Having access to robust data sets, including infection rates, symptoms, medication distribution and more will help providers better coordinate care and plan for possible surges, said Steve Herron, Cerner Corp. senior director, long-term and post-acute care. Also required will be tracking, monitoring and demonstrating results, he added. 

Claire Stephens, senior vice president, Post-acute care, American HealthTech, said providers’ requirements for supporting documentation around disease and infection management with COVID-19 will expand across their workflows.

Among the many other COVID-related needs will be additional documentation on staff reporting and tracking across local, state and national levels, Stephens said. This likely will include providing pertinent and useful information on lab results and pharmacy-related data for medications and vaccination reporting.

Some long-term care facilities could expect some compensation for these newfound documentation efforts in the form of grants and financial incentives, but such funding may have strings attached, such as expanded documentation requirements to ensure transparency and reimbursement efforts, Stephens added. Long-term care facilities also will be looking for new tools as well as additional time and resources.

Finally, efforts to achieve data interoperability will accelerate as vendors scramble to make up for lost time.

“NetSmart will be focused on electronic health record integration, making data interoperable and sharing it across other healthcare providers,” said AJ Peterson, vice president and general manager of Netsmart, an IT partner with clients in the post-acute care sector.

Those efforts will, among other things, improve and streamline care coordination referrals and transition-of-care issues.

Q: Aegis Living has 32 communities right now and plans to double in size over the next decade. Did you know how big you wanted the company to grow when you founded it in 1997?

A: I wrote the business plan for this company 24 years ago, when I was looking at the first 20 years. Our first business announcement said we wanted to be 20 to 25 properties in the next 20 years. So, mission accomplished on that.

I’ve always believed that what I call “super regionals” are the companies that will dictate our industry. It’s not the companies that have 500 units, but the companies that have 25 to 75 units [per community] that will dominate our industry, because they’re most in touch with the neighborhoods in which they build, in the clientele, the state licensing, the food, the idiosyncrasies and so on.

I’ve had that belief for 30 years. It’s one of the reasons that I don’t think public companies will ever be successful in our industry.

Q: You’re in three states — California, Nevada and Washington. Do you have any plans right now to grow beyond those three states?

A: Well, I will never say never. We’ve looked at Oregon because it makes sense geographically. But the reality of the situation is, we’re a metro developer. And what I mean by that is, we like to create brand awareness and create operational efficiencies within a metro area.

With things that we have in the works, we’ll probably be close to 30 properties just in Seattle, and we’ll probably go north of that. I could see us having 70 properties, with half of those being in Seattle and half of those being in California.

What we often overlook is the fact that California is not really a state. It’s more like a country. It’s got a top-five gross domestic product. It’s essentially the size of Spain. So you can do lots and lots of stuff in that state. Between California and Washington, there are north of 50 million people. It’s one-sixth of the country.

So we essentially have a lot of growth in very fertile metro markets that we feel good about.

Q: What have you found to be the keys to choosing your next location, and then the one after that?’

A: We’re very focused in terms of our demographic profile, site location, what the neighborhoods need to look like, proximity to certain retail and so on. So there’s not one answer to that question.

I recently was in San Francisco, Oakland and Santa Cruz, and we looked at nine sites. We look at a lot of things a lot of people look at. We look at average household income and average house value, because those are indicators of wealth. We look at the density of the senior population, because that proves the depth of market.

And then we’ll look at rates that “like kind” — and I put the emphasis on “like kind” — providers are getting in terms of, are they getting a community fee? If so, how much? What is the rate? What are they charging for Alzheimer’s units? And so on.

We look at the drive-by possibility, because almost 50% of our clientele come through driving past the site and looking at it and having a curiosity about it. So drive-by is a big factor for us. We look at proximity to medical facilities.

But we also look at proximity to retail factors that are emblematic of our clientele demographics. For instance, Nordstrom is a great anchor. They have a propensity of wealthy middle-aged women who go there. So if a Nordstrom is doing well within three to five miles, that’s an indicator that our property would probably do well there as well. And we have other retail stores that we look for.

Q: How do you know when it’s the right time to expand the number of properties?

A: A variety of factors go into that decision. You have to have the bandwidth in terms of your staff, equity, debt financing and the market. You don’t try to grow if you’re not doing well with the properties you have right now. I say that, but a lot of operators I know have done that, and that’s why they haven’t had tremendous success.

