Closing the Gap: Women Leading Long-Term Care Facilities

“I think the reasons for the gender gap in senior living leadership are probably no different than the dynamic in so many other fields.”

Denise Boudreau-Scott, President of Drive (Senior Living Consultancy)

The healthcare workforce is overwhelmingly female, constituting 75 percent of the industry, according to the Bureau of Labor Statistics. But when it comes to positions of higher authority in healthcare (e.g., managerial executives and the C-suite), the representation of women drops to an abysmal rate—under 20 percent. Healthcare is America’s biggest employer and has several different sectors. Granular data isn’t as easily found in a niche segment of the industry, such as long-term care administration, but there is still evidence of the gender gap.

A cursory scan of the names of C-suite executives in a 2017 report on the top long-term care facilities reveals a gender gap on par with most industries, with men holding approximately 80 percent of the high leadership positions. While the average gender gap across all industries is already bad enough, it feels more severe in an industry like healthcare that has such a large number of women in the workforce. Furthermore, the leadership gap feels more critical in long-term care administration, where not just the workforce but also the clients are predominantly female.

Meet the Expert: Denise Boudreau-Scott

Denise Boudreau Scott

“I think the reasons for the gender gap in senior living leadership are probably no different than the dynamic in so many other fields,” says Denise Boudreau-Scott, the President of Drive, a consultancy which helps senior living and healthcare organizations improve their patient and staff experiences (and their bottom line) through creating more engaged leaders.

“Women don’t typically ask for promotions. Women typically suffer through some imposter syndrome. It’s that and it’s a lot of other different things. And that goes for any field. But it impacts senior living as well.”

Boudreau-Scott relates a story from a recent solo business trip. She’d wanted to grab a meal, but, instead of taking a table for one, she sat at the bar of a fancy restaurant, on a lark. She started talking to the men next to her and discovered they were on the board of directors of a senior living facility in the state—a total coincidence. A restaurant bar is a much more male-dominated space than a table for one, and, after her chance encounter, Boudreau-Scott began to imagine how many people she wasn’t meeting, and how many coincidences were going unrealized by career-minded women, and going uncategorized by quantitative data, due to certain societal norms and pretenses.

“I know it’s silly,” she says, “but you wonder, is it opportunities like that where women don’t have an equal opportunity to network?”

It’s hard to envision Boudreau-Scott missing an opportunity. She’s an avid volunteer. She’s a member of the Center of Excellence in Assisted Living’s advisory council. She co-founded the New Jersey Alliance for Cultural Change.

A former nursing home and assisted living administrator, she received her MHA from Cornell University, where she’s been appointed as Executive in Residence. Inspired by her grandmother, for whom she was a caregiver, Boudreau-Scott began her career in the long-term care field by starting near the bottom of the totem pole, as a dietary aide and nursing assistant.

“Network, network, network,” Boudreau-Scott says, when asked her advice for women considering a career in long-term care administration. “There is such a deep need for volunteers in our field, in tons of associations and groups. There are for-profit and not-for-profit associations in every state. To be involved and stretch your network is one of the best ways to stretch yourself. When you’re looking for other opportunities, you’re out there, you’re showing yourself as someone who’s a go-getter and wants to grow. That’s a big opportunity.”

In more profit-driven, product-selling industries, diversity and inclusion have a clear business case. A company wants to sell its products to everyone, not just a certain social class of men. Therefore they’re incentivized to build the sort of diverse leadership teams that take a wide range of perspectives into consideration—and such teams are on average more productive and more profitable than a more homogenous structure. But in an industry such as long-term care, where the product is more of a social good, the business case for inclusion isn’t made as easily in dollars and cents. It needs a little human nudge.

For Boudreau-Scott, one of those little nudges comes through her association with the Sloan Program in Health Administration at Cornell University. Together with her fellow alumni, she funds scholarships for women at Cornell who aspire to careers in healthcare leadership. Additionally, the school hosts symposiums and conferences that address the need for more women in healthcare leadership, providing mentorship and education in skills like negotiation, communication, and networking.

Empower: A Senior Housing Forum Initiative

Another little nudge comes through organizations like Empower, a project of the Senior Housing Forum. Empower highlights the achievements of women in long-term care and senior living, from the entry-level to the C-suite.

“People should be allowed to have the maximum opportunity to hit their peak performance goals, regardless of their gender, skin color, or sexual orientation,” says Steven Moran, the founder of Empower. “At a fundamental level, it’s a matter of moral rightness.”

Getting the word out is the first step towards normalizing a new and more inclusive culture in the industry, and that’s one of Empower’s primary goals. It also provides a connection point for women to help women advance in their careers. And their digital door is always open.

“One of the things that makes ours a little different is we actually want to tackle some of the harder questions,” Moran says.

Highlighting accomplishments is a step down the right path, but it’s not the final destination. Moran sees Empower hosting a conference, and eventually evolving into a platform for fostering mentoring relationships. While he initially felt a little strange as a man starting and leading an organization designed to boost female leadership, he’s reached out and recruited other women in the industry to help inform what Empower is—and can be—as well as to take co-ownership.

“Ultimately, it takes both men and women to make this work,” Moran says, describing what he’s learned in the process of forming Empower. “Because if it’s just women talking to women, the sad reality is men still sit in the primary place of power in really all sectors of business. It takes men as well as women to really make a difference.”

To take Empower to the next level, Moran has partnered with Fara Gold, a senior housing, services, and care advisor with over three decades of experience in specialty healthcare. As a co-creator of Empower, Gold has been critical in growing the initiative to include growing Empower’s partnerships and sponsors, as well as bringing in interviews with industry leaders.

“Today, there are a great number of women executives emerging from the tactical to strategic positions,” Gold says. “However, it takes visionary leaders willing to create succession planning to include these women.”

It’s unfortunate that so much work still has to be done—and so much of that work is being taken on by women—when the natural solution to the gender gap, which reaches across all industries, is for men to simply start hiring and promoting a more representative set of leaders. But there’s a problem in the pipeline. And that’s where initiatives like Empower and schools like Cornell step in to rebuild the onramps to leadership positions in more equitable ways.

“My greatest advice to women is to step up and ask for assignments and challenging work,” Gold says. “Find out what your manager’s greatest problems are and volunteer to help solve the issues. I had so much fun in my early career when I realized no one would give me an opportunity until I raised my hand and stepped up for the biggest challenges.”

In many industries, including long-term care facilities, one is elevated to the C-suite through networking and negotiation, but also through simply outlasting their colleagues. As a result, many of the current demographics in leadership are reflective of a decades-old system and its inherent imbalances. But new leadership is stepping in, and it has a fresh face.

“Don’t be afraid to fail,” Gold says. “You won’t have all the answers and you won’t always get it right, but, if you can find others to join your team and collaborate on solutions you can share the credit and the failures. And what I’ve learned is there are fewer failures if you create teams to tackle problems versus going out and being a solo maverick.”

Matt Zbrog
Matt Zbrog

Matt Zbrog is a writer and researcher from Southern California. Since 2018, he’s written extensively about emerging issues in healthcare administration and public health, with a particular focus on progressive policies that empower communities and reduce health disparities. His work centers around detailed interviews with researchers, professors, and practitioners, as well as with subject matter experts from professional associations such as the American Health Care Association / National Center for Assisted Living (AHCA/NCAL) and the American College of Health Care Executives (ACHCA).

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