The SHB Interview: Larry Cohen, CEO, Trustwell Living

by Jeff Shaw

Industry stalwart comes out of retirement to launch a national operator with his former colleagues.

By Jeff Shaw

Larry Cohen knows a little something about growth.

He spent 22 years (19 of them as CEO) at Capital Senior Living, which in 2021 changed its name to Sonida Senior Living (NYSE: SNDA). Cohen grew the company’s portfolio from 27 communities with a resident capacity of approximately 5,000 to 129 communities with a capacity of approximately 16,500 residents.

He oversaw the boom years of the company, which saw stock prices peak at nearly $400 per share in 2015, as well as a decline to about $100 per share around his retirement at the end of 2018. SNDA stock currently trades at about $10 per share.

But retirement apparently didn’t suit him. He admits that he found it “very difficult not to work,” especially when the COVID-19 pandemic forced everyone to stay home. Combined with frequent calls from former colleagues asking if he would get back into the seniors housing industry, he launched Trustwell Living in 2021, largely as a third-party operator. 

He was immediately joined by several former Capital associates, with Gary Fernandez heading up sales and marketing, Greg Boemer leading operations and Colleen Honors taking the lead on clinical care. At the time of launch, Cohen said the company was started “to redefine senior living services for the better.”

In just three years of existence, growth has once again been the hallmark of Cohen’s leadership — Trustwell already operates 46 communities in 14 states with capacity to house 2,522 residents. The company offers independent living, assisted living, memory care and respite care.

Seniors Housing Business sat down with Cohen to discuss his un-retirement, how to grow responsibly and how he aims to “redefine” senior care.

Seniors Housing Business: Walk me through your career, starting from the beginning and through your 22 years with Capital Senior Living Corp.

Larry Cohen: I graduated college and worked in public accounting. I was working on my CPA and decided to go to law school. I then worked for two law firms for five years. I represented many of the largest investment banks and brokerage firms in real estate. 

I was recruited to work for one that opened an office in New York in 1986. The company was one of the largest owners of hotels and apartments in the country, but it decided to build four independent living communities — back then they were called congregate care. 

I was then recruited by Paine Webber to head up its real estate company, which at that time included approximately 33,000 apartment units, plus shopping centers and some hotels. There we formed two private real estate investment trusts to finance the acquisition and development of independent living properties. The company that was the borrower and operator had financial difficulties during a real estate downturn and we ended up taking back the assets.

We did a search for a new operator, and brought in Capital Senior Living to come in and take over management. They did a fantastic job. A few years later they asked me to join them. 

Initially I was vice chairman and chief financial officer — that was in 1996. In 1997 we did an initial public offering and went public. That was the beginning of my career in senior living. I’ve been involved now since 1986 and exclusively focused on senior living since 1996. I became CEO in 1999 and stayed there until my retirement at the end of 2018.

SHB: What did you accomplish in your time at Capital?

Cohen: When I joined, we had 27 communities with a capacity of 5,000 residents. Over my 22 years, we grew the company to 129 communities in 23 states with a capacity to serve 16,500 residents with more than 7,500 employees.

When we went public, our growth was predominantly through development. We built 17 buildings. In 1999, seniors housing had become overbuilt, so we stopped development plans on 40 or so buildings and focused on operations. 

We took a pause to focus on filling buildings, stabilizing the portfolio, and then we started to look at our growth. We formed joint ventures with large private equity firms. Partners included Blackstone, Prudential, General Electric and Lehman Brothers. 

We started to grow through joint ventures, and the success of those funded almost $1 billion in acquisitions on balance sheet.

Coming home

SHB: We wrote a news brief about your retirement at the end of 2018, but then you founded Trustwell at the start of 2021. What brought you back to the industry?

Cohen: With COVID, it was really challenging not to work. My former colleagues kept reaching out seeing what my plans were. We had the opportunity to launch Trustwell, and some of my former colleagues joined me to create a leadership team.

I’m passionate about serving seniors, I always had tremendous regard for the team, and I was excited to get back into business with people I had spent so much time with.

SHB: Capital Senior Living Corp. (now Sonida) is one of the few publicly traded operators in our space. What’s the difference, from your seat at the top, between running a publicly traded company and the private one you lead now?

Cohen: The core business doesn’t change. That is operating senior living properties. We have a culture where we really promote onsite leadership to have the autonomy and responsibility and accountability. We continue to have the same type of reporting, same analytics. 

One of the benefits of a public company is quarterly reporting, so you have to stay focused on financial results. What we have instead is a monthly meeting where we talk with the team about strategy.

One of the biggest differences is I’m not on road shows with investors and analysts. I’m not worrying about reports and 10-Q filings. We have quarterly in-person meetings with the whole team. We do a deep dive into strategy and operations. I get to visit the team, visit properties. I have more time to do that than I did running a public company.

At the end of the day, the key function is making sure we have the right resources, tools and focus to successfully operate these buildings.

At Capital, we built an organization on compassion and respect. We’ve continued that at Trustwell. That has helped us strengthen the local leadership at the communities. 