But if you look at the market as a whole, we’re headed for this “hockey stick” growth that is quite compelling. The first baby boomer will be 80 years old in 2026, and that trend, that aging, will continue for 18 years. Everyone who is in our market is looking at that trend. We’re looking for areas that are underserved markets.

I’ve talked to some people in our industry and researchers and analysis who have said, “In five or six years, people will have to be put on a wait list two years in advance to get into assisted living.” We see that kind of demand happening. We’re not supplying units fast enough for the growth of the demographic.

Q: What kind of “growing pains” type of lessons have you learned over the years as you’ve expanded?

A: You’re not in business for 23 years unless you have growing pains. The important thing is that they not be catastrophic, and we have not had catastrophic growing pains.

We’ve had buildings that have filled more slowly than we projected them to fill, but they eventually filled. We’ve had places where we’ve gotten rent that has been less than we thought it would be, but we eventually got the rents that we planned. A couple of years ago, we built in a market that we thought was one of the best markets in the country. At the exact same time that we built, two other buildings were being built, and another older building went through a complete remodel. So the absorption scenario ramped up. So when our 100-and-some units came on, the building filled more slowly. That wasn’t indicative that the market was bad. What that was indicative of was that the market just swallowed 200 extra units, plus there was a renewed appetite for the building that was being remodeled.

You have things like that happen, but I think we’re pretty sophisticated, and I’ve been involved in about 230 or 240 properties. At some point, it becomes both science and art, but you get pretty good at making sure you’re on the right site at the right time with the right demographic and the right performance.

Q: You recently added to your board of managers in advance of a plan to deliver more health and wellness services. Could talk about how your newest member rounds out the board compared with other skills that already are represented on your board?

A: Nader Naini is one of the smartest guys I know. He’s a very close friend of mine that I met through YPO, the Young Presidents Organization, and he’s also my neighbor. So I know a lot of things about him in terms of his character, his business dealings and his capacity. I’m also impressed that he’s done more healthcare deals than probably anyone I know in terms of having funds, raising capital and doing various ventures in the healthcare space.

We’re a company that wants to grow, and Nader has the capacity to help us be creative about where we grow. We may at some point acquire a company. He would be very helpful in that regard. So that’s a skill that we find very refreshing. We will continue to grow our board and bring on people who represent things that we think are strategic to our growth.

Editor’s Note: This article appeared as an “Executive Decisions” titled “Smart Growth,” in the April 2020 issue of McKnight’s Senior Living. See the print version here.

See part two of the interview, about Aegis Living’s plans for personalized medicine, here.

A: Yes. You can obtain very valuable information to help make your community more competitive in the marketplace.

The information gathered during a mystery shop of your local competitors can result in obtaining a variety of data that can be useful in making your community more desirable. For example, once a mystery shop is completed for your area competitors, you can compare and measure the following types of information:

1) services offered that are included and not included in the monthly service fee,

2) the types of living arrangements offered,

3) current rates and possible “special offers,”

4) special events and other promotions,

5) quality of marketing collaterals,

6) renovations or additions to competitive communities and

7) the competitive community’s overall marketing and sales process (from first encounter
to trying to close a sale).

You also can mystery shop your own community or your portfolio of properties. That’s because what is relevant for expanding the understanding of your competitors also will help you sharpen your internal operation.

McKnight’s 2020 Workforce Development Guide PDF

McKnight’s 2020 Workforce Development Guide Digital Edition

Click on either of the links above to view these articles and additional information:

• Attracting and keeping talent today requires a multifaceted approach
• Wages, unfilled job openings rise in expanding assisted living sector
• The hottest jobs in senior living today
• Tapping into the millennial mindset
• ‘I hate my job!’ Tips to prevent burnout
• Want to hire me? Show me the money
• Wages for SNF administrators, DONs show strength in tight labor market

The company will ensure sick pay for all full- and part-time employees for up to 21 work days if they have a confirmed case of COVID-19 or are asked not to come to work for COVID-19 related symptoms. Vacation time and other paid time off will not have to be used during any COVID-19 related absences.

“Sodexo is committed to the health and safety of our employees, our clients and the communities we serve, and that includes supporting our employees where we can if they get sick as they service our clients,” Sodexo USA President Sarosh Mistry said. “As the service industry deals with the business implications of COVID-19, it’s just as important that we look at the human impact of our work as it is that we look at the bottom line.”

