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Episode 104: Clay Crosson

Clay Crosson is the COO & President of AmeriCare where he holds high value in the importance of culture. The company’s partnership with NRC Health has improved their ability to track and engage with employees leading to higher quality and success.

Recorded at the NRC Symposium in Nashville, Tennessee.

Luacs: Welcome to Bridge the Gap podcast, the senior living podcast with Josh and Lucas. We are in Nashville, Tennessee. NRC Symposium. Thought leadership I mean is just sky high here. We’ve got a star-studded list of interviews and we’re really grateful to welcome Clay Crosson. You are the president and chief operating officer at Americare. Welcome to the show. 


Clay: Thanks. Good to be here. 


Josh: Awesome to have you on the show. 


Clay: My hometown, Nashville, Tennessee. I get to come back to my hometown, so. 


Lucas: That’s great. That’s great. Well we’ve got a lot of different topics to jump into today. We found out that you and Josh are connected both personally and professionally and we want to talk about that. But let’s dive into your background. You’ve done this for awhile. You’ve seen a few things. So let’s share some of that with the audience. 


Clay: I’ll try to keep it brief cause it’s been 39 years worth. So I’ll try and to speed up. But actually when I was in college at the University of Tennessee I thought I wanted to be a hospital executive. Growing up in Nashville, HCA, all the big hospital companies were here. So it actually talked with them, what career path, how is this going to work? And they kinda told me, get your business degree then we want you to get your masters from this school and then you know, eventually you’ll be a hospital CEO. So I said, okay.


So I guess as close to my senior year, I had nothing on my resume about healthcare or anything. So I said, I better get something on my resume. So I went and applied at a nursing home in Knoxville, Tennessee. And to show you how smart I was, I didn’t know it was a nursing home. It was Shannondell Healthcare Center. 


Josh: It’s still there. 


Clay: I can tell you they’re a very nice facility. Downtown, well, not downtown, close to the university. And so I got a job as an orderly. They don’t even use those terms anymore. Now it’s a caregiver. There was no CNA, there was no certification. And so I did that one semester, 11-7 shift if you can believe that. And my fraternity brothers thought I was crazy. But anyway, I did. And as I got into it I realized, you know, there were some magazines laying around and periodicals and I started reading about senior care and the graying of America.


And actually I spoke to the administrator there and I told him, hey, I’m interested in learning more about it. I know you probably go to meetings. If I could tag along, I’ll wear a coat and tie. I won’t say a word. I won’t embarrass you. I’m just trying to find out what’s going on in this space. And he was nice enough to let me do it. So that’s how I started. And when I graduated from UT, I got an AIT position administrator in training position with a nursing home cone. NHC a very solid company and got great training from them. It was a year of training and Kentucky. I got nursing home administrators license, but I was still thinking, okay, I’m going to get a little experience as an administrator in nursing homes. I’m going to get them to pay for my MBA and then I’m going to go to hospitals. So that was still my plan.

So when I got into it, after a year of AIT, I’m an administrator and I really started opening my eyes to the things that were going on and I just loved being around, you know, building a team and the seniors would kind of always close to my heart too. But really I was looking at opportunity. So went from administrator, then advanced to regional and into a senior VP and then a divisional and then a joined Americare Senior Living almost 18 years ago as a present COO. So that’s a Reader’s Digest version of how I got here.


Josh: Well, it’s fascinating and we love talking about the career pathways that people have ended up where they are here and it’s amazing how diverse it always is. So very cool. Now one of the things I want to talk about is I know a lot of your team, very good people and I’ve shared that with you that not only are they just awesome at their profession, but they’re really good people, which I think speaks to a lot about your culture in your communities. And you guys have something, I think that’s pretty unique and special from the outside looking in that I know our listeners would love to hear about. We talk a lot about culture, but it’s great when you can really hear some of the behind the curtain of how it works. You know, we see the result when we go in the communities, but like what was the intention and the thought behind it and then kind of the strategy. So talk to us about, and I may butcher this, but it’s, is it hometown hospitality? Is that right? 


Clay: That’s it. Hometown hospitality. 


Josh: So talk to us a little bit about your platform, why the hometown hospitality, how that works kind of at a high level? 


