The last fifteen months have taken a significant toll on senior care and living organizations throughout the country. As a nationwide management and consulting company, Health Dimensions Group is in a unique position to observe impact of the pandemic on census and occupancy. As a manager, HDG has seen occupancy declines in our own 46 senior living managed communities in seven states—which are just now beginning to rebuild. On the consulting side, our clients have experienced varying degrees of occupancy declines. Our consulting team recently presented to LeadingAge Oklahoma, and our research indicated skilled nursing facility occupancy in the Sooner State declined from 64% to 54% during the pandemic. While these statistics are disconcerting, we do know that in many areas of the country, occupancy is beginning to rebound—particularly when there is a strong sales and marketing strategy in place and the onsite team works collaboratively toward common goals.

What is the secret to a strong sales and marketing strategy? The answer, of course, differs by product and market. However, there is one component that is foundational to all solid plans: a disciplined communication approach.

Environmental Challenges

As sales and marketing professionals, we have been faced with what arguably will be the greatest challenge we can expect in our careers. The pandemic affected our senior care and living communities in immeasurable ways—and we are still working to turnaround the impact to census and occupancy in most markets. While there were many environmental challenges over the last 15 months, there are three that were quite significant.

First, one of the most notable effects was the rapid decline in skilled nursing facility occupancy. In fact, since February 2020 to January 2021, our industry has experienced a 13.7% nationwide decline in skilled nursing facility occupancy, which brings us to our current level of 71.2% (NIC).

It is important to note that this data is from urban areas, and declining occupancy has been even more significant in rural areas. As of January 2021, the national occupancy rate in rural areas was down to 69.4%.

The declines in occupancy are not just on the skilled nursing facility side. We have also experienced challenges in the assisted living and independent living sectors. From June 2020 to March 2021, occupancy declined from 84.7% to 78.8%.

Multiple factors have led to the decline in census and occupancy over the last 15 months. First, elective surgeries in hospitals were paused or postponed (surgeries that drive post-acute care in our communities). There has also been an increase in the provision of care at home. Recent data suggests that the shift to home care began as early as June of 2020. The decline in occupancy has been affected by COVID-19 deaths among the older adults in our care as well. And finally, consumer demand has declined during the last 14 months, which has affected SNF occupancy.

A second environmental challenge that continues to affect us is our public perception. In comparison to other parts of the health care continuum, the public perception of aging services profession has always been a struggle. During the pandemic, it seemed we were unfairly targeted and criticized for our COVID-19 response. Major publications like the New York Times published articles with headlines like, “This is Why Nursing Homes Failed So Badly.”

While national and local media outlets are quick to point out challenges in senior care and living communities, hospital employees were billed as health care heroes during the pandemic. Certainly, our colleagues in acute care deserved this recognition, yet we in aging services did as well.

While our negative perception in the public or media can be disheartening, there is a lot of hope. As operators, we know that the vast majority of those in our profession are highly committed to our residents and improving the care and service we provide. It truly is a mission and a calling for most of us. Additionally, our professional associations, such as LeadingAge, Argentum, and the American Health Care Association, have been very supportive in trying to efforts to improve our reputation through national media campaigns and social media campaigns. And third, digital and social media allows us to tell our own story.

Another challenge that we have experienced during the pandemic is the significant number of deaths in senior care and living communities. In an HDG analysis of Minnesota Department of Health data, 61.3% of all congregate care communities in Minnesota had one or more residents pass away from COVID-19 and 20.1% of congregate care facilities have lost 10 or more residents due to COVID-19.

While these deaths have rocked us to our core, we do know that vaccinations make a huge difference. Since the vaccination clinics began in nursing homes, we have seen a significant decline in COVID-19 deaths in nursing homes nationally– and this decline outpaces the decline in deaths of the U.S. population as a whole.

HDG performed an analysis of COVID-19 deaths as reported in the National Healthcare Safety Network (NHSN). In the week ending December 20, 2020, there were 6,000 COVID-19 deaths reported. In the week ending March 21, 2021, there were 351 deaths. Indeed, in just three months, our nation went from 6,000 deaths among 15,000 facilities – to just 351 deaths! Encouraging numbers!

As the above summary illustrates, senior care and living organizations have had multiple hurdles to overcome. We do not share this data to depress you, but rather acknowledge the environmental challenges or context that we face as we work to develop and implement a more effective sales and marketing plan, and ultimately rebuild our census and occupancy.

