The CEO Series: Susan DiMickele, National Church Residences
By Jim Nelson | November 13, 2024
National Church Residences President/CEO Susan DiMickele began her career as a lawyer. “You could say I’m a recovering lawyer,” she joked early in our conversation. After more than two decades at a large law firm where she was an equity partner, then-National Church Residences’ CEO Mark Ricketts invited DiMickele to join their cause. That was roughly eight years ago, and she accepted the offer to become NCR’s first general counsel.
DiMickele took over the company’s senior living division at the end of the pandemic, and she rose to the top executive position roughly a year and a half ago.
The Columbus, Ohio-based nonprofit organization has a stated vision to advance better living for 100,000 seniors by 2030. It was that intention that served as the impetus for my chat with Susan DiMickele.
SENIOR LIVING NEWS: Do you recall how many senior living communities and residents you were serving before you stated your goal to serve 100,000 people by 2030?
SUSAN DiMICKELE: We set this goal in 2021. At that time, we had roughly 20,000 units of affordable housing, probably just shy of 2,000 units of senior living. We also had service coordination in a number of other communities — we’ve consistently, over the last few years, served about 14,000 older adults in service coordination alone who don’t live in a National Church Residences property. We provide service coordination for a lot of other like organizations through HUD grants. If you added all that up, you would have been probably just under 50,000 and we were really wanting to double that. We know that if we’re really aggressive we can add, I’ll say, between 700 and 1,000 units of affordable housing a year, either through acquisition or through new construction. That is still our goal. I think this year we’ll probably add about 700, other years it might be 500, other years it might be 1,000. And we do that consistently, we do it well. We also renovate affordable housing, but adding new units has been our goal. At the same time, we’ve added, I would say, three modest-sized senior living communities more geared toward reaching the middle market; those have been 70-80 units per community. So, that means anywhere from 35,000 to 40,000 lives or touches are going to have to come from somewhere else. What we said at the time was, “We really think there’s an opportunity in services.” We can serve people who live with us — that’s the best-case scenario — we can serve people who don’t live with us and help them age in place, and we can also serve other senior living communities that don’t have home- and community-based services, and build an ecosystem of a continuum where we can help an older adults age in place, stay healthy, focus on wellness, and really make sure that last chapter of life is high quality, one that we feel good about being part of.
So, our vision isn’t just to reach 100,000 by 2030, it’s to advance better living for 100,000 seniors by 2030. Sometimes we focus on that 100,000 and we don’t talk as much as we should about advancing better living. And it’s both. It’s not just about the number, it’s about truly advancing better living.
A Venn diagram I’ve recently shared with our team [shows] our future: One circle is housing. We’ve done housing for 62 years. We’re going to keep doing housing; we want to remain the largest provider of affordable housing for older adults in the United States. Right now, we are a top provider of senior living in the state of Ohio — we’re in the top 10 — and we want to continue to build on that. We have over $2 billion worth of real estate assets. We know how to acquire housing, we know how to build housing, we know how to operate housing, we know how to renovate housing. So that’s one circle. But not every older adult is going to move into a senior living community. We also know that the acuity levels are rising, the aging population is growing, and we can’t build enough housing to serve everyone, so this is where services come in. The first circle is housing, the second circle is services. In my diagram there’s an overlap in the middle, and that’s our sweet spot, where we provide both housing and services, because we’re really good at serving older adults in community. We’re passionate about not only what we can provide in terms of services, but what they gain from each other in terms of relationships and socialization. We’re really committed to that community approach, but we know the services are needed to help age in place so that they can stay living in independent living for as long as possible. If we overlap services, now we’re really completing the picture of what the vision is for National Church Residences in the future. You have housing, you have services, and ideally you have the middle where we’re providing both. We also know that we can’t be everywhere, and we’re going to have to partner with other senior living organizations.
