2019 McKnight’s Women of Distinction Hall of Honor inductee Stephanie Harris, CEO and principal of Arrow Senior Living, recently sat down with McKnight’s Senior Livingto discuss the growing role of technology in senior living, the lasting effects of mentorship, and the best part of her day.

Q: How do you see the role of technology growing over the next 10 years?

A: I think it’s all going to be about affordability.

So much of the industry has been built around growing rates to cover the inflationary costs, the impacts of higher salaries, the ups and downs of the economy and the impact it has on our prices. But we can’t continue to see that climb of rates that were once covering our margins.

I think one of the things that we’re going to see over the next 10 years will be some introductions of different systems of technology to reduce our reliance upon workforce. We are so exposed to this healthcare worker shortage in our country that if we don’t find new ways to reduce our reliance, to be able to use different methods that are going to allow for more efficient delivery of medications or more efficient delivery of care, it’s just going to continue to stack, staffing on top of staffing on top of staffing. Plus our acuity problem.

I think technology is going to be key at helping us drive down our costs, helping us to increase our length of stay, lower our reliance upon employees. I think we are just on the cutting edge of what that’s going to do to our industry over the next 10 years.

Q: Can you talk about a mentor who has been important to your career?

A: I had the most incredible mentor, a gentleman named Paul Karseras. He passed away a few years ago, but the thing that I had was a coach. He wasn’t even just a mentor. This was somebody who had built companies that had gone public in this industry, and the fact that he came out of retirement — I was in my early 20s, fresh out of law school, fresh passing the bar — and he said, “We’re going to make something happen here.” And it’s incredible to think that I went from a consulting business to a management company to the growth of adding 1,000+ employees, and I think it was all because of somebody like him taking the time and giving me that coaching moment I needed each day or when I needed that extra bit of advice.

Nobody taught me how to be CEO. I had to learn through some sort of informal system or some informal group of mentors like him.

Many of our core values of the company come from our mentor, Paul. Every single year on the anniversary of his death, our company has a Wednesday “all call” called the “bull’s-eye all call,” and we focus on a business development topic that we journal. Many topics are based upon him, but every year, we take a moment to celebrate somebody who really has helped pave the future of this company and the successes we’ve built today.

Q: What is the best part of your day?

A: The best part of my day is engaging with the sales teams and my staff. Nearly every morning, I will hop into one sales team or another, through videoconferencing, and do a case study, where we actually talk about sales prospects.

I may be CEO of our company, which has grown tremendously over the last couple of years … but my heart and soul is still in the sales and marketing and being able to engage with the sales teams.

Marrying attractive, timeless and appropriate furnishings with durability, comfort and flexibility is essential in any senior living environment. Operators must serve residents of varying needs, and their furnishings should reflect that — and be able to continue meeting residents’ needs as they evolve, experts say.

“Furnishings set the tone and ambience of the facility. Residents and their loved ones are evaluating communities with great scrutiny and are deciding a path to take that most resembles a home that feels right to them,” says Don Toner Jr., sales manager at SpaceTables. Selecting a senior living community is a big decision, and families will be evaluating transitions, flooring and furnishings to ensure their loved ones will be living in a safe, comfortable environment.

Fortunately, more operators understand that the functional abilities of seniors are declining, and they are striving to create safe, functional communities that still appeal to the sense of “home” that residents and their loved ones seek. “An integral part of the process and facilitating more understanding are designers and builders that are focused on senior living communities. They are making great strides and creating an inclusive environment,” Toner notes.

Value purchasing

One all-too-common misstep operators make when evaluating and purchasing furnishings is basing the decision solely on cost and initial appearance instead of quality, performance and long-term value. 

Although price is important, Kevin Swanson, senior interior designer for Columbia Pacific Advisors, stresses “there are times in our industry where the saying, ‘You get what you pay for,’ is quite true,” and furnishings are a prime example.