How to grow

SHB: Under your leadership, Capital Senior Living grew significantly. Last year alone, Trustwell added 41 communities to its portfolio. Obviously, you know how to grow a company. How do you maintain quality while adding properties to the portfolio at that breakneck pace?

Cohen: It is a collaborative process that we developed from our history of seamless transitions. Operations and marketing  developed business plans that are tailored to meet specific market goals in the community regarding staffing, rents, levels of care and labor. We develop strategies to optimize the operations and the financial performance. 

The most important factor when we take over buildings is the onsite staff. We go in and visit with the staff before we transition. We introduce Trustwell. We explain and compare our benefits. We spend a lot of time onboarding residents and families. I do video calls with families when we take over buildings. It’s very helpful to introduce ourselves and hear their concerns.

We have a lot of experience. I give a lot of credit and thanks to my team. They’re traveling extensively to onboard these buildings. To accommodate the growth last year, we also grew our corporate staff. What’s really interesting is the expansion of this culture of community-focused leadership and clinical excellence throughout every property.

We took over 41 buildings between June and October 2023. Since transition, we’ve hired more than 500 employees. Within the first 90 days we’ve seen a reduction of contract labor of 70 to 80 percent.

Another metric we track, we find that our turnover at the community level stays below 20 percent, which is very low compared to industry averages. It’s a team that’s very seasoned, very proven, systematic, organized and well planned.

We find very often that we want to have leaders that are very strong at the community level and can operate with autonomy, responsibility and accountability. Prior to transition, a lot of times things get pushed up to corporate office. We have training programs for executive directors and other leaders, teaching them how to understand and read financial statements, how to read key metrics, how to develop budgets. They’re used as tools to operate the buildings post-transition.

That builds strong local leadership with a passion for serving seniors. We have so many executive directors who left under prior management come back under Trustwell. We really pride ourselves on having a culture and reputation that attract dependable, loyal and caring employees. High satisfaction leads to low turnover, which leads to high resident satisfaction.

SHB: When you founded Trustwell, the marketing materials said it was “to redefine senior living services for the better.” What does that redefinition look like on the ground?

Cohen: We’re using electronic health records, we’re using better IT and systems. A lot of caregivers were keeping paper records. They’re given much better tools to take care of the residents. We focus on making sure we have strong health service directors, and have great clinical oversight with our clinical directors and our head of clinical.

The best way to articulate it: We’ve had surveyors come in December and their response to our staff is “this is how assisted living should be run.” We have a building in Missouri where the state asked our leadership to do seminars for other properties in the state. 

We train the leadership to have strengths to serve their community better. We renovate communities so the physical plant is much more homey.

We think about break rooms and employee quarters to have comfortable areas to take their breaks. We bring in new food programs to make it easier to order food at more competitive prices and buffer inflationary forces. We benchmark and track key quality indicators, enhancing care to residents, and we measure that.

Focus on operations

SHB: Does Trustwell generally own a piece of the real estate portion, or do you prefer to stay firmly in the “operator” lane?

Cohen: Trustwell is the operator, but I personally have ownership in some of the real estate with partners. We also manage four properties that we own, and then we manage for private equity firms, for lenders, for institutions. Our focus is really the operations.

SHB: What do the future growth plans look like for Trustwell?

Cohen: Our future growth is both organic growth and external growth. We had nice growth in census last year. 

Buildings we acquired in 2022 that were renovated had occupancy growth of nearly 20 percentage points in 2023. We reduced contract labor, brought down expenses. Now we’re focusing on revenue growth.

I see us growing by another 10 to 15 buildings this year, particularly if they’re in the regions where we already operate.

We will remain focused and disciplined in what we do, particularly as it relates to serving residents and staff.

SHB: You’ve been a longtime fixture on many of the boards in the industry, particularly the associations. What are your proudest accomplishments from that time?

Cohen: I’ve been involved with ASHA since its inception, and Argentum and NIC for many years. There are two accomplishments I take pride in.

I was very active in National Multifamily Housing Council (NMHC). In 1991, NMHC formed ASHA as a committee, and we hired David Schless back then. So, he’s been a friend for a long time. Then we spun off ASHA in 2001 as a fully independent organization. I’m very proud both as a founder and past chairman in the growth of ASHA and its consistency in being a resource for executives in the industry.

The other accomplishment is we formed a Senior Living Hall of Fame committee in 2018. We have a format similar to the baseball hall of fame, with the leading writers on the industry voting to recognize visionaries who’ve distinguished themselves over long careers. Every year we install three new members. The most recent class was inducted at the ASHA meeting in January.

[The 2024 class includes Marilynn Duker of Brightview Senior Living, longtime NIC CEO Robert G. Kramer and the late George Chapman, former CEO of Welltower.]

I take great pride in that. It’s very rewarding to recognize many of the real pioneers and visionaries of this industry who have had successful careers in building up seniors housing.

SHB: What’s something people in the industry would be surprised to learn about you?

Cohen: People would be surprised on my focus on the real root of this business, and that I’m very much into the numbers. I look at every building every month in great detail, working with our team on what we can do to make improvements.

I actually have daily calls with our communities to see where we can help improve what they’re doing. It helps them get to know me, not only as a name but as someone that is aligned with what’s happening at the community level.

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