Clay: Okay. And to give you some context too, before that, just of who we are. So we’re, we’re based in the Midwest. Our home office is in Sikeston, Missouri, a little small town and that’s our niche is small towns, mainly Missouri, Kansas, Tennessee. We have a couple in Illinois, Mississippi. We’re primarily an AL company. We’ve got about 110 AL about 30 of those are memory care. We also have 23 skill. We have a pharmacy, a therapy and some other ancillary companies. But our blocking and tackling is ancillary, I mean assisted living and skilled nursing. 


For us it was actually about 16 years ago, the owner and founder of our company, we’re a privately- held company. He said we, cause the company been around 20 years before I got there, and he said, we used to have some kind of little saying that helped with our customer experience and nobody could remember what it was. It was like something like smile, greet, and you know, say hello or something. It was some kind of acronym. I, nobody knew what it was and said. And so I figured we need to do something different here. We need to have something that’s meaningful to us and something that can be not just a notebook beyond the shelf and gathering dust, but really in our DNA. So we realized that it was going to be hard for us to put it together by ourselves. So we hired a consultant and we had caregivers, nurses, administrators, regionals, corporate people, a broad group of people sit together and think, what, what is genuine to us? What, what was meaningful to us. Our niche is small towns. It’s gotta be something meaningful to us. 


So we came up with this program. It’s called Hometown Hospitality. It fits perfectly with our DNA. And what it does is there’s four levels that employees can aspire to. And it’s through video learning. It’s online learning, but it’s also a return example where people can actually see, did you learn something? Let me see if you’re doing it. And then, so hometown hospitality started as a customer relations program but really became also an employee ladder. So we looked at two companies, and this is gonna be for your viewers, you might not realize all of them, but one is Ritz Carlton. Everybody knows about their training. And so we took little bits of that, but then we also took some bits from Cracker Barrel. It’s a little Southern restaurant around here. 


Josh: We know about Cracker Barrel trust us. 


Clay: And actually I was living down here before in Missouri before my family came. So I ate at Cracker Barrel a lot and I noticed the servers would have one, two or three or four stars. And I noticed the really good ones have the four stars. And so I asked them, how do you get these stars and then what do you get from it? And they started sharing with me how they got trained and now they’re mentors for others and they could get better benefits and so forth. And a funny thing, I called Cracker Barrel and I said, hey, could I come and visit you just to learn a little bit more about it? I said, we’re not in the restaurant but we kind are. No, we’re in the senior living business. We’re not competitors at all. And they were very closed with it. No that’s kind of like their secrets all so okay. That was fine. But it turns out one of our regional directors, her daughter worked at Cracker Barrel so we kind of get the secret sauce anyway.


But anyway, it doesn’t sound like something that would fit. But we took some Ritz Carlton parts of their customer service and then Cracker Barrel and formed what we call Hometown Hospitality program. And it’s really in our DNA. It was important for me to be outright in the center of it because everybody knew that it was important to us cause I just didn’t want it to be another, you know, quarter, you know, idea of the quarter or the program of the month kind of thing. All of us, several of us had seen those before and they just don’t work. 


And so there are four levels to Hometown Hospitality employees through online education, again, as some demonstration can advance through the four levels on their own. It’s kind of whatever pace they want to go. You could get through the whole four level in 18 months. At each level, there’s a monetary award. They get through the first segment, they get 50 bucks. Next segment, it’s 100 bucks. Level three, it’s 250 and level four then they’re actually getting a bigger compensation, actually hourly wage increase for the quarter. And once they become a level four, we call them CEOs, Customer Experience Officers. 


So it’s funny when I go to conferences like this, they’ll say, okay, president COO, who’s your CEO? And I say, well, we’ve got about 800 of them and here’s the truth, you know, and so it’s kinda catchy like that, but it really does kind of dive into the DNA of our company. Our culture is really built around that and really about a culture of recognition at every, every time we turn around, we were at thank you notes in front of people. You know, I try to write at least one a week to somebody and all our team does. And so we really look to pat each other on the back and you know, who doesn’t like that doesn’t cost surely much of anything, but it’s very powerful.