Furnishings should be able to withstand everyday use, be easy to clean and care for, and be crafted in a way that is suitable for the environment in which it is being placed, says Chelsea Rolf, an interior designer for Medline Industries. 

Some operators make the mistake of buying directly from a retail store’s showroom. Although retail furnishings may be eye-catching, they seldom are commercial grade and likely will not feature proper moisture protection and durability needed in the senior living environment, says David Sullivan, senior living business manager at Flexsteel Industries. 

When it comes to furniture coverings, for example, he says a perfect scenario is having them wear out before the construction fails. Desirable manufacturers of commercial-grade furnishings also will stand behind their products with a proven track record and an above-average warranty period.

For high-performance liquid barrier protection and enhanced cleanability, Rolf recommends furnishings with healthcare-grade Crypton fabrics or vinyl. Crypton offers a built-in moisture barrier, and most are antimicrobial, which can help address incontinence issues and improve infection prevention efforts, she says.

For dining rooms, experts recommend resin-based or attractive metal furnishings over wood, because wheelchairs can scratch or otherwise damage wooden legs and frames. “There are some very nice resin-based or metal faux wood [furnishings] that have the essence of classic pieces but are more durable,” says Julia Bailey, NCIDQ, LEED GA, an interior designer for OZ Architecture’s senior living team in Colorado. 

Tables with adjustable-height bases also are available to more easily accommodate wheelchairs and scooters, Toner adds. Beyond that, Sullivan reminds that many senior care-specific furnishings offer a “clean-out design” that allows food crumbs, liquids and other debris to drop to the floor for easy cleanup. 

Instead of sharp corners, all tables used in senior living settings ideally will have bullnose edges for added safety, according to Bailey — and she says operators should pass on bench or banquet seating in memory care and some assisted living areas.

Balance the scales 

Comfort and safety should be viewed in tandem when selecting furnishings, and that begins with ensuring that pieces are dimensionally appropriate. A too-deep, too-high or too-soft chair, loveseat or sofa will be neither comfortable nor safe for older adults.

“Without having the proper dimensions and seat foam density, a resident would need assistance getting in and out of the seating, and that defeats the purpose of ideal upholstered furnishings,” notes Mike Mickey, sales manager for Flexsteel Industries.

Eighteen- to 21-inch seat height is preferred, and seating depth will vary according to furniture type, Bailey notes. Seat depth for lounge pieces in senior living environment typically will fall in the mid-20-inch range, whereas dining room seating will be shallower, around 18 to 20 inches.

Operators also should opt for furnishings with arms. Rolf recommends arms on seating that extend to the end of the seat, to serve as sturdy support when a resident takes a seat or rises from the seated position. 

Furnishings also should be flexible, ideally allowing them to serve a dual purpose to maximize a community’s existing space. Seating that can be moved easily from one area to another is ideal, and game tables that also can be used for casual dining, for example, can create a more usable and home-like space. When designing interiors, Bailey often uses 42-inch square tables that can be pushed together to create a larger table. 

Rolf recommends smaller seating groups over expansive lounge spaces that don’t allow for intimate gatherings or easy conversation among residents. Chairs and loveseats are preferred, because sofa length can make conversation more difficult — and residents rarely sit three to a seat, she reasons.

Café- and pub-style furnishings also can serve multiple purposes. Bailey likes them in lounge or reception areas because they are attractive and allow residents to play cards or visit with friends while they wait for loved ones or a ride. 

For communities with limited space, creative division of larger common areas also can encourage greater resident use, without the need to add on or permanently reconfigure larger rooms into smaller ones for specific purposes. “Nobody is a money tree, and nothing is as constant as change,” says Rich Mass, vice president of Screenflex. Moveable wall partitions can divide rooms quickly and easily, reduce noise and display materials, allowing operators to convert dining rooms, lounges and other common areas into different spaces. 

