A: Yes, simply stated, the independent living service offerings of many retirement communities are not totally responsive to today’s complex operating strategies and unmet needs of the resident:

1. Typical community entry age for many independent living residents is 75-plus.
2. Increasing acuity levels are resulting in a higher concentration of need-driven residents actually requiring increased assistance with activities of daily living upon initial entry to independent living communities.
3. There is stronger recognition that the decision influencers (family members and medical practitioners, etc.) likely will play an increasing role in pursuing their respective opinions regarding the optimum living arrangement for residents.
4. Market positioning for independent living must be enhanced and expanded using terms such as “catered” or “enriched” living.

Observation: Operating expenses can be significant. A 150-unit independent living community at 90% occupancy and 25% couples results in approximately 170 residents or 62,000 annual resident-days.

The joint program of McKnight’s Senior Living and McKnight’s Long-Term Care News resulted in more than 300 nominations.

The nurse who rose through the ranks, the entrepreneurs, the corporate stars, the 68-year-old who recently added “volunteer firefighter” to her resume. They, and others, came from coast to coast to be honored.

“It’s an honor to call myself a McKnight’s Rising Star, in addition to be part of the first class,” Berenice Galvez-Soto of HealthPro Heritage said.

“I love that McKnight’s is recognizing women in the industry,” Hall of Honor inductee Crystal Bowens, Ph.D., CB Strategies and Solutions, added.

The night’s celebration drew almost 200 guests. It included cocktails, light refreshments, trophy presentations and plenty of networking opportunities.

PointClickCare was the platinum sponsor of the program, and Simply Connect/Eldermark was the gold sponsor.

For more information about individual inductees, visit
https://www.mcknightsseniorliving.com/tag/women-of-distinction/

Photos by Social Snacks.

In doing so, Verandah wants to be a place where people from the surrounding area will feel comfortable sharing nationality, culture and language in a senior living environment.

The Chicago suburb is home to more than a half-million people who have immigrated from India and other south Asian countries, making it the second-largest concentration in the United States.
“Minorities can feel out of place in traditional communities because they want to feel more at home with people of their culture,” says Anuja Gupta, M.D., principal and managing partner of Aman Living, developer of Verandah Senior Living. “Being a physician, I worked at a hospital, and the owner of a senior living community asked me, ‘Where do south Asian people go (for care in old age)?’ That got me thinking. Where do they go? They don’t go to assisted living, because that is a long-term residence, and south Asians cannot imagine living somewhere without their culture.”

The newly constructed continuing care retirement community broke ground in 2016 and held its grand opening in July. Residences are neighborhood-style, and the campus houses 55 townhomes, 72 condominiums and an 80-bed facility with 68 assisted living units and 12 memory care studios.

The décor includes various facets that Indian people will find familiar, Gupta says, including paintings, fixtures, furnishings, colors and lighting. Ambient music features Indian songs and artists.

“Everything we do is intended to cater to South Asian preferences,” she says.

“Cuisine, activities, engagement and entertainment are all done in a way that would appeal to Indian people,” she adds.

That means meals that are predominantly vegetarian and spiced with curry; activities that include yoga and meditation; Bollywood movies and TV shows; and celebrations of Indian national holidays Diwali (Festival of Light) and Holi (Water Festival).

Mary Cook, whose Chicago-based design firm creates interiors for various congregate housing developments, says ethnically themed communities are becoming more commonplace.

“What we’re finding is that our clients don’t necessarily want to capture a certain aesthetic, but a design that understands their needs and fills them,” Cook says. “For instance, Indian people do not eat cold food, so everything is heated at a high temperature with a lot of oil. That requires over-sized, top-of-the-line cook tops and ventilation. Counters should be non-permeable, appliances should be stainless steel and tile and grout should be resistant to liquids.”

Although new senior living communities all must be designed to accommodate aging residents, catering to certain cultures can mean adhering to particular sensibilities, Cook says.

“There are cultural things to consider, such as feng shui for each room, being aware of certain numbers and close attention to the direction the doors are facing,” she says.

