Q: What are the most important components of Brookdale’s turnaround plan?

A: There are three pillars. The first is focused on our associates. We want to attract, engage, develop and retain the very best associates in the industry. That is the most important thing, because our services are delivered locally, and when we have the right people in the role, everything works. We are increasing our total compensation costs 5.5% to 6% in 2018. That’s well above the cost of inflation, and it includes not only increases in salaries and wages but also better benefits for our people. The second pillar is focused on our residents. We’re trying to deliver differentiated services to our residents so that we create lasting relationships that provide referrals. And by focusing on both mission and margin and taking actions that will deliver improved results, our shareholders will benefit. There’s a lot of our strategy that relates to simplifying and streamlining our business. We’re moving from a national focus to a local focus, which leverages our scale. For real estate, we’re looking at taking the opportunity to create value by monetizing certain assets that are performing at a very high level.

Q: Could you elaborate on the reasoning behind putting more control at the community level?

A: We are delivering services person-to-person, 24 hours a day, seven days a week, 365 days a year. So making as many decisions as we can as close to the community and as close to the customer as possible is a key priority for us. Now that’s not to say that we’re backing away from taking advantage of our scale, but it’s really thinking about which decisions are best made at the local level and which decisions are best made at the corporate level.

Q: What are some other ways that Brookdale is simplifying and streamlining the business?

A: We have already cut some pilot projects, and we have more work to do. We have initiated our general and administrative reductions. And on capital expenditures, we have made initial decisions for the year, including investing more in Program Max, which is our program that we use to redevelop a community, to make sure that our configuration matches the local community and its needs most effectively. It’s fair to say that there’s a lot of heavy lifting left. We’re also trying to use technology to replace repetitive tasks. Wherever possible, we’re trying to streamline the work that is done by using automation and better technology to get a higher quality at a more attractive cost. Over the years, we have put in electronic medical records. We’re looking at scheduling tools now. And accounts receivable management.

Q: What attracted you to senior living in the first place, and what continues to appeal to you about the industry?

A: My interest in caregiving dates back to my teenage years, when I first started taking care of my grandfather, who was blind. As his needs increased, I eventually moved in with him during my college years to help. That early experience is what drew me to Brookdale. In the past year, my mom’s health declined, and she moved into a skilled nursing facility, where she was dependent on the community’s staff. My mom was eventually moved into hospice and passed, but witnessing it all was truly both the best of times and the worst of times. Seeing how the staff took care of my mom as well as my family during this difficult time gave me a newfound appreciation for everyone who works in senior living.

“Data is today’s currency. If cash is king, then in this day and age, data is the queen,” says Majd Alwan, Ph.D., senior VP of technology for LeadingAge. He explained that data elements affecting quality measures, such as readmission rates, are impacting 5-Star ratings. “Quality data and effective analysis also impacts reimbursement levels, the ability to participate in accountable care organizations and other alternative models, such as bundled payments, and the ability to contract with payers like managed care or Medicare Advantage Plus. It’s even driving referrals and consumer choices.”

Experts largely agree the use (or misuse) of data will make or break an operator of any size. “If a home doesn’t invest in tools that provide them with proper data capture, they will not be able to keep up with the money-saving decisions that the larger companies are learning about,” says Dan Roberge, president of Maintenance Care.

While operators have always been interested in “real estate-centric” data, such as occupancy, rent rates and net operating income, forward-looking providers are more closely examining service-centric data and analytics, says Travis Palmquist, vice president of senior living at PointClickCare. “Specifically, we are beginning to see a greater shift toward capturing data around service delivery, resident experience, readmissions, staff and resident engagement, wellness, workforce management and the like.”

Operators don’t have to try to harness and analyze all these data on their own. Today, many low-cost, flexible software solutions take the data management burden off the operator and give meaningful, accurate and current information with an immediate return on investment.

MEASURES OF SUCCESS

With so much data being gathered at nearly every turn, some operators may struggle with what to analyze first — and how. Thinking about end goals is a great place to start, according to Jim Rubadue, chief customer officer for OnShift.

