UK CEO Natalie-Jane Macdonald explains how private pay pioneers Sunrise Senior Living and Gracewell Healthcare have maintained their cutting edge in an increasingly crowded market.
Established in the UK 17 years ago, Sunrise Senior Living was one of the early pioneers of the luxury, private pay care home market.
“When Sunrise came to the UK it offered something very unusual,” Natalie-Jane told CHP.
“It was distinctive in terms of the building design and also in terms of its offering and its proposition as a home-from-home rather than a clinical and institutional place.”
The organisation was set up by husband and wife Paul and Terri Klaasen in the US in 1981.
Hailing from the Netherlands, the couple set out to establish a premium offering influenced by the Dutch community living model, which promotes independent lifestyles for the elderly and those living with dementia.
“They set up an organisation whose mission was to transform the quality of experience for elderly people who were no longer able to live independently,” Natalie-Jane told us.
Since launching its first community in Frognal, Kent, Sunrise has gone on to establish 25 communities in the UK.
The acquisition of Gracewell Healthcare four years ago has now added a further 21 homes to its portfolio.
Geographically, Sunrise remains focused on the affluent southern private pay market with its most northerly community being in Cheshire.
The Sunrise community home in Cardiff is its most westerly service, with Gracewell in Kentford, Newmarket being the most easterly.
“The majority of our homes are either in the Home Counties, the south coast or in the south west,” Natalie-Jane noted, while adding that the provider aimed to expand its footprint.
“We are just coming to the end of the cycle of developing new Gracewell homes and are in the process of finding new sites for both Sunrise and Gracewell,” she said.
The CEO appointed a property and development director towards the end of last year with the remit of expanding the Sunrise and Gracewell portfolio.
She said the programme would take a partnership approach by initially focusing on “filling in the gaps” in areas where only one of the two brands currently operates.
“We work very closely in terms of quality assurance and quality improvement with our regional nurses,” she noted.
“Our regional operations directors have a portfolio that is a mixture of Sunrises and Gracewells.”
While espousing the same values and principles, the services provided by the partners look very different.
With their American colonial style designs, Sunrise properties are large, typically offering between 80 and 100 beds. The UK team is currently designing the Sunrise community of the future, which will build upon successful features of the current communities, including significant personal space, welcoming communal areas with a strong focus on the quality of dining and the availability of a wide range of activities and hobbies.
Gracewell, on the other hand, offers a more modern setting and its homes are slightly smaller, with bed numbers ranging from 60 to 80 and a greater focus on nursing care. Gracewell fees are typically 30% slightly below those at Sunrise.
The two brands have historically operated different pricing structures, Gracewell with the more usual approach in the UK of a bundled fee, whilst Sunrise communities charge separately for their accommodation and their care.
Sunrise was a high profile target of the CMA’s investigation into how providers charge their customers. The provider reached a voluntary agreement with the CMA to pay £2m in compensation to residents as part of an investigation into ‘upfront’ fees in April 2018.
Sunrise and Gracewell also take a partnership approach with regard to commissioning and recruitment.
“We are conscious of the fact that we have to build homes in areas where we can attract and sustain a fully employed team,” Natalie-Jane said.
“We need to build homes in areas where there is a big enough population to draw our team members and good transport links. I don’t think that was as front of mind when Sunrise first came to the UK. People have lots of choices now for work and obviously we have Brexit and the huge shortage in nurses.”
Being the employer of choice wherever it operates is one of the main pillars of the group’s strategy.
“We are offering communities with teams whose managers have sometimes been with us for eight to ten years and management teams whose continuity of service is in the hundreds of years,” Natalie-Jane said.
With all Gracewell homes, bar one, and half of its Sunrise services offering nursing care, the group has had to take measures to counteract the nursing shortage afflicting the industry.
“We have some very established Sunrise communities and Gracewell homes who have a fantastic team of nurses and we never need to use agency but in other places we struggle more,” Natalie-Jane told us.
“We want to recruit and retain a permanent care and nursing team as it makes such a difference to the quality of care delivered. We have a lot of communities that use no agency with agency costs just over 5% over our people costs.”
Sunrise launched its first nursing student placement programme in Reading in February and is looking to expand the scheme.
“We want to attract those people who can see this will be a good place to work and want to give back to the communities where we are located,” the CEO said.
“We have to be able to pay well and offer meaningful benefits. We recruit for values and attitude. Working in care is very hard work and you have to be resilient and a very good team player. We are very happy that people come to us who have not worked in care before. We can train people with the right skills but if you don’t have the right values it can’t work.
