Ascension Living Ceo: Senior Living Industry Must Make Services ‘easier’ For The Boomers 

Ascension Living CEO Erin Shadbolt believes the senior living industry must rethink services and make them more accessible for the incoming generation.

“If we can’t streamline this and make it easier and smoother for our residents, they’ll find someone who can, and they just won’t come to us,” Shadbolt said during the most recent episode of the Transform podcast.

In July of last year, Ascension Living promoted Shadbolt to CEO. She originally joined the organization in 2022 after working as chief nursing officer and interim COO. Also in that same month, Ascension Living sold four senior living properties in Illinois to realign its communities more closely with hospital systems. 

Shadbolt sees the future of senior living “on the housing side” as operators now bring a “team of service providers” into independent living, assisted living and memory care settings to improve care and avoid transitions into skilled nursing.

Ascension Living has focused on improving staffing conditions for employees in recent years. That push was informed by the need to give senior living staffers more support and stability.

Shadbolt helped create an electronic system where associates can submit concerns directly to top company leaders. To further improve staffing, Ascension Living implemented mandatory, 30-minute development meetings between managers and associates to improve communication and help solve friction at the community level on a quarterly basis. The company also implemented a standardized orientation process for frontline clinicians and community leaders.

“We’ve made a lot of progress connecting associates to their leaders and leaders to associates, building the feeling that we’re all in this together,” Shadbolt said. “It’s a hard time to be a business and a hard time to be a person trying to care for a family, but we’ll get through it together.” 

She added: “The number one factor in retention and we know this evidence is strong, it is the relationship with the manager. And so we have done a ton of work around providing our leaders with the tools and best practices,” Shadbolt added.

St. Louis-based Ascension Living operates 21 senior living communities.

Listen to the full episode here.

Editor’s Note: The following transcript has been edited for length and clarity.

On Ascension Living’s recent portfolio sales, realignment:

I would say the sales are really the result of already shifted strategic priorities. We’ve been thinking about Ascension for years now: how do we support our patients across a continuum of health care, including ensuring they can stay in the place they call home to receive services?

Ascension has committed to that with our joint venture with [home health provider] Compassus and Ascension at Home and through our ongoing management of a senior living portfolio, which we see a lot of health systems getting out of. For us, as we looked at our health system and how we strategically partner to serve Ascension patients, it became clear we needed to operate in sites mostly aligned to our hospital system. As Ascension reduced the number of hospitals in the Chicago area, it made sense for us to reduce the number of senior living communities as well because we’re mirroring that acute care footprint.

At the same time, we see the future of senior living being on the housing side—bringing a team of service providers into independent, assisted living, or memory support settings to elevate care and avoid transitions into skilled nursing whenever possible. We hear from consumers they don’t like the institutional setting and unfortunately most skilled nursing facilities are still very institutional.

How her experience as chief nursing officer and chief operating officer inform her CEO role:

I am a nurse, an RN by background, mostly hospice, which is an interesting background because I’m new to senior living. I’m nearing the end of my third year, so I don’t know if I’m new much longer, but I’m not brand new anymore. Being a nurse gives me a different connection to our frontline clinicians and a better understanding of the very real challenges they face. I’ve worked the floor and know the workflows, which is a real advantage.

I use my experience as CNO to think about how we leverage our people and staffing to drive better financial performance and that’s still a work in progress. When I started, we had a lot of agency use and turnover. Over the past three years we’ve reduced agency staffing to a quarter of what it was, which is a big improvement.

As CEO, I’m focused on supporting clinicians and associates in ways that create a feeling of family. I’m at a community right now where that sense of community is strong, associates love it, residents love it, visitors love it. We’re working to elevate associates so they help drive process improvement. One example is real-time listening, where associates can submit electronic concerns anytime, day or night. It’s not anonymous, so they take ownership and we track leadership response times. This creates follow-up and leadership engagement that I think is unique and will help us attract and retain the best associates in senior living.

On building a culture of “connection and transparency”:

I like to think of myself as a scientist. I have a background in healthcare innovation and implementation, with a certificate from IU Health, so I think a lot about experiments and how to test what really works. I’ve tried a lot of things. I even used puppets in a town hall with mixed results. People mostly liked it, but I also got complaints that I wasn’t taking things seriously enough and I heard that. Some associates aren’t comfortable with that level of levity and part of being a CEO is knowing what’s okay and what isn’t.

