Sage Oak Ceo: Why Personalization Could Be Industry’s ‘silver Bullet’ To Meet Demand

The senior living industry is experiencing strong demand in 2026, and providers must focus on personalization to capitalize on the incoming wave, according to The Sage Oak CEO Loe Hornbuckle.

In the latest episode of the Senior Housing News Transform podcast, Hornbuckle said a new wave of pioneers in the industry is focused on creating “incredibly personalized” experiences rather than a one-size-fits-all model.

Personalization of senior living operations is the “silver bullet” for serving incoming baby boomers who demand services tailored to their individual preferences, lifestyles and care needs. Operators that design their operations around flexibility and customization will be positioned strongly to capture new demand, Hornbuckle noted.

“If you’re flexible enough to give that to them in some meaningful way, then you have an opportunity to not really have to reinvent your company because your company started off as being a highly personalized thing,” Hornbuckle said during the interview.

The company’s curated care model, which aims to pair residents in homes that fit acuity and lifestyle needs, has grown to help meet the changing demand for greater personalization, Hornbuckle said. Residents are placed in homes that meet their social needs and match them with residents of similar cultural backgrounds. For example, at one community an all-women home has been well-received by older adults that stand alongside co-ed communities that blend acuity and social needs.

The Sage Oak was founded in 2015 and now operates 14 boutique assisted living and memory care residential homes totaling 218 beds in Texas and Louisiana.

Listen to the latest episode of Transform here.

Editor’s note: The following transcript has been edited for length and clarity.

On Sage Oak’s operating model:

We have a trademark on “boutique assisted living and memory care,” so that’s the phraseology we use. But I’m not necessarily uncomfortable referring to it as residential assisted living, boutique, or the small-home model.

Residential assisted living is probably the most dominant phraseology in the marketplace. My problem with it is that quite a few projects are, by definition, commercial, so “residential” can sometimes be misleading. I think “boutique” is often correct, although we have a trademark on it, so people obviously need to call it something else.

Residential-style assisted living, small-home model, boutique — there are lots of different ways to refer to it. I’m more concerned with how we explain it than what we label it. It’s called all kinds of things by different governments in different states. Ultimately, residential assisted living is probably the dominant moniker I’ve come across.

On Sage Oak’s Curated Care concept:

It’s been interesting. We’ve done some things that were very heavily curated and some things that have been a little bit more blended. Probably the best examples are in Lake Charles, where we have five 16-bed homes, and there aren’t really two homes that are similar. We have an independent assisted living product, a higher-needs assisted living product and then an advanced [memory] care product, which is your highest acuity, and that often involves merging dementia care and assisted living because at a certain point, from an acuity perspective, you’re not necessarily an elopement risk.

Louisiana really is in favor of not putting somebody in a locked dementia care setting if they don’t have to be. Maybe their health won’t allow them to elope. Louisiana really likes you to put them in the least restrictive setting possible, so that’s the AL side, and then we have a high-functioning and a high-needs dementia care to round out the other houses. Lake Charles has five houses, and they’re all somewhat different from each other. The advantage is that you have a higher opportunity of having an environment that will fit whatever the client, the family, and the resident need. The challenge is that sometimes you don’t get your lead flow in a predictable, perfectly allocated way, or one lead for each house. Sometimes you might get leads for a house that’s full, and you don’t necessarily have something similar enough for them to consider. That’s the pros and cons. You can be really specialized and really personalized, and the con is that the more personalized or specialized you are, the more you’re narrowing down what kind of avatar would really consider your alternative houses.

Then on the other end of the spectrum is Colleyville, our newest acquisition. We didn’t build it; it was a foreclosure that was vacant when we bought it, so we got to build the culture and add the residents to the community. Colleyville has an all-female house, which we’ve never done before, and that’s been going well. The advantage of an all-female house is probably known to quite a few people. The interesting disadvantage is that if you curate gender then by definition, you’re probably going to have a much more polarized acuity experience. Our all-female house is blended, meaning we have residents that have dementia and don’t have dementia living together, because the way we chose to curate wasn’t social; it wasn’t disease, it wasn’t diagnosis, it wasn’t cultural. It was simply if you’re a woman then you’re eligible for this house. Then we have a co-ed house that is also blended.

So I think Colleyville is an example of the opposite of curation. Granted we did curate women and men, but the populations are very similar. When you walk into Denton, it’s very likely Denton is more similar to Lake Charles. It’s got six houses: four memory care houses, one assisted living house, so we have a lot of memory care in Denton compared to assisted living. If you walk into any one of those houses, you’re likely to see people inside of a narrow range in a relative way.

I’m all about creating that environment for clients if that’s what they want. I would say I lean personally towards the idea that the best social environment is going to be curated for social reasons.

On the industry’s need for ‘pioneers’ amid strong demand:

I actually feel that way now more than ever. I think you have a couple of things happening simultaneously. The first is everyone’s been talking about a changing consumer that’s coming in. The general consensus in the industry, and I’m using air quotes here, is that baby boomers are going to demand certain things, and the companies that figure out how to give baby boomers what they demand will succeed. I think personalization is to some degree the silver bullet. If you say, “OK, we’re going to offer a food program, this is our menu, it’s going to be amazing,” [then you need to deliver]. Well, if it doesn’t appeal to someone’s palate, it’s kind of irrelevant. If you serve a certain meal and you cook the best proteins, but your clients are vegan, then you’re probably not going to be able to offer a great experience.