“Some residents may not want to play games, but may want to watch television, read or visit instead. Dividers that are sound-absorbing and create a physical [barrier between activities] makes spaces more comfortable and usable.” Vinyl versions in various colors are easy to clean, and an antimicrobial coating can be applied to fabric-covered dividers.  

Bright ideas in lighting

Lighting is another aspect of interior design that never should be overlooked, and it’s especially important in senior living environments because most residents have some degree of vision impairment. Greater lighting helps reduce falls and allows seniors to easily see flooring transitions, such as when moving from a hard surface to a carpeted area, Rolf explains. 

“Lights should not be glaring, but evenly distributed and ambient style. As seniors age, their lenses in their eyes change at a greater rate, and most colors become more muted or have a hint of yellow.” Evenly distributed light creates fewer shadows and improves visibility as residents move throughout the facility, she says. 

The right lighting also can improve residents’ sleep and wake cycles. Lighting science has shown that seniors exposed to the wrong type of light at the wrong time of day will not sleep as well as those exposed to circadian lighting solutions that broadcast blue-enriched light at proper levels and effectively remove almost all blue-enriched light at night, notes Jeffrey Spilfogel, director of business development for Healthe Lighting. Regulating sleep and wake cycles also can “aid in the uptake of medication [and] improve overall well-being. [Circadian lighting also may] decrease dementia and Alzheimer’s symptoms and slow the onset of the disease.” 

With the right approach, however, procedures and bathing options, the process doesn’t have to be a stressful one, experts in the field say.

Len Sears, director of sales for ProCare Medical, says a high degree of safety has been part of the bathing procedure infrastructure in the skilled nursing sector for years and should serve as a blueprint for senior living operators.

For instance, skilled nursing facilities are required to evaluate a resident’s physical and mental ability on admission, which determines how care should be administered and which aids to daily living assistance are required. This evaluation includes risk assessments for falls and flight. As a result, there are different types of equipment specifically geared for individuals based on their abilities.

“A good analogy involves cars — different vehicles are designed for different tasks, such as pickup trucks and minivans,” Sears says. “You cannot properly maintain a car without the right tools, and different cars require different tools. The same can said for care of the elderly, as you cannot buy one lift that is appropriate for everybody. The challenge for residents is accepting the fact they need assistance, and for operators it is providing resident-centric equipment for that assistance.”

New requirements of participation in long-term care mandate a focus on the individual, and the “inevitable migration” of these rules to senior living means that operators also must provide this focus on individual need, Sears says. A major part of this focus, he adds, is handling each resident’s transition to higher acuity of care, which mitigates the stress of moving.

Resident transport is a key part of the bathing safety process, and residents always should be transported by wheelchair, says Matt Jante, product manager for healthcare equipment and textiles at Direct Supply.

“For dignity purposes, it is highly recommended that residents be moved fully clothed or in a robe,” he says. “That way, the resident can undress in privacy instead of being moved around half-clothed. This makes the whole bathing experience a much more dignified routine.”

Sears contends the situation differs based on the individual’s abilities and that senior living residents usually aren’t as dependent as those in skilled nursing. Still, he says it is a natural trait to deny the onset of physical limitations and that caregivers need to be compassionate and gently persuasive in assisting each resident.

“For safety purposes, it’s important to show that we care and have their best interests at heart, and for those reasons, we need them to work with us during their transition in life,” he says. “There is no shame in that. But allowing them to think they are still capable of living like they used to, when it’s evident they can’t, is problematic and dangerous. Hip fractures from falls are still too common and can be avoided with proper care and practice.”

Safety and comfort

The bathing suite can be fraught with dangers if routine safety checks are not made constantly, Jante says.

“Areas that need specific inspection include the floors for slip-and-fall hazards,” he adds. “Areas where water collects and does not drain are incredibly dangerous. Tubs should be cleaned and sterilized routinely based on manufacturer directions to prevent the spread of infection throughout the facility.”

