Q: What are the biggest ways in which senior living has changed in the decades that Gurwin has operated?

A: In a nutshell, the nursing home of yesteryear is assisted living today. Assisted living represents a higher level of care.

In the olden days, when your activities of daily living were compromised, you went to a nursing home. Today, when your ADLs are compromised, you go to assisted living. A nursing home is for when you’re much sicker; you need intense rehab; or you need nursing care on a much higher level.

As far as Gurwin specifically, 29 years ago, Gurwin was nonexistent. We’ve grown to literally a system. We have five corporate entities today.

Today, there’s a focus on aging in place and home care. We do a lot of subacute care to get people home quickly after a hospital stay.

Our physical therapists, occupational therapists and speech therapists come in early, work late, and work on Saturdays and Sundays to evaluate and treat people discharged from the hospital. It’s also in Gurwin’s best interest for hospitals that discharge to us Medicare patients who are part of bundled payment programs. We also have on-site dialysis now, so people who come for short-term rehab don’t have to skip it.

In the olden days, they were sent out. Dialysis lasted three to four hours, with an hour of travel time before and after, so if you had to go out of the building, you were not getting rehab that day. But here, we can give you rehab in the morning, and we just wheel you right down the corridor to our 12-station dialysis unit. We have about 30 people, between the nursing home and our assisted living, who get dialysis three times a week. They can get it at whatever time they want it. It’s open for four shifts, from 6 a.m. until late in the evening.

Q: When Gurwin first started, was the thought that ultimately there would be these various elements of a continuing care retirement community? Or did it grow more or less organically?

A: It depends who you ask. When I look at my groundbreaking speech, in which I forecast what I envisioned, 90% to 95% came true. I remember board members saying — I overheard them, and they didn’t know that I was right behind them — “It’s good to hear a young guy dream.”

Gurwin Jewish was created in the early 1980s. Our 300-bed nursing home opened in 1988, followed the next year by an adult day program. We added a home care program in 1997, a 160-bed unit in 1999 that included a 28-bed ventilator dependent unit, and the 160-apartment Fay J. Lindner Residences assisted living community in 2001. We began offering on-site dialysis in 2008 and opened a 60-bed memory care unit in 2016.

If we were starting today, we would begin with independent living. But I started in 1986 and our first admission was in 1988, and in those days you began with the nursing home.

If you look at the typical CCRC today, about three-quarters is independent housing, then assisted living, and then the smallest component is skilled nursing.

If well elderly individuals go into independent housing, they want to age in place. If they need help, the first thing they would get is home care. If they need more help, then they would go to assisted living. And if they need additional help, the skilled nursing facility.

Today the focus is on independent living, and that’s exactly what we’re now doing at Gurwin. We’re building Fountaingate Gardens. We’ll offer a complete continuum of care when it opens.

Phase one is 176 units, and then phase two will bring it up to about 230 apartments.

CCRCs are gaining in New York, which had very strict regulations. New York now has 12 CCRCs — Gurwin will be the 13th — compared with New Jersey, which has 27; Massachusetts, which has 32; and Pennsylvania, which has 271. On Long Island, there are three CCRCs right now. Gurwin will be the fourth.

Our three current entities — nursing home, assisted living and independent living — will total almost 35 acres. Fountaingate is not operational, but the operational budgets of the other two combined are $115 million. Collectively, we employ 1,300 individuals.

Q: If you had a crystal ball, what would you say the future will bring?

A: The future of long-term care is in the CCRC. I would like to see Gurwin of the South Shore, Gurwin of the Hamptons, Gurwin of the Five Towns. That’s really dreaming, but there still is incredible need.

A: Being competitive in the near future could be a challenge. The senior living industry has grown significantly over the past 40 years. That represents at least two generations of seniors and their adult children, many identified as decision-influencers for their parents when it comes to retirement living.

The psychographics of today’s seniors and their adult children has changed. Senior living and healthcare designs have experienced changes and innovations.