Because Verandah is located amid a high concentration of South Asians, residents have close access to their houses of worship, Indian grocery stores and restaurants, as well as an annual festival that celebrates Indian heritage.

More than 100,000 Indian-origin people live in the Chicago area. More than 2 million Indian-born people reside in the United States.

Prevention and early intervention are the best way to head off potential wounds, rashes, infections, inflammation and other skin disorders and this approach requires only a dose of common sense, along with TLC.

The American Academy of Dermatology has issued a list of guidelines designed to keep residents’ skin healthy, thus maintaining their quality of life.

One of the biggest culprits in dermal disorders is dry, irritated skin. Heat and humidity are prime causes of skin irritation, which can lead to shear and, ultimately, pressure ulcers and wounds. SPF 30+ sunscreen offers protection from the sun’s radioactive rays. Broad-spectrum sunscreen provides protection from both UVA and UVB rays.

Cleansers are effective in keeping skin moist, but antibacterial and deodorant soaps and body washes actually can dry the skin. Warm baths and showers are preferable to hot ones, followed by application of fragrance-free moisturizer.

“Because moisturizer works by trapping water in the skin, it needs to be applied within five minutes of taking a shower or bath,” the AAD recommends.

Sunburn and melasma are two conditions caused by direct sun exposure. Because many senior living communities are located in sunbelt locations and have ample outdoor areas, the risk for sunburn and melasma (gray-brown skin patches) is high — especially in seniors.

The AAD recommends avoiding direct sun and that residents should sit in shaded areas. A wide-brimmed hat, sunglasses, long sleeves and pants should be worn, when possible.

To protect all exposed skin, a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher should be applied.

Apply enough sunscreen to cover all exposed skin. Most adults need about 1 ounce to fully cover the body. Important areas to cover include tops of feet, neck, ears and top of the head. When outdoors, sunscreen should be reapplied every two hours.

Prickly heat, or heat rash, can be a painful condition caused by blocked sweat glands. Because the sweat cannot get out, it builds up under the skin, causing a rash and tiny, itchy bumps. When the bumps burst and release sweat, people typically feel a prickly sensation on the skin.

Tips that dermatologists offer to their patients to help them sweat less and thereby lessen their risk of getting prickly heat:

• Wear lightweight, loose-fitting clothes made of cotton.

• Exercise outdoors during the coolest parts of the day or move the workout indoors where there is air-conditioning.

• Try to keep skin cool by using fans, cool showers and air conditioning, when possible.

“Anything that can be done to stop sweating profusely will help reduce the risk of heat rash,” the AAD advises.

Infections, allergies

Sun and heat can cause various infections, some of which can be serious, especially for older adults. One common summer infection is folliculitis, a bacterial invasion of the hair follicle. When hair follicles get infected, they look like pimples, but are itchy and tender.

The best way to avoid this condition is to change out of sweaty clothes, wear loose-fitting garments and shower. Tubs and whirlpools should be avoided if acid and chlorine levels aren’t known.

“So many people get folliculitis from a hot tub that there is actually a condition called ‘hot tub folliculitis,’” the AAD reports.

It also is possible to acquire a skin infection from a manicure or pedicure. Although these treatments are good for the nails, they also can expose the skin to infections. With proper precautions, these infections can be avoided if the salon staff is properly trained.

Excessive sun exposure also can cause allergies in which hives can develop if a resident takes certain medications or has sun sensitivity. Hives are a painful and itchy skin irritation caused by an allergic reaction to the sun. In serious cases, blisters appear.

To prevent an allergic skin reaction, residents should check their medication containers or consult with their pharmacists to see whether they react to sun exposure.

The best way to avoid this condition is to change out of sweaty clothes, wear loose-fitting garments and shower. Tubs and whirlpools should be avoided if acid and chlorine levels aren’t known.

It also is possible to acquire a skin infection from a manicure or pedicure. Although these treatments are good for the nails, they also can expose the skin to infections. With proper precautions, these infections can be avoided if the salon staff is properly trained.

The messages behind design

Designers sweat over the most seemingly trivial things. Working for clients in senior living care requires that because a lot is at stake, particularly in competitive markets.

