Six C's of continuing care retirement communities (CCRC) leadership development.

Author:Sweem, Susan


Peter Drucker is well known for his statement that, "Management is doing things right; leadership is doing the right things." Leadership is defined as "the ability of an individual to influence, motivate, and enable others to contribute toward the effectiveness and success of the organization" (House et al., 1999, p. 188). It goes beyond the ability to just do things right but creates an environment of learning and positive culture towards higher organizational performance. According to a survey by the Health Management Academy of executive leaders in both healthcare and Fortune 500 companies, there is clear consensus that strong leadership is the key to organizational success (W. Wells & Hejna, 2009). Developing leaders is a daunting task for most organizations and has become especially salient in the healthcare industry.

The 21st century brings new and continuing challenges for the healthcare organizations. The industry is changing and having to adapt to new business models on a continuous basis. This is especially true with the new federal healthcare legislation that was recently passed. The complexity of the healthcare arena has multiplied and leaders will need to satisfy all stakeholders including the payers, consumers and regulators. There is a shortage of labor to fill many healthcare jobs and the demand will likely increase as the baby-boomers retire and require additional services. It will take extraordinary leaders to guide healthcare organizations forward, particularly those dealing with the older population.

Continuing care retirement communities (CCRCs) are one piece of this healthcare web. CCRCs are typically non-profit organizations that provide living arrangements for various stages of the aging process. This includes options of living in individual apartments, assisted living arrangements or nursing facility beds (Winklevoss & Powell, 1984). The number of CCRCs has continued to grow since the late 1980s and the Commission on Accreditation of Rehabilitation Facilities has indicated that there are approximately 1,100 in existence today in the US ("CARF Commission on Accreditation of Rehabilitation Facilities," 2010). Little research has focused on this niche of healthcare organizations, yet, with the potential explosion of the baby-boomer population moving into CCRCs, leadership will be vital to appropriately grow the industry. The question will be what type of leader should be at the helm of the CCRC and what kind of leadership development is necessary for future transformation and growth?


Literature on leadership in healthcare organizations is extensive but little focuses specifically on CCRCs. Researchers have conducted many studies examining the knowledge, skills and abilities of healthcare executives in hospital settings (Guo, 2002; Hudak, 1994). Glister and Dalessandro (2009) discovered that leaders are key to the culture creation, culture change and organizational success. These align closely with characteristics found in other types of industries as well. Hyatt (1997) identified key components in defining successful assisted living administrators. Similar to CCRCs, assisted living facilities provide care to older adults and are more focused on providing supportive services than independent living yet not as intensive as a nursing facility. Hyatt indicated three dimensions for successfully managing an assisted living facility: 1) organizational skills, 2) communication skills and 3) people skills. Richie and Alperin (1989) also researched the characteristics of successful executive directors in continuing care retirement communities and found that administrators performed a variety of managerial functions that were both healthcare and hospitality related. However, it has been through more recent research that these basic building blocks are transcending leadership in healthcare to a higher level. The unprecedented changes facing healthcare have forced a paradigm shift and reinvention of leadership traits and behavior as a result of organizational changes. Leaders must be prepared to be flexible and shift skill sets to best address the business needs and goals.

The CCRC industry is one area where change is occurring rapidly. Typically, CCRCs were used as the last resort for individuals who could not live on their own (Chung-Herrera, Enz, & Lankau, 2003). This is no longer the situation as CCRCs have now developed into retirement communities that offer services and amenities for residents in all stages of their lives. The business model has changed. Hurley and Brewer (1991) predicted long ago that the CCRC model would move toward "hospitality" service. They concluded from their research with CCRC leaders that interpersonal and organizational skills were the most important skill sets for executives. Interpersonal skills included interaction with residents, negotiation skills and conflict resolution. Organizational skills included time management, leadership, decision-making, delegation and training. It seems logical that with these changes, the skill sets for leadership would also change.

Stefl (2008) describes the common competencies for all healthcare managers. In a study completed through the Healthcare Leadership Alliance (HLA) (M.E. Stefl, 2003), five competency domains were established: 1) communication and relationship management, 2) leadership, 3) professionalism, 4) knowledge of the healthcare environment and 5) business skills and knowledge. The leadership domain anchors the HLA model since it is central to any executive's performance and success. The message that the model provides is clear for all healthcare managers; there is commonality across the board and a cause for collaboration. This could be significant if leadership can be transformed and transpired through all types of healthcare organizations for executive healthcare managers.

In addition, leadership has taken on new challenges with the economic recession and the need to run operations lean and efficient. Are the current leaders optimizing their skill sets for the new business model and what are the most important characteristics? This is a key question as one study conducted by IBM of 1500 CEOs indicated that the most important leadership quality required of leadership today is creativity (Minter, 2010). Leaders must be ready to change the status quo even if it is during difficult economic times.

Another factor that has to be incorporated into the leadership equation is that the current leaders are nearing retirement. In one report sixty-seven percent of 3,572 CEOs in hospitals affiliated with the American College of Healthcare Executives are 50 or older ("Reinventing healthcare leadership," 2008). New leadership will have to emerge with the pending retirements. This will be a similar situation in CCRCs but will also provide an opportunity for further change.

This paper explores the leadership knowledge, skills and abilities that executives of CCRCs need to continue to move the industry forward. It examines what skills current leaders believe are important to be successful and also reviews the data based on demographics such as age, gender and tenure in position. A proposed model for the development of future CCRC leadership is discussed along with the potential link to healthcare organizations in general.


This study examines the knowledge, skills, and abilities of executive directors perceived as being associated with successfully leading a continuing care retirement community. The targeted population was the 347 accredited continuing care retirement communities within the United States.

The study followed Dillman's (2000) research design method for surveys and questionnaires. Dillman's (2000) methodology incorporates a process from instrument design through follow-up calls to ensure that the required sample of participants is included in the study. The population for the research study was 347 accredited continuing care retirement communities located in the United States. The Commission on Accreditation of Rehabilitation Facilities (CARF) accredits the CCRCs. CARF accreditation indicates that CCRCs have met certain standards in the provision and quality of care.

An expert panel of executives familiar with CCRC executive directors and key leadership skills, reviewed the instrument for comprehensiveness, completeness, grammar, and readability. Additionally, they provided feedback on the data elements to determine both...

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