“Is [the end goal] to provide better quality care? Are profit margins where they need to be to meet financial goals? Is turnover a major problem?” With end goals in mind, it can be determined which data need to be collected to meet those goals, he says.

Focusing on resident-specific data that will help improve care and meet requirements, such as for MDS and OASIS, is critical for surviving and thriving in today’s quality-focused environment. This includes ongoing assessment information, vital signs and staff observations, documentation on social support needs and electronic health record documentation of chronic diagnoses, medication administration and/or adherence records, and other interventional outcomes.

“This data, if collected once, shared and leveraged in multiple ways, can lead to efficiencies and insights that can be used in conjunction with some advanced health information technology functionalities like dashboards, clinical decision support systems and population management tools,” Alwan says. When properly shared with care partners, the data can improve care coordination.

The richest data capture happens at the level of direct care staff, says Trisha Cole, COO and general counsel for Medtelligent. To catch acuity changes earlier, dynamic data are essential. “This information is pulled from interactions between staff and residents during activities of daily living charting, meals and from health progress notes and related activities attendance.”

With all senior living operators vying for maximum occupancy in their buildings, assessment and incident data form the baseline of documented care activities, events and needs. This data set is essential to finding macro trends in the resident population, such as more falls in one building over others, which can then be used to manage risk and improve care practices, says Rob Price, senior product manager of analytics for MatrixCare.

Capturing current data on staffing, hiring or capacity statistics, for example, helps operators determine their present baselines, so they can determine where best to place their strategic focus. “Labor and time tracking can also help identify overages that lead to staffing changes, which benefits both operators and residents.”

Matching staffing to residents’ needs is more about nursing staff ratios, however. It also requires attention to non-nursing professional services, the level of involvement of medical professionals, use of telecare services, how staff are assigned to units and scheduled 24/7 and how wearable technologies can be used to substitute for certain staff functions or enable them to be delivered more efficiently, says Barry Fogel, M.D., inventor and co-founder of PointRight and a professor of psychiatry at Harvard Medical School.

“Identifying gaps in staff competencies and addressing them is another opportunity for getting better results without adding more fulltime equivalents. All of this requires sufficiently fine-grained detail of how staff are assigned to time and space, which technologies are used, use of outside services, including hospitals, emergency [departments] and consultants, and contemporaneous measures of resident need,” he says. These data then feed into models that match resident needs to optimal patterns of staffing, technology and training.

SO LONG, DATA SILOS

More than ever, software solutions are being developed to meaningfully integrate scores of different data and alleviate the time and resource burdens on operators and staff. As Richard Roberts, COO and chief information security officer for Stratus Interoperable, explains, current transactional database systems such as electronic health records, billing, payroll or family management software are designed to process transactions quickly but have very limited analytics capabilities.

“The key is deploying more advanced technologies that provide centralized and normalized data with an easy-to-use analytics tools to help make data meaningful and actionable,” he says. “These advanced technologies are optimized for efficiently retrieving and organizing large data sets from disparate systems and handling the complex analytical queries the long-term care market needs to measure and manage organizational performance and align with payers, referral partners and patients.”

Taking integrated data and marrying it with user-friendly dashboards that provide up-to-date and at-a-glance information are changing the way operators capture, analyze and strategically employ critical data.

“A vendor’s ability to take data from multiple sources so it can be analyzed and [shared, as needed] is becoming increasingly important,” says Cheryl Field, chief product officer for Prime Care Technologies. “Providers become frustrated when they want to send data to a third party, but another party doesn’t want to integrate. We own our own middleware, so we are vendor-neutral and can truly integrate all the different clinical and labor data to help operators make the best decisions, but without having to spend time collecting data and doing the math.”

Prime Care Technologies customers can access their integrated data through one login to the company’s PrimeVIEW dashboard. The web-based dashboard provides a multi-facility view of performance data — including daily census and labor — that are automatically matched and married to ensure proper staffing.

