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What Young Senior Care Leaders Can Learn From 25 Years in Care · Hearts of Excellence

• [00:00:00] Dave Alexander: Early on in my career, I learned that if you take care of the residents first, everything else seems to fall into place. When I look back to my experience when I got in the business as a AIT, I was truly blessed to have a really good mentor when I did my AIT as well as had a really good director of nursing. [00:00:14] I would say she was one of the old school director of nursings that you'd have, maybe a little rough around the edges, but extremely compassionate, and really taught me that if you keep your heart at the core of your residents, then the sky's the limit on where you can take a building, take a company, take an organization, take a region. [00:00:30] Wherever you're at in your career, you just put your head down and stay focused on the residents, and the rest is history. [00:00:39] Chelsey Gheyara: You're listening to Hearts of Excellence, brought to you by Majestic Care, where real stories from long-term care come to life. Today, we're sitting down with someone whose leadership has helped guide Majestic Care through one of the most significant periods of growth in our organization's history. Dave Alexander has spent 25 years in senior care operations, nearly two decades of it at one of the largest operators in the country. [00:01:06] In 2023, Majestic Care created a role that had never existed before, Chief Operating Officer, and handed it to him at the exact moment the company was shifting from a regional player into a fast-growing operator, taking on new communities across multiple states, including a recent expansion into West Virginia. [00:01:28] In other words, his job from day one has been to make sure growth doesn't outrun care. Today, Dave's gonna talk about what that tension actually feels like day-to-day and what 25 years in this industry taught him about the difference between a company that's just getting bigger and one that's actually getting better. [00:01:48] Dave, welcome to Hearts of Excellence. Thanks. [00:01:50] Dave Alexander: Thanks for having me. [00:01:52] Chelsey Gheyara: That was a lot. That [00:01:53] Dave Alexander: was a lot. [00:01:54] Chelsey Gheyara: We're so excited. Oh, thanks. Oh my gosh. You know, honestly, I was not sure this day would ever come. I'm not gonna lie. I wasn't sure if you would say yes to joining us- Oh, really? ... but I'm so glad that you did. [00:02:07] Dave Alexander: Good. I'm glad to be here. [00:02:08] Chelsey Gheyara: Yeah. How are you feeling today, Paul? [00:02:11] Paul Pruitt: I'm actually excited 'cause I always say Dave and I was an arranged marriage. [00:02:15] Dave Alexander: Yes, we were. Yeah. [00:02:16] Paul Pruitt: We've all started May 1st of 2023, but that month before I think is when Dave was offered and I was offered, and it's kinda like we both flew into New York. [00:02:27] Dave Alexander: Had dinner. Had dinner. And that was our first interaction. [00:02:30] Paul Pruitt: It's like, okay. [00:02:31] Dave Alexander: We shared some french fries. [00:02:32] Paul Pruitt: Yep. Shared a big f- [00:02:33] Chelsey Gheyara: That's when you know. [00:02:34] Paul Pruitt: A big old plate of french fries. That's [00:02:35] Chelsey Gheyara: when you know. My favorite. [00:02:36] Paul Pruitt: That's the [00:02:37] Chelsey Gheyara: best. [00:02:38] Paul Pruitt: Were they- But it was kind of like one of those moments that's like my boss shared with me that he hired Dave. [00:02:44] He shared with Dave he hired me, and basically said, "Come out to New York." So Dave and I get on the phone and we're like, "Well, we probably should at least meet before we get o- to the office." So we met up for dinner the night before, and it's just been a great ride- It has been ... for the last three years. [00:03:01] Chelsey Gheyara: That's awesome. Were they- So I'm [00:03:03] Paul Pruitt: very excited ... [00:03:04] Chelsey Gheyara: were they Parmesan french fries or just- [00:03:06] Paul Pruitt: Yeah. They- ... [00:03:07] Chelsey Gheyara: truffle fries? I think they were. [00:03:08] Dave Alexander: Truffle. Truffle fries. I think- [00:03:09] Chelsey Gheyara: Truffle [00:03:10] Dave Alexander: fries. Yes ... [00:03:10] Chelsey Gheyara: we have to always fit some sort of food thing into our- ... podcast, so that was it. Um- [00:03:15] Paul Pruitt: They were very good truffle fri- They have- They were [00:03:17] very good fries. [00:03:18] Chelsey Gheyara: That's awesome. Well, we're gonna talk more about this today, and Dave, particularly your journey, and I'm so excited for our listeners to hear all of it. So let's dive in. [00:03:28] Dave Alexander: Sure. [00:03:28] Chelsey Gheyara: So Dave, you've spent your career balancing two things that people often think compete with each other, growing the business and doing what's right for the residents. [00:03:39] Was there ever a moment where you thought, "I don't know if we can do both"? [00:03:43] Dave Alexander: You know, I don't think so, because from early on in my career, I learned that if you take care of the residents first, everything else seems to fall into place. When I look back to my experience when I got in the business as a AIT, I was truly blessed to have a really good mentor. [00:03:58] When I did my AIT, as well, I had a really good director of nursing. I would say she was one of the old-school director of nursings that you'd have, maybe a little rough around the edges, but extremely compassionate, and really taught me that if you keep your heart at the core of your residents, then the sky's the limit on where you can take a building, take a company, take an organization, take a region. [00:04:16] Wherever you're at in your career, uh, you just s- put your head down and stay focused on the residents, and the rest is history. [00:04:22] Chelsey Gheyara: That's beautiful. [00:04:23] Dave Alexander: So- [00:04:24] Chelsey Gheyara: Mm-hmm. Thank you for sharing [00:04:25] Paul Pruitt: that. And I could tell you it's... You know, you've always resonated that message. I remember Dave and I, when we first started, we did a road show. [00:04:34] So to get in a vehicle, and we'd start going to buildings. And I remember we would just... There were times where we'd just look at each other and like Okay, what? So I remember we were at Fairfield, and it was, we were on the third floor of the AL. [00:04:48] Dave Alexander: Oh, yeah. Yeah. [00:04:49] Paul Pruitt: And it was hotter than blazes. I mean, nurses had the fans around their necks blowing. [00:04:55] They had fans up and down the hallways, so on and so forth. And I remember Dave just saying, "Okay, what