Probably the most impactful thing I’ve done is send monthly videos—short, usually under two minutes—called What Makes You Smile at Work. Anytime I’m in a community, I grab someone to share what makes them smile. It’s amazing because people recognize me now. We’re 100% remote with no corporate office, so normally associates wouldn’t know me unless they happen to be on shift when I visit or they see these videos. Now they see me, recognize me, ask questions and even volunteer to share what makes them smile.

This has created a greater sense of connection and willingness to share concerns with leadership and with me. We’re also implementing an electronic process to make that even faster and more timely. Of course, retention involves big factors like compensation and it’s hard right now. I rounded with associates last night and many struggle to pay their bills and need second jobs.

As a CEO, that’s gut-wrenching. We have budgets to follow, but because people know me from those videos, they come up and tell me, ‘I can’t feed my family with what you pay me.’ Those face-to-face conversations are critical.

We’re not perfect at Ascension Living, but we’ve made a lot of progress connecting associates to their leaders and leaders to associates, building the feeling that we’re all in this together. It’s a hard time to be a business and a hard time to be a person trying to care for a family, but we’ll get through it together. And we’re fortunate at Ascension Living that we can pray together about it, which makes a big difference for our associates too.

On priorities in senior living operations for 2025:

I’m at the end of my first quarter of the fiscal year so I can tell you what it’s looking like. We’ve done deep dives on staffing and most of it isn’t a mystery. It’s good scheduling, connecting with associates, strong recruitment, speeding up processes and making them seamless. Now we’re at the next step where every community is creating its own action plan for what it takes to get staffed.

For example, I have communities practically next door to a college which requires a very different staffing solution than communities isolated in rural Indiana. We’re empowering executive directors to identify what data and analytics they need, what resources and tools they have or don’t have and what their biggest workforce issues are. Because we’ve spent so much time reducing agency use we now see a lot of overtime. I’d rather have overtime from our own associates than rely on agency staff but I also want associates to have work-life balance and to be staffed well enough that overtime isn’t part of day-to-day operations.

On new growth for Ascension in 2026:

Yeah, I think there’s a couple of places that I’m looking at with growth. In general, as I mentioned, our divestments were part of trying to get closer alignment with the hospital system. There are some significant gaps to being aligned with our hospital system, so we are looking at acquisitions or potentially new builds to align better to that acute care footprint and serve Ascension patients with our services.

When we look at the way we’re partnering, we’re working diligently with our home health and hospice partners to screen residents who need those services, make sure referrals are timely and ensure timely initiation of care. We sometimes see that care starts for home health are slower than they should be, so we’re working with agencies to say, hey, there are residents we really need you to get to right away, and we’re going to have a process to communicate who those are.

The thing I’m most excited about is the start of a geriatric care coordination program, and that, I think, is the gap in senior living we see. I’m the CEO of Ascension Living, and I have a boss. My boss knows a lot about senior living, and I think I know a bit, and my family has had to place a family member, and she’s also had to place a family member. It’s hard. We know the rules, we know the options, we know the financial impacts. A lot of families are finding out they’re going to have to pay out of pocket for this, and it’s still so hard.

Even today I have a family member who probably needs an official dementia diagnosis. We know that changes access to services. We cannot get her access to that. We’re at a place as a family where we’ve given up on being able to access it, and that’s going to be a problem in the future because she’s not memory care right now and is probably going to need it. We’ll cross that bridge when we get there, but it’s hard.

I feel like if we really want to invite the next generation of residents in with us, we are going to have to make it a lot easier. I think about my parents, who are boomers, and there’s a much lower tolerance for frustration and barriers than we’ve seen before. If we can’t streamline this and make it easier and smoother for our residents, they’ll find someone who can, and they just won’t come to us.

On improving retention:

There’s a direct link to the bottom line around retention. I think it’s easy sometimes to forget that, and it is very real. For me, that’s hundreds and hundreds of nurses a year that I need to hire to fill all the positions turning over. When I’m thinking about retention, the number one factor—and the evidence is strong—is the relationships with [a] manager.

We’ve done a ton of work giving our leaders tools and best practices, like how often to meet with associates for development conversations to retain them. It’s a minimum of once a quarter—30 minutes every 90 days to find out how they’re doing. We’ve also spent a lot of time on the new associate experience. Orientation was not standardized, so over the last year we’ve overhauled it not only for frontline clinician associates but maybe even more importantly for leaders. We provide intense orientation as leaders come into the organization on what is the Ascension Living way, how to stay compliant, how to do service recovery, how to serve residents, how to serve associates, and how often to check in and document those conversations.

