Executives at Trilogy Health Services have a term for the way they like to lead: “rounding.”

It’s a riff off the “rounds” that doctors make to check on patients, and it captures the way leaders at Trilogy regularly visit front line employees and residents of their skilled nursing facilities.

The COVID pandemic has forced Trilogy CEO Leigh Ann Barney and her lieutenants to change their rounding rituals. But despite safety protocols to remain physically distant, they still found a way to get around. Barney and others have hosted barbecues at Trilogy’s 117 locations throughout several midwestern states. You’ll find her cooking for 30 or so people, giving out retention bonuses and offering encouraging words during a very difficult year in senior care.

“I can be at the grill with steak and chicken,” Barney says. “We’re socially distanced, but people can come and chat with me.”

Barney serving up food is a fitting metaphor for the way Trilogy leaders have navigated the challenges of 2020 from a foundation of servant leadership. They have sought to match the hard work and sacrifice of their employees, and to respond as best they could to a disease that has taken the lives of a number of Trilogy employees and residents.

Remarkably, Trilogy’s employees have continued to rate the company highly, with 8 in 10 calling it a great place to work this year.

If anything, Trilogy’s leaders see the COVID crisis as an opportunity. Not just to elevate the culture and performance of their company, but to aid the elder care industry as a whole. The pandemic—which ravaged many nursing homes and killed many older Americans—may have given the aging services industry a black eye. But it also opened eyes to the heroic, caring, meaningful work people in the field do day in and day out. Not to mention the way leading organizations in the industry combine clinical expertise with high-quality hospitality and lifestyle services, Barney says.

“Nursing homes and long-term care haven’t been thought of in this way,” she says. But perhaps the attention provided by the pandemic “will be a way to bring this forward and to advocate for our industry and our employees.”

With a deep culture of service and visionary leadership, it’s no wonder that Trilogy Health Services has earned a spot on the third annual Best Workplaces for Aging Services list. Activated Insights, the senior care affiliate of Great Place to Work, just announced this year’s ranking in partnership with Fortune.

A 'Great Place to Work For All'

Over the past year, Great Place to Work and Activated Insights surveyed 189,159 employees across nearly all 50 states to measure the workplace experience in areas such as respect, fairness, and leadership competence. Our methodology also captures how consistent an organization’s culture is across demographic groups and job levels.

Addressing workplace culture within the aging services field is critical. The pandemic’s toll has exacerbated workforce shortages and employee turnover in the sector. At the same time, our research shows that better cultures translate into lower employee turnover, and studies in health care have shown that a more stable workforce leads to better care outcomes.

In this year of economic turmoil, a great workplace culture experienced by all also is better for business. Great Place to Work research following the Great Recession found that the most inclusive high-trust workplaces outperformed peers before, during and after the 2007-2009 downturn.

Elder care’s struggles

Getting mislabeled is a challenge elder care providers face. Even when a family has financial resources to pay privately, many people, including journalists, seem to sweep all of senior living into the largely government-funded facilities called “nursing homes.” Of course, it did not help that the elder care industry resorted to a set of confusing names to describe a wide array of services and housing options. In reality, many of these options look like lush apartment complexes with hotel-like amenities, where COVID-19 has been as well controlled as in multi-family apartment settings.

Elder care providers also face economic pressures from all sides. With a lack of information that distinctly shows which retirement home is better, families will often select an option based on price. Meanwhile, with downward spiraling of government budgets and the public demanding more controls, the nursing home side of the industry has been collapsing for decades. Given that staff pay comprises two-thirds of an operating budget for most homes, these pricing pressures have compressed pay and workplace investments, further increasing employee turnover. In 2019, employee turnover in seniors housing and care averaged a whopping 65% per year. In 2020, the average has increased.

Contrast these industry norms with a culture that invests in its people. By putting its employees first, Trilogy has nearly 50 percent lower employee turnover than the industry average.

Sticking to its people-first approach has required some business heroics. This year, in spite of falling revenues and profits, Trilogy spent millions of dollars delivering wage increases to direct-care staff. In addition, the company provided more than 2,000 employees with Walmart gift cards to pay for food, and staff with children whose schools shut down in the spring received childcare assistance.