is going on?" And they were like, "Well, obviously the cooling system had to be fixed." And he goes, "Okay, then get it fixed while we're waiting for corporate." And he goes, "Okay." And from that point on, every time we'd go into a building, he's like, "Okay, just get it taken care of. [00:05:16] We'll deal with the paperwork later." [00:05:17] Chelsey Gheyara: Yeah. [00:05:18] Paul Pruitt: So again, he was putting the residents and the care team members first, and then saying, "We'll deal with the finances and the paperwork later, but we're not gonna let our residents and staff sit in this environment." And that's what I always appreciated. It is, it was never a pause or a question. [00:05:34] It was always an instant, like, "Get it taken care of," 'cause that's what we need to do. [00:05:39] Dave Alexander: That's the fun part of the business. I mean, you know, it is obviously a business of taking care of people, but that's the fun part. Yeah. You know, I think that's what attracted me the most when I got out of college. I mean, my dad was in the business, so I grew up in the business, but I wasn't sure this is where I wanted to be and land at. [00:05:54] Struggled with finding a job when I got out of college, so ended up going into an AIT, and absolutely fell in love with it, with a specific resident I really got to sit down and hear her story, which was fantastic. Uh, really then just kind of led my pathway moving forward. And then, you know, the, that you have the people side of the business, residents, the care team members, and then, you know, the reimbursement side and stuff is just a, it's a big puzzle. [00:06:17] And actually, I don't like puzzles, but I do like, um- Yeah ... this puzzle. So- [00:06:21] Chelsey Gheyara: Yeah. Yeah. That's a great way to put it. So that particular, do you remember what her story was? Do you mind sharing? [00:06:27] Dave Alexander: No, not at all. Yeah, so it was when I was working in Florida, and she was refusing to take showers constantly. So a lot of, a lot of, uh, employees have spoken to her about her, you know, not being... [00:06:40] They called it noncompliance, which she wasn't being noncompliant when I finished my story. So I went down and talked with her and I just sat down and started having a conversation with her, and just got to know each other, and then it led into, you know, "Why don't you wanna take a shower today?" And it came out that she was a Holocaust survivor. [00:06:56] And so the shower room reminded of her being sprayed with a shower hose. And so from there on out, you know, we accommodated those needs and those wants, but until you know their story- Mm ... you don't know how to take care of someone. [00:07:08] Chelsey Gheyara: Yeah, that just gave me, like, chills. [00:07:10] Dave Alexander: Yeah. [00:07:12] Chelsey Gheyara: That's very- Yeah ... very, very sad. [00:07:15] Very sad. [00:07:15] Dave Alexander: It was, but she was a... I mean, she's an awesome lady. Yeah. I mean, and then actually from there on out, we were, like, tight at the hip. [00:07:22] Chelsey Gheyara: Yeah. [00:07:22] Dave Alexander: You know? [00:07:23] Chelsey Gheyara: Aw. [00:07:23] Dave Alexander: So... [00:07:24] Paul Pruitt: You know, throughout my journey and my career, I've always heard take care of the resident, the rest will follow. I can't say I've always felt that that statement was always true from previous leaders that I've worked under. [00:07:36] It was almost like the tongue in cheek statement- Mm ... or I guess I have to say it type statement- Mm ... versus truly living it and breathing it. And that's what I appreciate about our company, is we do put the residents first- Mm ... and our care team members, and we are striving to make it better for them so that I think the money... [00:07:55] What is it? Put your money where your mouth is. Mm. I think that truly is happening in our company, which is phenomenal. Agreed. And I think the other piece is, what I value is David's ability to story tell. [00:08:08] Dave Alexander: Hmm. [00:08:08] Chelsey Gheyara: Yeah. [00:08:09] Paul Pruitt: So, and, or use analogies to paint a picture So again, it helps connect the dots. [00:08:17] Chelsey Gheyara: Yeah. [00:08:17] Paul Pruitt: It's not just a business. [00:08:19] Mm-hmm. It's not just taking care of people. It's, there's a whole element- Right ... to this of connecting it all, and that's what I've always appreciated working with him, beside him, is really seeing him be able to take something that I may have scattering around in my head and flying all over the place, and starting to hone that into ability to articulate- Yeah [00:08:39] where we need to go as a company. [00:08:41] Chelsey Gheyara: Yeah. It is a beautiful thing. You alluded to it earlier that, you know, it is a holistic approach. Yeah. And then you can make that, have that f- full circle moment. That, that's just beautiful. Every story has a different purpose, and it brings us back to the same place, which is so beautiful. [00:08:58] Okay, another question. So what was the hardest part, in your opinion, of scaling operations across dozens of communities while still making sure every resident feels seen? [00:09:11] Dave Alexander: Sure. Uh, you know, that's an interesting question, and really what it comes down to is the, of having the right people in the right seats. [00:09:18] You know, when I look at, in previous organizations where I've been, where we've had certain scales, things happening, it's been far and few between that they tried to manage the growth with just the same people that are managing the day-to-day activities. [00:09:32] Chelsey Gheyara: Mm-hmm. [00:09:32] Dave Alexander: And if you wanna do something correct, which is what I appreciate what Paul was alluding to when we said we want growth, we're gonna have to put a few people in certain positions that can help us maintain all the hard work that we've done here and, and to be able to continue to grow the company, especially when we ventured into a whole new state that we weren't in before. [00:09:49] And so hiring some key roles that understood the business, that could, you know, help us with the acquisition piece, lots of paperwork, lots of moving parts, making sure that we have face time in the buildings- Mm-hmm ... while my core operations team could stay focused on the core business at hand. I think that has been our success of how our acquisitions have gone really smooth, especially the last one as we went out to West Virginia, which was some challenging buildings that we've, you know, taken on out there, so. [00:10:14] Chelsey Gheyara: Yeah. All right. So Majestic has grown quite a bit since you really, you both have joined, including taking