Communications – The Often Forgotten Discipline

A strong sales and marketing strategy is instrumental to supporting senior care and living organizations in rebuilding their occupancy. However, in doing so, many organizations forget a fundamental component: the communications plan.

Communications is an often “forgotten discipline” in senior communities’ sales and marketing efforts. This is really a gap—as the communications plan should be the foundation of the strategy.

This is because your internal stakeholders—residents, families, team members, board members, vendors, and donors—know more about your organization than anyone else! The residents personally know the valued team members who care deeply about them. Families know how hard you worked to keep them updated on their loved one’s well-being. And team members know the efforts you made to support their health during the pandemic and keep them safe. These are just a few examples of how your internal stakeholders can “vouch” for what your team does every day to serve and honor your residents.

Therefore, internal stakeholders are the most equipped to market and sell your services. For those of you who provided superb care during the pandemic or had a low number of positive resident cases or deaths, your internal stakeholders will serve greatest witness and cheerleader for the care and services you provide. They will also be able to describe how you promoted, and continue to promote, their safety, health, and wellbeing.

Therefore, while communications has always been important—especially during a pandemic—it is even more important as we move forward. Communicating with our internal stakeholders is not only the right thing to do, but if you are able to prepare your internal stakeholders with stories of your excellent care and compassion, you can also educate and better influence your referral sources and prospects.

As stated, the importance of communications in senior living sales and marketing efforts is often overlooked, but what are the essential strategies for developing a comprehensive communications plan?

An Effective Communications Approach

It is essential to develop a comprehensive and effective communications approach. Consistency and regular communication is key here. At a minimum, you should develop and update your communications plan on a quarterly basis. The plan should include key audiences, key messages, and specific tactics. Above all, you should be as transparent as you possibly can. As our former owner once remarked, “people are down on what they are not up on!” And of course, your communication should be in line with federal and state regulations as well as your organization’s values and culture.

To ensure the content of your communications plan is sound, the sales, marketing, and admissions team needs to be aligned with other members of operations, including the clinical team. Effective communications requires that you know the details of operations. Is there a new case of COVID-19 in the community and will visitation be suspended? Are you able to have onsite tours at this time? Are activities the same today or will they be altered in some way? It is through a true partnership between the sales and marketing team and the entire interdisciplinary team (IDT) that will help strengthen your communications plan—and ultimately the sales and marketing strategic plan.

To develop a strong relationship with your IDT colleagues, it is important that you listen—and listen well. Different information is important to different stakeholders, so listen with an ear for what matters to your various audiences and communicate in various ways to ensure your messages are heard.

Different people have different ways in which they prefer to receive information. Verbal, written, virtual, and digital communication channels are important depending on the individual. You need to really consider the platinum rule. Many of us are familiar with the golden rule: do unto others as you would have others do unto you. The platinum rule in communications is different: do unto others as they would want done unto them.

So, in other words, consider your audience and how they prefer to be communicated with. The following are examples of various communication methods:


  • 1-to-1 meetings and conversations with residents
  • Resident councils
  • Team member huddles
  • 1-to-1 meetings with team members
  • Mass voice messaging services
  • Personal phone calls
  • Hotlines
  • Drive-through events
  • Videos
  • Hold messages


  • Family emails
  • Team member emails
  • Family and team member letters
  • Resident flyers
  • Newsletter
  • Time clock messaging
  • Posters
  • Text messages
  • Press releases / media statements

Virtual and Digital:

  • Family Zoom meetings
  • Virtual visitation between residents and families
  • Website updates
  • Social media
  • Email marketing
  • Virtual tours
  • Virtual events

As you explore various communication approaches, we encourage you to utilize and/or expand technology and tools available to you. Early in the pandemic, HDG explored and rolled-out several new technologies to support our communications as well as sales and marketing efforts. For example, we adopted LifeLoop and OneDay in several of our managed communities. LifeLoop is a technology platform designed to support internal and external stakeholder communication as well as other operational process. We also used the templates created in LifeLoop for calendars, newsletters, and other collateral development. OneDay is a video story telling platform that allows you to send customized videos, including prospective residents and families and potential employees. We have seen up to 70% engagement on emails delivered through OneDay. While there are many other companies that provide technology solutions, the key is to select one with a high likelihood of adoption, develop strong processes and expectations, and identify a process owner.