Cloud-based platforms eliminate the need for equipment installation and maintenance and make it easy to securely analyze and share centrally accessible data across the care continuum. Stratus Interoperable’s StratusLink platform delivers “fully integrated single versions of truth” patient records to ensure data integrity, eliminate report conflicts and improve performance reporting. Care transitions, care coordination and proactive care management are data-driven and measurable, Roberts says.

Data-on-demand solutions also help operators manage care and operations more proactively, as opposed to primarily relying on information for retrospective analysis. Medtelligent’s ALIS software solution, for example, uses integrated data to implement realtime feedback loops through an instantaneous alerting system that coaches each staff member to excel at their specific job. This can include highlighting upcoming assessments for the nurse, queuing up reviews of possible clinical charge information to the business office manager or notifying a salesperson when an assessment of a prospective resident is complete, Cole says.

Software solutions that grant all caregivers in the care circle — across different specialties and the care continuum — permissible access to resident-specific data not only improve decision-making but ensures that key health information is ready whenever needed and not accidentally overlooked or omitted. “With any post-acute care, there are a lot of moving parts, and we’re working to pull all those parts together to improve care,” says Val Ornoy, CEO of LifeAssist Technologies.

Through a single tab, the company’s Circura platform connects all invited and permission-granted people within the care circle access to defined patient information, and another tab provides current data points for all technology used on the individual. Weight, glucose and blood pressure monitoring, gait assessments and fall history are just a few of the data points gathered in the portal, and this information can be uploaded manually or automatically through wireless or Internet of Things computing devices. Currently, Circura links to approximately 150 monitoring devices and technologies, and Ornoy says that number will total 500 devices within the next few months.

“Having critical data in one secure place eliminates the need for people in the care circle to download apps for each technology, and then gather and send that data to other caregivers,” Ornoy says. “Once they log in, it’s all right there — notes, communication and current and historical data, with results charted and graphed. If a person’s weight is down, their heart rate is elevated or their Fitbit showed they only took 2,000 steps when they normally take 6,000, for example, that information can all be used to provide a holistic view of health.”

The key to long-term data analytics success lies in ensuring it is problem-focused, predictive and prescriptive. Fogel stressed a provider should identify points of pain in advance and work with its analytics supplier to match an analytic solution to a problem and an analytics action plan.

“Every number on a spreadsheet or dashboard should be associated with three questions: So what? What now? How much? That is, where does this number come from, why does it matter, how should I act on it, what will the action cost be and what benefit should I expect to get from it?”

SMARTER SOLUTIONS

Experts predict data capture and analytics will become even more sophisticated by tapping the power of artificial intelligence, voice recognition, natural language processing and advanced sensors.

“The future will bring sophisticated algorithms using machine learning to predict what might happen or prescribe actions based on what did happen,” Price says.

As technology continues to improve, so will the ability to predict specific work scenarios with stronger confidence, assured Adam Wallace, chief product officer at OnShift. “This is especially true when it comes to understanding the trends of employees in senior care.”

Remote care technologies also will catch on, according to PointClickCare’s Palmquist, and will be part of the care plan that will help achieve and maintain resident satisfaction. “As the industry moves toward the use of real-time mobile technologies, data capture will only improve.”

In the meantime, and until advanced capabilities such as artificial intelligence take over, high-level data reporting may require operators to create new roles for the sole purpose of focused analysis, according to Roberge. “A data mining and ‘interpreter’ will become a valuable and necessary person to an organization by becoming part of the day-to-day decision-making teams for changes within an organization.”

A: Here are three big challenges:

1. Future minimum wage increases. These increases will vary from market to market. You may not hire any minimum wage workers, but there is another pricing tier that starts at about $1.50 per hour above the prevailing minimum wage in a particular area. This means those workers expect to have a wage “premium” over and above the prevailing minimum wage.
2. CNA labor shortage. Due to shortages, many CNAs are opting for other employers who offer higher base salaries and the perception of future and better benefits.
3. Aging physical plants. Some operators are actually in their third generation with their older physical plants. Many communities no longer look like the state-of-the-art competitors emerging in many primary market areas. When considering moving to senior living, new prospects and their families are focusing on many competitive issues, such as favorable first impressions, cosmetics, innovative designs and new technology. The senior living business will continue to get more complex. We have to deal with it.

