With 2014 well underway we have spent time examining common threads in our portfolio of recently completed senior living projects as well as the consistent needs and challenges arising in requests for proposal and projects in the master planning stage. The nature in which community leaders are looking to poise themselves for the future is all about the people they plan to serve. The design challenge ahead is to create “Real Projects for Real People.” This means developing a deep understanding of the markets that our clients are serving and the lifestyle of these Real People. Over the course of this year, we will look at what this means to the future of senior living and share success stories of how forward-thinking providers are creating innovative solutions at a scale that best serves their current senior population while preparing for the arrival of Baby Boomers.
After a year’s worth of master planning and programming various existing senior living communities, we are hearing that because of the delayed entry phenomenon in the senior living industry, a new definition of independent living is evolving.
According to Senior Housing Net the current definition of Independent Living is –
“Multi-unit senior housing development that may provide supportive services such as meals, housekeeping, social activities, and transportation (Congregate Housing, Supportive Housing, Retirement Community). Independent Living typically encourages socialization by provision of meals in a central dining area and scheduled social programs. May also be used to describe housing with few or no services (Senior Apartment).”
As a veteran provider of a decades-old community described it, “The new definition of Independent Living is that ‘I live Independently with YOUR help’.” And ‘your’ is the sponsor/provider or the adult child who visits multiple times each week or any member of a professional care assistance organization. We are also finding that the term “assisted living resident” has growing negative connotations. Clearly these are both matters of dignity, which we believe will become important topics that need to be addressed in the coming years.
What Industry Leaders Say
“We are in a phase of product maturation that ultimately may lead to a recasting of the definition of Independent Living,” says Troy Hart, president at SantaFe Senior Living. “I recall a speaker at LeadingAge saying ‘If you call it independent living, then it probably isn’t.’ Implying that truly independent living is somewhere else, like an apartment building or single-family home. I believe as our product matures we will need to become much better at helping seniors take control of their own aging by offering amenities that support their independence. Much the same way as the industry has worked to make our dining and lifestyle experiences similar to a resort’s, our health support and coordination services will need to step up to the next level. I believe the key is putting the customer in charge, by making health services intuitive, easy, affordable and dignified.”
Both Hart and Charlie Nelson of Milwaukee-based Congregational Home feel that about 50% of their populations are truly living independently. The remaining 50% need the support provided by the community, a family member or a professional assistance organization to remain high functioning.
“Independent persons, at least in CCRCs, are often only able to remain in that setting because they receive assistance from a spouse, family member or contracted service providers,” describes Nelson. “I often think of this population as comparable to that of the early Residential Care Apartment Complexes (RCAC) in the state of Wisconsin. I would say that 50% of our apartment population is truly independent; we have an RCAC license for that building and 50% are receiving services from us, and we know that several others maintain through the support of a spouse, family members, etc.”
For forward-thinking providers like Renee Anderson, president and CEO of Saint John’s on the Lake, messaging is key when exploring the evolving definition of senior living. “Needing help and being willing to accept it are two different things,” says Anderson. “We make every effort to ensure that our residents are able to live in the setting of their choice for as long as possible and we try to “begin at the beginning.” Nursing and Marketing collaborate such that prospects applying for residency who demonstrate need during the health assessment are connected with services immediately. Oftentimes, service is discontinued after the resident has moved and is acclimated to the Community.”
At Saint John’s services are presented concierge style with an emphasis on maintenance of wellness instead of treatment of illness. Services include everything from dog walking, vehicle portering and chef prepared in-home meals to advocacy and case management and skilled nursing in ‘independent living.’ “We strive to ensure services are personalized, tailoring frequency and duration to individual needs,” describes Anderson. This differs from a more traditional home health approach with scheduled blocks of time for services. “Building relationships through transportation, dog walking or housekeeping provides an entrée to additional services. When staff is known and trusted, residents are more likely to avail themselves of available services,” adds Anderson. She finds that approximately 20% of the Saint John’s apartment residents arrange for services beyond their monthly service package while another 5-10% has services provided by someone other than Saint John’s.
David Loop, executive director of The Garlands of Barrington in Barrington, IL believes that for the near future we will continue to see a combination of healthy and need driven older adults making up the IL dynamic. At The Garlands, the community currently defines 88% of its population as truly independent with about 12% needing caregiver assistance. “For the need driven, yes the definition “with YOUR help” fits. However, many older adults still want independence, autonomy and most importantly dignity. For these individuals “YOUR help” must remain invisible.”
Design Solutions for a New Definition
As the new definition for senior living evolves, design strategies and solutions will continue to be explored in order to facilitate a greater sense of “independence and dignity” for today’s residents.
“I’m a believer in clustering of service around amenity hubs that result in social interaction and a sense of community,” says Hart.
This solution can be explored in a variety of ways from a central commons area to a more decentralized approach with destinations of discovery scattered in appropriate distances to residential units throughout the community.
However, leaders such as Hart feel this strategy goes beyond the dining venues and lifestyle amenities that are currently being addressed by many communities to include health services and support too. Many organizations are also re-addressing their definition of wellness and providing more holistic health services in order to be preventative as well as reactive to resident health care needs.
“I think more preventive health services and awareness will become more commonplace and automated,” describes Hart. “Take a trip to your local warehouse store, grocery store or drug store. You are very likely to find a smart kiosk for health information that goes significantly beyond blood pressure. This technology is evolving quickly and will be a ubiquitous part of our aging experience someday soon. We need to be planning for that and leading that change so that health services and health care isn’t something that happens somewhere else, it happens everywhere. Our refrigerators will talk to our scales, which will link to our blood pressure cuff, which will talk to our doctor’s office as well as one of the several wellness and preventive health coordinators at our retirement community. Our industry needs to lead that change and take us around the corner to a truly better more proactive approach to living well longer.”
These industry leaders believe specific design features in IL units such as walk-in showers, computerized medication dispensers, call lights and supportive grab points throughout units will help people remain independent longer. “For independence, technology, technology and more technology,” says Loop.
When it comes to design considerations that address “YOUR help,” Loop references space accommodations such as a second bedroom for a live-in caregiver or “garage-storage” for an in-home electric scooter.
“Customized residences support both dignity and a sense of control over their environment,” says Anderson. “Living in community is a huge adjustment and almost all have given up significant personal possessions downsizing. These factors coupled with the cultural stigma generally associated with moving to a retirement community can result in anxiety and depression especially if coupled with personal illness and/or the loss of a spouse.”
Based on this commentary from industry leaders, it would appear that there is a shift in what might be considered earlier “norms” used to describe our resident population. In the past when we described successful senior living communities, we often focused on the building and grounds and less on the residents. As we look to the future, the discussion seems to be shifting to the residents themselves. Clearly the fine line between living independently and living with some daily support has become blurred. The challenge, as always, is about quality of life and how can the environment, services and technology be blended in order to enhance it!