In addition to different platforms, it is important to remember there may be generational differences in preferred communication methods. Your residents who are Traditionalists may prefer more formal, written communication while Millennial employees may prefer digital communication. The following is an outline of issues to consider when communicating with audiences of various ages.

Chart describing the differences in preferred communication methods between generations. The Greatest Generation (1910–1924) and Silent Generation (1925–1945) tend to appreciate formal and direct communications with preferences for face-to-face, written letters, and handwritten notes. They value respectful and formal messaging. Baby Boomers (1946–1964) tend to appreciate formal and direct communications with preference for face-to-face, phone, and email. They also value background information and details. Generation X (1965–1979) tend to appreciate informal and flexible communications with preference for email, text, and Facebook and value professional etiquette.

Chart describing the differences in preferred communication methods between generations. Millennials (1980–1994) tend to appreciate authentic and fast communications with a preference for using text, chat, email, and Instagram, and value efficiency and a digital-first approach. Generation Z (1995–2012) tend to appreciate transparent and visual communications with preference for using face-to-face, Snapchat, YouTube, TikTok, and FaceTime, and value video, voice-command, and mobile-only approach.

The “how” of communication is essential, but “what” you communicate is equally important.

Message Development

Give the People What They Want

Now that you have selected the tools and channels you will use to communicate with your stakeholders, you must answer the tough question—what do you say to them?

When developing your messaging, put yourself in the shoes of each audience member and think about what is important to them. Including not only what they need to know, but also what they want to know will be an important factor in building the trust of your audience. What would you want to know if your parents were in living in the community or if you were the CNA?

As we emerge from the pandemic, messaging surrounding health and safety measures is going to continue to be key in rebuilding your audience’s trust. However, beyond that, each audience will require unique and customized messaging in order to drive home the idea that your community is a safe place to live or work.

For example, while your residents, families, and prospects are going to be most concerned with the health and safety, socialization, and visitation changes that occur, your team members may be more interested in operational and leadership changes taking place, changes to wages and benefits, vaccination information and incentives, and recognition.

Going above and beyond to provide each audience with the information they want and is relevant to them can lead to higher satisfaction and referrals for both residents and team members.

A Picture is Worth 1,000 Words

Beyond the words you use in your messaging, you may also consider adding visuals to aid in conveying your message. Think back to grade school when you learned about the different learning styles—one of the most common being visual learners. For visual learners, adding a picture or infographic to your message may just be worth 1,000 words.

While it may be easier to blast out a quick email or create a Word document with a bulleted list of the different required PPE for each room or unit, a CNA who is quickly moving from room to room, it may be easier for them to see visually on a poster on the door which PPE is required before they enter.

Let Your Values Be Your North Star

As our industry works together to repair our reputation and to regain the trust of the general population, keeping your values in mind and allowing them to guide your message development will be extremely beneficial.

At HDG, we live by our five core values: hospitality, stewardship, integrity, respect, and humor. Not only do our values guide important business decisions, but they have also helped to guide our messaging surrounding COVID-19.

From the onset of the pandemic, before communications surrounding positive and suspected COVID-19 cases was mandated by CMS is QSO-20-29-NH, HDG cited our integrity value and made the decision to be open and honest about any positive COVID-19 cases in our communities.

With our value of hospitality in mind and knowing that visitation with loved ones is on the tops of our residents’ and family members’ minds, we make sure that we are consistently including information on visitation procedures and any changes that may occur due to a positive COVID-19 case.

With the mental and emotional toll of the pandemic as well as other world events that were occurring during this time, in line with our humor value, we took every opportunity we could to share positive or uplifting news. We frequently shared the number of residents and staff who had recovered from COVID-19, heartwarming stories on safe visitations that had taken place, recognition of staff members for their achievements, creative and safe activities taking place, inspirational quotes and song lyrics, and much more. And then we shared these moments on social media, which was extremely valuable, especially as the visitation restrictions were in place.

That Was Then, This Is Now

With the darkest days of the pandemic behind us and we look ahead to refilling our communities with residents and hiring new staff, we need to remember that the messaging necessary in the early days of the pandemic is not the same messaging that is necessary today.

Thanks to the vaccine, we are reopening our doors to visitation, resulting in additional and more positive messaging.

