Digital version of Dealmaker’s Handbook 2021

Download the 2021 Dealmaker’s Handbook

Among the articles:

• Q&A: NIC’s Brian Jurutka on how the sector has evolved
• Strategic shifts: Some pandemic changes are permanent
• Emerging juggernaut: Home care is too big to ignore

A. Beside value-engineering the physical product (as was discussed in my previous column), reduced operating expenses also can play a role. Many active adult communities are positioned as “service-free,” meaning that they do not provide services that typically are available in traditional independent living. They do, however, facilitate access to these services at the residents’ discretion. For example, referrals can be provided for grocery delivery or restaurant delivery services for meals, Uber or Lyft for transportation, laundry/dry cleaning or housekeeping services.

By not actually providing those services, active adult communities operate with a smaller staff, thereby reducing overall operating expenses. In independent living, staffing expenses can represent approximately 40% of total operating expenses depending on the services provided. Reducing this one area of expense could result in a substantially lower price point for this living arrangement.

Although the physical product is a key component, most consumers interested in this living arrangement desire a maintenance-free lifestyle, with an emphasis on active living and opportunities for social companionship. This should be reflected in all aspects of the community, including location, design, common area spaces, programming and access to services and amenities.

This article appears in the October issue of McKnight’s Senior Living as “You’ve Got Questions, We’ve Got Answers” column.

Jim Moore is president of Moore Diversified Services Inc., a national senior living and healthcare consulting firm based in Fort Worth, TX, that has been serving clients for 50 years. He has written five books about senior living and healthcare, including “Assisted Living Strategies for Changing Markets” and “Independent Living and CCRCs.” He has published senior living bimonthly columns for the past 28 years. Moore may be reached at (817) 731-4266 or jimmoore@m-d-s.com.

Chris Belford, CEO of Sinceri Senior Living, with 37 communities and approximately 2,500 employees across 15 states, recently spoke with McKnight’s Senior Living about the company’s rebranding and name change from JEA Senior Living, the firm’s future plans, and how the senior living industry could change in the future.

Q: What was the impetus for the name change?

A: JEA is an acronym for the former ownership group, Jerry Erwin Associates. It had wide appeal throughout the industry, having been around for 35 years, but with Jerry Erwin and his associates no longer being with the company, we wanted to refresh the brand. JEA was founded on really great principles, and we wanted to rebrand the company to reflect more what we do and those founding principles rather than the ownership’s acronym. 

Q: How did the company arrive at the name Sinceri?

A: Ultimately, we felt that the name fit the tone and tenor of what we do and how people feel about JEA.

We hired an agency, Big Buzz, in Denver. They pulled together a number of stakeholders and asked them, “What does JEA mean to you?” and “How do you feel about JEA?” We got an underlying theme about what JEA meant to all of our residents, our family members, our caregivers and our team members.

I do town hall meetings as I visit our communities, and I ask team members many questions, but one specific to this is, “Why do you get up every single day and come to work for JEA?” And in almost every case, team members will respond, “These residents are like family to me, and I feel a sense of duty to come to work every day and take care of our family members.” That supported what Big Buzz had uncovered as well.

Q: Has the company made any changes based on what you’ve heard in your town hall meetings?

A: After I came here in November 2020, in conversations with our team members, I learned that they wanted more of a career path. So we instituted things like mentorship programs and apprenticeship programs where caregivers and team members can advance their careers while working for Sinceri Senior Living.

So maybe a caregiver wants to be a nurse someday. We’ll provide an opportunity for her to learn what the director of nursing services does in our communities and help her to be able to go to school and get licensed. For food servers who want to be cooks, we’ve developed an apprenticeship program.

Some team members have told us that they don’t like their uniforms, so we’re giving our caregivers choices.

Many of the changes that we make at Sinceri Senior Living are based on commentary that I get from the team members. 

Q. How has Sinceri’s COVID-19 vaccine mandate been received?

It’s been received really well. The messaging to our team members, family members and residents is that we have a responsibility to our residents. The last thing that we need is to be the ones who carry that virus into our communities.

There are exemptions to our policy, but the message about all of us working together to stamp out the coronavirus is well-received. We haven’t really received any really bad feedback or employees leaving the company because of the mandatory vaccination. All our team members recognize the need to get vaccinated and protect our residents. It doesn’t seem to be a barrier to hiring employees, either.

Q: Sinceri plans to expand its offerings. Could you talk more about that?

A: When JEA first started, it was a stand-alone memory care company. Stand-alone memory care is foundational to what we do, because it has generated a lot of great care practices. We’ve introduced a lot of technology to care for our residents as well. Those practices and technology will now be expanded into the other product lines, like independent and assisted living, where we believe that our programming will be valuable to residents.

You’ll see Sinceri growing its current footprint and size to other product lines in other communities and other states. We’re very excited about this growth opportunity we have available to us.

Q: And there are plans to offer ancillary services as well?

A: We’re considering it. We’re looking at opportunities to go into an ancillary service like pharmacy or rehab. We’re not dedicated to one ancillary service or another; we’re trying to be opportunistic about what improves our existing platform and what ancillary product would best fit within our footprint. We haven’t decided to go one way or another. Where we see an opportunity, we may go for it if it improves our ability to serve our residents.