Here is your future challenge. Consider a new “state-of-the-art” senior living project that might locate within three to five miles of your mature community. For many potential residents (and their adult children), their perception of today’s state-of-the-art might include granite countertops, stainless steel kitchen appliances, new flooring, modern lighting devices, new plumbing fixtures and sophisticated, in-unit, high-technology internet innovations. That’s just a sample of the living unit enhancements.

The cosmetics and functions of public/common spaces also are changing, including lighting, carpeting and innovative wall treatments. Bistros are being added to expand the choices of multiple dining venues.

Some owner-operators are investing at least $20,000 to $30,000 in many of their independent living units for comprehensive, market-responsive upgrades. Many also are investing in common/public area cosmetic and functional improvements creating a strong first impression for prospects and enhancing resident satisfaction.

Sustaining the competitiveness of older communities can represent a significant investment. Properly executed, however, the cost-benefit can be very favorable. When integrated with a comprehensive operations analysis and responsible unit price adjustments, many owner-operators are executing this strategy in a successful, financially responsible manner.

Jim Moore is president of Moore Diversified Services, 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.  He can be reached at (817) 731-4266 or jimmoore@m-d-s.com.

While experts agree not every fall can be prevented, the risks can be significantly reduced. The key to success, they say, lies in the adoption of a comprehensive fall management approach and community-wide participation.

“Successful fall programs in senior living involve an integrated and holistic approach that starts with a strong fall management culture. [That culture must then be supported] with people, processes and technology all focused on keeping residents safe,” explains Lauren Horn, RN, MSN, senior clinical consultant for Stanley Healthcare.

Communities should standardize on the overall fall program for ease of implementation and increased compliance, she adds, while also empowering caregivers to individualize approaches based on each resident’s needs.

ASSESS FOR SUCCESS

Today, communities recognize proactive and ongoing fall risk assessments as the first critical step in a comprehensive fall management program. Fall assessments should be conducted upon move-in and on an ongoing and as-needed basis to determine physiological, behavioral or cognitive changes that might affect risk status.

Assessment tools can help identify and score risks by exploring variables such as a resident’s fall history, secondary diagnoses, ambulatory status, gait, cognitive status, presence of IV or IV access and use of medications that could increase fall risks. This information is then used to align resident-specific interventions to reduce those risks, whenever possible.

“Implementing an objective fall risk screening test for new residents as a baseline, [followed by] periodic retests, will help staff quickly identify change and give focus to those most vulnerable,” notes Lila Corwin, VP of marketing communications for Biodex Medical Systems. The Biodex Balance SD is a simple two-minute test that can accurately and objectively pinpoint risks. Test results are given numerically, so residents can potentially be graded by risk level, Corwin says. Beyond that, the tool is used for strengthening and retraining balance.

“With improved balance comes increased independence,” she says.

Life Care Center of Waynesville, MO, integrates the screening test into its rehabilitation programs. “After using the system to work on balance, we find residents can walk farther without fear of falling, and [they] demonstrate improved proprioception, stability, agility and mobility,” says Jacquie Bodkin, LPTA, the facility’s director of rehabilitation.

COORDINATED CARE

Acts Retirement-Life Communities relies on an “all-hands-on-deck approach” to managing high-risk residents. “It’s not just our nursing that is responsible. Other departments are made aware and check in on those residents and sometimes sit and talk or take them for a walk, if appropriate,” says Teresa Moore, RN, NHA, corporate director of resident health services.

Silverado communities also make medication management a top priority. “There is a full-time RN director of health services at each community as well as licensed nurses who provide all medications and treatments. At the resident’s care conferences, all medications are reviewed to identify any need for adjustments in dosing,” says Silverado’s Senior Public Relations and Communications Director David Gill.

MINOR ADJUSTMENTS

Some simple practice shifts also can play an important role in fall risk reduction while improving resident satisfaction and outcomes.

In many Acts communities, dining venues remain open much of the day to allow residents the opportunity to eat on their schedules. This can decrease falls if a resident is hungry during off-hours, Moore says.