Sears offers a safety checklist for the bathing suite that includes ensuring that grab bars are secure, no loose materials or debris are on the floor, installing slip-resistant strips on the floor and checking them regularly, maintaining a proper working space with a caregiver always present, ensuring the emergency call is working properly, and cleaning tubs and showers after every use.

Space utilization in the bathing suite is a key safety and comfort factor, especially for swing-out, step-in tubs, Sears says.

“Try to have the tub centered on a wall and not in a corner,” he says. “This allows the door to fully open for access. There should also be adequate space around the tub for the caregiver, for a wheelchair and for a lift, with proper doorway width for entrance to the room.”

If space is an issue, then Sears recommends a tub with a door that swings inside the tub.

“However, these tubs should only be used for residents who are ambulatory or need minimal assistance, which reduces their versatility with a diversified population,” he says.

Atmosphere and ambience are critical ingredients for creating a pleasant, comfortable bathing atmosphere and can be achieved multiple ways: soft colors in the room, plants, artwork, lighting in the water and various media.

“Media can provide soothing music through a Bluetooth or plug-in device, for example, or a TV to watch their favorite shows,” Sears says. “These features can be achieved with all types of tubs.”

Tubs versus showers

When it comes to which bathing method is most suitable, opinions are split about whether communal tubs or private showers offer the best resident experience.

Overall, the move toward a “wellness” atmosphere similar to a resort has gained strength in senior living and should become more popular in the future, Jante says.

“This evolution started with shower chairs, which now offer tilt-in-space for added comfort and is a trend we are seeing in senior living communities,” he says. “Creating an environment that not only is meant for hygiene but also for overall health improvement should continue to grow.”

Market observers see a shift away from bath tubs in a communal setting in favor of in-room private shower units.

“In the senior living market, the definitive trend is towards accessible roll-in showers in each room, accompanied by pull-down bath benches or stand-alone showering stand or chair,” Sears says. “These shower stalls are supported by properly located grab bars. Most communities have central areas for individuals wanting to immerse in water, but it should be noted the trend towards showering could be viewed as behavioral, because many people grew up taking showers. Yet others grew up taking baths, so it is still up to individual preference.”

Tubs inherently are designed to accommodate different levels of physical ability. But aesthetics also play a role — a tub designed for higher-acuity residents may have an institutional look that a senior living community is trying to avoid.

Ultimately, senior living operators need to consider the various tub models — standard, walk-in, swing-out or swing-in styles — and determine the options that fit the acuity levels and preferences of residents.

Tub manufacturer Lee Penner acknowledges the trend but maintains that bathing in a tub is a superior hygiene experience.

“Residents need more than just a shower,” he says. “In a shower, the water hits the body and runs off. It gets you somewhat clean. But in a spa tub, the cavitation of the bubbles creates a vacuum and pulls dead skin and dirt away from the body. This isn’t just a claim — it is a scientifically proven fact.”

Future of bathing

How the bathing suite evolves in the future will be determined largely by the Baby Boom generation, which has members retiring at a rate of 10,000 per day. Their preferences and influence will decide whether communal baths will continue to be a part of a community or if in-room, private bathing will become exclusive.

Penner says there is a lot of opportunity for bathing manufacturers to shape the future for the senior living industry. He reports working on a project that will take bathing “in a different direction by building a better mousetrap.” Although tight-lipped about specifics, he indicates that it will be revealed in the fall.

Sears sees various potential innovations, such as voice-activated directions to the tub, programmed preferences that include water temperature, duration of the bath, strength of water agitation and custom music playlists for residents. Even so, he says the most important innovation is ensuring that the caregiver is always present because “it negates the need for innovation.”

It’s one thing for a simple door lock to deny a memory-addled elderly man to take a leisurely walk outside his senior living community at 2 a.m. But what happens when a strong, able-bodied 75-year-old is threatened by a financial predator, or buys an over-the-counter weight loss supplement at the corner drug store, only to be found hours later in his unit suffering from kidney failure?