Q. You’ve worked in senior living for a long time. What are the biggest changes that have occurred during that time?

The recent pandemic we went through is probably the biggest change. At the end of the day, we will be a better industry coming out of the pandemic than we were at the start of it. That was a tremendous learning opportunity for us, and we’ve improved a lot of systems based on it — infection control processes, services for our residents, the social nature of our communities. 

I think the other piece of it is how we treat our staff members who want to come to work for us. We have a fairly low unemployment rate, but a lot of positions are available throughout the country. How do we as an industry attract those people who are on the sidelines looking for opportunities to grow within themselves and with the industry?

Q: What do you think the future holds for the industry?

A: We’ve all learned more about infection control due to the pandemic, and that will continue, but the marrying of technology and direct hands-on care is going to be an evolution in senior housing, in my view. The challenge for many industry leaders is to use technology in a way that doesn’t take away from direct hands-on care.

A disposable personal protective equipment shortage hit communities hard and early, exponentially increasing the need to process reusables. And in many communities, on-premise laundries spent most of the pandemic operating under less-than-ideal conditions, including major staff shortages.

That led regulatory agencies to tell laundries to clean up their act when it comes to cleaning and disinfection practices. Some states issued new COVID laundry-handling guidance and restricted families from washing their relatives’ clothing at home. Consequently, safety issues were paramount for both in-house and outsourced operations.

“Operators that installed robust and durable corporate systems before COVID were able to sustain through the tumultuous period far better from an outcome and safety perspective,” says David Potack, president of Unitex Healthcare Laundry Services. “Maintaining a redundant supply chain for PPE and all supplies was important pre-COVID and has been shown to be even more important now.”

Keeping on-premise machines and systems up to date and efficient also was challenging because site visits by family members and non-essential vendors, such as some repair workers, were curtailed severely for months at a time.

Overall, Potack says, the COVID-19 pandemic has driven communities to pursue greater awareness of infection risks and controls. 

In the future, laundries should expect greater scrutiny over internal processes regarding cleaning and decontamination.

“Facilities will be tasked with greater documentation that prescribed processes were followed,” says Randy Radtke, content and media relations manager for Alliance Laundry Systems. 

“Dealing with a pandemic isn’t anything any of us would choose to go through. However, the good that can come from this is a renewed emphasis on process and equipping laundries with all the tools and technology to better manage and deliver the cleanest laundry possible,” he says.

Infection control professionals often recommend reusable personal protective equipment during surge capacity situations, such as the COVID-19 pandemic, in part because of shortages of disposables.

A new study published in the American Journal of Infection Control concluded that adopting reusable gowns may result in increased protection and significant cost savings due to their superior durability and sustainability when compared with disposable gowns.

The research evaluated the performance of disposable versus reusable medical gowns by assessing their ability to provide adequate protection across their expected service lifespan.

Responding to the study, Unitex noted reusables provide more durability, were unaffected by commercial laundry processing in terms of protection and performance, had lower environmental impact and have been endorsed by the federal government.

Thermal disinfection advised for hygienically clean laundry

With older adults being one of the most at-risk populations for COVID-19, long-term care facilities must go the extra mile to protect the health and well-being of residents and the staff members providing their care, according to Paulo Rocha, a sales executive at Miele Professional/USA.

“It’s no surprise the COVID-19 pandemic has increased the demand for hygienic best practices around the globe,” he added.

Hygienic cleanliness is enabled by a combination of several factors that involve the environment, process and handling. Key elements of the laundering process include physical agitation, a chemical or detergent treatment, thermal immersive hot water and a time specification. For textiles that can’t withstand maximum 160° F temperatures or 25-minute duration, chemical/thermal disinfection can be used.

Rocha said today’s washing machines should feature high temperature disinfection programs, which are ideal for long-term care environments.

David Tate, chief strategy officer for Reliant Rehab, says that rehab indeed is becoming more associated with senior living. “It is common for senior living operators to promote the availability of on-site therapy services,” he adds.

“Whether in a small skilled nursing unit, memory care unit or in a dedicated outpatient therapy gym, therapy services are increasingly available to senior living residents,” Tate says. “For senior living communities without dedicated therapy space, an approved therapy facility may offer ‘off-premises’ services in a patient’s room. Home health is another provider commonly offering therapy services to residents of senior living communities.”

Although short-term rehab infrastructure may not be universal in senior living yet, Tate says it is more commonplace to see senior living communities with dedicated therapy gyms that occupy prominent locations and can be accessed by residents and potential residents.

“Short-term rehabilitation provides senior living residents an opportunity to receive therapy services in an ideal environment for restoring optimal functional abilities,” he says. 

Rockland Berg, architect and principal with the Dallas-based architectural firm three, has witnessed the needs-related shift and rehab migration trend over the course of decades. If skilled nursing has owned the rehab component, it is because the facilities have a more clinical focus — and image — than senior living, he says.

“Skilled nursing in the past seemed to be a competitor for the hospital environment, but that fundamentally changed about 10 to 15 years ago as hospitals needed to shed patients as required by new regulations.”

Even so, post-acute care and senior living are evolving in their identities, approaches to care and overall environments and are gaining more influence over public policy, so the migration of rehab into assisted living is a natural result of that evolution, Berg says.

“We’re seeing operators getting more creative with licensing regulators so that they can provide better care in less restrictive environments,” he says.