It’s easy to understand why sourcing a particular piece of fine art or choosing black walnut over rosewood for the centerpiece coffee table in a commons area is so important.

To these designers, everything from the frames to fabrics is meant to convey a message.

It’s about creating “a positive ecosystem of spaces for residents, staff and visitors,” says Jim McLain, general manager of Construction Specialties.

For example, nature is a common thread in so many new types of senior living settings, achieved in large part through biophilic design. Those biophilic elements combine to evoke a myriad of emotional connections and positive messages, including hope, comfort, warmth, engagement, community, security, independence, active lifestyle and vibrancy. “Thoughtful, creative and alluring spaces that promote emotional connections with good vibes while encouraging both social interaction and strategic areas of retreat instill the notion that change can be positive, bringing forth excitement, empowerment and the confidence of an enriched and meaningful lifestyle,” McLain says.

Without diving too deeply into the lexicon of thoughtful and visionary designers, Dean Maddalena, founder and president of StudioSIX5 (a clever play off the customary retirement age) puts it this way: “We are seeing slightly rounded or eased furniture profiles, soft edges on millwork, and elegant metallics in lighting and design accents that feel modern and sleek, yet warm and inviting. We are also seeing a mixture of organic and softer shapes and simple linear lines with varying widths and depths and having modern, abstract and artful interpretations of natural elements. This design combination supports and promotes relaxation with an active and lively community culture.”

What the lay people see is artistic and refined and luxurious. What they feel is quality, durability and function, McLain adds. This isn’t the stuff for amateurs.

Put differently, “senior care providers are focused on enhancing the lifestyle of their residents while providing safe and healthy environments that contribute to that experience,” says Mark Huxta, director of sales-healthcare for Ecore.

Spend enough time with designers and one can begin to grasp just how these subtle messages – both overt and covert – can influence that oldest daughter’s tie-breaking opinion of where mom or dad’s money will be best spent.

Furnishings can convey such easily discernible messages as higher quality (which to many equates with expensive and rich) and more covert notions as durability (for those residents who are mobility challenged), says Melinda Avila-Torio, an interior designer for THW.

Still, there’s no substitute for the powerful messages conveyed by any elements seniors associate with home.

Nothing has conveyed that message more than the point at which “home” was replaced by the word “community” in describing senior living spaces, says Randy Schellenberg, president of ComforTek.

“The furniture profiles and feel of hospitality and warmth play a major role in the resident’s emotional well-being,” Avila-Torio adds. “The transition from home to a new community is never easy. The element of familiarity, comfortability and positive visual cues are integral to their ease of assimilating in their new surroundings.”

Teri Jablonski, senior living corporate account manager for Inpro Corp., agrees.

“It’s important for furniture and furnishings to be homelike, non-institutional and inviting products that represent; safety, durability, functionality and quality,” Jablonski says.

Key considerations

Here’s a quick look at two key considerations that come into play for ensuring that your community makes the best possible first impression.

Ergonomics. The coming big kahuna of baby boomers in assisted living will be full of robust and healthier-than-usual older adults who prefer to stay that way as long as possible. At the risk of overstatement, ergonomics matters more than ever. Maddalena considers it priority No. 1 when selecting furniture. “It doesn’t get much worse than a potential resident sitting in a chair they can’t get out of,” he says. “The construction of the pieces must be commercial grade because of the excessive wear and tear they receive. The same applies to the fabric and finishes.” Spatial considerations are another consideration, according to Paige Hudgins, an interior designer for THW. “Those in wheelchairs or walkers need to easily maneuver,” she adds.

Durability and cost. One keeps the other in check, says Deanna D’Addario Martinez, CID, IIDA, NCIDQ, principal at Design Implementation Group.

Sudden impact

Jablonski believes it’s the “homey, clean, calming and warm energy” created with the furniture and furnishings that impresses first-time visitors.