Providers today find themselves trying to balance residents’ fiery desires to live this so-called “third act” on their own terms while living long and whole enough to enjoy it.

All while facing the cruel irony that the very things that give them freedom also can expose them to risk.

The scales are being tipped constantly, and more and more seniors today are discovering the truth behind that familiar idiom, “freedom ain’t free.”

In its 2019 report, “The State of Senior Living: An industry grappling with autonomy,” Perkins-Eastman shows a demographic that fiercely values its ability to make decisions about wellness, but one that is less confident of being able to afford comfortable housing offered by providers struggling to keep up with engorged pipelines of new technology.

Among the report’s major takeaways: Its survey finding that 80% of respondents (chiefly owner-operators themselves) think technology, products and services that allow consumers to be autonomous and proactive in their care will affect the senior living market more than anything else.

Only recently have we begun to glimpse at what that means.

How fierce is older adults’ need for living independently?

Ask Laura Wasson, executive
director of sales for Tech Electronics, who knows of residents declining to report a fall or minimizing a change in health “just to maintain the level of privacy and independence they want.”

Yet in most cases, even the most independent seniors have no qualms about resident security measures today, says James Jansen, product manager for Direct Supply Technology Solutions.

“Resident security is a top concern for operators, residents and family members. The right level of physical, cyber or other security measures is a blend of operator capability, family and resident request, and local or national code mandate,” he adds. “Often, increased levels of security, like video surveillance and identification badges for door access, are driven by operators who listen to the specific requests of residents and family members seeking a safer environment. Safety is an expectation, and in a vibrant, dynamic environment like senior living, there are a lot of players who need to come together to define what is best for everyone.”

But what happens when seniors’ need for independence collides with security risks? It’s a question fraught with even other more difficult questions that can pit seniors’ civil liberties against risk-averse communities’ resident care mandates. 

Balancing Act

“Security must be carefully balanced against resident autonomy. You can’t turn your facility into a police state, but neither can you let security be so lax that it exposes residents to an unacceptable level of risk,” says Patrick Hardy, LL.M., CEM, MEP, CRM, president of Hytropy, a continuity and disaster planning solutions provider.

“Part of the promise of the internet of things is that it stands to improve older adults’ abilities to live independently despite mounting health conditions and also to keep those health conditions under control for a long time,” as “Slate” magazine describes in “Grandma got hacked.”

As the elderly learn to count on interconnected technologies to take care of things from medication adherence and dosage adjustment to personal security, the question the article leaves the reader with is, Will that trust be misplaced?

In what arguably is an unglamorous look at the vulnerabilities associated with aging, the article asserts that the older user population is being handed a bevy of complex smart devices by their “adult children purchasers” with very little idea on how to use them safely and correctly. The dangers become even more ominous with hackable life-dependent devices such as implanted insulin pumps and defibrillators.

It’s no wonder resident tech adoption in senior living is as slow as the Perkins-Eastman study revealed.

Still, the decisions become easier as the level of acuity increases. A perfect example is memory care, where aggressive resident behavior mandates high-level security measures, says Majd Alwan, Ph.D., senior vice president of technology for LeadingAge and executive director of the Center for Aging Services Technologies. 

“The need to protect residents against wandering and elopement in memory care is paramount,” adds Mike Webster, director of senior living, fall management and security solutions for Stanley Healthcare. In any senior living setting, meanwhile, even seemingly trivial decisions such as the color or style of an emergency call pendant could mean the difference between wearing one and purposely leaving it on a nightstand, he adds. “It’s a dignity issue.”

Despite these stricter guidelines, video surveillance may be surging as one way to replace the eyes and ears of thinned-out staffs, says Patricia Howell, RN, BSN, WCC, CFCS, clinical support manager for McKesson Medical-Surgical Extended Care.

