A: Yes. Active adult communities are appealing to a new target market segment that can expand the pool of prospects for a community.

As acuity levels continue to rise in independent living and assisted living communities, active adult (age-restricted living arrangements) effectively can expand an operator’s continuum in a market-responsive and financially viable manner. Several distinct advantages exist for considering this strategy, which enables operators to:

1. Provide a sharpened, market-responsive focus to the campus;

2. Appeal to a “younger” older prospect;

3. Provide a “feeder market” to other existing living arrangements;

4. Provide an option for middle-income seniors who cannot afford or do not want a service-enriched environment;

5. Provide an avenue for home healthcare and other supportive services offered on the campus; and

6. Expand operating profit margins.

The active adult concept is growing and being offered in many settings, including apartments, condos, villas, cottages and other single family and multifamily dwellings. It could provide a solution for the classic “I’m not ready for retirement living” sales objection. Operators who choose not to pursue this expansion may miss the boat on developing a relationship with a new consumer audience — before they have the care needs that initiate the consideration for senior housing options.

An abbreviated version of this content appeared in the “You’ve Got Questions? We’ve Got Answers” column in the February print issue.

To that casual observer, record shortages are inexplicable in an industry that boasts a highly enviable job growth rate that’s five times greater than the economy in general.

Over the past decade, 21 million new jobs were created in the field. Yet senior housing and care is crushed by turnover as high as 66% in some places, according to PHI (formerly known as the Paraprofessional Healthcare Institute).

At any given moment, one in four nurse’s aides is actively looking for another job. Why do senior living and care communities have such a difficult time finding and keeping staff?

Some experts blame immigration restrictions and the lethal combination of declining birth and skyrocketing baby boomer retirement rates.

Most say money is the main culprit. And candidates aren’t shy asking for more of it.

It is not uncommon for wage wars to erupt among neighboring communities. “We’ve heard stories where people are raising wages by 25 cents,” OnShift CEO Mark Woodka says. (See related survey findings in Briefs.)

Getting creative

Operators are getting clever in other ways. One community recruiter tossed inscribed footballs into the stands of a high school football game to attract graduating seniors.

Despite efforts by workforce solutions companies to raise awareness, many employers continue making the same mistakes, such as ignoring coveted perks such as flex time and smartphone use.

It turns out that saving money and avoiding debt is an effective turnover antidote, at least for Louisville- KY-based Trilogy Health Services. Employees are staying an average 30 months longer since the company began offering student loan repayment assistance, scholarships and other financial help.

Most savvy senior users of these devices – from smart watches and scales and personal security to phones – can have a coherent conversation about all the bells and whistles yet know practically nothing of the very thing that drives their proliferation: data.

Data are driving not only innovation but also everything from organizational strategy to medical care. 

New discoveries

An engineering executive at one tech company serving older adults and disabled individuals finds it easy to see how data are being used by government, pharmacies and insurance companies to predict health problems and prescribe medication or lifestyle changes. 

One recent study, for example, confirmed that data mined in electronic health record systems now can predict ulcers better than conventional Braden techniques.

Interoperability will continue to be one of the most critical front-burner projects in senior care in the near future.

Some other notable data developments to watch, according to experts:

• Privacy and security protections will be top of mind, says Cynthia Morton, executive vice president for the National Association for the Support of Long Term Care.

• Continued pressure on tech companies to beef up wireless bandwidth, particularly in rural areas, says Majd Alwan, Ph.D., senior vice president of technology and business strategy at LeadingAge and executive director for the LeadingAge Center for Aging Services Technologies. 

• Telehealth will see a resurgence in 2020 thanks to public and private pressures to reduce costs and increase critical access for seniors, Alwan adds. 

• In skilled nursing, ongoing enhancements to intelligence and data analysis will be needed to maximize reimbursement under the Patient Driven Payment Model, says Andrew Carle, an adjunct faculty member at Georgetown University.

By all accounts, it’s a huge and growing task. More than 5 million people are living with Alzheimer’s disease or dementia today, according to the Centers for Disease Control & Prevention. By 2060, the figure is projected to surpass 14 million. For perspective, that’s more people than now live in all but four states.