on those brand-new communities that we've talked about in West Virginia. Tell me about a moment, Dave, of one of those transitions when you were maybe standing in a building that was just becoming a part of Majestic Care. [00:10:36] Dave Alexander: Early on, uh, West Virginia came about, and I was the first one to go out in the company and just do a drive-by, kinda mystery shop the buildings, take a peek at it. And for those that don't know, the West Virginia buildings, several of them are old tuberculosis hospitals from, like, the 1900s, so we're talking about massive properties, had not been Probably well kept as they could, or they're past their prime. [00:11:00] So I, I, I took pictures and was sending stuff back to Paul, 'cause there was still jail bars in one of the floors from where they used to keep people who were non-compliant and, and such place. I've seen many, many buildings. I've never seen anything as in despair shape as these were. And so I came back, Paul, and I said, "Absolutely not." [00:11:19] I said, "There's no way we can do this." I said, "The only, the only reason I would ever say yes is if we can improve the care that the residents were getting." I knew that was something we could make a difference, and that's truly what we're out to do. Lo and behold, here we are. We sit with the four West Virginia buildings, and they've been a pleasure to work with. [00:11:35] I mean, the one thing that is significant about that is the heart. I mean, you look at some of the residents they take care of there, which are- Mm-hmm ... you know, I would say it's sad, because they're the ones that didn't have a place to go. So these care team members hung in there, you know, and dealt with very difficult behaviors and, and different clients and residents that they had to deal with. [00:11:55] So, you know, heart goes out to them. I think when we went back out there after we acquired them, and we were walking through and kinda just giving our speeches, like, to see some of the faces light up at what they were gonna get, what we were bringing, and what we've brought today into the buildings, and then even some of the ones that we just divested. [00:12:12] Um, we got... You know, they were sad that we were leaving. Unfortunately, the buildings had been bought and sold a couple of times, and they were really pleased with us being as the operator. But, you know, change is inevitable at times. Yeah. So... [00:12:23] Paul Pruitt: Yeah. I have never seen, like Beckley, like the size of that building is just astronomical. [00:12:31] Dave Alexander: It is. [00:12:32] Chelsey Gheyara: It is like- [00:12:33] Paul Pruitt: Tens of thousands, if not hundreds of thousands square feet- Oh, yeah ... of just running building. And so again, they're old, antiquated. And I think to your point, David, I think standing at our facility in Holtman and recognizing The challenges for that population that the care team members have, but the environment that they're working within, I've never seen such a thing. [00:12:59] It's... The buildings have lived past, way past their prime. And it, the staff show up, and they show up every day, and they continue to do and take care of. And there were people with tenure, quite a bit of tenure in the building. Uh, there was the agency and stuff, but, but the people that have hung in there and stayed and done the care- [00:13:21] Dave Alexander: Right [00:13:21] Paul Pruitt: was huge. [00:13:22] Dave Alexander: I commend the organization, and Chelsey, you're part of this, but when we've had new acquisitions, a lot of companies will go in and call, well, let's go in and do the dog and pony show and move on, and then here comes all the workforce, right? Change over EMR systems, med carts, whatever you're doing for the change, and you kind of now lost that piece. [00:13:39] And I think what we do a really good job in is that we're very careful knowing that that transition that all the care team members are gonna go through, and the residents are going through, and their families- [00:13:47] Chelsey Gheyara: Yeah ... [00:13:48] Dave Alexander: is not an easy time. I mean, you think about any time you get a new leader, what's the, what's the trust like? [00:13:53] I mean, these, these care team members are like, "Well, am I gonna have a job?" You know, they don't know the company. Right. But we do a great job with going in and celebrating- Mm-hmm ... with them and telling them that you're part of our family now. [00:14:03] Chelsey Gheyara: Yeah. [00:14:03] Dave Alexander: It's sad because we're in a business that you would think that would just be natural, and sometimes it's just, it's treated as an acquisition, not as a, a new family member. [00:14:13] Chelsey Gheyara: Yeah, absolutely. We absolutely love our West Virginia teams, and I will say they have welcomed us with open arms, and we've learned a lot, and we've gotten closer to them, and I'm so excited to see the future of West Virginia with Majestic Care. It's gonna be very exciting. [00:14:29] Dave Alexander: I think that's something too that, you know, when we went in and they- Yeah [00:14:33] I think they thought there was gonna be a dog and pony show when we talked about that we were investing in West Virginia to build new buildings for them, and they're seeing that come to fruition, and groundbreaking's just around the corner. So it's an exciting time for our West Virginia folks, for sure. [00:14:47] Chelsey Gheyara: Yes. So for our listeners, more to come on that. We are so excited to bring you along with us, um, on our journey. So make sure you keep listening. Alrighty. Let's switch gears a little bit here. So I wanna, I wanna back up for a second. Take us back to your first year as COO here at Majestic Care. We have to. [00:15:09] Um, what was a... Oh my gosh. Yes. I'm so excited. What was a moment that completely changed how you thought about leading a growing healthcare organization? [00:15:21] Dave Alexander: Sure. You know, I'll be vulnerable here. It was my first COO job. I, you know, held a, a large position over quite a few communities in my prior life, but I wasn't the one at that point. [00:15:33] And so it kind of made me reminisce a little back to when I first got my first building, and my boss came in, and Jason Buck, who was a great guy, came in and introduced me to the team, and basically tossed the keys and said, "Good luck." I was a 23-year-old kid, you know, and here you just got handed this responsibility of 100-plus residents and 100-plus care team members that you're responsible for. [00:15:59] And- Wow ... that same first day, uh, a state walked in on me, and my person I was with before I came had pranked me and called me and said that he