As we contemplate the future of the senior living industry, the expectation of what the “future” resident will want is an important focus of most, if not all, providers. One of the hallmarks of baby boomers is the emphasis on wellness. Yet, it’s inevitable that the reality of care “needs” remains a constant both among existing community populations just as it will eventually be for boomers. Innovations in health care have seen an evolution from institutional nursing homes to the development of the household model. Providers, senior living organizations, health care advocates and design teams continue to discuss how to best serve residents at every level of care while balancing the need to create a community that entices vibrant, active seniors. With our recent Boomers in Transition Survey Series we have been focusing a lot of attention on the independent living component and how to meet the expectations of future residents. Now, we want to dig deeper into the health care components to explore What’s Next in care models and learn how different providers are approaching this important topic. Join us in these senior living conversations as we contemplate the future of health care.

Recent conversations revealed the thought of careful planning to “conceal” care components, so we wanted to gain greater perspective on what that means and how our colleagues are approaching the care components of their communities. Here are some thoughts from:

Q: To stay competitive, do you agree that greater emphasis will need to be given to “concealing” the care component of your community?

Riddell: We are a life plan community with the usual levels of care. Several years ago, our Board of Trustees challenged us to rethink how we view health care. From that our Optimal Health and Wellness Philosophy was born. This philosophy guides our residents to live well, get well, and die well no matter where they live in our community. Living, healing and dying are no longer tied to a specific level of care. We (board, staff and residents) spent the past year, assessing our health care environment and the external health care environment. We visited communities with interesting and new health care ideas, we attended educational sessions, we held resident and staff focus groups, and we surveyed our residents. As a result of our work, we decided to adopt the small home model and adjust it to our community’s culture, reduce the number and consolidate our Medicare nursing beds, and to continue serving our memory care residents within, not separated from, the community allowing them to live where their needs are best met.

Gouhin: We do not “conceal” the health care services at our CCRC. We include all levels of living in our marketing efforts and ensure those planning for “what if’s” know our community helps answer those questions. We do find IL residents vary in terms of how much information they want about health care services and tailor our presentations accordingly.

Tarantino: When we look at today’s market, we are keenly aware that what a 65 or 70-year-old active adult wants (and needs) is markedly different than what an 85-year-old wants and needs. We need to be able to comprehensively deliver a full spectrum of care options to our residents. When you think about a hotel brand, say the Marriott, they have a variety of hotel products to serve different consumers. We are approaching our new developments with that hotelier mindset. For example, our IL offerings need to fulfill the needs of residents who are just moving out of their home after many years. They want to socialize, maintain an active and healthy lifestyle, and lessen their “home maintenance” responsibilities. With that said, while a 70-year-old is focused on the programs, amenities and activities for the “here and now” they are also thinking about what 10 to 15 years looks like. And, that is where we see the biggest change in how care is being delivered. Consumers want personal and private care support in their apartment or private residence. For example, they do not want to do PT/OT in a vast room, rather they want it done in their apartment. The term ‘wellness’ should not be lumped in with care; the thought of wellness needs to be about fulfilling the social, emotional and physical perspective. From a true care perspective, our residents do not want to move out of their IL apartment, they want AL services brought to them. So, I’m not sure that this is “concealing” care, as much as delivering the care in the most comfortable manner possible for our residents.

Witz: It is not so much concealing as it is better incorporating them into the (hopefully already) fully residential look and feel of the rest of campus, on both the outside and inside. Make the care components as residential as possible and then blur the line between independent living and care components on both the outside and inside.

When I visit a new campus, I can almost always immediately identify the care components from the outside and then on the inside there is always a feeling of ‘crossing over’ into the health care area. So, we don’t need to conceal as much as re-think and integrate.

 

Q: What strategies are you currently employing to do so?

Tarantino: First and foremost, we are working to understand – firsthand – what our future resident wants and needs. We are about to embark on a focus group study to learn what’s most important to them when making a senior living decision for the immediate and long-term. Second, we are hiring the best and brightest in our workforce. Think about health care meeting hospitality. We want our team to be a partner and concierge to our resident, along with a companion and guidance provider.

Our residents want to live a purpose-driven life no matter where they are in their aging experience. The best way to do this has been to implement a model to allow IL residents to stay in their residence. No one wants a label on where they are in terms of aging and care needs – they simply want to maintain their individuality and identity. We are changing our language from assisted living to enhanced service programming. By blending IL and AL living, we find our community’s common area and amenity spaces need to feel more transitional yet elevated for the full population. More hospitality, superior delivery of dining options to meet resident satisfaction, wellness, and attention to detail need to permeate all aspects of the building, not just a room.