Improving balance is another weapon in the fall prevention arsenal. In addition to initial and ongoing fall assessments, residents at Silverado communities have access to the organization’s Nexus program, which offers balance and strengthening programming.

Ensuring effective and timely communication and informationsharing across all members of a resident’s care circle also is essential; however, meeting that need historically has been challenging as a resident’s needs shift and more specialists and care teams enter the picture.

“When a person’s [health needs] change, often their care circle will change. The various specialists may not know or communicate with one another, so important information can fall through the cracks,” says Val Ornoy, CEO of LifeAssist Technologies. Sometimes, personal health information is being shared unsecured through email, he warns. “What is needed is information that is centralized and able to be securely shared.”

To help close those gaps, LifeAssist developed a software as a solution (SaaS) care coordination platform that aggregates all data points for monitoring technology being used, such as from gait analysis and fall prevention solutions, blood pressure monitoring and so on, for a particular resident. When a new specialist or clinician needs to access the resident’s data, they will be invited to the care circle in the care coordination platform and can gain secure access to appropriate information through a single tab. This allows various care providers to collaborate and coordinate care information and quickly see changes with a resident, such as blood pressure or weight changes, or to see whether a resident is ambulating or sleeping more or less frequently, Ornoy explains.

WORKING TOGETHER

Increasingly, traditional alarms and stand-alone technologies designed to alert staff when a resident attempts to exit a bed or chair are giving way to more predictive solutions that allow for more proactive response.

More and more fall management solutions also are able to integrate with other resident security and response technologies.

“The time to catch a fall is before it happens,” reminds Tim Fischer, vice president of sales at RF Technologies. “Rather than just a pad on the floor, we’ve integrated fall management into our Code Alert nurse call system. Caregivers can be notified as the resident starts to get up, so the closest person can immediately go to the resident.

Through use of artificial intelligence and non-intrusive passive monitoring, fall prevention technology can now identify movements and analyze activities that lead to a fall. This affords the ability to monitor specific markers such as gait, walking speed and posture, and to deliver numerous other metrics that can be precursors to a fall, explains Laura Wasson, director of healthcare for Tech Electronics.

“Our systems continuously monitor a resident’s movements in gait. By observing only a few initial steps, the system provides an assessment which is translated into a TUG [Time Up and Go] score,” she says.

“While most previous technologies were manual, such as, ‘In case of an emergency, press this button,’ the current trend is to allow more automatic observation of habits, so if a change from the norm occurs, staff are alerted and prepared for what the results could be,” says Brad Hyder, marketing manager for TekTone Sound & Signal Manufacturing. TekTone’s nurse call systems use wireless motion detectors, door and window monitors and check-in devices for residents, as well as auxiliary inputs on other hardwired systems, for interfacing with door monitoring, wander management and pressure pads for chairs and beside beds.

Still, experts warn that machines alone will not prevent a fall. “Only a human will do that,” says Steve Elder, director of communications for Stanley Healthcare. “Extensive education is needed to ensure caregivers are properly using the data being captured.”

If anyone doubts how tech is swarming through the corridors of every assisted living or residential community today, consider this assessment from the largest not-for-profit provider of senior care and services, and one of the country’s busiest incubators: “What is most surprising is the true adoption we already have among residents,” says Brad Edwards, innovation designer for the Evangelical Lutheran Good Samaritan Society, as he reflects on the ubiquity of iPads and Fitbits.

The pace has even given high-tech companies pause. “The biggest surprise in this market in general has been how quickly it is changing,” says Tim O’Malley, president of EarlySense, a leading provider of patient monitoring systems for hospitals, healthcare systems, integrated delivery networks and rehabilitation centers. For years, post-acute care was in tech marketers’ blind spot. But no more.

Still, adoption is uneven. Money is always tight, and only when it can save more of it does technology get a second and third look with many owner-operators, a fact not lost on researchers.

“Technology can be a really big driver of change when it starts impacting their bottom line,” says Kari R. Lane, Ph.D., RN, MOT, assistant professor at the Sinclair School of Nursing, University of Missouri, and a researcher for Aging in Place and Tiger Place, a large Columbia, MO-based retirement community.