Among the 30,000 or so senior living communities currently nationwide, most deliver care to adults with cognition deficits. For some firms, such as Silverado, memory care is all they do. More typical are settings where a separate wing or floor caters to those with dementia.

For virtually all services and programs, sparking engagement is key. As to how that is being done, a better question might be this: What’s not being done?

Consider: The organization Laughter on Call matches comedians with dementia and others with Alzheimer’s. The group also offers laughter workshops and live comedy shows at senior living organizations. 

Assisted living operators took an early lead in dementia-related services and programming. In fact, it is one of the reasons skilled care lost so many private-pay residents. But skilled care is getting involved here as well.

HCR ManorCare was one of the first skilled care providers to address this audience by establishing Arden Courts memory care communities more than a quarter century ago. Arden Courts since has provided care to more than 40,000 residents.

At the Pine Ridge Rehabilitation and Nursing Center in Stevensville, MI,  Activity Leader Ronda Holmes now uses the Montessori method of teaching to change the way the nursing center’s residents with dementia interact with their environment. The activities stimulate memories and movements they need in their day-to-day, such as feeding or dressing themselves. Other communities have begun using doll therapy, offering dolls to people living with dementia as a way to improve comfort and engagement. 

As demand for services that drive engagement grows, it’s a safe bet that new options will engage.

Situated on 13 acres, the 186,000-square-foot community has 91 independent living, 44 assisted living and 24 memory care apartments. The property is part of Texas A&M University’s healthcare expansion zone, congruent to the Traditions golf course and the Atlas Lake and Hotel Center.

“This location supports a true resort lifestyle as well as two-way learning experiences for residents and TAMU students,” says Chris Sullivan, principal for New York-based C.C. Sullivan. “The community is expected to attract the interest of retiring faculty and alumni.”

Opened in 2018, Parc at Tradition was designed “with a sense of discovery in mind,” Sullivan says. “The winding entrance drive reveals the building frontage through an unfolding arrival sequence. Framed within the overall natural hill country context, a manicured landscape welcomes guests to a front porch verandah and porte-cochere.”

The lobby is intentionally activated by its close proximity to the spacious living room with a foundational fireplace, which in turn flows into a bar. Both rooms boast scenic views through full-height windows. These spaces lead onto a picturesque porch and event space with a tree-lined backyard.

Integral to the community design are elements that are central to life at the community, including a wellness center, salon, arts studio, media library and lounge.

These spaces also connect to the outdoors and nature through indoor-outdoor shared living areas as well as interior design and architecture styles inspired by the rustic environment, Sullivan says.

‘Trilogy’ of life

Rocky Berg, principal and partner with the Dallas-based architectural firm three, says Parc at Traditions offers a “trilogy” of lifestyle benefits, with its close association to Texas A&M, the golf course “country club” atmosphere and location within the university’s health sciences corridor.

The design is “definitely not cookie cutter,” Berg says.

“The project is unique in that it is carved into the landscape. The expansive soils have a lot of swell and clay, so it required special engineering for the foundation to do structured slabs,” Berg adds.

An eldercare think tank has released a new white paper with practical ideas for person-directed dementia care.

In “Elevating Experience for those Living with Dementia,” the Beryl Institute offers perspectives from experts in the field as well as those living with the condition.

Contributors include Thrive Senior Living’s Chief Experience Officer Tammy Marshall, clinician-researchers and representatives from elder-advocate organizations the Eden Experience and the Pioneer Network.

Opportunities for action are focused on three recommendations:

• Apply a person-directed approach to caregiving and support systems

• Support societal changes aimed at improving the experience for people living with dementia

• Place human rights and personhood at the forefront of care for those living with dementia

Market growth predicted

The global dementia care products market is expected to grow significantly through 2027, according to a new report from Research Nester. Increasing dementia cases and healthcare services are expected to largely fuel the expansion, the report notes.

Call it a virtual partnership

Virtual reality firm MyndVR announced it has signed a partnership with Silverado, a memory care community operator with communities in six states. Under the deal,  Silverado will implement MyndVR’s VR platform in communities across Southern California.

“We are excited to partner with Silverado, leaders in the memory care space who are focused on improving the quality of life for their seniors,” MyndVR co-founder and CEO Chris Brickler said. “Silverado’s mission is directly in line with our core values: to lift the spirits of our seniors and improve their quality of life through immersive technology that provides joy and takes people out of the four walls of their existence.”