“We believe we have good governance and oversight but we have to be able to trust our team members and to do that we have to have people with the right ethos. We are about giving elderly residents the best life that they can possibly have – a much better life than they would have at home. To be able to do that we have to have sufficient team members in the right roles to give that rounded and holistic experience.”
The CEO said Sunrise was focused on offering people good and meaningful work with proper salary and career progression and was seeking to increase its rewards for people with long length of service to further reduce turnover.
“In terms of turnover we are currently slightly better than the market average,” Natalie-Jane said.
The CEO said turnover had improved by around 7-8% in the past year with a further 5% improvement targeted this year.
“Our focus on recruiting the right people, training them well and having sufficient numbers of them so that they don’t get over stretched has enabled us to materially improve our turnover across all roles but particularly in care assistants and nurses,” she said.
Having been a pioneer of the luxury, private-pay model offering high quality care and amenities, Natalie-Jane said Sunrise had been a victim of its success to a degree as more and more operators had sought to copy its model in recent years with the tightening of the local authority market.
Consequently, Sunrise has had to continue to evolve and offer more sources of differentiation from its competitors.
“A lot of that comes down to the individual resident’s experience we are able to give to the people who come to stay with us,” Natalie-Jane noted.
“We know that people like significant personal space. Our suites have kitchenettes where people can make small meals and entertain if they wish. Our services are en suite. We have different sizes of rooms ranging from studios to bedroom and sitting room.
“We focus on activities and living with purpose. We focus on spending a lot of time out in the community with people coming in, such as children and nurseries, as well as working on physical wellbeing.”
Physical activities include a scheme offering residents the virtual experience of cycling in different parts of the world.
Sunrise is also trialling a Nymbl activity programme, which is targeted at reducing the number of falls among residents.
“It’s a concept that combines physical activity and mental distraction and there is evidence this reduces likelihood of falls,” the CEO explained.
Natalie-Jane said she was determined that Sunrise would also remain at the cutting edge of evidence-based care.
“We are lucky with our Director of Memory Care Jackie Pool who is internationally reknowned for her work and research in dementia,” she said.
“We want to make sure that our services to residents with cognitive impairment, who make up a very large portion of our residents, are the highest possible standard.”
The provider is currently in trials with the University of Exeter looking at the effectiveness of cognitive rehabilitation in an operational environment.
“We will be running that trial in six services until the middle of the year,” Natalie-Jane said.
“We see a lot of our innovation and development as looking at the interplay between physical, mental and emotional wellbeing and ensuring that our residents can have the best of each element.”
The programme is targeted at residents who are not living in a dedicated dementia care setting.
“They may be in an assisted living setting but will have some degree of cognitive impairment,” Natalie-Jane said.
“The objective is to enable them to be as independent of function as they can be for as long as possible while they are still in that environment. It could be setting a goal to go out and go to the shops or get themselves up and dressed each day.”
Sunrise is also carrying out cognitive stimulation research to enable residents in a dementia setting to live as independently as possible.
Further innovation has been targeted at the provider’s dining model for residents living with dementia.
Dining trials where care assistants have had their meals with residents have achieved significant results in terms of increasing nutritional and hydration intake, reducing weight loss and cutting urinary tract infections.
The Enriched Dining trials are now being expanded to other homes and have also succeeded in creating a more calming home environment.
Effective use of technology to enhance the care offering is also key for the Sunrise head.
“We are still very dependent on people serving people so technology offers real opportunities in order to make us reduce the consequences of human error and become more systematised in what we do,” she noted.
“We look at technology in two areas: first of all there’s technology that helps us communicate and engage with residents and their families.
“We often have families who live far away from where their loved one is so enabling them to have access to information about their loved one through our propriety Care Connect electronic care records system is a key development area for us.
“On top of that in order to help our people who are delivering care to our residents we are focused on improving their access to technology, such as sensors, that helps us avoid or manage falls more effectively.
“Over the next few months we expect to see more of that technology deployed through Sunrise and Gracewell homes giving greater assurance to our care assistants and their managers so that people are safe at all times and that allows us to reduce errors and mistakes and keep our residents safe, our team members happy and fulfilled so that they can do their work with confidence.”
The provider is, furthermore, about to implement an Emar system in partnership with Boots and iCare.
Looking ahead, while continuing to provide some independent living services, Natalie-Jane said care homes would remain the core Sunrise offering.
“We are looking at some adjacent markets but have no specific diversification plans at the moment,” she added.
With little prospect of a resolution to the funding crisis afflicting the local authority end of the care home market, Sunrise is well-positioned to continue to thrive in the years ahead.
“It can be easier in places like Sunrise because we know why we exist and who we exist for and our purpose is to give our residents the highest quality of life we can,” Natalie-Jane.
“They pay for all our salaries and all our services so it’s very clear.”