After employees exhaust their accrued sick leave, Sodexo will provide additional sick leave for up to 21 regularly scheduled workdays at no cost to the employee and regardless of how many sick days the employee has accrued. If the employee is unable to return to work at that point, then he or she will be permitted to borrow up to seven additional days of sick leave.

The Families First Coronavirus Response Act, signed into law March 18 in response to the coronavirus, requires most employers to guarantee paid sick leave for 14 days at at least two-thirds of employees’ regular pay rates. Workers qualify if they are sick and have to be quarantined or treated, or if they need to care for an infected family member or a child whose childcare setting closes.

Sodexo announced its policy, which exceeds the requirement, on the same day.

Researchers who previously have studied the role paid sick leave has in stopping a contagious virus urged the government and more employers to act.

“Those who lack paid sick leave are highly represented among food service workers, day care workers and home health aides, who work in positions that can greatly influence the health of others, especially the elderly, vulnerably ill, and children,” said LeaAnne DeRigne, Ph.D., an associate professor at Florida Atlantic University.

FOOD SERVICES BRIEFS:

Aramark will continue to serve customers

Foodservice firm Aramark will continue to serve senior living firms and other customers during the COVID-19 pandemic, the company announced.

“We recognize that in this fast-moving environment, it is appropriate to be in more frequent communication with our stakeholders, and this communication is a first step in that direction,” CEO John Zillmer said. The firm operates in 18 countries, with the largest presence in Canada, Chile, China, Germany, Ireland and the United Kingdom.

Sysco to donate 2.5 million meals

Sysco will donate 2.5 million meals over 30 days as part of its community response strategy to the COVID-19 pandemic, the company announced.

“The COVID-19 virus has impacted all of us — our associates, customers, suppliers and communities — in unprecedented ways. Issues related to food accessibility and increasing food insecurity of our most vulnerable populations are adding to the unease in our communities,” Sysco President and CEO Kevin Hourican said.

Compass Group named top food company

Food Management named Compass Group North America, a unit of Compass Group, the top company in its Top 50 Contract Management Companies for 2020 report, an annual company-by-company assessment and two-year performance comparison of the largest contract management firms. The publication ranks large-scale foodservice companies based on revenue for fiscal or calendar year 2019. Compass Group North America is the parent company of Unidine.

Direct Supply unveils revamped center

Direct Supply recently unveiled the completion of a $14 million renovation of its Innovation & Technology Center on the Milwaukee School of Engineering campus. The center occupies the entire 55,000-square-foot building. Direct Sup- ply opened the ITC in 2012.

The result has been increased rates of adverse drug events. These events run the gamut from dizziness and falls to delirium, heart attack, stroke and even death.

Medication overload is especially prevalent in senior living settings, because residents tend to be older and frailer, with multiple chronic conditions.

Governments, organizations and individual facilities all have taken actions to reduce harm from adverse drug events in assisted living communities and nursing homes. Institutions and policymakers, however, still could do more to ensure that residents are not burdened by over-medication.

Here are a few recommendations for reducing medication overload, from the recently released report, “Eliminating Medication Overload: A National Action Plan”:

Recognize potential medication harms. The first step toward reducing medication overload is recognizing the harm that medications can cause for elderly and frail individuals. Administrators and clinicians all should be aware that certain medications — such as antipsychotics, blood thinners, anti-seizure meds and diuretics — are especially dangerous.

Implement regular prescription checkups. Prescription checkups are visits where the patient (and family member or caregiver) review all their medications with their primary care provider and identify unnecessary or potentially harmful meds that can be safely deprescribed (discontinued or reduced in dose).

Raise awareness of medication overload among residents and family. Residents and family members / caregivers may not be aware of the potential harms of taking multiple medications for very old and frail individuals. Even those who have concerns about the number of medications they or their loved one is taking may not feel comfortable bringing up the subject with their care team. Family members and caregivers often are the first to recognize drug side effects, so they should be empowered to start conversations with the care team about medications.

MEDICATION MANAGEMENT BRIEFS:

Drug treatment added to osteoporosis guidelines

The drug romosozumab (Evenity, Amgen) has been added to the Endocrine Society’s official guidelines for management of severe osteoporosis in women, the organization reported. Patients with heart conditions are not good candidates for the therapy, however.

