So the day before my fourth year, I told my parents I wasn’t going back to college. I got a full-time job and a part-time job, and my part-time job was in a nursing home as a receptionist.
What was the name of the nursing home?
Heritage of Edina; it was a private nursing home in Edina, Minnesota. The administrator was Greg Getchell; I’ve tried to find him since, but haven’t been able to get in touch with him. I brought my guitar in and would sing in the lobby, which was filled with residents. About six months in, the administrator said to me, “You know, you really need to get your nursing home administrator’s license.”
That was it! I went back to the University of Minnesota, wrote my own degree program and ended up with a long term care administration major and graduated from college—believe it or not—11 years later. Every time parents freak out when their kids aren’t working perfectly, I go, “Don’t worry about it!”
What do you think the administrator saw in you?
[He saw] the thing I always look for in people. You can teach the skill, but I think it was the passion and just the fact that I loved senior adults.
Did you look at it as just a part-time job, or were you actually interested in working in a nursing home?
I needed money. My parents moved me out of the house, and I just needed to make as much money as I could, and it seemed like a cush job. My friends thought I was crazy, like, “Why would you go into long term care?” But at that point I knew I wanted to become a nursing home administrator.
I just wanted to be with older adults. I didn’t even know what the job was other than Greg Getchell, seeing him out and about, but I just loved being with seniors.
After you got your administrator’s license, you joined Covenant?
I did an internship as part of my undergraduate degree, and I did it at Covenant Village of Golden Valley in the summer of 1987. Even at that point I was still trying to find myself and I enjoyed it, but I was enjoying being in my 20s, too. I finished that internship in August. Then in December, they called me and asked if I’d be interested in opening [an] assisted living [building] at Covenant Village of Florida. December 15, I had the conversation, and by January 4 I was down there and working.
Was it a brand new building?
It was brand new. It wasn’t open yet, so we were scrubbing, cleaning, getting all of that opened up; February 2 was the assisted living opening, and March 2 or 3 was the skilled nursing opening.
How’d the opening go?
To my recollection, it went pretty well. We had a lot of residents on campus that had already moved over from kind of a pseudo-assisted living to the new assisted living. We hand-carried their furniture over; I guess we were just too cheap to pay for a mover back in those days.
It was tough because it was my first leadership experience; I always said they took a big chance on me.
The leadership trusted you with the whole building?
More from the Leadership Series
They did! What I learned was, you can’t just go in and say, “We need to do this, this, this and this.” You need to go in and find out about the staff, about their kids… Once I learned about the person that was working with me, we had a completely different relationship. I also had a lot of residents in my Covenant Village of Florida days who really gave me a ton of insight into what I did, what I did well, what I did poorly—and as long as you listen to that life experience, I think that’s why I became who I am today.
When you took the job in Florida, did you ever think you might be the CEO?
No! Never. I was so glad to have a full-time job, and so were my parents!
I did assisted living for three years or so. Then the health care administrator left, I finished my master’s, got my Florida license and then I was moved into the skilled nursing role overseeing assisted and skilled. I did that for about five years. That was fabulous. It’s the people. You know, I only do this because of the people.
I remember calling my mom—she died while I was in that [administrator] position—shortly after. I remember calling my mom saying, “I will never do anything other than this. This is what I’ve always wanted to do, and I am just going to do this forever and ever.” So she’s in heaven right now smiling.
When did you first think, ‘Maybe I do want to be CEO’?
I was COO and my own CEO started to talk about potential retirement. But I think there was an external search that sought me out and asked if I’d be interested in interviewing for a CEO position, and I thought ‘Wow, I never really thought about that before.’
Why don’t you think you thought of it?
I just was always so happy with what I did. I loved my VP role in health care, I loved operations. I think what made me interested in [becoming the] CEO was the fact that I realized that’s the position that impacts culture.
What year did you become CEO?
June of 2015.
That was some time after all of the CCRC financial problems resulting from the housing crisis.
After 2008. We went into 2013 [with] 81% occupancy. Our VP of sales and marketing left and we engaged a marketing firm, and within two years we had to change. Probably one of the craziest things I’ve ever said publicly was in 2013, I stood in front of our leadership group and said, “We need to have 420 move-ins this year.” They looked at me like ‘What?!’ Our average was 250 to 300.