Josh: I think it’s so great, you know, some of the touch points even beyond just the culture of the program, but you guys have really, I think took a deep look into who you are. You use the term DNA and know who you are, who your target is, and not really stray from that and not deviate from that. And you just kind of doubled down on that. And I think nowadays in the idea of everybody talking about, we’ve gotta be recruiting, we got to do all these things. We got to do all these bells and whistles. They kind of forget the basics of who they are. And you know, it’s, it’s hard to be everything to everybody. But it seems to me from the outside looking in that you guys really focusing on who you are has been in building your culture that you can duplicate around that has been one of the secret sauces. So that’s really fascinating to me. 


So, you know, I, I think you probably made that sound extremely simplistic to our audience. Which maybe it’s not a lot of rocket science, but I know enough about senior care operations that actually delivering that plan, that’s a daily effort. A daily grind requires platforms and people working together. We’re here at the NRC Symposium, a great partner of ours. I know they’ve been a great partner of yours as well. So can you unpack a little bit of maybe how the touch points have been with an engagement platform like that and kind of your learning, your understanding and how you tap into their resources?


Clay: Yeah, sure. So, you know, prior to us learning and engaging  with NRC, we tried to kind of do a homemade satisfaction survey. You know, a Survey Monkey here, a Survey Monkey there. You know, we were writing our own questions and really we got the data, but really there was no benchmarking. You know, we couldn’t even compare ourselves from one year to another. So, we decided we need to be a little more sophisticated about it. And so we started to talk with NRC about what they do and how they do it. And so all those things came to be. So now we can and so when we talk about customer satisfaction and NRC, you know. 


There’s just, there’s so many things to keep track of in senior living and we know you can get very distracted. So we try to boil it down to just simple things. So, so for instance, customer satisfaction, particularly that question: would you recommend this place to others? It’s a huge, to me, that is the bottom line. And so our, our, our administrators and our leaders and our facilities, they’re bonused on that. Our regional people, they’re bonused on that. I’m bonused on that. So it’s meaningful. We also have a dashboard that whenever anybody in the company logs in in the morning, we’ve got a dashboard of kind of our key result areas. And one of those is resident satisfaction, so it’s there every day. Everybody seeing it all the time. We celebrate it, we bonus on it, we talk about it. 


But really as far as the culture goes, you know, it has to mean something. Even the Hometown Hospitality pro- we’ve got close to 4,000 employees, small towns. Some are more sophisticated than others, so we have to make it come to life for them. So we have to make sure they understand. This is what we’re talking about when we’re talking about (Hometown Hospitality). It’s really about family. And we have an acronym called Family Values, you know, and every letter stands for something: 


F: First impressions mean a lot. 

A: Always address people by name. People like hearing their name, you know, whether it’s the resident or their family, you know. 

M: Make people feel comfortable. 

I: Individuals deserve respect. 

L: Leave with graciousness when you’re dealing with the resident, leaving the room. 

Y: Finally, learn a way to say yes. 


And so we try to build around family values. Something that’s easy to understand and easy to put into action. And really most people, there’s, we do training. But really when people think about it, how do you want to be treated? It’s almost like the golden rule principle, but I think in our small towns in particular, people gravitate to that. They understand what family means. 


So I think that’s a little and NRC helps us really make sure everybody knows what that score is. When we get the 94 to 95 we have banners in the front lobby, you know, we’re proud of it, we’re showing it off and on our website, all our social media, we’re talking about it. So it’s a big thing for us. 


Josh: I love that. And I love that you guys reward and it’s one of your key performance indicators because I think a lot of times it’s misaligned. You know, what we talk about versus what we track and what we reward. And the fact that you guys, that’s on your daily dashboard, that everyone from the top down is incentivized to that culture. And that, that’s really fascinating. 


So I have another question and I, I tend to chase some rabbits, but while we’ve got you here, take advantage of the thought leadership, I know one of the things that everybody seems to be talking about right now is this place in our industry, so to speak, that we’re kind of in between the greatest generation, the boomer generation. Everybody’s like, some are really excited, some are really fretting and everybody’s still has this question mark above their head, like, we don’t know what’s coming next. When you and your group has seemed to be so focused on your DNA, who you are, I think to use your phrase blocking and tackling the basics, the culture, do you see that you guys are really going to have to look at changing your strategy? Are there things that you’re concerned about as we gravitate to a new generation of care? I mean, what’s on your dashboard for the future? What is there anything that keeps you up at night? 