Employee turnover is the top workforce challenge in senior living, according to a new survey sponsored by OnShift. Fully 72% of respondents cited this concern as their top workforce-related problem. More than 1,500 people participated in the survey, according to OnShift. 

Nurse aide wage demands increase 

Average hourly wages for aides and caregivers nationally rose to $13.34 and $12,68, respectively, in 2019, according to data compiled by myCNAjobs, which describes itself as the nation’s largest network of caregivers and nurse aides. Results were based on data collected across millions of care workers. The company said the increase was the most significant in nine years.

Kronos enhances workforce management solution suite

Kronos announced new global capabilities, enhancements and product integrations have been added to Workforce Dimensions, the company’s workforce management solution suite. “Intelligent, mobile-first enhancements provide unprecedented levels of usability, flexibility and labor insights that unburden managers and empower employees with new features tailored for industry-specific needs,” a spokesperson said.

LeaderStat celebrates 20-year anniversary

LeaderStat, an interim leadership, executive recruiting and consulting firm, is celebrating its 20th anniversary in 2020. The company was founded in 2000 in Columbus, OH, to provide interim leadership services to the post-acute industry and quickly expanded its service lines to include executive recruitment, consulting and, most recently, placement of advanced practice providers and travel nurses. LeaderStat has three offices and serves clients nationwide.

PointClickCare, a cloud-based software vendor for the senior living and long-term care markets, is aiming to help customers share clinical information with other healthcare providers by adding access to Carequality, an exchange framework that enables interoperable data-sharing among health networks and systems, as part of its base subscription. The company made the announcement during its annual summit in Dallas.

Monitoring, documenting technologies popular among providers

Safety monitoring and electronic documentation lead the list of most widely adopted technologies at the largest not-for-profit multi-site senior living and care organizations in the country, according to the recently released 2019 LeadingAge Ziegler 200.

CarePredict earns CES 2020 Innovation honors 

CarePredict’s Tempo Series 3 for the home, a smart wearable for older adults, was named a CES 2020 Innovation Awards Honoree in the Wearables category, the company announced in mid-January.

The device detects small changes in the daily activity patterns of seniors that can precede falls, malnutrition, depression and urinary tract infections. The CES Innovation Awards program is an annual competition honoring outstanding design and engineering in technology products. 

Electronic Caregiver and Realtime Senior Living partner 

Electronic Caregiver, a Las Cruces, NM-based remote patient monitoring company, has partnered with Realtime Senior Living. Through Realtime Senior Living’s apps, case managers and care coordinators soon will be able to search and direct patients and their families to senior living communities equipped with Electronic Caregiver’s health and safety monitoring devices, Chief Clinical Officer Tim Washburn said.

• With the recent opening of Grove at Canopy, Tallahassee, FL, has a new luxury senior living community. The property, promoted as a high-end resort for seniors, will offer independent and assisted living as well as memory and respite care.

• Presbyterian Village North in Dallas has announced plans for an expansion and renovation project that includes a new residential building featuring 112 one- to two-bedroom apartment homes ranging from 912 to 1,633 square feet. PVN anticipates a spring groundbreaking.

• Construction has begun on a $2.5 million expansion at Commonwealth Senior Living in South Boston, VA. Once completed, the new senior living community will offer 10 two-room apartments to residents.

Mike Ulm recently joined Chicago-based Pathway to Living as vice president of culture and brand loyalty after having consulted with the organization since 2017, helping create its internal brand promise through focus groups and then integrating it in key areas of the organization. He recently spoke with McKnight’s Senior Living about his more than 30 years in senior living.

What attracted you to senior living in the first place, and what keeps you in the industry?

I met my wife in college and then followed her to the Washington, D.C., area, trying to find a job that was associated with my human resource degree. I got a job with a home health agency. I learned a lot about the general idea of the industry and logistics, but I wasn’t hooked. The job only lasted 18 months, and then the agency was sold.

But as fate would have it, the mother of the director of nurses at the agency lived in a nursing home, and that nursing home had just made a commitment to hire a full-time HR person. She opened up the door for me, they interviewed me and I got the job.

My first day there was the first day I had ever stepped into a nursing home. I was scared to death. I was scared of death. I planned to quit.