was the AG's office and needed this type of stuff. So I'm, like, flipping out over here, so. [00:16:13] Chelsey Gheyara: Oh, wow. [00:16:14] Dave Alexander: So it was quite the experience. But, you know, coming here, yeah, it was a learning... [00:16:17] It was different, you know. It's like you had to just make decisions and go. We didn't have a lot of time to contemplate decisions. We couldn't sit around. There were some changes that needed to be done rapidly, and there was directions. You're making decisions that not really sure it was the right ones, but- Mm [00:16:29] you know, we had to just make a decision, and if we were wrong, own it, pick up the pieces, and move it forward. Yeah. I will tell you, it's the biggest onion or rock I've ever seen as we continue to, you know, pull back the, the layers. It's been fun, though. I've grown, pushed myself a lot, and Paul's pushed me a lot, and, you know, it's been a, it's been a fun ride. [00:16:48] But that first... Well, very first day was very weird and awkward, but, you know, it got better as things went on. Right. So I think, too, it was a little, I don't want to say nerve-wracking, but it was just, it's new, right? And so especially from my standpoint, I didn't switch organizations a lot. So I spent 20 years with that organization my prior life. [00:17:07] So I was the historian. You know, when you're the historian, it's easy. You know where everything's at. You know why everything was done the way it was done. And then you come in at this point, and you're looked at as the leader, and you don't have all the answers. But you can't, you can't show that you're, you know, that you don't know or that you're gonna waver, or else I thought we'd get off on the wrong foot. [00:17:25] So I also knew at the same time I was earning, trying to earn respect of everybody. So when you're in a short timeframe, and you're trying to earn respect, and you're trying to make decisions, it's a balance. [00:17:36] Chelsey Gheyara: Do you remember back to 23-year-old you and has put that moment when he hands you the keys and state walks in, do you remember anything about that day of how, how you were feeling or what you were thinking? [00:17:50] Dave Alexander: I was just, like, overwhelmed. Like, what did I get myself into? Luckily, I got blessed with a great team. I had a great director of nursing, that was the new director of nursing as well- Uh-huh ... but she was very talented, and the residents were fantastic. My resident council president was very welcoming and was very active. [00:18:06] And so it was almost kind of like, what do you do next? You know, from that standpoint. And, you know, I've been through state surveys, obviously, as an AIT, as an assistant administrator and stuff, so it wasn't like it was brand new. But again, it's... You have to make a decision, and you just got to own it and go with it. [00:18:22] So, and it's on the fly. It's just [00:18:24] Paul Pruitt: different. It's different when it's you're partnering versus you own it. [00:18:29] Dave Alexander: Right. [00:18:30] Paul Pruitt: It's just a different shift. It's like, to use your earlier statement, there is nobody else. At that point, it's not like you run down the hallway to the administrator and say, "Hey, this is what they're asking. [00:18:40] This is what I'm looking for." Mm-hmm. Everybody's now coming to you and saying- Right ... "Hey, this is what they're looking for and asking." And I just remember it was a, it was an interesting year [00:18:51] Dave Alexander: It was. [00:18:52] Paul Pruitt: I just remember like it was almost there was these points in time we would be talking, and it's like we don't wanna pick up the rock, and we call the issues rocks. [00:19:02] 'Cause as soon as we picked it up, there was probably about 18 more rocks underneath it. Like [00:19:05] Chelsey Gheyara: underneath. I [00:19:06] Dave Alexander: think I also look back to that too, and we had this conversation at one point, kind of gut check ourselves is it's very easy to walk in as the outsider and start rattling things off. And you had many, many care team members that were trying their hardest to do what they had with little or no resources or no direction. [00:19:23] Mm-hmm. And, you know, sometimes you can damper that by your facial expressions, like, "Oh my God, I can't believe you guys did stuff that way." Right. Well, that can hurt somebody's feeling. Right. I did the best that I could, you know? And so that was another step too, is to make sure that we were not overstepping our, our bounds by making sure that we truly listened to, you know, why did it get this way? [00:19:42] Paul Pruitt: Yeah. [00:19:42] Dave Alexander: Not it is this way. I don't-- It is what it is, we'll fix it. Mm-hmm. But just tell me how, how it's- Mm-hmm ... how it got this way so we can help fix the roadmap as we go forward. [00:19:51] Paul Pruitt: Yeah. Well, it was even, we talked about this a little bit earlier today in a different meeting, but even when it came to the mission statement, 'cause as we started looking at that, we had to be careful because what we didn't want people to feel is that we were walking in and changing the company, because again, people did give their heart and soul. [00:20:10] But it-- we wanted to make sure they understood, like, no, and we started using 2.0 or a new chapter. Chapter one was this, but now we're taking it to chapter two. We're trying to get them to understand, like, we're not here to blow up the company. Mm-hmm. We're here to just take it to a different level or to take it through a different journey. [00:20:27] And I just remember working through that, it took some time to get people working through the even changing the... Which we didn't change, we just modified it. [00:20:36] Dave Alexander: We did, yeah. Our [00:20:37] Paul Pruitt: mission statement. [00:20:38] Dave Alexander: Yeah, we modified the mission statement, modified the vision statement. You know, even to just now, we didn't change the logo, we modified it, you know- Yes [00:20:46] as, as we rebranded. Right. And so I think that's important though, for organizations to be able to do routinely. I mean, it's just you stay stagnant if you don't, you know? Right. It's part of looking at your organization and saying, "Okay, what's next?" [00:20:59] Chelsey Gheyara: Right. It's funny you bring up that. The rebrand, I had a meeting yesterday, and Someone asked why, and to your guys' point is we have to evolve, right? [00:21:07] We can't stay in chapter one, and our brand has to reflect the care that our care team members provide. Right. And we ha- we wanna be really, really proud of that. So I love that. Yeah. Excited for the next chapter. [00:21:19] Dave