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Finding satisfaction in adapting to change

Loren Ranaletta had a five-year plan in mind when he left his position at Monroe Community Hospital to become CEO of Episcopal SeniorLife Communities in 1984.
He figured he would stay a few years, gain experience running a health care organization and then consider moving on to a larger organization. Episcopal SeniorLife Communities turned out to be that larger entity.
Through his 28-year tenure with the non-profit, Ranaletta, 61, has put ESLC on a path of growth to meet the changing needs of seniors. The organization expanded its main facility on Mount Hope Avenue in Rochester and opened new ones across Monroe County.
"Part of the joy of this job is being able to use resources to change as the community changes," Ranaletta says. "The organization and the board has always been receptive to new ideas, and that’s helped us grow and be able to meet the changing needs."
Today Episcopal SeniorLife Communities has grown to an annual budget exceeding $20 million and plans even more expansion. Ranaletta expects not only to expand ESLC but to make the growth smarter as well, with new communities focused on consumers.

Steering growth
When Raneletta left his position as chief operating officer at Monroe Community Hospital, the Episcopal Church Home had 142 beds at its center on Mount Hope Avenue.
Though he is not Episcopalian himself, Ranaletta was drawn by the nature of the faith-based organization and the chance to grow with it. That is precisely how he spent the first five years with the agency-building the capacity needed to expand beyond its somewhat smaller size.
"By the late 1980s, it was time to think about what we wanted to do," Ranaletta says. "We decided to focus on housing."
It would mark another shift for an organization that had continually changed to meet community needs during its 144 years. It first opened as an orphanage and later became a home for unwed mothers. It eventually became a nursing home but did not take on a health care role until the 1960s.
Ranaletta and the board prepared for the transition to housing by purchasing the property adjacent to the Mount Hope Avenue site, a former Trailways bus station.
The right timing for the expansion came in the early 1990s, he recalls. Hospitals in the Rochester area had a large backup of patients needing long-term care placement, many of whom had dementia. The Finger Lakes Health Systems Agency put out a request for proposals to organizations that could take on more of these patients. Raneletta jumped at the chance.
"We put out a proposal to take our fourth floor and convert it to beds to accommodate these dementia patients who were on Medicaid," he says.
The organization started its dementia care services in 1994 and a few years later opened a 182-bed nursing home. ESLC then built River’s Edge Manor, its first housing project, and established a physical link between the buildings.

Adapting to change
The next venture came in 1998 when the organization took on more rehabilitation services as the nursing care industry itself shifted toward more transitional care.
"That marked a major shift for the industry," Ranaletta says. "All of a sudden we weren’t looking at the nursing home as a sort of final resting place."
ESLC was not done growing yet. In 1999 it took over management of Brentland Woods in Henrietta, a facility developed by Bishop Sheen Ecumenical Housing Foundation Inc. This too was a departure for the organization, its foray into an assisted-living environment for seniors, one in which residents have more independence and require less care.
Though it was away from the Mount Hope campus, Brentland Woods already had many similarities with the on-site programs.
"That was the first off-site campus in what is generically referred to as assisted living," Ranaletta says. "But the important thing about Brentland Woods was that there was already an existing Episcopal church on its campus, so it already had the volunteers and the spiritual aspects that we have in our programs."
This assisted-living theme continued into ECLS’ following project, the Seabury Woods development off Buffalo Road in Gates, which opened in 1999. This was a combination of assisted and independent living and also was the area’s first fully secured memory care unit.
"Before that, facilities like we had were only in nursing homes," Ranaletta says. "This gave a new option for people who could still get around."
ESLC’s growth came as a result of Ranaletta’s vision, says the Rev. Christopher Luedde, board chairman. Because he was able to foresee the changes, Ranaletta kept the non-profit ahead of the industry curve, Luedde says.
"Loren is very visionary, and that has been an important part of us seeing possible directions to go," he says. "He has the pulse of the direction of the industry, and that’s changed us from being a nursing home center to looking into other communities."
Ranaletta has put ESLC on a course of continual growth almost since the day he started with the agency, but that is in his nature.
An avid golfer-once playing California’s Pebble Beach and Cypress Point Club in the same day-Ranaletta has been a board member for Penfield Country Club. There he led a project to revamp and renovate the clubhouse.
Life is not all about work for Ranaletta, though. Aside from golfing, he also enjoys spending time with his family and young grandchildren, reading and visiting botanical gardens. A passion for biology remains from his time as a pre-med undergraduate student at Canisius College.

