Senior living communities are moving into a continuum of care focus, where they have amenities to suit every phase of the aging process - from independent and assisted living to skilled care - called continuing care retirement communities, or CCRC.  Each unique residential environment requires different levels of expertise and management, thus leaving support service departments and administrators exploring and adapting to the new, changing senior living design.  Joey Dowell, HHS Vice President of Senior Living, shared insight into the challenges facing support service organizations when contracting with a CCRC and the importance that adaptability plays in this role.

“Throughout HHS’ 42 year tenure, the main focus has been providing support to acute care facilities, but as we have expanded our services over the recent years, we have added new industries, one being senior living. This expansion has come with it’s own types of challenges and has taught us the importance of adaptability within the workplace, especially when handling CCRCs,” states Dowell.

CCRCs offer three different types of environments which have very unique management styles and require different levels of programs and training services. “When we first began working with CCRCs it was a learning curve and we had to adapt our cleaning programs to accommodate each facility's needs. We had to figure out what we needed to clean, how it should be done, and even if it was protocol to wash dishes for a resident living in the independent care unit,” continues Dowell.  “By taking our extensive housekeeping training for acute care facilities, and updating and adjusting our procedures, we have been able to develop more effective materials to better accommodate the senior living industry’s needs.”

“An aspect that really helped the process was understanding and taking into consideration the differences between the facility types. By acknowledging that independent living had completely different expectations than those in skilled care helped us more efficiently manage our programs. In an independent living environment we are not cleaning a patient’s room, we are cleaning someone’s home - where they live and where they sleep.  We began meeting with residents and adjusting to their needs, learning about the products they preferred to be used in their rooms, and their certain specifications.  A best practice has been to chart and track all the residents’ expectations, so we can continue to provide them with the housekeeping they want every single time.  Moreover, when we are handling skilled care, our operations and roles become more acute care based and we have to adjust our cleaning programs to prioritize protecting residents from acquiring infections.”

“What I found to work efficiently when being faced with the task of starting a new CCRC program was to evaluate, review, and resource policies that were in place at the facility prior to our partnership.  This helped us determine what worked and what didn’t work and develop more true HHS policies and procedures for Senior Living,” adds Dowell.

The same challenges are faced within the culinary department as well.  “Food is an important aspect of CCRCs, where menus need to be creative and interesting  for independent and assisted living, but need to be more nutritionally focused for skilled care.  Developing diverse menus and tracking favorite meals, as well as ones that didn’t work so well, has helped our team keep residents happy.  ”

There is a lot to learn when entering into a new industry and more often than not, it takes perseverance and a little trial and error. However, these challenges serve as a learning curve to expand knowledge in different areas and adapt programming to better represent an industry's needs.  No two facilities are alike, so it is important not to become stagnant in the way you approach services. It’s vital to take on new challenges and discover what elements to incorporate to make programs successful and unique.  


Joey Dowell joined HHS in 2010, serving as a floor technician at a facility in Florida.  As a result of his leadership, Dowell was quickly promoted and served in leadership roles as a supervisor, assistant director, and executive director.  In his current role as Vice President of Senior Living, Dowell helps develop and build new service lines within the industry.  Dowell earned his Bachelor of Science in Family Youth and Community Sciences from University of Florida and currently resides in Nashville, Tennessee.

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