Alexander: Our daughter was valedictorian this year, and so she got to give the, the speech at graduation, and she used a speech of a story. [00:21:26] It's a true story about, I think his name was Larry, of Larry the Lawn Chair, and he stuck a bunch of balloons to his lawn chair, so many till he's wanting to lift off the ground and float. Well, he put so many on his chair that he, like, went up to, like, 6,000 feet or something like that and had to wait till they deflated to come back down. [00:21:42] And so when they interviewed him when he came back down, they said, "Why did you bother doing that?" And he goes, "Well, you just can't sit there." [00:21:47] Paul Pruitt: Yeah. [00:21:47] Dave Alexander: And so it was kind of the story of, you know, you gotta do something. You can't just sit around. Right. You gotta go be the person that you think you can be or do, do the job that you think you can do, otherwise you'll just sit there. [00:21:57] It's a fun story read if anybody's looking for something. That's awesome. It's a short little article, but it's, it's a neat [00:22:02] Chelsey Gheyara: read. I'll have to read that. [00:22:02] Dave Alexander: Yeah. [00:22:03] Chelsey Gheyara: That's really cool, and congrats to her. That's an amazing accomplishment. [00:22:06] Dave Alexander: It was. [00:22:07] Chelsey Gheyara: That's awesome. [00:22:07] Dave Alexander: Thank you. [00:22:08] Chelsey Gheyara: Okay. Looking back now, how did... Thinking back to 23-year-old you, and we just talked about the previous chapter. [00:22:16] Now we're, we're evolving as a family together here at Majestic Care. But looking back, how did that experience in those early days change the leader you are today? And what do you wish every new healthcare leader understood before they're sitting in that same chair? [00:22:34] Dave Alexander: Yeah, that's a loaded question. You know, I think change, I never stop changing. [00:22:37] I think I keep learning and growing every day. I think, you know, you just don't have the experience at that point to be able to, to grasp certain things. So I think some of the decisions you make, I mean, you learn from your decisions, obviously, right? But again, it goes back to that puzzle of knowing how to put that piece of puzzle together and which way you put it based off how you failed, you know, in previous times and ways. [00:22:58] But it's different levels of leadership, you know, even with different levels. So as a building, you're over the one building, you've got the, your core team, and so you're there every day When I moved to a regional role, it was completely different. Everybody's road warriors. Everybody's on the road. And now you're not the one making the decisions, you're the one influencing people to make the decisions. [00:23:16] So how, how do you become the influencer versus the director? And then when you get actually the regionals underneath you, it's a completely different thing because now you really want them to be the owners and make the decisions and bring recommendations to you from that standpoint. And, and now in this role, you know, it's more strategic execution portion pieces of it than it is anything else. [00:23:37] So it just takes its stages, and I think it's recognized. And I always tell new regionals that get into regional roles, like, you're gonna struggle to taking off your ED hat, and that's the other piece. Mm-hmm. Yeah. So they always wanna go defend the executive directors versus saying, you know, "Look, you gotta support the company's mission." [00:23:51] And from that standpoint, you gotta get them to see that. That's part of your job. Your job anymore is not to do the job. Your job is to influence the person who's doing the job. Mm-hmm. Right? And that's not as an easy task as people can sometimes make that change, because it's easy to be, just go do the job and know what you gotta do, and, and you wanna make the answer. [00:24:09] And I remember sitting in a financial meeting with one of my regionals one time, and after we were done, I questioned her on how she presented the question, 'cause she asked a question, and before, you know, the ED was kinda sitting there and didn't know how to answer it. And before they answered, she went, "Well, maybe do you think it was this?" [00:24:24] Like, it's okay to allow the person to sit in the chair and sweat a little bit from that standpoint. That's how you, that's how you push people to get them to grow, you know- Yeah ... and, and, and coach them up from that standpoint. I think they truly need to understand what compassion truly is in many different fashions. [00:24:39] It's not just about what you think in layman's term about being compassionate to residents. It's being compassionate to knowing that your CNAs may be having bad days. They may be in abusive relationship. Mm-hmm. It's being compassionate that not everybody's gonna come in and have the same motivation that you have to drive. [00:24:55] It's being compassionate to understanding that, you know, not everything's gonna work in the building the right way. Yeah. You know, and knowing how to, how to deal with those things. So it's just compassion I think is an underrated word, in my opinion. And people just gravitate to, it's just, you know, putting my arm around somebody and, and being compassionate. [00:25:13] And it's, there's many more avenues to that than just being the hand holder. [00:25:17] Chelsey Gheyara: And I think, too, you're right, it is very underrated, and it's also a skill. I think a lot of people, if they're not... They don't think they're born with, oh, well, I'm just not that type of person. It's like, I feel, I personally feel like in this day and age, you know, we're post-COVID now, you, you have to be, right? [00:25:34] People are different. Companies are different. Our, our residents are different now than they used to be. So it is. It's, it is very underrated, for sure. [00:25:42] Paul Pruitt: You know, what's interesting is how do you get young leaders or people to 'Cause we see everything through the lens of a clinician or the lens of an operator, admini- administration type thing. [00:25:57] But how do you get them to see that whole picture of... And it's the old cliche, what if it was your family? Thank goodness a, a lot of our listeners may not have gone through anything negative with their families. But when you start enter- entering the healthcare system- [00:26:14] Chelsey Gheyara: Yeah ... [00:26:14] Paul Pruitt: and you have to navigate it, which is very complex, is- [00:26:17] Chelsey Gheyara: Yes, it is [00:26:19] Paul Pruitt: if you were to then say, "Well, I have a family member that has an addiction," or, "I have a family member that has this, that, or the other going on," and then you find out that people are sitting in meetings and labeling your family member. [00:26:33] Chelsey Gheyara: Yeah That's hard. [00:26:35] Paul Pruitt: That's very hard. So again, teaching that side of compassion is like... [00:26:39] But, and I always say this, when my mom, we had to place my mom, she actually ended up in one of my buildings that I was the administrator for. She had vascular dementia, and, and I'm like, "Oh, this is gonna be a wild ride." Love my family dearly, but we are just like any other American family. We're dysfunctional. [00:26:58] We have our issues and... But again, what I di- My point of reference was I don't want anybody to sit in a meeting and say that stuff about my family- Mm-hmm ... 