Social-centered model
ESLC is preparing for even bigger changes ahead, Ranaletta says, ones that stem from changes in the funding system for senior living communities.
"Medicaid and Medicare are on a path that’s not sustainable, and we know there are going to be changes coming for them and how we’re funded," he says.
The coming changes have put the organization on two tracks for the future. One is moderately priced housing, settings that will give seniors on a strict budget more options for their future. ESLC has secured some federal funding as well as tax credits to build 40 units, and construction is expected to start this fall in Henrietta.
The project would look like housing offered to higher-income seniors, with multiple levels of care within one complex.
"We want to be able to offer that kind of care to people of true middle income," Ranaletta says. "Someone who retires with $5,000 of disposable income per month will have a lot of options, but someone who has $1,200 usually doesn’t have as many."
ESLC already has identified a site for another campus in Greece, at the former Our Lady of Mercy Church.
These sites also would take a new approach, discarding the old medical-centered model for a social-centered one, Ranaletta says.
"If you could provide a living environment for a senior, especially a single-person household, you have to make sure you’re meeting all of their needs," he says.
This new setting also would be neighborhood-centered, allowing seniors to remain close to family members, doctors and pharmacies they are familiar with, Ranaletta says. This already is the direction many private developers have taken, creating 10- to 15-unit complexes of homes away from busy streets.
Ranaletta says he sees this trend continuing and eventually becoming the predominant model for senior care once the baby boomer generation reaches the age of senior living. He envisions small housing units with shared resources, not unlike the communal homes shared by college students on campus.

Neighborhood outreach
The other track for ESLC is reaching seniors where they already are, providing better connections with day programs and other services, Ranaletta says.
The organization will test a plan in Henrietta for community outreach programs that teach emphasize nutrition, meal preparation and healthy eating choices. It also is developing an exercise program aimed at preventing falls.
"This track is about what we can do with our existing resources to keep people in their homes for a longer period of time and deliver services directly to them," Ranaletta says.
But like all public funding, the money that would support these programs will only get tighter in the coming years, Ranaletta says. So in order to sustain itself, ESLC has developed partnerships with other local non-profit organizations in senior living, including Lifespan and Jewish Senior Life.
The organization also is seeking a grant from the New York State Health Foundation to fund this program, one that would require commitment from other groups as well.
"We all see different populations, which is good, because older people can sometimes trip up into depression and those are the ones we want to find and engage," Ranaletta says. "With everyone on board, it works much more effectively."

Planning ahead
This new system would be more cost-efficient, Ranaletta says, but the shift alone would not be enough to guarantee the organization’s continued viability. ESLC will need to diversify its funding streams, he says, ensuring that declines in public funding will not have too great an impact.
The non-profit has started the process. In 2005 and 2006, when ESLC experienced great financial pressure, it started to build out its housing programs to create a funding stream that could offset the losses elsewhere, Ranaletta says. The shift to the social-centered model should help with the creation of new revenue streams, he adds.
"As we look to do more moderately priced housing, we aren’t looking at public dollars," he says. "We’re trying to build something affordable for people, and we know that the consumer is wanting more and more to choose what services they have. As an organization, we feel we should help people know their choices at what their income level is."
In the future ESLC will look to re-engineer some of its positions to emphasize more efficiency, Ranaletta says. There are also investments in technology to run the organization more efficiently, like a touch-screen system for electronic medical records that saves time and money in taking care of residents while also reducing the risk of errors.
Collaborative efforts continue in this area as well, he adds.
"We’ve been working with the Senior Health Alliance of Greater Rochester, which includes five local organizations," Ranaletta says. "We’ve been looking as a group on what collective costs we can reduce."
The alliance has a wide range of benefits to the organizations involved, says Daniel Katz, president and CEO of Jewish Senior Life and chairman of the Senior Health Alliance. The groups share some best practices and some purchasing, including a common vendor for customer satisfaction surveys.
"If one group scores particularly high in a certain area, then all the other groups can learn something from them and what they’re doing," Katz says.
The alliance also shares in a number of grants, including one funded by the Robert Wood Johnson Foundation and Daisy Marquis Jones Foundation to educate and train nurse managers.
"The CEOs of the organizations involved get together regularly to discuss issues, and we have a good relationship," Katz says. "Loren is a terrific CEO and statewide leader as well, serving as chair of Leading-Age New York, our major organization."
The collaborative efforts and new revenue streams ESLC is working on now will become increasingly important, Ranaletta says.
"The economy is drastically changed as jobs in the area have changed," he says. "The jobs people have now as the economy recovers are not the same as they once were, and retirement plans aren’t either. That will create in 20 years a retirement community without as many resources, and we need to be ready to accommodate them."

Loren Ranaletta
Position: President and CEO, Episcopal SeniorLife Communities
Age: 61
Education: B.A., biochemistry (pre-med), Canisius College, 1973; master’s degree in public health, University of Rochester, 1981
Family: Wife Janet; daughter Joellen; sons Daniel and Chip; three grandchildren
Residence: Pittsford
Interests: Golf, visiting botanical gardens, reading
Quote: "Part of the joy of this job is being able to use resources to change as the community changes. The organization and the board has always been receptive to new ideas, and that’s helped us grow and be able to meet the changing needs."

8/3/12 (c) 2012 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email rbj@rbj.net.


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