Here at Kendal, I find that residents often discuss what their role should be in how the place runs. There is a range of opinions on this topic, both here at Kendal and at other communities. In some instances (both here and elsewhere) there are residents who seem content to let the management make all the decisions (or at least, they feel they don’t have the power to change the system), whereas other residents are eager for a bigger role.
When I saw that there was a session relating to this topic at the recent annual meeting of LeadingAge (which I was able to attend), I decided to see what I could learn in that session.
The session was called “From Consumers into Empowered Citizens: Measuring the Culture Shift in Senior Living”. It dealt primarily with an organizational approach called “the Citizenship Model”. This is being implemented at Christian Living Communities (CLC), a group of retirement communities based in Colorado.
The Citizenship Model. Jill Vitale-Aussem (the President and CEO of CLC) and her colleagues have developed the Citizenship Model for their retirement communities. Vitale-Aussem came from a background in the hotel industry, and she had initially thought that retirement-community residents’ preferences would be like those of hotel guests. But then, her perspective changed.
In a blog post, Vitale-Aussem describes a seminal experience as a guest in a resort hotel on an island hit by a hurricane. She writes, “After the storm, the resort did its best to keep us safe: rules, schedules, controlled spaces. Still, I felt a crushing helplessness. When I offered to help, drawing on years of emergency-planning experience, the staff smiled and said, ‘We’ve got this.’ I realized I’d done the same thing to residents countless times, believing I was easing their burden. In truth, I was stripping them of agency.”
This was the genesis of the Citizenship Model at CLC. CLC residents are not just assured they will be well taken care of; they are asked to consider two questions:
- What gifts, passions and talents will you bring to make our community stronger?
- Who will you become? What do you want to learn? How do you want to grow?
Those are not questions that hotel guests are asked to think about.
Customer vs. citizen. Vitale-Aussem calls the more conventional hotel-like retirement-community model the “hospitality model”, in which the resident is treated as a customer, not a citizen. That approach can ultimately make residents feel helpless, entitled, and self-centered. By contrast, in the citizenship model, residents are encouraged to be more engaged with the community, take on more responsibility, and have a strong say in decision-making.
In her LeadingAge presentation, Vitale-Aussem made the distinction in resident roles clear with the following table.
| Consumer/Customer | Citizen |
| Depends on others to have needs met, helpless | Plays an active role in meeting needs of self and community, interdependence |
| “Love of leadership” | Part of the solution, shared decision making |
| Focused on self | Focus on, and responsibility to, the whole, connectedness |
| Nothing expected, focused on “my rights” | Responsibilities, expectations, norms for living in the community |
| Entitlement | Empowerment & engagement |
| Policies and rules govern behavior | Community norms govern behavior |
| Executive Director = Manager | Executive Director = Community Builder (infrastructure & build social fabric) |
| Marketing focus on what “we can do for you” | Focus on what each person can contribute to the community “what gifts can you share with this community to make it stronger and better?” |
Communities can be ranked according to the degree to which the residents act as citizens. Vitale-Aussem presented the following table to help classify the degree to which the residents illustrate citizenship, ranked from “provider directed” (minimal citizenship) to full “citizenship”. I have edited and reformatted the table slightly.
| Management/staff role | Resident role | |
| Provider Directed | Management makes most of the decisions with little conscious consideration of the impact on residents or staff. | Residents accommodate staff preferences; are expected to follow existing routines. |
| Staff Centered | Staff consult residents or put themselves in residents’ place while making the decisions. | Residents accommodate staff much of the time but have some choices within existing routines and options. |
| Person Centered | Staff begin to organize routines in order to accommodate resident preferences, either articulated or observed. | Resident preferences or past patterns form basis of decision making about some routines. |
| Person Directed | Staff organize their hours, patterns and assignments to meet resident preferences. | Residents make decisions every day about their individual routines. When not capable of articulating needs, staff honor observed preferences and habits. |
| Citizenship | Residents influence their community, they are problem solvers, they share responsibility for each other, they are expected to contribute. The organization, leadership, management and staff support others to exercise autonomy, connection and well-being, and work to remove systemic barriers. | |
The main focus of Vitale-Aussem’s LeadingAge presentation was the results of surveys of residents, staff, and executive directors at the CLC campuses, assessing how well the Citizenship Model is being implemented. The numeric results give CLC insights into how they are doing and what needs improving. Progress can be measured by repeating the surveys in future years.
The thoughtful and extensive survey questions were shared with LeadingAge attendees, and it would be interesting to see how they would be answered by residents, staff, and administrators here at Kendal. I have listed a few examples of the survey questions here.
I found the presentation fascinating and useful. I thought about how I would classify Kendal-Crosslands on the scale in the second table above. My assessment is that we lie on the boundary between “person directed” and “citizenship”, with some characteristics of each.
What do you think? Should we be discussing how KCC can shift more fully into the “citizenship” category? How should we begin this conversation?