'cause we aren't your Brady Bunch family. [00:27:11] Chelsey Gheyara: Yeah. I don't think anyone is. But we [00:27:13] Paul Pruitt: care. [00:27:13] Chelsey Gheyara: You know? [00:27:14] Paul Pruitt: Right. [00:27:14] Chelsey Gheyara: Yeah. [00:27:15] Dave Alexander: We talk about our, you know, our, our rounds that we ask the department leaders to do their Hearts of Excellence rounds. [00:27:20] And, you know, it's frustrating when people say, "Well, what do you have? I have room 101 through 110." No, you don't. [00:27:26] Chelsey Gheyara: Yeah. [00:27:26] Dave Alexander: You have resident names- [00:27:27] Chelsey Gheyara: Yeah ... [00:27:28] Dave Alexander: that are in there, and you have, you know- Right ... Jackie Smith and John Doe. You don't have room 110. Right. So they're the, th- they're missing the boat when those w- those, you know, words come out of their mouth that way. [00:27:39] Mm-hmm. It's, it's got to... It's a, it's a change. [00:27:41] Chelsey Gheyara: Yeah. [00:27:42] Paul Pruitt: For sure. It's a big change. [00:27:43] Dave Alexander: It's easy to slip up. [00:27:44] Paul Pruitt: Oh. [00:27:45] Dave Alexander: It's easy to sit in a- Absolutely ... clinical meeting and just go through- Right ... not the motions. It's the sad part is too, it's some- sometimes like death. We can make it a great experience for folks, but when you get too mundane to it and it just becomes another thing 'cause it happens- Other tasks [00:27:58] in our business, you forget the impact, not only that it's happened on the families, but on those care team members- Yeah ... that took care potentially that, that resident- Right ... for 20-plus years, and they just lost them. [00:28:07] Chelsey Gheyara: Yeah. It's very sad. [00:28:09] Dave Alexander: So... [00:28:10] Chelsey Gheyara: Okay. Was there a moment early on when you realized Majestic Care approached growth differently than what you'd seen at your last organization? [00:28:20] Dave Alexander: Yeah, I did. I, you know, I think they put, back to Paul's comment, we put our money where our mouth was. We made sure that the resources were there, the tools were there. I mean, I think the first acquisition we did, it was a little bumpy 'cause it was our first one all together, but- Right ... you know, we figured it out from that standpoint. [00:28:34] And again, with all the acquisitions that we've been through, we've had hiccups, but we haven't had any major, you know, failures. And we've closed acquisitions and brought new family members on extreme, extremely quick, quicker than I've ever, you know, done before- Yeah ... from that standpoint. But, you know, again, I think even back down to, like we spoke earlier about the welcoming party, you know, just making sure that everybody feels loved on and, and aware. [00:28:56] And I think something else that we've really pushed to do, which we've seen other organizations not do, is get into the buildings as fast as we can, as quick, as early as we can- Mm-hmm ... to start building that trust. We all know we have to build the trust up first and understand who they are and- Yeah ... get to know them. [00:29:12] So when day one does come, it's not like, oh, here comes the newbies- [00:29:15] Chelsey Gheyara: Right ... [00:29:15] Dave Alexander: you know, walking in, and they don't feel like they're a part of the family, and they're still kind of got that wandering feeling going on. I think we do a fantastic job with that, and I think every care team member that goes in and does the acquisition truly understands that and goes back to that word of compassion, understanding that this is gonna be nerve-wracking for them. [00:29:31] Chelsey Gheyara: That's a good word, nerve-wracking. Just understanding that that's okay too, to feel that way. Absolutely. [00:29:36] Dave Alexander: That's what we say. We tell people it's totally fine to feel the way you're feeling. We get it. It's a big change, and again, as we talk about, it's your livelihood, right? Mm-hmm. You know, from a job standpoint and whether they're supporting their family or not, so. [00:29:48] Chelsey Gheyara: Yeah. [00:29:49] Paul Pruitt: Absolutely. It, I think it goes back to what you meant. It's the compassion. It's having the compassion to know you're not just a number. [00:29:56] Dave Alexander: Right. [00:29:57] Paul Pruitt: So what's interesting is when I think about when we've gone into buildings, the fear factor of it is, will I have a job? Because again, your fear starts overriding- Mm-hmm [00:30:07] your side of your brain, which is more logical, and you lose sight, like, well, there's not gonna be a bus that pulls up on day one, and you're gonna walk out the back door, and the new bus people are gonna walk in the front door. So, but again, it's, that's hard to grasp when you're worried about what am I gonna do, and especially for some of our staff that live check to check or live barely check to check. [00:30:29] You know, I still have to do this, or I have to pay my light bill. Will I have a check, or what's gonna happen? So I think knowing we have the compassion of this company that really is there, and I think the fastest we did was they announced the sale of West Virginia on like, I don't know, we'll just say on Monday. [00:30:48] David and I were in a car Tuesday driving to West Virginia. Again, no negative or positive way it was done, but that's how the care team members found out about the sale was on, through the news. And so we were like, we just need to go out there in all four buildings, which is in the four corners of the state. [00:31:09] Yeah. [00:31:09] Dave Alexander: Yeah. Yeah, I'd say also when we talk about what we do differently, it's just the growth strategy. We are very methodical on knowing what we can handle and what we cannot handle. And that meaning more or less, you know, some companies will go out there just 'cause it's a good deal. It's one building, you know, picking up one building in, let's just say, Texas, knowing that we're not in Texas. [00:31:30] Not having the resources, that's not fair to that building. We know we can't support it. Yeah. So, and that's a, that's a culture break and a mission break would be of ours, too. So I think we have very understanding owners and investors that, you know, from that standpoint that, you know, really listen to, to Paul's, you know, advice back to them when we think that we can't do something. [00:31:50] Mm-hmm. Knowing that that might break our brand, and that's the last thing that we wanna do. Happy to go in any state we can, as long as we can get a region together so we can support them appropriately. 