Longtime industry veteran and Symphony Senior Living CEO Lisa Brush has long had ambitions to grow a new senior living platform in the U.S. — but she is in no hurry, either.

In the third quarter of 2023, occupancy recovery for the Ontario-based senior living operator and its four communities still “is a little slow,” Brush told Senior Housing News. But she is balancing that slower occupancy growth with other bright spots in the company’s operations — notably that Symphony did not have to resort to using any agency labor since the pandemic began.

She is also trying to crack the code of middle-market memory care for potential deployment in the U.S. In Canada, the operator is able to charge monthly rates of about 6,000 Canadian dollars which works out to just over $4,400 at today’s exchange rates, “and we make money,” she said. Although Brush sees some differences that help keep senior living costs down in Canada, she also sees promise in concepts such as Illinois’ supportive living program.

In the meantime, Brush is on the hunt for potential deals that could present themselves to build a U.S.-based senior living platform, particularly in Florida under the company’s stateside Blue Lotus brand; or even just to consult with other companies and share her knowledge.

“We are cautiously opportunistic,” Brush said.

Staffing creativity, lowering costs

One of the brightest spots for Symphony since the start of the pandemic has been in staffing. As Brush noted, the operator did not have to lean on agency staffing for help. She credits the fact that the operator got more “creative” with staffing as the reason why.

Symphony’s executive directors — CEOs, as the company calls them — wear many hats. They are required to have certification to pass medications to residents if they are not a nurse already, and they are sometimes handling care duties throughout the community.

And they are accompanied by a community director that acts as a “right hand” for the community CEOs. Together, the two positions can fill many roles throughout the community and have helped undergird the company’s operations, Brush said.

Sometimes, the community leaders went to extreme measures to keep their communities running smoothly. For example, Brush shared an example of a community CEO who braved a snowstorm in their truck to help take an employee to work to fill their shift.

Symphony also has worked to instill flexibility in all of the company’s roles and promote people from within, where possible. That has resulted in some creative ways to fill gaps — for example, a Symphony building service manager staying to pull night shifts in the community or a care aide helping out in the community’s kitchen.

Although Brush said staffing discipline has helped keep the company’s costs from ballooning, Canada is somewhat of a different beast given its more robust public supports. Insurance premiums for operators are somewhat lower — though that is changing, Brush said — and a public health care system that is more cost-effective than in the U.S.

Many senior living operators in Canada lean on government-funded health care agencies to help staff their communities and supplement their margins. But Symphony does not, she said. Instead, Brush credits the company’s profitability with its unique “complete care model,” which lets residents pay an all-inclusive rate during their entire stay in a manner similar to a standard life plan agreement but without an entry fee.

Brush described it as “like an insurance program.”

“You’re paying $5,000 a month now, but you won’t pay $8,000 when Mom needs everything,” she said.

Brush said she also sees opportunities to lower costs for senior living services in the U.S., especially memory care. She said Symphony has had success in Canada upgrading older properties into lower-cost memory care settings, and that it is a model she thinks could work in the U.S., too.

But she also believes that it’s high time for the lawmakers in the U.S. to enshrine long-term care subsidies as a public good. She sees Illinois’ supportive living program, through which operators can be reimbursed for affordable assisted living, as a potential blueprint for other states to follow.

“When you get into some of the Medicare in the U.S. over the years, it’s gotten pretty icky,” she said. “I think that’s got to change.”

Diving for growth

Brush, an avid scuba diver, said she is most interested in growing a senior living platform in Florida under the Blue Lotus banner.

Though the company does not have any Blue Lotus communities at the moment, Brush said the company is “actively looking at several properties” in the Sunshine State, and that a next step in that plan could be to bring aboard a capital partner. Florida is not the only part of the world that Brush has her eye on.

Still, Brush is not seeing quite as robust of an M&A market as she would like right now. Many of the opportunities the company comes across are for properties with decent occupancy but negative NOI.

Though she has seen some “incredible deals” come across her desk with regard to older properties, the bid-ask spread is still too far apart for her liking at the moment.

“That said, if we saw a really good opportunity that was a portfolio in another state, we could get our head around it and it wasn’t just one or two properties, we’d certainly consider it,” she said.

Brush is also currently considering moving to Mexico and is selling her house in Canada, and she sees potential opportunities to grow senior living operations in other countries. She noted that she enjoys spending time consulting for other senior living companies and sees that as a potential avenue for more collaboration with another company down the road.

Over the years, Brush — who has spent years as a leader at Sunrise Senior Living and Ventas (NYSE: VTR) — has taken on plenty of risk and jumped from flying pans and into fires. Given where Symphony is today, she is in no hurry to rush into the next thing. And she is also enjoying a new role at the company — not as an executive, but as a customer, with both of her parents having moved into Symphony properties since 2019.

“It has been really enlightening in some ways,” she said. “After 30 years in the business, I’ve learned a lot more in the last four.”

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