1. Increased unit turnover / move-outs due to an increase in older, high-acuity residents.
   • Likely lower net stabilized occupancy — in the 85% range.
2. Incorrectly estimating age and income qualified leads. Truly qualified leads for a community’s primary market area typically need to be:
   • Age 70 to 75+
   • Income screen: $60,000 to $75,000+
3. Higher-acuity residents in the future will change the characteristics of living unit demand mix:
   • Moderate demand for independent living that offers increased supporting assistance in living services.
   • Increase in demand for assisted living and memory care units.
   Exercising caution that . . .
   • Future supply of these units possibly could exceed market demand.

These emerging headwinds are driving a relative new senior living and health care trend. The fancy word for this is “disruption.” This means that we may need to change the way we think from three major perspectives:

1. Introduction of new, state-of-the-art designs in a market could threaten the acceptance of existing, older properties.
2. Overall operations must be sharpened to enhance the fundamental business of the senior living and health care industries.
3. Residence care and life satisfaction.

Regardless of these 2019 headwind trends resulting from emerging new technology and disruptions, one strategy for optimum profitability and success will always require a continuing focus on fundamentals!

Jim Moore is president of Moore Diversified Services Inc., a national senior housing and healthcare consulting firm based in Fort Worth, TX, that has been serving clients for 48 years. He has authored five books about senior living and healthcare, including Assisted Living Strategies for Changing Markets and Independent Living and CCRCs. He has published senior living monthly columns for the past 28 years. Jim Moore can be reached at (817) 731-4266 or jimmoore@m-d-s.com.

“Our goal was simple: to create spaces where our members feel at home in an atmosphere that is warm, welcoming and peaceful,” said Gina Gaines, director of design for Senior Living Communities, Brightwater’s owner and operator. “Members and future residents will find themselves walking into an oasis of peaceful hues and unparalleled styles throughout the Clubhouse.”

The all-inclusive, luxury retirement community offers independent, assisted living and memory care residences as well as skilled nursing. 

With décor fashioned to make a good first impression, the entrance, living room, dining room and library all have “wow factor” design elements. Because the Clubhouse is the central location for dining, meetings, activities and gatherings, company leadership thought it should have a thorough makeover to emphasize that importance.

Although the Clubhouse was not enlarged, Gaines said the design team opened it up and used creative lighting to instill a bright and airy feel. The project itself took a tidy three-to-four months to complete and the work barely registered on the inconvenience scale, said executive director Leslie Fryar.

“The project was done in phases to minimize disruption and members enjoyed watching the progress,” she said. “Our Clubhouse is an extension of our members’ home. They are enjoying their new space and are proud to show it to their family and friends.”

Color is important to the décor throughout the community and integral to the Clubhouse’s seashore vibe, Gaines said.

“We opted to go with a soothing color palette that promotes a calm and bright environment,” she said. “Therefore, we use a lot of soft blue and green tones as well as neutrals to reflect the sand and sea. 

“This seems to appeal to our members and is especially nice at the coast. Our goal is to promote a ‘casual elegance’ that our members can enjoy. The exterior of our building is very bright and happy; we wanted the inside to feel the same.”

The key element in the design is the coastal, peaceful, airy feel that the new Clubhouse conveys, Gaines said. 

“Our goal is to make our facility a haven or sanctuary for our members, where they can be at peace and be comfortable,” she said. “By removing heavy drapery and opening up the windows, we allowed the light to come in. We feel it is important to bring light and life to the community, since a lot of our members don’t get out often.”

Download the 2019 Technology Supplement

Inside:

• Alexa, are you HIPAA-compliant? The new answer may be ‘Yes’
• Tech investment targets residents, caregivers
• Top 12 phishing email subject lines
• Department, job level among top factors in targeted email attacks
• Operators double down on digital
• Getting employees to key in on cybersecurity
• 6 ways tech can curb hospital readmissions
• Manager’s Toolboxes:
  • EHRs help providers assume, manage risk
  • ‘Old school’ TV meets internet of things
  • Property maintenance goes high-tech