Did you know what you were getting into?
Yes. The VP of sales and marketing had left and we had brought in Martino & Binzer to help with marketing. One of the principals was with our staff on one of the campuses, and someone texted me and said, “420 Disney World.” I wasn’t paying any attention and I texted back, “421.” I just committed going to Disney World with I didn’t know who! So we’re clipping along, not much is happening, and about July I think [it’s time to call the travel agent]. I said, “Alright, well I’ve got myself in a bind, and so tell me what it would cost if I were to take, let’s say, 100 people to Disney World”—I don’t even know who these people are yet. I go to my CEO, I said, “I have a confession to make—I committed to going to Disney World [and we’re going to have to take everyone], if we hit 421.” Fast forward to the end of the year: 452 move-ins. So unbelievably crazy. In May, we bring 100 people to Disney World, we celebrate, just have an amazing time, we do some education too.
What were you aiming for in terms of occupancy?
[I was aiming for] 90%, so we went from 81% to 91% in two years. It was all hands on deck, people believing they could finally do it. We had never, ever set out just crazy goals like that before, and it was just, I think people were just, ‘No way can we do this,’ and as they started to see the momentum, it was more and more motivating.
It’s funny you bring up Disney because I understand Covenant has done some work with Disney on culture.
That was happenstance. We went to Disney and decided to do one day with the Disney Institute. We did it just as a fun educational experience, but it really transformed our business in the long run.
Tell me about CRC’s technology, LifeConnect.
In 2000 when I went into the VP of health and wellness role, that role attracted me because I really wanted to create a culture that I thought I could live in. [Some] senior living communities, at least ours, had a history of being very paternalistic. The other thing is, I would watch residents move in and I really didn’t know that much about their history, but when they came in they’d be assigned to somebody, and I would watch these residents take on the same activities as whoever their host was, whoever were the people they met at dinner. I thought, ‘You know, we really need to understand who our people are.’ That’s where LifeConnect came out. I was one of the youngest ones on the VP team, and I looked at the VP group and I said, “You know, we need a wellness program here,” and they were like, “Yeah, yeah, yeah, whatever.”
Wellness is very trendy right now.
It wasn’t then. We put together this whole person wellness model that had the six typical dimensions: community, wellness and then resident/staff involvement as kind of our bookends. The whole focus was to create a tool that would learn about what those residents’ preferences are, so when they move in we could match them up to the staff and the residents who have the same preferences, same goals, same lifestyle as they did before moving in.
It’s expanded since then; we did ask a lot of questions about how they live their life, what time they get up, what they do. I get up at 4:30 in the morning; I start with a cup of coffee within five minutes. When I move into a nursing home, I hope they don’t keep me in bed until 7:00 and wait until 8:00 for a cup of coffee, because if I’m in a bad mood that’ll be why.
Why do you think it’s taken people so long to adopt these kinds of technologies?
I think a lot of it is the challenge of change. The whole history of how we serve senior adults has been around a bulk of rooms. Until we get rid of that thinking, we are going to continue to struggle to serve the resident in the way they want to be served, at the time they want to be served.
When did you roll it out?
Believe it or not, we rolled this out initially in 2003 at a leadership summit.
How did you get staff to adapt?
We’re not perfect. People would say, “It takes a couple of hours to fill this profile out.” My response was, “So you don’t want to spend two hours learning about somebody who’s potentially going to spend 10 years with us?” It’s crickets after that. It’s still very hard to get people to see the value and then take that information and apply it. Over those periods of years, we’ve started and then we fall back, and then we get better, then we fall back, so it’s not even perfect in our own organization. The same software [that stores the wellness program data] I think also is an assisted living pricing tool. We use that same information to build a care plan, and then it’s security-based pricing.
Have you had to roll out additional technology to do that?
We’ve had to upgrade it. We’ve tweaked the tool over time. I do think we need to find a way for it to be more efficient. It’s really trained to be a conversation. I can do it on an iPad as a conversation, or I can give it to a resident to fill it out [on their own].
People say the resident is changing.
I think where the residents are changing is more in their need to know. I think 2008 with the economic debacle, the trust of corporations went down a lot, so I do think residents now are more interested in hearing more, knowing more, they’re more conscious about the financials, they have more to say about policies and practices.
