Amanda Scott, managing director of Gracewell Healthcare and Sunrise Senior Living, should be an inspiration to every nurse or carer with dreams of high office. Her career trajectory from nurse to head of care and quality for Sunrise, and now MD for the highly respected group, has been meteoric. But her feet remain firmly on the ground as she plots the next phase of expansion that will see Gracewell double its number of homes over the next three years. Care Home Professional’s Rob Corder caught up with her at Gracewell Church Cookham, to find out more about the group’s plans.
Care Home Professional: I am particularly interested in the past year in which you have rebranded and repositioned Gracewell, but could you take us a little further back to put the company, including parent company Sunrise Senior Living, into more of a historic context?
Amanda Scott: I have been with Sunrise for around five years now. My background is as a nurse and I have worked in the care sector for the last 18 years for a number of organisations. I joined Sunrise in 2011 as the care and quality director with a very clear remit to look at the clinical governance programme of the organisation and to drive that agenda forward.
About two and a half years ago I was appointed as managing director for what was then just Sunrise, operating 27 communities. 18 months ago we acquired Gracewell, which comprised of its existing homes and also the pipeline of homes planned for the future.
The role since then for the management team has been to determine, without a specific brief to keep the Sunrise and Gracewell brands separate, what was the right thing to do for both companies.
The most logical thing for me to do was to ask the customers what they think. We did a great piece of research that told us our customers see Sunrise and Gracewell as two very different brands. Sunrise is seen as more of a lifestyle choice. From a Gracewell perspective, the word Healthcare in the business name gave people a comfort in terms of expecting all of the services on offer within each of the Gracewell homes. They expect to see that light touch residential social care all the way up to very high dependency, high acuity nursing needs, and also the dementia care for people with memory loss.
CHP: How many homes did you acquire when Sunrise bought Gracewell?
AS: We acquired 11 homes, and shortly after that we opened Gracewell of Edgbaston, which was in the process of being built. We have a further four opening this year: a home in Knowle Gate in the Midlands that will open in May; we have Newbury, Camberley and Bournville near Birmingham opening in the Autumn. These were all part of the pipeline of properties that we acquired when we bought Gracewell.
CHP: Were all of the Gracewell homes that you acquired similar in their level of environment and service, or have you needed to change or improve them so that they feel like they are working to a certain Gracewell model?
AS: The homes we acquired were all of the same style. It is a very fresh approach to the design and look and feel. When you look around this [Church Cookham] home you will see that we have given the whole home a movie theme. The rooms are designed around that Hollywood glamour, so each room is given a name such as Marilyn Monroe or Carrie Grant. Our cinema room has a huge picture of Marilyn Monroe on the wall.
It is a very contemporary look, but underneath that, all of the furniture and fittings are designed with older people in mind. For example, the hair salon has high-low sinks. Bedrooms have call alarm systems and nursing beds, but they are all designed in a way that means the clinical side of things is not the first thing you see. For my Dad, the last thing I would want him to walk into is a bare room with a big metal hospital bed dominating it. We want bedrooms to feel like spaces people will be happy to live in.
CHP: How will people know they are walking into a Gracewell home as oppose to a Sunrise home?
AS: There are significant differences. If you look at Gracewell homes, although we do have a shared bistro and dining rooms, they are designed within smaller households. Should you need nursing, your room and your environment is contained in a household that has its own smaller sitting room, its own smaller dining area and kitchen area, and your own room within that household of 15 or so beds. Plus we have the communal areas where people can interact with other residents and have their family in to see them.
Sunrise homes are much larger open plan design. The living room area might accommodate up to 70 residents.
There will be a big bistro at the heart of the house and a large dining room. So, the biggest difference from an environment point of view is the way we create these smaller households in Gracewell homes.
CHP: How many beds do you have in a typical Gracewell home?
AS: Around 65-70.
CHP: How many of those beds are for dementia care and how many for lighter touch residential care?
AS: We really let the market decide. When you open any new home, regardless of any research we have done in the local market, the makeup of the home is always going to be driven by the customer. That is the beauty of the way we divide up a home into several smaller households. If you find that you have a high demand for dementia care, then you can accommodate that by fitting out an extra household with dementia care facilities. If you have less demand for dementia care, you can change the 15 bed household back to residential care.
We make this quick and easy because every household is designed in such a way that it can be tailored to the needs of the residents living there. For example, all households have secure access with key codes so that they are all safe and secure.
The building is future-proof to allow the whole home to be flexible to the needs of the local population. It also gives families and residents a lot of security because they can remain within the same home if their needs change and they require more care. We can even adjust care for people for short periods, if there is a crisis, without disrupting their lives. The assessment of everybody’s needs can be done on site because we have specialists in the home.
CHP: Are most of your residents self-funded, CCG-funded, a mixture of CCG money and top-ups?
AS: We have a mixture, but a good proportion of our residents are self-funded. But we also have some residents where their families make a third party payment. We have some spot contracting or block contracting with CCGs that work very well.
CHP: But the business model is based on your homes being populated with more affluent self-funding residents?
AS: Yes, absolutely.
CHP: Does that dictate where you look to build new care homes in the future?
AS: Yes, it is important that we have a sustainable model, so a lot of research goes into finding appropriate sites. We have a dedicated team that does that.
CHP: Unlike some of your competitors, Gracewell has homes in the affluent South and the less affluent Midlands. Does your team try to find pockets of more wealthy people even as they head into more deprived parts of the country?