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 46 years. He has authored five books about senior living and healthcare, including Assisted Living Strategies for Changing Markets and Independent Living and CCRCs. Jim Moore can be reached at (817) 731-4266 or jimmoore@m-d-s.com.

When industry veterans look back at the issues that occupied assisted living owner-operators not long ago, that segment bore very little resemblance to today’s senior living world.

“When I started in senior care in 1998, we still had nursing centers called ‘rest homes,’ ” says Chad Worz, Pharm.D., BCGP, executive director and CEO of the American Society of Consultant Pharmacists. “Those are a thing of the past. We now have ‘post-acute rehabilitation centers.’ Not only does that define the changing patient, but it requires a change in clinical acumen for practitioners.”

Residents in these settings today are typically sicker and more medically complex. As a result, medication services and delivery methods have changed exponentially. Pharmacy services for senior living are undergoing dramatic change. Consultation, compliance management, risk reduction, medication reviews and more are increasingly commonplace. And with assisted living settings taking on higher acuity residents, the stakes are higher than ever before.

RAPID PACE OF EVOLUTION

Alan Rosenbloom, president and CEO of the Senior Care Pharmacy Coalition, believes the “increasingly central role of medication therapy to healthcare and quality of life” is one of the four biggest drivers of this “very complex, multi-variate environment,” along with an aging population, consumer choice and resource allocation.

“Control” is the one word the defines how medications were managed in assisted living’s nascent years versus today.

“Residents and their families used to manage their own medications and looked to local pharmacies when it came to medication distribution,” observes Travis Palmquist, vice president and general manager of senior living at PointClickCare. “In fact, medications themselves were often kept at a resident’s bedside for self-administration. Today, we’re seeing residents with more chronic conditions and more complex medication regimens, or who may be cognitively impaired.”

Today, assisted living providers rely on pharmacy service companies and as much for adherence as they do on drug dispensing and distribution.

Khristy McClelland, president of Guardian Pharmacy of Jacksonville, FL, points to facilities’ need for long-term care pharmacies that work on each resident’s behalf to resolve insurance issues and reduce costs. “Payment models have also become more complex, with an increasing amount of medications that are non-formulary or require prior authorizations,” she adds.

In so many ways, medication management in assisted living is not unlike the skilled nursing side.

“There’s increased demand for consulting services and cart auditing to keep up with ever-changing regulations,” says John Dombach, Pharm.D, general manager of Turenne PharMedCo’s Tennessee, Kentucky and Florida client operations. “Depending on the state regulations, many non-skilled senior living settings have unlicensed personnel helping assist residents. As a result, non-skilled facilities often depend heavily on the pharmacy for clinical support and assistance to ensure regulatory compliance through on-site consulting services and training on medication pass technique, pharmacy regulations and infection control.”

Along the way, many owner-operators wrestling with polypharmacy issues are seeking to simplify arrangements with pharmacy companies to reign in the almost mind-boggling numbers of medications – an average of 12 to 14 per day for the typical assisted living resident.

“Many are moving to single-source ‘contracted’ or primary pharmacy providers,’” observes Tim Quarberg, vice president, medication management, of MatrixCare. “They want consistency and quality of medication packaging and consulting services. They also want reliability of delivery service and other advancements such as electronic prescribing and pharmacy integration.”

GROWING PAINS

Consumer choices that Rosenbloom alluded to could explain one reason for the rising acuity levels in assisted living. Seniors aren’t necessarily sicker; there are simply more of them choosing assisted living over nursing homes. In some respects, the industry wasn’t prepared for it, and it’s playing catch up, observers say.

Seniors today also are taking more and different medications than ever before. McClelland blames some of it on marketing, or “direct consumer advertising for pharmaceuticals and a substantial rise in OTC dietary supplement usage.”