How do you inspire staff?
First of all, you have to hire really smart people, smarter than you. But I love to set a vision and then engage the people in that vision, give them the tools and watch them do things they never thought were possible. It means encouragement, it means making the right decisions, it means supporting them, just cheering them on. It also means that if I ever doubt, I have to keep it to myself. But you know, normally I don’t. I always believe. I just really have a lot of faith in the staff.
…you have to hire really smart people, smarter than you. But I love to set a vision and then engage the people in that vision, give them the tools and watch them do things they never thought were possible.
You’ve done pretty much every job throughout the organization, for the most part. Is that ever a challenge for you when you’re working with people that might be doing it differently?
I’ve given up my job five times to five different people. I figure if I could give LifeConnect up to somebody else—that was my baby—I could give up anything. I think a leader has seasons, and you do what you need to do in that season and just keep hiring smarter people than yourself behind you. It never freaks me out when people do what I used to do differently; I think they’re just doing it better.
You said LifeConnect is your baby. Is it hard to see someone else with your baby?
No. As long as it’s growing, as long as it’s living, then no. You have to trust the people around you.
As the CEO, if you had a senior living dashboard that you could look at every morning, what would you be looking for?
I’d definitely look at census. Revenue, census, I’d really love to be able to measure employee engagement and resident engagement on a regular basis.
How do you create a culture so that the frontline staff want to stay for a long time?
We have got to create programs so that our employees can also move up the ranks. If I am a $12-an-hour employee and I want to make $20, what am I going to have to do to make more money and do something more? So that if I am a frontline employee doing whatever it is, and I want to do something more, I know what is expected of me, I know what I need to do to get there and I’ve got the resources in place to motivate myself; I’m not just waiting for that manager to identify me.
Do you find yourself telling your story to a lot of your employees? Since you’re kind of the shining example.
You know what I tell people more than anything? If you hear something in a meeting or in your building, or you see something that really needs to be done that would improve your work experience or a resident’s life, raise your hand. Say, “I’ll do it.” If you raise your hand, that’s how you’re noticed, that’s how you make a bigger impact, that’s how you stretch yourself.
You know what I tell people more than anything? If you hear something in a meeting or in your building, or you see something that really needs to be done that would improve your work experience or a resident’s life, raise your hand. Say, “I’ll do it.”
Tell us about your focusing on having a digital strategy and what that means.
Our digital strategy, our online presence, is a really technical area. I don’t know all the details, but in terms of just our presence, search engine optimization, geo-fencing and all that kind of stuff, we decided we would do it in-house. Because what we do for our resident recruiting, we can do for our resident sales, we can do for our employee recruiting. But you know, as Fran [Palma, SVP of digital strategies] tells me all the time, and I can’t remember exactly how he words it, “We’re not in a digital world, the digital world is first and we operate in a digital world.” It was a really big move on our part to bring that in-house, but it’s interesting because I just read a couple of articles about a chief digital officer, and I mean, that’s a key role that really runs everything digital. And I think that’s where we start—whether it’s applications, whether it’s just online presence, whatever it is—I think that role is really what’s driving a lot of our business.
Now is the next step to kind of make it consumer-facing?
I think the digital strategy is on the front end. It’s the positioning tool.
What’s your definition of leadership?
I approach leadership as finding people smarter than myself, giving them the tools, giving them the encouragement and letting them do what they do best. My job is to identify roadblocks and help them, or help them to identify those roadblocks before they hit them so it’s smoother sailing.
During your career, what’s the biggest challenge you’ve faced?
I think probably my greatest challenge was when I was at Covenant Village of Florida; it was early on in my career. I left after eight years and went to Acts [Retirement] for 11 months. I call it a sabbatical. But when I left Covenant for 11 months, I left as the health care administrator. We had exceptional surveys, and when I came back there was a resurvey that resulted in a very large fine and a 10-day period to clean up the skilled nursing facility. And that was in 11 months. I came in the next day and I fired the health care administrator, the director of nursing, and the MDS coordinator. At that point, we had zero corporate health care support. That was probably my biggest challenge; it was probably my stupidest move.