The full-time chaplain could probably see I was struggling, and he took me aside. He knew from the interview process that I love sports. It was June, so we started talking baseball, and he was so nice. A resident overheard our conversation, and as I went to walk away, she physically grabbed me. She said, “Sit down here, young man.” And then for the next five minutes, she very effectively told me why the Baltimore Orioles were going just beat the daylights out of my New York Yankees.

She had me about 90 seconds in. I just couldn’t believe it. I was enthralled with what she knew at 88 years old. And then at the end, she said, “You know what? You Yankee fans, you’re not so bad. I grew up with one of your better players.” It turned out that she grew up with Babe Ruth.

I went back to my boss and was going on and on about this experience, and she said two things that I’ll never forget. No. 1 was, “She may not have been able to tell that story to someone for decades. It could have been 20 years since she had the opportunity. You created this opportunity for her to tell that story, and she felt good.” And then she said, “We’ve got 199 more residents with stories like that, and that’s what we do.” And I was hooked.

I’ve never left senior housing. That was 35 years ago. I just love what we do for a living. I’ve never even been tempted to go to any other industry.

I still think of her, and when I teach and train, I tell people, “One of the ways to keep yourself going is, don’t forget your ‘hook’ story. Don’t forget that moment where it changed for you.” And if I’m speaking with people who are new to the industry who aren’t hooked yet, I say, “It’s OK, but let’s create an opportunity for you to really fall in love and get hooked in this industry.”

Can you describe the process to develop the internal brand promise that you worked on with Pathway as a consultant?

I had a four-step process. What you’re trying to capture in the essence of any organization with a brand promise is, what is the natural good that’s already there? What are the words that people use enthusiastically, naturally?

And so the discovery process is a series of focus groups with a variety of team members at every level of the company, getting them to think about stories and situations where they feel the best about what they’re doing. And then my role was to facilitate those sessions and just listen, and listen to the natural tendencies and words and focuses that the teams had.

What you get from those focus groups is a lot of words, and you begin to see patterns of intent, patterns of thought. I wrote down the words that keep coming up.

The second step is called define, and it’s pretty much that simple. It’s a statement stated as a promise — what everyone feels is the essence of what we’re really trying to do. 

The third step is to integrate that. So the second year, we took that concept and began to integrate it throughout the organization. Because the brand is really a promise that is uniquely delivered, meaning that you take that promise, and it shows itself uniquely throughout the organization. We integrated it in several key areas.

And then the final step is what I call “activate.” Because the original ideas for the brand promise come from a large group of people, it’s not a rollout. We’re not putting something out there that’s someone else’s idea. It truly was created internally by lots of people. So we call it activation. It’s more than anything a celebration of the stories, the concepts that already were alive. We just all brought it together.

As vice president of culture and brand loyalty, you’ll be helping with the evolution of Pathway’s Viva philosophy. Can you tell me more about Viva?

Viva represents that opportunity to bring celebration and purpose back into the lives of seniors. Every senior navigates seniorhood in his or her own way. What our culture brings is the opportunity to reunite them with the purpose they’ve had in their lives and celebrate and honor their histories and create opportunities for each of them to come back to that person who contributed so much to our society. Viva is our way to explore what our residents still can do and want to do.

What kinds of human resources tools and loyalty programs are you envisioning creating as part of your new role?

The three big areas that I’ll focus on are getting the right people, developing and creating a culture where the right people can thrive, and then helping tell our story. We’ve created an internal brand promise, “Care to Know, and Make it Matter,” that will be the platform that other programs will continue to grow from. It is how we go about business every day, focused on really caring to know the person who is our customer — not just residents but also each other — and then connecting the information we learn to our processes and solutions. My hope is that we continue to expand the influence of the internal brand promise to how we hire.

We want to establish programs that look at getting to know each team member and then partnering and supporting their efforts to thrive at work. The continuation of the piece is then, how do we then take advantage of that culture and that opportunity to help people tell our story, whether it’s getting team members to refer the right team members from a recruitment strategy or having residents who are enjoying our culture tell our story to other people they may know who could take advantage of it as well?

Editor’s Note: An abridged version of this interview appeared in the February 2020 print issue of McKnight’s Senior Living as “A Few Minutes With…”