It’s no accident that Lane is currently writing grant proposals for the National Institutes of Health and the National Science Foundation to research sensors that monitor and detect subtle physiological changes in residents with congestive heart failure. Lane is quick to acknowledge that providers face crushing penalties for hospital readmissions, and CHF is one of the biggest culprits.

As senior vice president of enterprise strategy and innovation with AARP, Jody Holtzman has a broader perspective on the market’s bifurcation and the myriad ways seniors react, respond, embrace and sometimes reject technology. 

PointClickCare, a leading developer and provider of electronic health record software, recently polled providers and found laptops, smart devices (such as wearables, tablets and phones), GPS, alarms/alerts and cellphones the top five most used tech devices for seniors. When recently accompanying a close relative on a senior living community tour, Holtzman witnessed firsthand why those kinds of personal devices are an easy sell, while cost often trumps every other adoption factor with other kinds of tech, even when it’s potentially life-saving. It happened during a facility representative’s explanation of the fees.

“When they asked, ‘Would you like to have these sensors in your room for an additional cost?’ I thought to myself, ‘Oh yes, and I’ll have an extra side of monitoring with that,’” he says. “The model is wrong. The cost for much of this technology needs to be built into the overall fee and not sold a la carte.” Lane agrees, adding, “We always look at the cost factor, because if you make something that isn’t accessible, it won’t get used.”

NOTABLE INNOVATIONS

Here’s a brief look at current innovations.

Information technology. The electronic health record continues to mature and developers are keenly focused on interoperability issues. Majd Alwan, Ph.D., senior vice president of technology for LeadingAge and executive director of the Center for Aging Services Technologies, says the most “exciting” current developments are advanced features such as clinical decision support, quality data analytic tools and dashboards, all of which “are improving quality of care, and impacting quality measures and metrics, like five-star ratings, which are shaping referral networks as well as contracts with managed care.”

Earlier this year, Alwan says, he was “pleasantly surprised” to learn that more than 30% of the industry’s largest 150 organizations have embraced the most sophisticated EHRs.

Sensors. Perhaps their most alluring feature is the ability to track and monitor things with eyes that never grow tired. And their applications are nearly limitless, especially when one considers “the big challenges for an aging population, like cognitive impairment, physical deterioration, disease conditions and medicines,” O’Malley says.

Lane believes sensors now hold the greatest promise in staving off costly and needless treatments for seniors with chronic diseases. The CHF sensors she’s researching are imbedded within mattresses while constantly measuring vitals such as heart and respiratory rates and restlessness — a key predictor of impending heart failure because related issues such as lower extremity pain and weight gain prompt victims to get up at night and move around or seek recliners to ease discomfort.

“We can see those subtle changes before they even realize that they’re having problems,” Lane says. Other sensors Tiger Place and other researchers have developed can predict falls through gait analysis.

Smart devices and smart homes. The market is now flooded with tech that can control locks and lights, summon help and track and upload vital health data, all through smartphone apps. Big box retailer Best Buy recently expanded its Minnesota pilot of “Assured Living,” a project that allows adults to remotely assist and monitor older relatives, regardless of location. Amazon reportedly is getting into the act as well.

Voice activation and artificial intelligence. Kristen Hanich, a research analyst for Parks Associates, says voice-activated and controlled “smart speakers,” such as the Amazon Echo and Google Home, are showing a great deal of promise. Adoption by seniors is currently low, but Hanich believes they are “potentially revolutionary,” especially for those with mobility issues.

“We likely will see a lot more innovation in this space, including tighter security based on your unique voice signature and easier language support through artificial intelligence,” Edwards adds. “Every day, voice technology becomes more simple, safe and reliable, which are critical needs of the aging population we serve.”

Alwan sees voice-activated technology becoming layered with existing tech such as telehealth, medication management and care coordination applications.