Well, you don’t just fire your entire leadership and clinical team without a Plan B. But what I did learn [about was] the relationship with my peers in other organizations. They were the ones who bailed me out. I borrowed time from other people, in other clinical staff, from other organizations that aren’t Covenant and had them come in and help me clean up the skilled nursing facility. So I think having relationships with your peers outside of your organization, I would’ve never made it through that [situation] if that hadn’t happened.
Tell me about the sabbatical.
That’s kind of everyone’s surprise. I was the health care administrator, and in the Covenant organization there were no female leaders at that point in any leadership position above health care administrator. Because I love meeting people in other organizations, I had an opportunity to interview with Acts for a CCRC just north of where I lived, so I thought, ‘You know what, I’ll go for the interview, I’ll see what the salary is.’ I mean that was literally, I knew the person, had high regard for the individual—and ended up getting the job. I took it. I think for a couple of different reasons. To have the experience as an executive director. Again, it’s that culture setting position. Maybe then to move my own career along, but I will tell you it broke my heart to leave CRC. It just broke my heart. I had an amazing experience at Edgewater, amazing.
It was a great 11 months, but a short time into it CRC asked if I would come back, and if I would ever consider coming back as the executive director. So I was the first female executive director in the Covenant system. I had a chance to come in, and I fixed all the things that bothered me before I left the community just in terms of resident relationships and stuff.
You were the first female executive director. Has that changed how you run the company?
I think in leadership you learn from two things: You learn from seeing what you really like that you want to do yourself, and you learn things that you don’t like that you don’t want to happen under your own leadership.
I think in leadership you learn from two things: You learn from seeing what you really like that you want to do yourself, and you learn things that you don’t like that you don’t want to happen under your own leadership.
What’s the biggest risk you’ve taken in your career?
Firing three people without a Plan B. I’m not anti-risk. I will say one risk was standing in front of leaders saying we needed 420 move-ins, and not really having every tool in place or not really having a clear understanding of how exactly we’re going to accomplish that. That could’ve been a leadership gap to be that bold about what we needed to do, and had we not achieved it, I don’t know, I probably could have– I might not have ever been able to be bold again.
Looking back on it, what would you have done differently?
Nothing. I will take risks, but I’m going to be pretty cautious.
What’s the best piece of advice you’ve received in your career?
I had an amazing mentor at Covenant Village of Florida. His name was Bert Frizen, he was the estate planning officer at the time. He taught me to play in the gray. I always believe you can get to the yes. You might have to tweak what you want, I might need to tweak what I need, but play in the gray because the farther you go in leadership, the deeper you are into gray and you’re always trying to get to that yes.
What would you say some of your greatest strengths are as a leader?
I think identifying potential people, potential leaders.
What are some of your greatest weaknesses?
My greatest weakness is, I can see the end [results] really clearly. The other side of the bridge. I can be on the front end of change and see exactly what it looks like on the back end of that change, and I’ll go from A-M to M-Z really, really fast, and everybody else is still sitting on the starting line. I have to be very, very careful not to move too quickly.
Say I’m about to graduate college, what would be your pitch as to why I should look to senior living as a career?
I’d first make sure you liked people. I think if you really enjoyed people– because I don’t think you can really, really enjoy this career to its full potential if you don’t care about the people around you. That’s the residents as well, because they’ll just teach you so much. What I love about this senior living career is that you can do anything. Go to a college, and you can do facilities management, you can be a chef, you can be an engineer, you can do HVAC, you can be a nurse, you know you don’t always have to be highly talented. There’s things you can do. You can be an executive.
What I love about senior living is that it’s just a great big pool of just about every degree, it seems, that a college offers—and you can find it here. Then I think there’s a lot of growth potential. Just the sheer numbers of senior adults; this business is really changing. If you have an entrepreneurial spirit, there’s a lot you can do down the road. It’s extremely fulfilling—but not without a passion for people.
Do you think the industry does a good job taking those people from the front lines and giving them a path to success?
I don’t think historically we have. I don’t foresee or see we have not. It’s an area of significant focus for us right now; [the goal] this fiscal year is to do a much better job at that, and I would think– I’m sure you’d hear that from just about any senior living workforce as one of our biggest concerns for the future.
Why do you think it’s taken people so long to realize that?