So what a lot of companies do is pick a lane, and it could be anything. You could see a house that specializes in kosher food, they’re going to try to cater to, say, a Jewish population. The problem with that is they’re saying, “Hey, we think there’s going to be sufficient demand for this.” But if you have the ability to say, “Whoever you are inside these parameters, we’re going to try to meet you where you are and try to become the provider that checks off the boxes for you personally,” then, to me, that’s the silver bullet for solving whatever the baby boomers demand. If you’re flexible enough to give that to them in some meaningful way, then you have an opportunity to not really have to reinvent your company because your company started off as being highly personalized. On personalization in residential assisted living:

I’ll set the stage. In general, small homes are not known to have better food than big buildings. We have good food in our eight-bed homes, but it doesn’t compare to having a private chef or really a team of two chefs per house, an A and a B doing cooking for 16 people, so you really start to see the food quality have the potential.

There are plenty of 16-bed homes that don’t think in this way, but from a scaling perspective, a great chef team might be $500 to $700 a month for 16 people, but it’s probably going to be $1,000 or $1,200 a month for eight people, just because the less people you can divide a cost over, the higher it is per person. And then you reach a certain point where if you have too large a number of people, you have to have an additional chef, so the cost no longer stays fixed and starts to vary.

When you build these campuses of multiple homes on one campus – or neighborhoods, as we like to call them – you can have an eight-to-10-person dietary team, and we don’t need servers, so we don’t have any waiters or waitresses or a person seating people at the front. The dietary team has cooks and chefs, so their situation looks much more comparable to a private chef cooking in your home than restaurant style food and quality.

If you’ve ever had the luxury of a private chef, they ask you ahead of time what do you like, what your allergies are, are there any special diets you want me to cook for, and then they come in and do that. If you have a dinner party with a private chef, they get that information on every one of your guests, and they either cook a meal that checks off all the boxes for everyone or every guest gets a slightly different version, maybe five versions of the same meal, one vegetarian, one substituting chicken for fish and so on.

We have a resident going through probably what could be end of life, and the family’s been present a lot. The chef noticed they were present a lot and cooked them grilled salmon, potatoes and broccoli, even though he didn’t know they were going to be there. Our chef just noticed a family needing something and prepared a meal that they raved about while sitting bedside, giving TLC to their loved one going through a tough time. That’s what I mean by personalization and dietary.

The old way of doing dietary, candidly, was bringing in some sort of affiliation with a restaurant or a celebrity chef, advertising that, and saying we have this amazing food, but that’s only going to appeal to a certain number of people.

On staffing differences in residential vs. traditional senior living:

Let’s give them the benefit of the doubt and say they’re 18-to-1. What everyone fails to do, once you establish 18-to-1, is think, “OK, well that’s a lot of people.” But what’s actually more powerful in my experience is to divide 18 into 24, which produces a theoretical per-resident, per-day amount of time. Eighteen goes into 24 one and a half times, roughly. So an 18-to-1 ratio gives you about one and a half hours, a little less, of theoretical direct care per resident per day.

Think about the average resident, a typical resident or a high-needs resident. If those residents need more than an hour and a half of TLC per day, either their needs are not going to be met, they’re going to be asked to supplement with private sitters or additional services, or the family is going to have to engage. I’d say if 18-to-1 is not the national average, it’s real close. 12-to-1 is only two hours a day, and we run on average between four to six depending on the place. Six goes into 24 four times, so that’s four hours of theoretical time per resident per day.

When you talk in those terms, a ratio isn’t just an abstract number. The other advantage we have is that it’s somewhat immutable, because any building or big provider could change their staffing ratios at any point. What they’ll struggle with is the size and square footage of their building. If you’ve got a lot of caregivers, let’s say you mimic our staffing ratios, but they’re all congregated 150 yards away from a resident in need; those response times are going to be low. So, you not only have ratios, but you also have a concept we’ve brought into the dialogue, which is caregivers per square foot.

We charge an average price to deliver an average service to an average client, whereas I think we offer a premium service to a discerning client that’s personalized to their discernment. There are a lot of people in assisted living and dementia care that are fundamentally not in the same business as us. They’re just not. Whenever we did this portfolio, we coveted the houses that were vacant, not the houses that had residents, because it’s easier for us to start from scratch and install people that fit the mission of what Sage Oak is trying to do, because we’re not for everybody.

On honing operations rather than changing the perception of the industry:

We’ve been talking about changing perceptions of senior housing, assisted living and dementia care for the entire 11 years I’ve been in the industry. However, I find it odd that we’ve had quarter-over-quarter occupancy growth for, I don’t know how many quarters in a row, maybe 12 or 16. It’s been three or four years coming out of COVID, and we’re at a high-water mark. We have both the highest percentage of occupancy in assisted living and memory care ever, and from a raw numbers perspective, more people live in assisted living and memory care than ever before.

So my point is, why are we trying to change the perceptions of something that’s been on a three or four-year bull run? Surely, we’d like to go from 91 to 100. A hundred is probably not theoretically possible, but we still have room to grow, and maybe the way we get there is by changing things. I’ve done nothing but change the way we do things, to change our little corner. But I don’t actually think the broader industry is all that misunderstood. I think there’s definitely some customer education that has to happen, but ultimately by the time they call us, they haven’t made a plan for something they should have been planning for 20 or 25 years ago.

There’s very little we can do other than educate someone on how Medicaid, Medicare and VA veteran benefits work. But the time to do all that was in financial planning 20 or 25 years ago. The time to buy a long-term care insurance policy was 20 or 25 years ago in most cases.

I think the industry is finally starting to fulfill its potential, and there isn’t really a need to tear down and redo this thing. The only thing I think we’re missing as an industry is personalization and really innovative ideas being a bigger part of the market share. Then of course the classic, we’ve got to figure out a way to drive down costs for certain folks. I’m not in the “finding-efficiency-to-reduce-cost business.” I’m in the “how-audacious-of-a-promise-can-we-make-and-keep business,” and that is an expensive proposition.

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