AS: Yes, but at the same time we know that things change and things move on. As the population continues to grow, we have seen families prepared to consider homes in a wider circumference around where their parents live. So, of course the positioning geographically needs to be right, but we also look at things like availability of people to recruit, so off the beaten track is difficult with transport links and things like that.
There is a whole algorithm of different permutations when we look at whether a particular location meets our business needs and the needs of the local community.
CHP: A key factor in your algorithm must be how easily you can run as close as possible to full occupancy. Is this something you achieve in most homes?
AS: Yes, Gracewell is still a young company, but if you look at properties like Gracewell of Church Cookham, you can see that within two years of opening the home is full. This is an example of choosing the right location and the right leader with the right team.
We recognise that the period of time from build to fill is a slow process and our emphasis is on making sure that the team is built properly and that, as residents arrive, we ensure that we keep our promises to our customers.
Every home is on a different journey. Some homes that are very quiet to begin with can suddenly reach the point where it is recognised and accepted locally. We put a huge emphasis on promoting our homes, not just in terms of advertising in local newspapers, etc, but making sure that our team engages with the local community. So, Sarah-Jane, [the care home manager at Gracewell Church Cookham] is a Dementia Friend, she joins local alliances, she invites the local community into the home. This work can see homes really take off.
CHP: One of the big problems facing some of the larger operators is that they have mortgaged their futures based on assumptions of rising fees and future growth. This has been a particular problem for those that are taxpayer-funded because the fees have been squeezed for so many years. How does your model differ?
AS: We have a great relationship with [Real Estate Investment Trust] Welltower (formerly known as Health Care REIT). It is important for us and for them that they understand the nuts and bolts of the operation. The security going forward is having a strong product in terms of appearance and going above and beyond all the regulations.
Welltower has a team in the UK that are very present and very supportive. It has been a real pleasure to work with them. They have given us the support so that if we come up with plans for the future, they are likely to be looked at strategically and given the chance to take those plans to fruition.
CHP: Does the combination of Sunrise and Gracewell give you a bit more opportunity to attract customers at a younger age and with less complex health needs?
AS: This is something that we work on in terms of marketing Sunrise and Gracewell homes to the local communities as more of a lifestyle choice. We advise people that they don’t have to wait until that moment when their mum or dad gets really sick and there is a crisis that needs a fast decision. We want to encourage people to make choices in a more measured way. We do things like offer holidays for elderly relatives so that their families can get a couple of weeks off. I can see an opportunity to build on that idea. There is a national psyche that we need to overcome because people are so resistant to the idea of leaving their own homes.
CHP: That could take decades to change, but many operators I speak to would love to see the sort of retirement villages they see in the United States take off over here because it provides a different entry point into homes where people need a little more care but don’t give up their independence.
AS: I do wonder when that change of attitude might start to take hold. I think the quantum shift might be when younger people now, who are much more likely to rent than a generation ago, will be used to having far more flexibility in terms of where they live and work in the country. The psyche that the right thing to do is always to get a mortgage and buy a property is changing, and that might lead to less of a ‘my home is my castle’ attitude. These people may be much more open later in life to the idea of living in a retirement village being just another type of rental property.
CHP: There are two things working against you getting this positive message heard. The first is that this is a privatised industry that is still very fragmented. The largest 25 operators account for less than 15% of the market. That makes it difficult to amass the PR power or the lobbying power. The second is that trade associations are struggling to present a positive message when they are always arguing for greater funding for a sector in crisis.
AS: It is important for the industry and for associations like Care England to tell the operators’ stories. Finding the right outlet for presenting the positive side of the industry is vital. There have been some positive initiatives, such as the National Care Home Open Day, which is a great joint piece of work between the operators, the associations and the regulators. I would like to see more vehicles like this throughout the year.
I am not turning my back on the very real challenges facing this industry, and the competition between operators, but I would like to see more work done to promote the positives.
CHP: You spoke about four homes opening this year. How do you see business developing five to 10 years out?
AS: Growth through new builds, new openings. We are always interested in land and growing the pipeline. We will study where we feel there is a need for a home, not just in the format that we are delivering now, but also looking at younger people that need care; younger people with early onset dementia; people with physical disabilities. Our minds are not closed to just one model, one type of build or one customer. We are really open to new ideas for growth.
CHP: If you manage to open four new homes every year, you will double the size of Gracewell within three years. That sort of growth is hard to manage.
AS: I agree, which is why underpinning what we do is the platform, and I am confident we have that right. It is about the process – in a young organisation process is really important and with every year that passes our processes are enhanced and solidified. And finally our people – as the operations team gets to know Gracewell better, then the energy and momentum builds and things get easier. You develop a formula that is tried and tested and works.
CHP: Do you think you can continue to grow organically by building, or do you think another acquisition is likely?
AS: I keep an open mind. There are always opportunities for acquisition. The market is volatile, some would say frothy, it is in a state of flux, and that does bring opportunity. I think with Gracewell particularly, the appearance of our buildings lends itself to being able to acquire and then convert properties to the Gracewell look, feel and offering. But build is very much on the cards because that gives us the ability to create the bespoke designs.
CHP: Acquisitions might mean one home at a time, or buying another multiple home operator, or even an operator with a pipeline of development sites. Are you saying both are possible?
AS: There is nothing in the check list of growth that is crossed off. Everything that contributes to growth, be that a rescue, a convert, acquiring homes, acquiring a pipeline; these are all open to me.
CHP: And does Sunrise have a similar growth strategy?
AS: Yes, the message is that if the location and opportunity is right to build a Sunrise, we will build a Sunrise. We have opened two new Sunrises in the US this year, so that growth strategy is global, rather than just the UK.