'Cause the last thing we wanna do is go out there and do the, the dog and pony show and then not commit. [00:32:04] Right. [00:32:04] Chelsey Gheyara: For sure. Yeah, absolutely. Is there a moment from your years before Majestic Care when you saw growth outpace care and it cost something? How did that shape how you wanted to build this role in this organization? [00:32:20] Dave Alexander: Sure. I, I did see that, and it was more or less transactional than it was compassion, I guess, use that word again, or just bringing people into the family. [00:32:29] It was more about a number than it was about what your mission was from that standpoint. So I knew when we were gonna come grow, grow from here, we really had to make sure that our mission was at the heart of the growth and that everything we did, that mission would bled into the decisions that were made from that standpoint. [00:32:47] So we didn't lose sight of that. So, you know, I think we've, we've always done that as, you know, truly sat back and said, "Okay, is this... And is this the right time?" There was timing that we, we'd asked to pause 'cause we were growing really fast, and we knew if we kept going this way, we, we potentially could damage a lot of the hard work that we've done. [00:33:05] And again, we, we succeeded with that, and then we got back in an area of like, "Hey, let's grow again," you know, as we get over those humps. I think it's, it's nice that the, you know, the organization wants to grow. I love to grow, but also understanding the temperature of the company and truly understanding what you can and cannot handle is a key, in my opinion. [00:33:23] Paul Pruitt: It's a big element of when you're growing is really do you have the bandwidth to grow? And again, I'll just say it. So sometimes it's not a democracy. So sometimes it's like, "We're going to grow. We're gonna grow here." But then it's really wrapping around that, but then saying, "Okay, if that's the decision, then what do we need, and how do we do it?" [00:33:45] And then bringing everybody that needs to be at the table. And sometimes, guess what? We miss it. Sometimes we forget somebody, or sometimes we forget to do X. But working with a team, and I think we have the best team here, is people will say, "Well, so-and-so should..." "Well, absolutely, let's bring him to the table." [00:34:01] And I use a word sometimes, I feel like we're a nimble company. I think we try to make sure we're pivoting constantly, that we're not just, "Well, it's Paul's opinion, so therefore we have to do it," or, "It's Dave's opinion, so therefore we have to do it." I think we're a company that we wanna have transparency. [00:34:18] I know Dave and I always talk, and, you know, I have this Pollyanna perspective where I just want everybody just to look at me. I'm just Paul, the guy that cares and wants to do the job. And he's like, "But you understand that's sometimes not reality 'cause they look at the CEO title." Mm-hmm. I do, but I hate that. [00:34:34] But I think we're a company where we do try to open the doors. We try to follow that philosophy. We're here to help anybody we can help. Yeah. And we will step in and do that at any time that someone needs it, and I really appreciate that about the company. [00:34:47] Chelsey Gheyara: Yeah. One thing that I love is we recently, for our listeners That don't know this, we just recently started doing our family town halls. [00:34:55] Yeah. Which I think is very different from many organizations and our folks, other folks out there in the world, our competitors or whomever, right? And I think it's a really great opportunity because it does build that bridge between what's going on behind the scenes, and we can- Yeah ... we can peel back the curtain and then also welcome them in as well. [00:35:16] And, you know, I think one thing we do really well is saying, "We're not gonna do it all right. However, we're gonna meet you there. We're gonna meet you where you're at- Yeah ... and we're gonna walk together to get where we need to be." So if you are a family member listening to this, please join us at our next family member town hall. [00:35:33] Okay, a few more questions left. Sure. This is probably my favorite question. It's normally the last one, but Dave, what does excellence mean to you? [00:35:43] Dave Alexander: It's a question that probably has to be answered in several different fashions. One, as we've spoke many times today about compassion, I think that's, you know, number one step. [00:35:51] Two is, which we haven't talked about today, is some of your system and integration that you have, and innovation from that standpoint, or utilizing what's out there to the ability to be excellent. Three would be development of workforce. You know, what are you doing- Yeah ... to build and coach up people from that standpoint and, and get people to rise to their best. [00:36:10] I always tell everybody, you know, when we're doing something that people don't get up in the morning and wake up and say, "How do I suck at my job today?" It's realizing that how to be an influencer and recognize people when they have bad days. How do you wrap your arms around them, you know, move things forward. [00:36:24] Excellence is walking in a building and you feel like a family member. It's not a P&L statement. It's, it's not a, uh, CMI score. It is truly how you feel when you walk into a building. And I mean, and Paul can probably attest to, you probably can too. You walk into a building, the first five minutes you can tell whether or not the culture is clicking or not. [00:36:41] Paul Pruitt: Yeah. [00:36:41] Dave Alexander: I mean, you know, whether you see a smile on a resident's face or you get addressed when you walk in a building by just a happy hello. To me, excellence is hard to describe. It's more felt, and you just know it when you're there. I mean, you can have all the KPIs you want. They definitely tell you and can help you drive in the right direction, so don't get me wrong. [00:37:01] But that's not the real