While QSO-20-29-NH is still in effect, and we still need to ensure that we are meeting the regulatory requirements related to COVID-19 case reporting, the scope of messaging has really evolved.

Safety and infection control will continue to be of top importance, but we also need to be talking about new visitation policies and procedures, recurrence of communal dining and activities, access to vaccination, and a return to a more normal, fuller lifestyle.

While we currently do not know how long COVID-19 communications will be mandated by CMS, we believe the pandemic has changed the way that our stakeholders expect to be communicated with going forward. HDG believes that the need for constant communication is here to stay.

Be Your Own Cheerleader!

Over the last year and a half, the picture of isolation, loneliness, depression, and death at senior care and living communities has been painted so vividly for the public in the media. For our profession to turn around the minds of the public and start to build back our reputation as not just a place seniors go to die but a place for our seniors to fully live life and to thrive, we must be our own biggest fans.

We all know by now that one of the most cost efficient and impactful ways to share your messaging with prospects is through social media. However, as an industry, we have been slow to jump on the bandwagon and to truly dedicate resources to social media. Given the severity of the need to rebuild occupancy and census, if social media was an “add-on” job or task given to someone on your team, you may want to rethink your strategy and ensure that someone with knowledge and experience is truly dedicated to your social media efforts.

While there are numerous things you can share on social media, posts about health and safety, the return to community lifestyle and socialization, user sentiment, and community awards are going to be most effective in helping you to rebuild your reputation. With this in mind, you should create a social media plan that reflects this. Your plan may include sharing pictures from unique and engaging activities where your residents are wearing masks and social distancing, highlighting your enhanced cleaning practices on Global Handwashing Day or Health Care Environmental Services Week. Community awards, like high star ratings, resident, family, and team member satisfaction results, testimonials, or even numbers such as lower-than-average COVID-19 cases can be great to share publicly and can help to ease the minds of the consumer. All of these options are terrific. Not only do current family and friends of your residents enjoy seeing their loved one back out of their room, socializing, but your prospective residents and families will also be able to see what life might be like in your community.

On top of the occupancy and census challenges, with the national staffing shortages occurring, all of us in the senior care and living industry are struggling to hire and retain staff. Using social media as a recruitment tool can be effective; however, be cautious of posting about vacant positions too often—this can be a red flag to prospective residents that you may be understaffed, and their care may suffer, or to potential team members that they will be overworked. A great alternative to help your recruitment efforts is to conduct video interviews and gather testimonials from your team members about why they love working for your community or even sharing a story of a special moment they have had with a resident.

It All Starts With Trust of Those To Whom You Are Closest

To build an effective communications plan, and ultimately a strong sales and marketing strategy, you need to develop trust among your internal and external stakeholders. There are several components to building trust with your stakeholders. Honesty is key.

As noted previously, HDG has a company value of integrity which guides our behavior every day. But even if you don’t have a specific value of integrity, honesty is the foundation of trust. So being honest at all times with your stakeholders, internally and externally, is really important.

The frequency and accuracy of your communication is also important in building trust. In this situation, more really is more. People are always hungry for information. They are looking for information that will help them do their jobs. Information helps to build engagement.

Another element of building trust in today’s environment is clearly articulating your COVID-19 infection control and response action plan. Although we’re all eager to move forward and have many good news stories to tell, people are still concerned about their health and safety. Outlining the detailed plans you have in place to promote great care will give people peace of mind in a congregate care setting.

Great customer service also helps build trust. How can you provide great customer service? At Health Dimensions Group, we’re exploring software to allow us to get more regular feedback from our customers, which will allow us to be even more responsive to customer service concerns and further trust with valued residents.

Ultimately, it is the trust and confidence of your current customer base that will help you earn new referral sources and prospects down the road. Earn their confidence and ask them to speak on your behalf through testimonials!

As sales and marketing professionals, we have experienced significant challenges over the last 15 months. The pandemic tested our physical and emotional health—and certainly equally   affected the older adults in our care and service. Our census and occupancy have declined, but we are all working hard to turnaround the performance of our senior care and living communities. One key lesson we learned during this time—partly driven by new mandatory communication regulations—was the importance of a strong communications approach with all stakeholders, including residents, families, team members, board members, and referral sources. By developing a strong communications approach, plan, and messaging, you can strengthen your sales and marketing strategic plan. Your current stakeholders will always be your biggest cheerleaders; they can help tell your story and better position your community for success!