Connectedness. This dovetails nicely into the industry’s transition toward resident-centered care. Seniors are becoming the focal hub inside and among the larger world outside, and devices and apps are offering up many ways of engaging with family and friends — something research now shows contributes to longer lives and delays in the onset of debilitating diseases and ailments. Alwan says CAST is now monitoring more than 40 social connectedness and engagement technologies, and the number continues growing.

Staffing technologies. As Alwan observes, “digital signage, resident portals and community apps can be leveraged to increase staff efficiencies.” In one way or another, all of the above are now finding applications to address one of the most vexing problems that dogs providers of all kinds — staffing attrition and turnover.

Just ask Travis Palmquist, vice president and general manager for senior living at PointClickCare, which has employee engagement and customer experience tools that “are giving providers the ability to manage employee engagement, improve resident outcomes and achieve a stronger bottom line. Through employee engagement and customer satisfaction tools like this, providers are able to improve organizational culture, reduce staff turnover rates and increase staff satisfaction, which will ultimately help improve quality of care and customer satisfaction.”

Hanich believes automation promises to “fill in the gap in care staffing via the connected medical home and different types of remote care monitoring” and is “just now beginning to see increased traction among payers and providers.”

Smartphones and apps not only help understaffed facilities multitask and schedule work more efficiently; they improve morale. Myriad IT innovations are streamlining charting and reporting. “In the future, voice recognition will allow staff to automatically log required work as it gets done through a biological signature like facial recognition,” Edwards says.

Fortunately, cooler heads prevailed in the ensuing years and though the financial crisis of 2008-09 threatened to be the dreaded “other shoe,” senior living managed to escape any lasting damage due to a tempering of over-exuberance that permeated residential real estate. Thus, the wait continues.

Although there currently are no overt signs of another negative financial situation occurring, some in the industry are concerned about possible triggers, such as the acuity shift throughout the sector, undisciplined expenditures of capital and supply-demand imbalances in some markets. At this point, though, senior living operators should find a sense of relative normalcy when approaching the financing community.

“There are signs of saturation in particular markets, but of the projects we have financed that are in lease-up, the vast majority are on or ahead of projections,” says Evelyn Lee, senior vice president of SunTrust’s Aging Services practice. “As it relates to the pipeline of projects, we see our operating clients continuing to be disciplined around where they deploy their time and capital. We have quite a few long-tenured, experienced clients who are sitting on the sidelines today with the expectation that there will be opportunities to rescue projects at attractive prices in the coming years. That patience is also being driven in part by rising construction costs.”

Anthony Luzzi, president of Sims Mortgage Funding, says seniors housing capital through the Department of Housing and Urban Development prolific LEAN mortgage insurance program continues unabated and that it remains a stronghold for dependable lending.

“Interest rates for HUD-insured loans remain favorable, and LEAN loan processing continues to be efficient, leading to timely and predictable outcomes,” he says. “The majority of HUD activity in the seniors housing space is under the Section 232/223(f) program, which covers existing properties. However, it is possible to use HUD for financing the construction of new developments. Using HUD for that option requires a strong developer and operator, a strong market and related demographics, a conservative underwriting profile and a relatively long lead time.”

Supply for senior housing has continued to grow due to the infusion of both foreign and domestic institutional equity into senior housing investments, and data from the National Investment Center for Seniors Housing & Care shows that inventory has been exceeding absorption for the past several years, notes Scott D. Frederick, vice president of asset management at Capital Health Group.

“Anecdotally, the majority of the overbuilding is occurring in markets with low barriers to entry,” he says. “However, there are still opportunities in high barrier to entry markets. This growth will continue, provided that the capital markets continue to invest into senior housing.”

An imbalance does exist with supply outstripping occupancy rates, Frederick says, and only a decline in capital inflow can move the market back toward an equilibrium.

Kristen Ahrens, managing director at Capital One Healthcare, acknowledges that concern about overbuilding in certain markets is real, but she says that the pace of new development overall seems to have slowed lately.

“As with any real estate type, the hope would be that supply and demand for seniors housing would find equilibrium based on information from the market,” she says. “While there is still a long way to go, information on occupancy, absorption and new construction is now more readily available in our space than ever before.”