We’ve focused heavily on the leadership piece of the retention equation because that’s really the key. The second piece, from the corporate support center standpoint, is building an orientation that’s easy to implement in communities and makes associates feel loved, welcomed and wanted. If we can give them that feeling in the first few weeks through the first 90 days, we know many will stay a year or two. Even if all we get is a year or two—which might be common in our industry, that’s a year or two of an associate who is consistent and gets to know our residents.

On technology upgrades:

Like a lot of senior living operators we had a lot of deferred maintenance through COVID. That was a hard time and there really was no capital available. I feel blessed to have come into the organization as that started to lighten up. My predecessors had to make really difficult decisions.

Now we’ve been able to invest in getting all of our facilities back into working order and where they should be. We’re also updating the look and feel, making sure our communities are presented as loved, cared for and updated. The past few years have really been about investing in physical facilities.

In the last year we’ve started updating and optimizing our Wi-Fi and preparing for the future of technology. Like many operators we’re probably a little behind where we’d like to be. We are now working on updated EHR integration. We needed better Wi-Fi to get a better EHR. Now that we have it the next step is building a very different data analytics platform.

This is a huge gap. At the NIC conference I went through an exercise assessing our data availability. We weren’t worse, we were solid in the middle because this is where a lot of senior living operators are. I can get my data sometimes right away, sometimes after a couple days. It’s probably not integrated and rarely ahead of what I’m trying to measure. It’s almost always reactive, often only catching lagging measures and that’s really hard to run a business.

We are working on building the analytics we need so data is easily accessible, actionable for our executive directors and directors of nursing and helps us truly run the business day to day. Right now we’re using a compass and protractor and a map and hoping we get where we need to go and we mostly do but it would be a lot better to have GPS. That’s where we’re trying to go.

On education needed to expand market penetration, care coordination:

I know that this is a problem and it’s something that I spend a lot of time thinking about. I’ll share my tactic right now. I am not new to healthcare. I’ve been in healthcare for a very long time and yet I was so surprised by so much of what I learned in senior living. It’s interesting that there is almost a curtain between senior living and the rest of health care where what we do is obscure. No one really knows. If you go into a hospital, unless they live there, they probably do not know what we’re doing.

This is really hard because when we think about where people get guidance for difficult decisions around their health, especially as they’re aging, our residents are going to physicians, they’re going to NPs, they’re going to their providers. I would bet that it is very rare for a provider to say, You know what, I think a senior living solution would really be ideal for you, and let me tell you all of the reasons why. The reasons are here, all the problems that we solve for seniors, but those physicians don’t even know that. That’s not how they think about us because what they see and hear about are probably mostly the things that go really poorly. Those are the patients that are coming back to them.

There is very much a preconceived notion of our partners in healthcare around what we do, who we are, what we’re trying to do and how we could partner with them. If we could get our colleagues in healthcare to also be advocates for us that will make a lot of movement because they are guiding people on these decisions and they are saying things, and sometimes it’s not intentional, like, Man, I’d never go somewhere once I’m older. We have to be really careful about that. I used to say that and now I’m like, there’s going to come a day where I’m not going to have any friends around me and no one to take care of me and I’m going to be bored. I don’t want to just have 60 cats. Maybe senior living is something for me to think about, where they feed me and they have activities and I get to have friends again and interaction and purpose and meaning. That’s a lot. We give people purpose and meaning when they often don’t have any left.

Outlook for 2026:

I have a really positive outlook for 2026. We have a lot of really exciting upgrades that are going to come to our organization in 2026. So, when I think about what next year is going to look like as we move through it, I think we’re going to see even better retention of our associates, which I’m excited about. I want associates who’ve been here for a long time and love it. We are starting to see waiting lists at communities so we’ve had a big push around occupancy, and that’s really exciting to start to see some of this reinvigoration of communities that we’ve been working on.

Probably the thing that I’m most excited about is we are doing a lot of work around memory support, including establishing some philanthropy options and really starting to drive a really robust Memory Care program that is training of our associates, training of family, engaging residents, managing activities, improving cognitive brain health where we can, slowing down progression of disease, and then early identification and intervention in all of our settings that are not memory support. So a lot of investment around that, and I’m really excited. I think that’s a huge need and is one of the things that’ll be, hopefully, something that residents are looking for, is somewhere that cares about keeping their brain as healthy for as long as possible.

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