We started tracking turnover at the board level about two years ago, and when we went to look for a national standard, you know what? There was nothing really collected out there.
There’s more of a career path in senior living, so if you go there’s an opportunity to do a lot more with your life, which I do think is a pitch if people have a passion for that.
One of the things we’ve noticed in the last two years, and this year especially, is people are really into ancillary services. Tell me a little bit about your strategy for that.
In 2008— not the best time to start a new business—we started Covenant Care at Home. The ultimate goal was to have a Covenant Care at Home agency in every one of our communities, or near one of our communities. However, that’s unrealistic just with health care reform; it didn’t work so well in Minnesota because of its health care reform [policies], its local market. Florida’s challenging because of the CON [certificate of need situation], so there’s some regulatory, there’s some Affordable Care Act, some local relationships that it doesn’t work in.
We have the agency in Illinois, one in Turlock, California, and one in Denver, Colorado. It’s a competitive business because anyone can start private duty from a bedroom, so private duty has a low margin. Hospice is good, and home health, Medicare, managed care, but it’s a tough business. It’s low-margin, it’s high labor, and you’ve got a lot of commuting in there. I think that it’s definitely been, it’s a great service, it’s a great revenue generator—or at least it brings some diversity to our revenue—but it is harder I think than it seems to get one started up in every one of your local footprints, and because we’re all over the country, it’s hard for us to do a regional office.
Is CRC also bringing in services to the CCRCs?
Yes, we do.
Is that challenging? As we talked about relative to your LifeConnect program, you have all of this information about what people want. Does it ever get overwhelming to customize the experience for residents?
LifeConnect really identifies those areas of where you can bring preventive services in, whether it’s therapy, whether it’s home care, whether it’s private duty service, maybe laundry, might have no health care at all to it. LifeConnect gives us the platform for identifying that, because the whole goal is to be preventive and not to just wait until something happens and then all hands on deck. So the goal is to identify those potential gaps or preferences where a home care service or home health service could step in. It’s actually to our benefit, which is really why we wanted to have a partnership of home health and our CCRC all in the same footprint. Then it gives you the same consistency in terms of service, the orientation, the mission-compatible staff that really live out the Covenant ministry and the Covenant mission in the same way that our on-campus staff do. So it actually brings it all together, and LifeConnect is a great vehicle for identifying what those potential services are. Now we do partnerships with other home health providers where we aren’t [present], where we don’t have an agency.
Is CRC doing anything with ACOs?
Yes. Every one of our markets is different, so you know a lot of ACOs like in Southern California have fallen apart, but we have very, very customized health care reform strategies in every one of our markets. So if it’s a physician-based market, we’ve approached it that way. If it’s a hospital-based market, we approach it that way. But every one of our markets is very, very different.
How have you approached them? Have you had to use the data you’ve gathered?
We track readmission rates and we’re very low. We track it by community, based on the state averages and the targets for that. We actually set a lower target for ourselves, so that’s a huge indicator for us, and I think LifeConnect being the preventive tool that it is has been good for us in terms of identifying things that could land somebody in a hospital or in a higher level of care ahead of time. Doesn’t always work perfectly, but that’s another tool that we have. I guess just the short-term stay, our [CMS Medicare] star rating, there’s a lot of different [factors]. Then we have over 100 managed care contracts around the country, and so it’s more around the managed care contracts in all of our communities. It’s more about having the right relationships than even an ACO, because the ACOs themselves have not been as obvious in our market areas.
When you started with these managed care organizations, did it take a long time for you to educate them on what you guys did?
Some yes, and some no.
What do you think is the biggest challenge the industry faces going forward?
Workforce. Leadership. Identifying leaders who want to be in this. The baby boomers, whether they– do they have the savings? Are they financially ready for retirement? I think that’s a big unknown. That’s a big concern, so I think just positioning ourselves for that. The amount of capital and reinvestment into our aging buildings. A lot of the senior living communities have been around for a long time, so it’s really nice when you can do the paint and the carpet and the lobby renovation, but what happens when you have to replace all the infrastructure of the building, such as your piping—[that’s] big, big dollars. Access to capital for not-for-profits is a big concern. The workforce, leadership development and just the baby boomers being able to afford to be in retirement.