McLain asserts that an overall carefully designed and thoughtful environment that conveys “an authentic culture that promotes exploration and discovery and enriches experiences for all stages in life.” No doubt the following features of such an environment likely would leave most visitors quite impressed: wine bistro bars with artisan foods, delis, brew pubs, theaters, bowling alleys and specialty shops and salons as well as walking trails, greenhouses, yoga spaces, grilling and lounging areas, bocce courts and dog parks that encourage social interaction, active living and areas of retreat,” McLain says.

To McLain, the successfully designed senior living community leaves a lasting impression by facilitating emotional connections to the past, present and future. “It’s an artform, but when designed successfully, can appeal to a broad range of current and future residents,” he says.

Savvy owner-operators in highly competitive markets often go to great lengths to achieve it.

Some will borrow from high-end luxury hotels, Avila-Torio says.

The usual targets can be such elements as custom banquette seating, lighting or furniture. “For example, the community center may have a lobby where the ceiling height may be a two-story interior,” she says. “The furniture scale is critical in creating a special feel and wonder of the space.”

Meanwhile, Maddalena believes few things convey “high end” more than artwork, accessories and a few select pieces.

In designing a new independent living community — Allegro Dadeland in Miami — StudioSIX5 “sought to create a luxurious hospitality vibe” through a mix of contemporary and transitional elements, elaborate features and statement pieces, and a curated art collection. One particular piece was at the entry and concierge desk, which incorporated backlit panels placed in front of carefully places sconces.

McLain and Jablonski both are proponents of digitally printed wall coverings that can help create a biophilic design to bring large imagery into the space to create a connection to people, places and ownership branding within facilities all while protecting the building.

“Natural light can add a ‘wow’ factor,” says Chelsea Rolf, interior designer for Medline. “Not only do more windows allow more light to enter, it allows for easier wayfinding along corridors, reduced electricity usage for lighting that may otherwise be turned on during the day, and may even increase the mental and emotional state of the residents,” she adds.

A few words of caution

Avoid outdated motifs and themes, the experts say. Few things set off more silent alarms in a prospective resident’s head than a design effort that got carried away with an obvious fad that had an appeal that faded fast. (One example may be the southwestern motif of the mid-1980s.) “Trends change, so providing timeless pieces that appeal to the masses and can be pushed to the current trend through use of accessories such as pillows, cushions and throws is the way to go,” D’Addario Martinez advises. Adds Avila-Torio, “It becomes more important that the design team also have a sense of how long the proposed palette can carry the community in the upcoming years.”

Don’t get carried away. An overly themed senior living community become stale very quickly, says Joyce Raedel, an interior designer for THW. “It’s best to create good bones for the space, with architectural finishes that can stand the test of time, then built another layer of design, with some features that add an element of surprise and interest.”

Loss of hearing and vision, coupled with a frailer body and some degree of cognitive impairment, can all make aging seniors feel vulnerable, unsafe and in less control of the environment, says Jacquie Brennan, vice president of Vigil Health Solutions.

“Resident safety and security solutions, such as voice-activated call systems and resident monitoring solutions, can provide residents with an easier way to get help when they need it. This makes them feel safer and more at ease,” she says.

Artificial intelligence-powered solutions are available as well, allowing staff to proactively predict negative incidents, such as falls, a week ahead, says Jerry Wilmink, Ph.D., chief business officer for CarePredict. “Armed with this knowledge, caregivers can take the necessary steps like muscle strengthening exercises and other precautionary measures, to avert a possible emergency.”

The adoption of proactive solutions also can ease caregivers and family members’ minds, which offers a host of additional benefits that trickle down to residents. When employees are more satisfied on the job, turnover improves and residents can become more comfortable in their care. Operators can breathe easier by implementing security solutions that let them focus on other tasks but without sacrificing resident safety.

“Operators wear many hats, from caregiver to clinician, to restaurant operator and facility manager. Juggling these priorities while making residents feel cared for is a tremendously hard challenge,” notes Julie Brown, institutional market leader for Johnson Controls, Building Solutions North America.

She says that, among other things, integrated technology can link access control video, visitor management and reporting to provide more protection with less effort. “Facilities that are in control of their operations in all areas have better resident health and experience. This drives up revenues, enabling access to more resources,” Brown says.