Riddell: One of our strategies came from our Resident Inclusivity Committee. The Committee, who surveyed our existing residents, determined that ageism should be a focus of their work. The survey results and the health care focus groups highlighted that residents often fear their future self and when that fear exists, the easy answer often is to define and create levels of care. We are in the process of identifying how, within our community, we can enhance the aging experience and allow each individual to live their best life.

Gouhin: We include the health care services in our website and have a separate brochure in the marketing handouts to help with planning purposes. The health care levels do have a separate identifying name and distinctions in activities, meals, common space, etc.  We also include a few things each year for the entire community (anniversary, outdoor picnic, outdoor concert) and invite families and friends.

Witz: Start first with defining and writing out the design and operations ‘experience’ you want for your care residents. Do this before you start any programming or design. If something happened to you tomorrow and you had to move into AL or NF, what experience would you want from both the perspective of a living environment and operations? Try to truly understand why the current experience of a resident moving from IL to a care environment, not just from a life change standpoint but also from a design and operations perspective, can be so very difficult.

Starting with the experience (rather than the program) will also entail figuring out where you might have to push back against the code and regulations. I’ve been lucky to work with providers that are really pushing the envelope on creating a true homelike, residential experience in the care environment (which also includes amazing personalized care) and which is incorporated into the full campus. To do that they had to apply, and sometimes really fight, to get variances from the local or state health authorities.

Strip away every single thing that does not convey a sense of residential, homelike feel— institutional or  too-much signage, institutional lighting fixtures, non-varied floor and wall finishes, carts or back-of-house elements—design that doesn’t incorporate story or whimsy, exterior design and materials that scream “health center,” etc. This includes the naming and building signage. Would you want to live in a ‘unit’ in the XYZ Care Center or XYZ Health Center? Location siting needs to not only address back-of-house connections but also promote the true integration of care settings into the campus. Are common spaces designed and placed to effortlessly create crossover use between all residents?

 

Q: Does something more fundamentally radical need to be done, such as separating components like memory care from independent living completely?

Tarantino: We all realize the incredible heavy responsibility of providing memory care services. This is truly a specialty and needs to be designed and delivered as such. And while one could argue that the separation makes a great deal of sense operationally, we continue to worry about our prospective resident. For example, in one of our campuses without memory care, prospective residents question what will happen to them if they become impacted by Alzheimer’s. If we had the perfect solution for this conundrum, we’d be the first to trademark it. I think every senior living operator grapples with this. In fact, this is why we see some providers focus strictly on Independent Living, with the focus on a “back door” which helps transition their resident to another provider when additional services are needed. Conversely, some providers focus only on Assisted Living and Memory Care, where they see a resident’s average stay just the last 24-30 months of a person’s life. We have not yet ‘disconnected’ IL and MC all together as it seems counterintuitive to the whole person culture we strive for. But we are very focused on developing thoughtful and innovative solutions to ensure safety for a memory care resident.

Senior living providers who look at the whole resident – from living accommodations and care spaces to more wellness and engagement perspectives – will be those who find their residents living the happiest and most fulfilling lives.

Witz: Rather than segregating, I think the key is integrating. I think older adults (as should we all) accept the reality that life and physical conditions change, either to themselves or loved ones and friends. The care components are obviously separate spaces, but they need to be integrated and incorporated as seamlessly as possible into the campus so there is not this great architectural and operational ‘divide’ between independent living and the care setting. I believe the next generation of residents, as well as their family and friends, will expect this.

Gouhin: The memory care component and IL are separated at our community in terms of physical environment as each has its own needs, regulations, services, etc. The culture at our community is one of inclusion rather than exclusion. Some IL residents do not want to acknowledge health care service levels; however, the greater majority want to plan for their future. We have many IL residents who volunteer their time in our health care services.

Riddell: In one of the LeadingAge educational sessions we attended, one comment really hit home for us – it is a generalization but a powerful one. “There are only two types of people we lock up: criminals and those who are in memory care.” With our Optimal Health and Wellness Philosophy and our Inclusivity Philosophy, we believe there has to be a better way to allow our residents to age than to always segregate them by their health status. While we have not found the exact right solution, we continue to work towards it.

Continuing the conversation

As you can see these providers are all carefully considering their organizations’ approach to health care and making it part of their greater mission. There is more to learn and discuss. We look forward to continuing these senior living conversations and contemplating the future of health care.

If you want to share your thoughts on how your organization is approaching the care components of your community, I welcome the conversation.

Feel free to email me – ergusz@agarch.com so we can set up a call to discuss further.