Clay: Well, I’d say to me it’s exciting that we’ve got this opportunity. You know, you would go to these seminars and people say, somebody’s going to Uber-ize our industry. And so I’d tell my company, let’s be our own Uber. Who best to do it? And so even we, as we’ve structured even meetings with our senior management group about every other month we’ll have what we call just to a maintain meeting. So we’re going through agenda items and you know, things people need to know about. Within the most effective meetings we call gain meetings. And these game meetingss, there’s no handouts. Nobody comes with an agenda. We put names in a hat and I draw your name, what’s on your mind? What are you thinking about? What have you heard about? 


And then actually a couple of years ago, we had a conference, actually, here in Nashville and it was called, the whole name of the conference was #Reinvent. And we had people, we had big #Reinvent letters throughout the, you know, the whole conference. And people on posted notes were putting ideas up there. So we typed them up, we put them together, and we picked the best 10 that we could take action on. And it was amazing. Just when you ask people what’s on your mind, what are you thinking about? 


Like, why didn’t we think about that? So we’re always saying, you know, let’s think differently than others, you know? Yeah, we’re in small towns, but this is going to be affecting us too. In fact, it’s funny, my friends, I’m 62, so my friends, some of them are retired and they’re like, when are you going to build a place that we want to go to? You know? So it’s kinda interesting to that dynamic, like you say, the ones that are in there now, the baby boomers that are coming and then others, you know, the taste is going to be different. What they’re going to ask for us to be different, we better be ready to deliver it differently. 


Josh: So you’ve got some friends close to retirement and they’re asking those questions to you. Are you getting any feedback? I mean, what’s the insight? Because I think that is one of the questions. It’s like, you know, we kind of know that, hey, they want something different. They don’t know what’s there. Are there any insights as, as you’re looking into that age group and your peer group and what is it, what is it that they’re looking for? What is so different? Do you know?


Clay: Well, I tell them when they asked that question out, describe what we’ve all kind of read about. I’ve hadn’t seen it yet with the Margaritaville Senior Living. And as soon as you kind of talk about that, you understand what that is and our friend says, that’s where I want to go. You know? Now that’s not exactly, you know active assisted living or active skill. It’ll probably happen on those campuses. But I think that’s what my group is saying. No, that sounds interesting. That sounds like I might be interested in, and there’s still a lot of PIP folks, unless they’ve had a personal experience with assisted living and nursing home and most kind of have at this point. But a lot of it had, even my friends hadn’t been into new at anytime, you know, recently. And so I think a lot, you know, wellness is a big thing for us. You know, having chefs are a big thing for us. Training our staff on all of these things. I think he’s become more and more meaningful and also getting students in there to make it more of a lively, educational, more of an interactive kind of program. I think it’s going to be critical for all of it. 


Josh: Well, I know you guys are focused on blocking and tackling, but a lot of what you’re doing is really, I think relevant for the next generation. It’s these timeless principles of just humanity and treating people, I’m really excited to hear that you’re excited about the future and it’s not a thing that’s scary to you and you’re going to become your own Uber. So that’s pretty, that’s pretty cool. We really appreciate you taking time out of your busy schedule and the busy conference schedule to spend time with us here. I know our audience is going to want to connect with him. 


Lucas: Yeah. Clay, thank you so much, and we’ll make sure that we put you and your company into the show notes so that our audience can connect and get more information if they’d like to learn more about your, your organization. Thanks for adding value back on the topic of culture. It’s very meaningful. That seems to be a continual theme here and then a way to measure that and which is the other part of it. So thank you so much for listening to another great episode of Bridge the Gap. 

Thank you to our supporting partners
NRC Health, OneDay, TIS, Morrison Living, Argentum, Solinity, and The Bridge Group Construction. 

Leave a Comment

  1. Guys, thank you for this episode. It is very interesting and very useful. Thank you for choosing interesting people for interviews and very good questions asked. Thank you for what you are doing.

Episode 104: Clay Crosson