Speedier response

Resident safety and security solutions have become far more sophisticated and flexible. Nurse call systems, for example, are adapting to include wireless technologies, such as wearable pendants, so residents can call from any location, says Kaley Davis, marketing coordinator for TekTone Sound & Signal Mfg. Increasingly, solutions also are able to report to smartphones and WiFi-enabled devices, which makes it easier to notify staff, regardless of where they are in the facility.

With mobile app technology, Davis says, staff members even can talk with residents while performing other tasks and contact others for added assistance. “A higher focus on mobility and efficiency will lead to greater resident reassurance and satisfaction,” she says.

More advanced systems provide greater context to incidents and even faster response through meaningful data capture and, in some cases, analytics, adds Martin Rokicki, CEO of Skynet Healthcare Technologies. If a system shows a resident is getting up to go to the bathroom more frequently, for example, caregivers can intervene to determine whether a urinary tract infection or other issue could be to blame, and then initiate prompt treatment — all of which can help keep the resident healthier and more engaged within the community.

Wearables that offer two-way communication are giving residents greater freedom and assurance that help is available at a click of a button on their wrists — and when coupled with radio frequency identification, that eliminates the need to carry access keys to access residence and other key-accessible areas of the facility, Wilmink says. “This is not just a great security feature; it is also a matter of great convenience.”

Sensor-based technology and motion-detecting solutions have gained ground in the senior living segment recently. Often, they can be customized to each resident and can send silent alarms to designated caregivers when a potential incident arises. Sensors and software can track residents’ patterns and behaviors and also analyze them to provide useful care information. Sensor-embedded mats, for example, passively can alert employees whenever a resident who is a fall risk attempts to rise from a chair or bed, but without disrupting the resident’s routines, says Patricia Brunn, general manager for Smart Caregiver. Often, the caregiver is able to appear, seemingly coincidentally in the eyes of the resident, to assist. Experts agree this further lessens residents’ anxiety about caregivers not being there when needed.

It is tucked away among Pacific Northwest greenery, creating a resort-like getaway that is within walking distance of the center of downtown Mercer Island.

A 35-foot-wide waterfall and four-story exterior fireplace anchor the building and create

Editor’s Note: This is a longer version of “A Few Minutes With” from our August 2019 print issue. Subscription is free to those who qualify; sign up here.

Debra A. Cafaro, chairman and CEO of real estate investment trust Ventas Inc. recently spent a few minutes answering questions for McKnight’s Senior Living about the middle market, sustainability and hockey.

What attracted you to areas such as senior living, healthcare and research, and what keeps you attracted to those areas?

Getting to work in a large, highly successful, respected and innovative firm with great colleagues, and partnering with best in class care providers and top researchers who are literally curing cancer is a pretty great career in my book.

The real estate industry captivated me early on in my career, and I am fortunate to have been a part of the emergence of the modern REIT era that boasts the most entrepreneurial, energetic and authentic personalities of any industry.

My vision in 1999 was that demographics would fuel demand for healthcare real estate, that healthcare real estate was large and desirable enough to become an institutionally prized asset class, and that more healthcare real estate should be owned in public hands, because we are the most compelling owners of that real estate. Sitting as the intersection of healthcare and real estate — each nearly 20% of our GDP — made the potential seem limitless. 

That vision has become a reality and is a big reason we’ve delivered over 23% compound annual return to shareholders for 20 years. But the potential is even greater. Today, we are in a needs-based, demographically driven business with a senior population that is undergoing fast and high growth, and it is that future opportunity that continues to attract me.

Within our portfolio, our seniors housing portfolio sees a powerful upside as the 80+ consumer base grows from 12 million today to more than 20 million in 2030. Our medical office and outpatient portfolio plays to the Baby Boomers with more than 10,000 of them turning 65 every day, while our university-focused research and innovation portfolio encompasses those researchers, scientists and entrepreneurs that address chronic conditions and cure diseases.

Through our portfolio of five verticals and in partnering with the best care providers and institutions in the nation, we are an integral part of industries that focus on healing, wellness, care and cures for millions every day. What could be more satisfying?