When you bring housing and services together, you have the very best outcomes for older adults in terms of longevity, health, vitality. We talk a lot about lifespan, and in this industry you’re hearing more about healthspan, which is not just length of life, it’s quality of life, it’s wellness, it’s finishing the last act of life with intention and purpose. When those two come together, we have great outcomes. Guess who cares about great outcomes? The payers. All of a sudden, we become a force in healthcare. The payers need us because we’re the ones getting great outcomes for older adults, so we are positioned to participate in value-based care. We know that Medicare is continually being challenged. We know that by 2030, the Medicare trust fund is not going to have enough resources, so value-based care is going to become the norm, not the exception. As housing providers and partners with others, we are in the best position to create value and participate in value. We are positioned to really participate, and that becomes so exciting for our industry.
To be clear, please don’t hear that National Church Residences is going to have 100,000 units of housing; the goal is to think outside of our own walls and to think about the industry holistically, and to really not be a silo. I think we really need to come together as an industry. And if we can break down some of those corporate walls and really focus on servicing the older adult, we’re all going to get to the right place, and we’re going to be reimbursed appropriately.
SLN: So, what’s the 30,000-foot view of how you’re reaching that goal?
SD: Continuing the path to keep adding more affordable housing units, and we’d like to get to a place where we’re adding 1,200 units a year, 1,500 units a year. We’re trying to be more intentional, thinking two, three, four, five years down the road. It’s acquiring land where we can, where there’s a need; it’s building relationships with the right communities that maybe will want to partner with us in the coming years. And we’ve been opening new senior living communities, which is definitely a space where we have a passion to serve that middle-market older adult; we’re really trying to reach into the middle market. And the final thing is continuing on our services journey. Right now, we have service coordination at scale. We want to look at home- and community-based services throughout the state of Ohio, and then potentially look at expanding into some new states in the next two to three years. That’s going to require a multiyear strategy. It may require new partnerships with others who are already established.
We have had two very strategic acquisitions in the last two years: one of them was right before I became CEO, that I was very involved with, and one was right after. First, we acquired a 25 percent interest in a Medicare Advantage brokerage firm, which is primarily in the state of Ohio, although they’re licensed, and they do work outside of the state. They help older adults make sure that they’re in the right health plan and can navigate all the benefits that they have. For an affordable older adult, it can be the difference of getting your medication paid for in a given month, of having enough extra food to provide groceries or transportation. Helping our residents and those who don’t live with us make the right decisions around benefits is huge; it’s overwhelming for older adults and their families. The group that we’re now a part of serves over 50,000 older adults every year.
The other thing that we’ve done is acquire a very substantial primary care practice here in Ohio, called At Your Door; they work in all different kinds of senior living communities throughout the state of Ohio, serving almost 10,000 older adults every year. That positions us to really serve older adults, help them age in place, be that quarterback for care, and execute on that vision with the two circles — the housing and the services — really coming together. We’re really excited about that. That’s something that we want to grow and look at where we can do it elsewhere once we get our legs underneath us here in Ohio.
SLN: Talk about growing pains a little bit; the first thing that comes to mind is staffing.
SD: We’re struggling along with everyone else and recognizing that it goes back to why are people in this industry. Why do they want to come and work for us? Recruiting talent that wants to have purpose and not just a paycheck.
We have doubled down on our core values this year. I started by going on a listening tour; in my first 100 days as CEO, I said I wanted to meet with 100 people in our organization, and I stopped counting at around 130 people. I just listened, and in the course of that decided that we would begin a “100 Reasons Why” campaign. We were able to get over 100 people to share why [they] work at National Church Residences and post a video across our organization.
We still have a lot of work to do, but we’ve come a long way; people want to work here because of the mission, and they appreciate — and they’re leaning into — our core values. We have to create that kind of culture if we’re going to have a sustainable workforce. That is something that we are investing in. I’ve been having not only monthly videos, but town halls with all employees, and they can submit questions; every question has been sincere and thoughtful. That’s the kind of culture that we have to create in order to get a workforce that wants to stay. It is a multiyear process, and we are just bending the curve.