Finally, resident acuity in general actually is rising, which leads to more complex medication regimens. It’s hard sometimes to decide which of all this leads to the other. For the typical assisted living owner-operator, the risks are higher than ever before.

Another vexing issue is coordinating each resident’s care as they move from one setting to another — from home to hospital to home to assisted living and so on. Vital information can fall through proverbial cracks during each transition. “From an operations standpoint, navigating all the communication methods to the pharmacy is complex and, at times, more information, more data equate to more room for error,” explains Sarah Barker, Pharm.D., general manager of Montgomery Pharmacy, Turenne PharMedCo.

Rosenbloom calls poor care coordination a “principal impediment” to effective medication management, adding “business models and regulatory approaches that bifurcate care settings from healthcare services make decreasing sense.”

There’s also a people problem affecting medication services outside of skilled nursing facilities. McClelland asserts assisted living is based on a “social rather than medical model,” which leaves a kind of clinical vacuum. “Because of this, these settings may or may not be staffed with nurses, and prescribers and pharmacists located off-site,” she adds.

TECH TO THE RESCUE

So, as assisted living plays catch-up to its elder sister, technological innovations have vastly improved dispensing, distribution and security.

Many cite specialized and multi-dose packaging as critical improvements. Worz, for example, says multi-dose packaging systems promote easier nurse administration or easier patient administration at home.

Joe Kramer, vice president of sales and marketing for Geri-Care Pharmaceuticals Corp., credits geriatric-trained nurses for playing an innovative role in medication service and delivery in the past few years. “The Program for All-Inclusive Care for the Elderly, or PACE, is an example of a nurse-driven innovation in geriatric care,” he says. “By using coordinated medical, health and social support, the program, as a result, has allowed seniors to remain living in their respective homes for longer periods of time. Geriatric consultation expansion has also played advances in medication services and delivery, and computer-based consultation services are allowing primary care physicians to receive guidance from geriatricians.”

In the end, seniors themselves are the biggest incubators of all.

Says Kramer: “One of the biggest advances in senior care isn’t necessarily the care itself but the seniors who need it. As we begin to get more technologically savvy, so do the seniors who need to be cared for, and many seniors are actively seeking tech to make their living experiences much easier.”

Residents have become greatly empowered in communities’ quest to provide a food service component that excels in menu diversity, appearance, taste and dining atmosphere. Meals have not only become more nutritionally sound, they have added a stylistic panache that turns every visit to the dining room into a pleasant and memorable social experience, food service experts say.

To be sure, meal service has gone beyond just satisfying residents’ appetites and plays a vital role in keeping them content and comfortable, says Ray Costello, founder and CEO of bmrbnb.

“Meal service is huge – it provides some of the most meaningful daily resident interactions with each other and staff,” he says.

The days of cafeteria-style take-it-or-leave-it selections “have reached the end of their cycle,” Costello notes, and it is being replaced by several more palatable options, including restaurant-style dining, short-order diner style, buffet style and pub-style finger food.

“This is the future, and if you’re not doing it, you cannot compete in the senior living marketplace,” he says.

Of all the formats beyond the conventional cafeteria style, restaurant-style dining is becoming “a very common trend” within the senior living industry, says Shellee Roloff, category manager for food service at Direct Supply.

“We see many variations and different levels of service under the term ‘restaurant-style dining,’” she says. “A great start is to offer two main menu items along with the simple ‘always available’ items, such as soup, sandwiches and salads.”

Another version of restaurant-style is “tableside service,” furnished with either a mini buffet cart that moves from table to table or a small buffet cart that remains in one area of the dining room. Orders are taken at the table and the meal is plated and brought to the resident. Roloff calls this format “a hybrid style of service between restaurant style and buffet style.”

BUFFET AND BISTRO

Buffet-style is popular with residents and is gaining in sophistication. For instance, more communities are offering a breakfast buffet with expanded hours to incorporate more choice for residents, Roloff says.

“This enhanced breakfast service typically results in more residents in your dining room versus tray service in the rooms,” she says. “Lunch and dinner buffets can be a great style of service to offer choice and get aromas into the dining room. However, even buffets can feel like the same old thing after a while, so it’s important to keep it fresh by incorporating buffets into the other various dining styles.”