Everyone in the industry is familiar with the impending “silver wave.” What other trends are you expecting that will affect or shape senior living?

Beyond demographic growth and longevity trends, we will see a continuous increase in awareness and interest in the value proposition of senior housing: a better quality of life that includes socialization and peer-to-peer support, activities and programming, safety and security, hospitality and levels of care that evolve as resident needs change. 

Technology, data and analytics are increasingly sophisticated and more deeply integrated into our business. For example, as the second largest owner of senior housing in the country, Ventas uses a proprietary data analytics ecosystem that consolidates billions of data points from our years of experience, portfolio and operator scale to provide proprietary insights to help us excel.

We also foresee more connectivity of senior housing with payers who focus on lower healthcare costs and better health.

Do you see Ventas becoming more involved in trying to serve the so-called middle market in the future?

With the number of middle-income seniors aged 75+ predicted to double over the next decade to more than 14 million people, there is a large middle market that is attractive and that deserves a quality experience at an accessible price. Ventas already serves that market in a portion of our communities, and we recently acquired a very high quality portfolio in Canada, Le Groupe Maurice, that provides an incredible product at an accessible price.

Our consistent focus remains on private-pay customers and partnering with operators who offer a compelling value proposition to residents through their experience at various levels of acuity and price points. Whenever we see the right combination of value to, and care for, the customer, profitability to the operator and returns to Ventas, we will be active in the market.

Congratulations on the many accolades you have received over the course of your career. What career advice would you have for professionals at earlier stages in their work lives?

Thank you for saying so. It’s been and continues to be a great privilege to lead Ventas.

I’d say to professionals at all levels that you should demonstrate a fierce courage and commitment to validate others’ confidence in you by contributing, learning new things and embracing every challenge that comes your way. Be curious, useful and productive. Be the kind of person others want to work for and with, acting with ethics, integrity and contributing at every turn. At the same time, expect others you work with to earn your trust and respect; and when you decide where you want to work, place a high emphasis on being with those who are excellent and who take a sincere interest in you.

What has been the biggest surprise to you in your career?

I didn’t anticipate how exciting and rewarding building a business and being part of a winning team would be, and how fun it is to watch colleagues flourish and succeed. From Ventas’s very challenging beginnings, the valid opportunity that the company could become a $100 billion enterprise continues to surprise and motivate me every day.

Ventas has been recognized for its sustainability efforts. What do you believe are the most important ways that senior living operators can work to improve sustainability?

At Ventas, we have long been committed to fundamental and meaningful sustainability throughout our business, which means running a business that can be successful through cycles, improving the portfolio’s environmental profile, investing in your employees, seeking diversity and making sure to pursue responsible investments and policies.

We embed sustainability into the way we do business and who we do business with. We believe, and have shown, that sustainability efforts are congruent with delivering outsize shareholder value. 

Some practical recommendations for senior care providers include making capital and technology investments that reduce operating costs, increase business insights and improve environmental impact such as LED lighting and energy controls. We often partner with our senior living care providers on capital for these types of projects. In addition, it is important to emphasize retention and training of employees at all levels of the organization, which can result in better bottom line results, higher employee engagement and an enhanced resident experience.

These commitments take financial strength and focus, and we want our industry operators to achieve and maintain financial stability and success to enable their long-term sustainability goals.

What is the best part of your day?

Having coffee early in the morning and preparing to take on a day that will be challenging, fun and interesting. Every day, I resolve to be and to try my best and to bring out the best in our team. At that point in the day I get to focus forward, knowing I’ll learn something; I’ll enjoy my colleagues and we’ll discuss new opportunities and solve problems; and I’ll get to talk to some of our partners or board members.

This is off topic, but as an owner of the Pittsburgh Penguins hockey team, what do you think of the team for 2019–2020?

Winning the Stanley Cup — and drinking from it — in my first two years of team ownership (2016–2017) were a dream come true. I can’t wait until hockey season starts in the fall, and I know the championship-caliber Pens will give it their all to win a sixth Stanley Cup this year.