DOI: 10.31038/AWHC.2025823

In 2020, one in six Americans were age 65 or older, with this segment expected to grow to one in five by 2030. Moreover, within the next 25 years, the number of Americans age 65 and over is expected to increase 47 percent to 82 million in 2050. Over this 25-year period, the U.S. also is projected to become significantly more racially and ethnically diverse. For example, those who identify as something other than a non-Hispanic white are expected to increase from 25 percent to 40 percent over this period. With this increase in the aging population, it is predicted that there will be a sharp increase in the need for both healthcare and housing for the elderly [1-5].

One option that combines both healthcare and housing for this segment is the continuing care retirement community (CCRC), sometimes called a life plan community. CCRCs offer a combination of healthcare, hospitality, insurance, and residential services to the aging population. Furthermore, most CCRCs offer an amalgamation of living arrangements and services including independent living, assisted living or personal care, memory care, short-term rehabilitative services, long term care, and hospice or end-of-life care. There are about 2,000 CCRCs in operation in the United States (U.S.), with this setting expected to increase considerably to meet the growing demand [6-8].

An issue (and an opportunity) for many of these CCRCs is the lack of diversity among their residents. Two recent surveys [9,10] find that 95 to 97 percent of all CCRCs’ residents are non-Hispanic white. It has been suggested that one barrier to CCRC diversity is due to the lack of diversity of its leadership [10]. Senior housing executives have begun to address this issue seeking to expand the percentage of senior executives and residents who identify as persons of color and female [11].

With this in mind, we surveyed chief executive officers (CEOs) of non-profit CCRCs. We surveyed non-profits as they represent 80 percent of all CCRCs in the U.S. [8]. Specifically, we surveyed CCRC CEOs whose organizations were members of Leading Age. Leading Age is an organization representing 5,000 non-profit and government organizations which offer aging services in adult day care centers, CCRCs, home health services, and other outreach programs.

Our interest, here, was to determine the demographic composition of CCRC CEOs and to discern their organizations’ efforts related to promoting diversity in their leadership ranks. This was a subset of questions that were part of a broader survey we did on CEO characteristics and skillsets [7]. We sent surveys to 999 CCRC CEOs. Related to our questions on diversity, 173 to 233 CEOs responded to the individual diversity questions. Thirty-eight percent of the CEOs who responded to our survey were women and 62 percent were men (N=233). Four percent identified as a person of color (N=230). We asked CEOs five questions related to expanding their CEO recruitment and other efforts related to underrepresented groups. These questions and their responses are:

• Does your organization collaborate with recruiters who have expertise in sourcing racially and ethnically diverse candidates for the CEO position? 31 percent responded in the affirmative (N=189);
• Does your organization have a formal succession planning process that considers racial and ethnic diversity for the CEO position? 35 percent responded in the affirmative (N=187);
• On a scale of 1 to 10 with 1 as “not at all” and 10 as “extremely well,” how well do you believe the organization supports the career advancement and leadership aspirations of individuals from an underrepresented racial and ethnic minority Average score was 7.1 (N=173);
• Does your organization have a formal mentorship program in place to support the career development of individuals from underrepresented groups into leadership roles? A mentor acts as a career guide and provides guidance, advice, feedback on skills, coaching, and strategizes career moves and professional 24 percent responded in the affirmative (N=189); and
• Does your organization have a formal sponsorship program in place to support the career development of individuals from underrepresented groups into leadership roles? A sponsor invests in the person’s success and promotes them to other people to help advance their career. 21 percent responded in the affirmative (N=189).

As seen above, 21 to 35 percent of the CEO participants responded that their organizations are actively engaged in developing, mentoring, and sponsoring diverse leaders. Given this, it is apparent that more work is needed. We believe that CEOs should examine this as both a moral imperative and business opportunity. We agree with Garcia et al.’s overall statement about healthcare when they say “understanding and respecting diverse cultural backgrounds, including non-English languages and non-traditional health beliefs, is fundamental in ensuring equitable and effective healthcare services for the aging population. This can be achieved by…promoting diverse representation in the healthcare workforce to increase cultural competency and care”[2: 2]. Given this growing population, there is also a business case to be made as well, as the non-white population is growing significantly but remains grossly underrepresented as CCRC residents . Similar arguments can be made related to gender. Thus, our survey results of 38 percent female CEOs signifies that females are underrepresented in this role, as historically, female residents outnumber male residents four to one and almost three-fourths of all CCRC employees are female [11-14].

In order to increase diversity executive efforts, CCRCs may wish to create more diverse boards. As noted elsewhere, CCRC board members are less diverse than CCRC CEOs [12]. The election of a more diverse board may increase the number of CEOs with a diverse background. As Dr. Patricia Maryland, CEO of St. John Health, notes “a diverse board is more apt to hold the organization accountable and insist on recruitment of diverse leaders” [15: 303]. In addition, CCRCs also may wish to develop more focused marketing campaigns for these types of residents and executive candidates [13], and provide richer more diverse program offerings [9], the latter of which may be unknown to the current population of CCRC CEOs.

The present study has sought to show the efforts of CCRCs related to leadership diversity development. Some improvement has been made in this regard; yet more progress is needed.

References

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