Buffets are especially effective when held in conjunction with special events such as holidays, or a weekly prime rib night, Costello says.

“Food costs are too high to make this an everyday thing,” he says. “If your community rolls out and markets specialty nights correctly, they will play a big role in resident satisfaction and excitement about the dining program.”

Pub-style and day-to-night bistros are gaining in popularity at senior living communities and offer residents nourishment in the off hours between mealtimes, Roloff says.

“The bistro will serve coffee, pastries and simple breakfast items in the morning and then convert to a happy hour theme in the afternoon,” she says. “Existing buildings with limited space will incorporate small mobile counters that can service a similar purpose. If possible, it’s helpful to locate these stations near the reception desk for operational efficiency.”

Several equipment options, such as speed ovens, which are typically vent less and can cook anything from open-faced sandwiches to French fries and pizzas can help support made-to-order bar bites, Roloff says. If point-of-service cooking is not an option, she says heated and refrigerated merchandisers can hold and display items that are made in the back-of-house kitchen.

INTO THE KITCHEN

Getting residents into the kitchen for meal preparation is an activity that “neighborhood” and “household” communities are doing, using the more intimate surroundings to create the kind of home-cooked meals those residents remember. The concept is trickier for the larger senior living communities, however, and is usually limited due to concerns about resident safety and cross-contamination.

Visible, open kitchens where residents can watch meal preparation are becoming more common in the larger communities and they are serving as an attraction that creates an engaging experience for residents, Roloff says.

“At the high end, we see exhibition kitchens featuring hands-on cooking lessons and demonstrations — even if a community isn’t able to create a robust exhibition kitchen, a similar concept can be created on a smaller scale with action stations,” she says.

TALK TO THE CHEF

With baby boomers now starting to influence senior living communities, they are looking for more upscale elements of food service, including chef-prepared dishes that would be included on a fine dining establishment’s menu.

In fact, more chefs are being employed by senior living communities and are proudly applying their expertise to residents’ meal service. Companies such as FLIK Lifestyles have focused on escalating food options for senior residents and are getting very creative in their menu choices, says Lisa Harkins, director of clinical and wellness support.

“We need to address the demand for ‘meat and potatoes’ while balancing the demands from the boomer generation, which is more interested in healthier items like smoothies, hummus, grains and greens,” she says. “It also doesn’t hurt that boomers’ children have a strong influence on their parents’ choices and are very vocal in requesting more healthy menu options.”

To keep abreast of the boomers’ and their kids’ tastes, FLIK is consistently updating its menu offerings to introduce more residents to healthier foods such as ancient grains, including chia seeds and farro. Harkins and her team are also focused on incorporating new spices, herbs and flavors into their menus by serving globally influenced dishes such as Indian dosa, Korean bulgogi, South American arepas, Hawaiian poke bowls and Chinese jian bings.

“We are also incorporating a wider variety of alternative proteins, like tofu into vegetarian dishes, and including more menu items that push vegetables to the forefront of dishes, allowing them to serve as the star of the plate,” Harkins says.

Food programs run by FLIK chefs such as Adam Grafton are committed to providing a “wow” factor for residents through a concept he calls Plate Palette. “This offering incorporates an artistic element to our meals, redefining natural ingredients into a new form or shape that is both aesthetically pleasing and simultaneously delicious,” Grafton says.

MORE THAN FOOD

Meal service has become more than the food — it is an experience that residents should savor and remember every time. Senior living communities aiming to draw maximum occupancy rates understand this and are making dining a centerpiece to their business model.

“It isn’t just about food service — it’s about hospitality,” says Jack Silk, president of FLIK Lifestyles. “Our entire brand is built on the philosophy of creating strong, meaningful interpersonal relationships between our team and our residents. We pride ourselves on giving each employee the right tools and training required to provide quality service and achieve the highest levels of customers satisfaction. This training emphasizes relationships built on respect, warmth and understanding. We build customer loyalty, and that is the foundation for providing a meaningful experience for every resident.”