MANAGING ACUITY CREEP

To ascertain whether trouble is brewing and how it could manifest itself one needs to look at what’s driving the market, says David Friend, M.D., managing director and chief transformation officer for BDO Boston. If one culprit can be identified, it might be the acuity shift throughout the post-acute care continuum.

“The assisted living community of today is yesterday’s nursing home,” he says. “Is assisted living equipped to provide the kind of care that their residents need? And what happens when these residents need even more care? Assisted living communities are becoming a part of the medical establishment, whether they are ready or not.”

Comparing assisted living demographics between 2000 and 2017 is like night and day, Friend says. New construction projects need to be in tune with what the residents of today demand and avoid looking like “cookie-cutter, boxy buildings,” Friend says, “because that is the wrong kind of product.”

To be sure, as residents come to independent and assisted living communities at a more advanced age, operators of these properties need to make arrangements to provide more care, Frederick agrees.

“For example, this can be in the form of providing direct access to home healthcare or making preparations for companion care in independent living, while assisted living operators will continue to increase their level of care,” he says. “We also expect, as baby boomers enter the market, the senior housing paradigm will have to change and offer more services and amenities.”

On the financing side, investors are generally more cognizant of the acuity creep and that investor interest in settings with multiple levels of acuity generally outweighs single-acuity communities, says Jeff Binder, principal and managing director for Senior Living Investment Brokerage.

“If a community consists of just one level of care, the typical investor wants to know what opportunities exist to add additional levels of acuity and ancillary services, and to increase length of stay,” Binder says. “It is no secret that the average age of residents in seniors housing has increased, and with this brings higher care needs. That facet distinguishes this sector from other types of real estate that investors may find more comfortable.”

THE ‘IDEAL’ INVESTMENT

Market concerns aside, senior living operators have access to capital from various sources if they meet the criteria investors have set.

“We like to partner with experienced and proven operators, because it is ultimately the operations that drive the value of the real estate,” Lee says. “We also like to work with clients who have several or more properties because they benefit from a more diverse cash flow stream.”

Binder says his firm looks for two primary factors: location and operating partner.

“Both of these play into the type-acuity-size of the project, as they are dependent on the location market and the operator’s track record with that type of project,” he says. “There is a direct correlation in the seniors housing sector between the distressed, newly developed communities we see, the lack of experience of the operator and the poorly selected site for the project.”

Tim Cobb, managing director for senior housing and healthcare at Berkadia, says assisted living is gradually being seen as more of a real estate option, which indicates a progressive change in how potential projects are assessed.

“As this perspective continues to shift, the industry will see more capital along with better risk management and enhanced innovative thinking,” he says.

Cobb maintains that it is imperative for operators and developers to focus on increasing their market penetration, focusing on innovation and design while finding a way to lower costs for a majority of the population. Technology — so far vastly underutilized in senior living — is one way for operators to make themselves more desirable, he says.

“One thing that remains constant throughout this evolution is an investor’s desire for strong financial, risk and process management,” Cobb says. “As such, an area that should be watched closely is the role of technology. With the ability to speed information and mitigate risk brought on by legislative changes, technological advancements will be a key factor in an investor’s decision-making process.”

It is this new approach to design that Aspired Living of Westmont, IL, revealed to the crowd of visitors who attended the community’s open house on Sept. 28. The 107- unit assisted living and memory care property is also the first senior living community in the United States to provide residents with Spark of Life, a treatment and support program for dementia care.

Set on an approximately threeacre site, Aspired Living of Westmont offers 73 independent and assisted living apartments ranging in size from 400 to 1,180 square feet. Each unit features a kitchen with stainless steel appliances, private bathrooms with walk-in showers, closet space and Juliet balconies. The memory care segment, called A Knew Day, includes 34 studios, each with a private bathroom.

The interiors were created by senior living design firm ThomaHolec Design. Keith Stanton, director of design development, says his main objective was to use all facets of décor — including lighting, color, flooring and fabric — to radiate warmth and stimulate senses.