Trilogy also doubled down on its investment to upskill and educate those who want to advance. These dollars not only improve Trilogy’s customer service and clinical care, but also help its people overcome economic and racial disadvantages. Nearly half of Trilogy employees are furthering their skills through a structured apprenticeship program which can result in a certification and more pay every few months. And, one in fifteen employees are studying for a free online college degree despite it being the first full year of partnership between Trilogy and Purdue Global, a program of Purdue University. Given the digital divide born from racial and economic inequities, Trilogy worked to get laptops, internet access, and other resources to employees who did not have them to study.

COVID strikes

When the COVID pandemic hit the United States in force in March, Trilogy leaders tried to keep their 9,000 residents and 12,000 employees safe. Barney organized daily meetings with staffers to create new safety procedures, gather personal protective equipment and share the latest information. For a few weeks, Trilogy avoided serious trouble. But the company and its people did not emerge unscathed from what experts in elder care have described as “the perfect killing machine.”

In late March, a Trilogy facility in Indiana had an outbreak. Numerous residents experience respiratory difficulties.

“They’d come from the hospital, and there was no testing at the time,” Barney recalls. Trilogy at that point was dependent on local health department testing. Results required waits of several days.

“For a week period of time I remember being on telephone at office, at home, outside on patio—talking constantly,” Barney says.

Unfortunately, several residents died. In the course of the year, across Trilogy’s entire operations, three employees also died of COVID.

Although Barney believes the company did all it could at the time to prevent COVID-related casualties, Trilogy nonetheless aimed to learn from the tragedies.

It beefed up safety procedures, including creating its own weekly testing system for residents and employees. Trilogy’s charitable foundation supported the families of the victims. And the company launched a chaplain service to supplement the counseling available through its Employee Assistance Program.

Although Trilogy and its people have been buffeted by 2020, the company and its culture are proving to be resilient. Employee scores on the Great Place to Work Trust Index survey have dipped just 3 percentage points from 2019, with 80 percent of Trilogy staffers calling the company a great place to work. Similar skilled nursing facilities have seen their employee Trust Index scores fall more than 7 percentage points.

The opportunity ahead

In fact, with the U.S. population aging at unprecedented rates, Trilogy’s leaders believe that dark times in 2020 have pointed to two bright opportunities ahead.

One involves the relative status of the elder care industry. “For a long time, we’ve been the stepchild of health care,” Barney says. “With the spotlight on aging services during the pandemic, we’ve shown how central our services are.” She goes on to note that that elder care has arrived “at the forefront in people’s minds and has found a natural stage.”

In other words, the opportunity now exists to transform the narrative of aging services from clinical backwater to pioneer showing the way to blend customer service and hospitality with health care, starting with service to our elders. In this way, the industry and leading workplaces in aging services can overcome the trials of this year and continue to blossom as businesses.

Trilogy’s Chief Human Resources Officer Priscila Mattingly takes it a step further. She highlights the opportunity of attracting more and better talent to the workforce. “One of the best things about COVID and the challenges of this year is that if you care to make an impact, you can see that you can make as big an impact here in senior living as you can in pediatrics.”

These opportunities require work on the part of industry leaders. At Trilogy, the work of leaders includes investing in employees’ growth and continuing the “rounding” that has long kept executives close to what’s happening at the front lines.

This holiday season, Barney will be out at Trilogy facilities. Physically distancing and wearing a mask but still connecting with residents and employees.

One of her favorite stories is a visit during a prior December to Trilogy’s Wellbrooke of Carmel campus in central Indiana. She chatted with a company chef, pointing to the four stars on the chef’s coat. The stars signified that the employee had completed all four chef apprenticeship courses, elevating her cooking skills and enabling her to earn a $3,000 annual wage increase.

The chef responded that she had four children, and this was the first holiday season where she did not have to worry about paying for Christmas.

“This is what we strive for,” Barney says, “to let our employees know that we care about you, we invest in you, and we want to make your life better.”

Dr. Jacquelyn Kung is CEO of Activated Insights, an elder tech company and Great Place to Work affiliate. Ed Frauenheim is senior director of content at Great Place to Work and co-author of A Great Place to Work For All.