Newly opened in February, The Highlands features 70 assisted living units and occupies a significant portion of a 45-acre campus called The Moorings, owned and operated by Presbyterian Homes. Its completion marks the latest phase of renovation at the life plan community, which includes independent and assisted living, skilled nursing, rehabilitation and memory care.

The new assisted living residence marks an important milestone for The Moorings community because it provides the “homogenous flow” for independent living residents who need that extra level of care, says Bob Werdan, vice president of marketing and public relations for Presbyterian Homes.

“We provide the full continuum of care, and we needed an environment that allowed for a seamless transition,” he says. “If the environment isn’t right, residents won’t want to change when they need to. This new building removes the stigma and stress of that transition.”

‘WOW FACTOR’

The Highlands has plenty of “wow factor” design points throughout the community, from spacious windows that let in abundant sunlight and offer panoramic vistas of the beautiful duck pond and walking trails to a modern décor that conveys an upscale atmosphere.

But perhaps more importantly, the “bones” of the building — the plumbing, heating and lighting elements — are what provide residents with a level of superior comfort, says project manager Jim Martin.

For instance, the building’s “light-harvesting” system is designed to furnish optimal illumination in common areas by balancing outdoor and indoor light.

“We’re trying not to drench rooms with too much interior light,” Martin says. “This system utilizes the intensity of outdoor light and adjusts it accordingly inside.”

The boilers use the same concept — instead of heating to 180 degrees regardless of the outdoor temperature, they compensate depending on how warm it is outside.

“By modulating on outdoor temperatures, the system is automated to provide ambient temperatures,” Martin says. The building also has a robust diesel-powered generator that draws from a 4,600-gallon tank, which is sufficient to help residents get through protracted power outages that can happen after severe weather.

If any details have been overlooked in the design, it’s not apparent. There are no elevated thresholds in doorways, and surface changes are undetectable.

To prevent potential tripping hazards on carpet seams, some passageways — including a 200-foot corridor — have been laid out contiguously.

This meticulous attention is due to Presbyterian Homes taking the long view on the future of its properties, Werdan says.

“We do things the right way because we build, own and operate our facilities for the long term,” Werdan says.

The brand is up for national and regional 2018 Azbee Awards for Best Web News Section, for www.mcknightsseniorliving.com. Additionally, McKnight’s Senior Living is a regional finalist in the Best Print News Section and Best Regular Column, Staff Written, categories. The latter is for the Editor’s Column written by Senior Editor Lois A. Bowers.

National awards will be presented May 10 at ASBPE’s annual conference, to be held this year in Washington, D.C. Regional awards will be presented at several events around the country before that time.

McKnight’s Senior Living’s sister brand, McKnight’s Long-Term Care News, is a finalist for a total of seven Azbee Awards in 2018.

The former McKnight’s Assisted Living changed its name to McKnight’s Senior Living in 2015 and at that time expanded to include a new website (www.McKnightsSeniorLiving.com), daily e-newsletter (the Daily Briefing) and social media in addition to the bimonthly magazine that had been printed since 2003.

Since that time, McKnight’s Senior Living earned two national and four regional Azbee Awards in 2016 and one national and three regional Azbee Awards in 2017, in addition to earning awards in other competitions.

Often, the authors found, older adults changed their preferences based on the concerns of family members or a wish to avoid “being a burden” to others. This basis was especially true for preferences regarding the places where people wished to receive care — for example, at home or in a residential care setting, they said.

The researchers, all of whom were affiliated with the Cicely Saunders Institute of Palliative Care Policy and Rehabilitation at Kings College London, examined 57 previous studies about the preferences of older adults with advanced illness. They included research that investigated preferences for where people wanted to be cared for, the kinds of communication and decision-making they wanted and the quality of life they hoped to have over time.

Although support from family was the most important influence on their care preferences, older adults usually formed their preferences based on several other factors, too, including their experiences related to previous illness and caring for others as well as having a serious illness, according to the study.