“Romosozumab offers promising results for postmenopausal women with severe osteoporosis or who have a history of fractures,” wrote Dolores Shoback, M.D., from the San Francisco Veterans Affairs Medical Center, and colleagues. “It does, however, come with a risk of heart disease, so clinicians need to be careful when selecting patients for this therapy.”

Continue hypertension drugs despite COVID-19: ESC

The European Society of Cardiology is recommending that physicians urge their patients to continue high blood pressure medications, even though a study suggested that those medications could increase the risk of COVID-19.

Connected Living app adds coronavirus information

Thirteen-year-old Quincy, MA-based technology solution company Connected Living is updating its free public app to provide real-time updates about coronavirus disease 2019 (COVID-19) to senior living staff members, residents and families. Connected Living’s app, available on iOS and Android platforms, functions as a communication hub for senior living residents and their families, allowing them to share information on a private social feed, along with their location and activities, as well as access a concierge.

Drug information available on Alexa-enabled devices

Amazon’s Alexa and other so-called virtual assistants increasingly are used by senior living residents either on their own or as technology integrated into other systems used at their communities. Now, through a partnership with First Databank, residents and others will be able to access drug information through Alexa queries.

VR is getting a lot of attention these days at LeadingAge, which has a Center for Aging Services Technology team constantly immersed in all things tech.

“I’m seeing more and more aging service providers intrigued and interested in learning more about virtual reality and the different applications in our space,” CAST Senior Director Scott Code says. He is most excited with VR’s potential for shared experiences among small groups of seniors.

Brian Geyser, vice president of clinical innovation and population health for Maplewood Senior Living, marvels at the kinds of connections VR gives residents as they don the somewhat clunky headsets with gaping smiles heads bobbing up, down and sideways while virtually visiting landmarks and childhood neighborhoods.

Among VR’s greatest promise is memory care. “For people with cognitive impairment or dementia, they have memories often locked deep inside their brains that they can’t access and one way to access those memories is through reminiscence therapy,” Geyser remarks during a YouTube video produced by Mashable, a multi-platform media company.

Adds Emily Rampmaier, vice president of clinical services for Reliant Rehabilitation, “Virtual reality is an engaging concept that can target physical functionality goals and cognitive goals.”

Other promising uses:

• Education and sensitivity training.

• Overcoming profound isolation. AARP, for example, has developed Acove, a VR app, to rekindle family and social connections

• Rehab. Over the years, VR has shown a great deal of promise in restoring mobility in Parkinson’s and stroke patients, and as a May 2018 article in the journal Neurology showed, conclusive improvements in the gait and balance in neurologic patients, especially when combined with conventional therapy.

• Pain management. Researchers have already found convincing ways of using VR as a powerful drug-free tool for burn patients.

FOCUS ON TECHNOLOGY BRIEFS:

Ocutrx Vision Technologies promotes AR

A California-based technology startup has developed an augmented reality headset meant to help patients cope with macular degeneration. Michael Freeman, COO of Ocutrx Vision Technologies, presented the products and discussed how wearable devices, smartphones and artificial intelligence are changing healthcare at the Medical Design & Manufacturing West Conference in mid-February.

Jintronix releases group therapy program

Jintronix, a developer of rehabilitation technology, recently released an interactive person-centered group therapy program designed to support skilled nursing providers in their transition to the Patient Driven Payment Model. Jintronix Group Therapy is offered as part of a comprehensive virtual rehabilitation system.

John Knox Village partners with MyndVR, cutting-edge virtual reality solutions

South Florida life plan community John Knox Village says it will be working with MyndVR, a provider of virtual reality solutions for senior living communities, to provide residents with new means of engagement to support “compassionate, empathetic interactions with staff, as well as a resource for holistic interventions.”

MatrixCare’s Pederson lauds tech’s impact

Technology increasingly is being used help residents manage chronic conditions while leading healthier lives, according to Gary Pederson, MatrixCare’s executive vice president of Connected Health & Wellness. Pederson spoke March 24 during a webinar by sister media brand McKnight’s Long-Term Care News.

CPSI offering free COVID-19 toolkit

CPSI announced that clients can receive COVID-19 Toolkits at no charge. The CPSI COVID-19 Toolkit provides current coronavirus information, as well as additional for dealing with the pandemic.