story. The real story is the emotion. [00:37:04] Chelsey Gheyara: Okay. Couple final questions. We've talked about how hard... You mentioned earlier the balance. There's a balance to hold. I wanna end by looking forward. Looking ahead, what do you most want care team members and families to feel when they hear Majestic Care is growing? [00:37:23] Dave Alexander: There's more quality care that's coming to their town soon from that standpoint. You know, I- we want people to think and believe in Majestic Care as, you know, the provider of, of healthcare, where your... know your loved one can live the best quality of life that they can. And we've talked about this term before. [00:37:43] Yeah. But just, you know, where daughters and sons get to be daughters and sons again, not caregivers. That's our jobs to do that. And so when you go visit, you get to be, you know, Chelsey. [00:37:54] Paul Pruitt: Yeah. [00:37:54] Dave Alexander: And spend time with your mom or your dad and not have to worry about the care. Will we ever be perfect? No. We're humans taking care of humans. [00:38:00] That can't happen. But we will continue to strive for excellence, and that to me is what perfection truly is, as long as you continue to strive for it. But, you know, I want families to feel excited when we come to, come to a new town. Move your loved one from wherever you're at over to our building as fast as you can, 'cause we have that, such excellent care and quality outcomes, and not only for the residents, but for the families, as well as the care team members. [00:38:22] Uh, the experience is great. You've got a great employer coming to town. And so there's no reason why Paul or I or Sarah can't be on the front cover of a, a magazine like Chick-fil-A and Starbucks are for being, you know, the top-rated em- employer. Yeah. Right. And you don't see that with healthcare. You've never seen a long-term care company be in the ranks of being like... [00:38:41] I mean, you see they're in the top 100, you know, whatever, but, you know, people pay for that. So that's the other piece. As we continue to strive for, you know, being the premier provider, it's not just about resident outcomes and care. It's about care team members' outcomes and feelings as well. [00:38:55] Chelsey Gheyara: Yeah. That is huge. [00:38:58] If you could go back and tell yourself one thing about keeping growth and care in balance on the day you started this role, what would it be? [00:39:09] Dave Alexander: Ooh. I think sometimes you scoop past things so fast because you're trying to get to the end result and accomplish that you didn't stop and methodically think about, okay, how does this impact and affect this side of the, the story? [00:39:22] And so sometimes you get so excited about growth, you just jump, right? And that's what becomes your priority. And so it's, it's really, I think, going back to saying slow down and utilize resources. You know, I think there's a lot of stuff in the very beginning that I tried to take on, on myself versus leaning on some of my team members that I could have leaned on, and it would allow me to stay focused and maybe have a little bit better oversight of some things and be more methodical in, in some of the approaches or decisions that we made. [00:39:46] I [00:39:47] Paul Pruitt: think what's exciting now is Dave and I have always talked about this is because we would do a kind of a gut check with each other or like, okay, am I getting in your way or you type thing. But at the time when we both came, we were just both, we were running. Mm-hmm. Like we had running shoes on, and we were just going and just basically two people just dealing with operations everywhere. [00:40:10] And I think what's exciting now is we're really, we've met a lot of those goals that we both wanted to when we walked in here on May 1st of '23. But what I'm excited about is we're on to, we'll say chapter three. And it's really defining our company more strategic. It's more of truly my role as a CEO, Dave's role as our COO. [00:40:34] How does that fit within the framework with the other executives, making sure that we're getting the results that we want because at the end it is about the care of our residents and our care team members. And, you know, again, Dave's right, KPIs are the numbers. But I'm very excited to see where our numbers were when we first came in to where our numbers are now. [00:40:54] But not only just the numbers, it's when you go out into a facility or when you do talk to one of those care team members, or you get an email. I got an email yesterday, and it was from a care team member, and I said, "Well, you know, I'm sorry about that, but let me connect you with the right person." Sarah was the person, and Sarah talked to them, and Sarah sent me back a message that said, "What a great way to end the day." [00:41:16] She was so appreciative and, but again, it's changing the culture and moving forward and getting into a different strategy. And that's what I'm very excited about for- as we move forward as a company. [00:41:29] Dave Alexander: I would agree. [00:41:30] Chelsey Gheyara: Me too. Is there anything else you would like our listeners to hear today? [00:41:35] Dave Alexander: I think just treat people as they need to be treated. [00:41:38] Listen to them. I think listening is a key thing as you continue to go through. And, you know, go love on a senior. Go listen to their story. They have amazing stories to tell. And if you're ever having a bad day, I can assure you might just walk into a nursing home, sit down, grab lunch with a resident, and just be amazed of what they went through in their life and what they've seen. [00:41:59] It will totally open your eyes to a new experience. [00:42:02] Chelsey Gheyara: Yeah. Absolutely. That's great. And they're very honest. [00:42:06] Dave Alexander: Oh, yes. [00:42:07] Chelsey Gheyara: And give... I- it could be a great confidence boost, too. [00:42:10] Dave Alexander: It could be, yes. [00:42:11] Chelsey Gheyara: Well, thank you for tuning in to Hearts of Excellence. Dave's journey is a reminder that real growth in this industry only means something if it protects the people at the center of it all. [00:42:21] If you're interested in learning more about the culture at Majestic Care or want to find out more about our career opportunities, visit majesticcare.com/contactus. If you or a loved one needs long-term care, reach out to us. We're here to support your next chapter. Talk to you soon. [00:42:42] Thanks for listening to Hearts of Excellence. To learn more about becoming a care team member or how we can support your loved ones, visit majesticcare.com. 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