The coronavirus situation is changing rapidly, but National Investment Center for Seniors Housing and Care Chief Economist Beth Burnham Mace recently spent some quality social distancing time on the telephone with McKnight’s Senior Living to share her insights on where things stand and where they might be headed.

2020 started out relatively well for senior living. How has the coronavirus affected things?

In terms of areas of impact, I’ve spent a lot of time thinking about this, and I think there are six interconnected areas of industry impact, although that might change over time.

The first impact involves the residents and healthcare workers. That is safety and staffing issues and what operators are doing to provide staffing. A lot of operators are building contingency plans — for instance, how much staff would have to be replaced if they got sick? This area also involves all of the different cleaning protocols and contact intervention protocols and limitations on visits.

The second area of impact is operations — what impact is COVID-19 having on move-in and move-out rates, occupancy patterns and construction development plans. There’s a lot of speculation and hearsay right now about what’s going on. Toward that end, NIC is creating a new survey tool that we’ll be sending out to operators to try to gauge what’s going on.

The third is simply a broad economic impact, on confidence levels, on people’s willingness and ability to move. In my view, we are in a recession, and we’re likely to go deeper into recession in the second quarter. We know from experiences in the past that the economy does have an impact on demand and on supply conditions.

In a period of slowdown in the economy, there are two effects on consumer behavior. One is their confidence, and a second would be their means. The two go hand-in-hand, and for a lot of individuals, that’s not going to be the case for a while.

In the last downturn in 2008-2009, we saw that senior housing was recession-resilient, not necessarily recession-resistant. We saw a loss of occupancy more so in independent living than in assisted living because of the need-based component of assisted living. We didn’t see any decline in actual rents. And from an investor return point, there was some decline, but it wasn’t nearly as severe as it was for the other property types. So now we’ll have to wait to see what the impact of this recession will be on the senior housing sector. This is unprecedented in terms of the impact on consumers, the retail sector and the manufacturing sector. Our world is globally interconnected, and what happens in one part of the world does, in fact, affect us in the rest of the world through the linkages that we’ve created.

The fourth impact is the financial markets. Credit really makes the economy spin. Without credit, the economy would grind to a halt, and this is a big concern for the Federal Reserve and for monetary policy. In the past few weeks, the Federal Reserve has been trying to keep the credit markets open and functioning. This translates into how banks are responding to this crisis, and that translates into the cost of capital and how much financing is going to be available to finance senior housing deals.

The fifth area is transactions and pricing. We’re starting to see a slowdown in transaction activity, and part of the reason for that is that we simply don’t have people who can go out and do the walk-around tours that you need to do evaluations. We need some type of transparency in the world of buying and selling any kind of real estate. There’s less transparency in terms of what the pricing is, so that that’s having an impact on that market.

And the sixth area is construction. In senior housing, the delivery pipeline has been pretty intense in certain markets, such as Atlanta, for quite a long time. The COVID-19 pandemic is going to affect that. Cities like San Francisco and Boston have mandated that all nonessential commercial real estate construction cease for the immediate future. Because of cutbacks in who can be working and who can’t be working, there’s going to be an issue in terms of government workers being able to provide a permit for the inspection processes. And we also know that supply chain disruption translates into higher pricing for a lot of materials, and that’s going to create cost overruns and another set of challenges for developers and operators and investors.

What can we learn from the past?

We will get through this, and then the question becomes what the recovery will be like, whenever that happens.

The way a lot of people think about that is as the shape of different letters. The V shape, the W, the L and the U. And all of those portend different ways of improvement in the economy. With the V, we go down hard and deep, but we come back up fairly quickly. The W would be like what we saw in the early 1980s; we had a recovery, but it wasn’t huge, and then it went down again and then back up. That was the shape during the Great Depression, too. There was a series of ups and downs, like a W or maybe a double W. The U is sort of a slow recovery. The last recovery from the most recent recession was probably an elongated U. It came down, but it was flat for a long time and then it came up, but kind of gradually. And then the L goes down and stays down for a long time.

It’s hard to know what will happen, but we’re all wishing for a good letter.

This interview will appear in McKnight’s Senior Living’s April print magazine. To subscribe, visit https://www.mcknightsseniorliving.com/mcknights-senior-living-subscription/