“I’m an advocate for residents,” he says. “A warm environment creates a strong sense of well-being.”

Little details are important, he says, such as commercial fabrics stirring tactile senses, whereas wider hallways and no reflective surfaces help memory care residents feel more comfortable navigating the corridors. Line-of-sight layouts help with wayfinding, balance and orientation, he added.

“We are fanatical about line of sight,” says Maria Olivia, chief operating officer of Pathway to Living, which operates the community. “For design, we have made sure each resident has a line of sight to the toilet from the bed. The wall color design sets off the toilet location so it can be found easily. The environment plays an important role in cueing behavior.”

Wall art also serves as an orientation cue for residents. In assisted living, each neighborhood is distinguished by a theme — one hallway features different representations of dogs, whereas another features an array of fish and another a series of birds. Memory care adds a palette of pastel colors to its sections so residents can find their units easily.

The community features a long list of amenities, including a restaurant and bistro, resident lounge with demonstration kitchen, cocktail lounge and bar, library, technology center, movie theater, art studio, salon and spa.

Residents also have access to fitness options, including a yoga studio, gym with personal trainers, high-tech pneumatic exercise equipment and outdoor walking paths. An on-site therapy gym offers physical, occupational and speech therapy.

Enrichment programs are at the heart of the community’s approach to resident fulfillment. The organization’s VIVA! philosophy is designed to enhance residents through various social, educational and recreational pursuits.

The action stems from disagreement over the ramifications of a state Division of Administrative Hearings decision Friday that the emergency rules set into motion by Gov. Rick Scott on Sept. 16 “are invalid exercises of delegated legislative authority.”

Provider groups believe that the DOAH decision puts compliance with the rules on hold. Scott, however, appealed the decision and told the state Department of Elder Affairs and the Agency for Health Care Administration — which, respectively, issued the rules covering assisted living communities and nursing homes at his direction — that the rules remain in effect during the appeal.

“Because the agencies have taken the position that the emergency rules remain in effect despite the final order declaring their invalidity, all nursing homes and assisted living facilities are at risk of daily fines of $1,000 per day, and potential license revocation for failure to install commercial generators and provide sufficient fuel for 96 hours of power,” LeadingAge Florida and Florida Argentum said in their emergency joint motion.

Scott had announced the rules following the deaths of eight residents of a rehabilitation facility who died after a power outage related to Hurricane Irma knocked out the facility’s air conditioning. Since then, six additional residents of the facility have died.

LeadingAge Florida and Florida Argentum on Monday had asked DOAH Administrative Law Judge Gar W. Chisenhall for clarification on whether the rules remained in effect during the appeal of his decision, but he said he did not have the authority to make clarifications.

“The judge stated that he only has approval to correct a clerical error,” Florida Argentum said in a message to members.

The rules had given assisted living communities and nursing homes 60 days to obtain generators and enough fuel to enable them “to sustain operations and maintain comfortable temperatures” for at least 96 hours following a power outage.

Operators were required to submit emergency power plans by Oct. 31 and to have generators installed by Nov. 15. In light of AHCA’s and DOEA’s interpretations of statute, the provider groups encouraged their members to meet the deadlines or ask for variances, involving attorneys as appropriate.

The First District Court of Appeals previously rejected a provider group challenge to the emergency rules.

He is chief operating officer and chief financial officer of The Legacy Senior Communities, and the company’s The Legacy at Willow Bend in Plano, TX, served as the site of a recent field trial for MyndVR’s virtual reality solution. About 20 residents across all parts of the continuing care retirement community participated, he told McKnight’s Senior Living.

“Some residents started to connect the experience to memories in their own lives, and they began to reminisce. Others were brought to tears of joy and their moods were positively impacted,” Barnes said. “Some even had a reduction in symptoms related to medical conditions while using virtual reality.”

Virtual reality has the potential to become part of the CCRC’s programming as a form of clinical treatment or entertainment in the future, he said.

Other field trial locations where MyndVR has been testing its proprietary virtual reality interface over the past year, company representatives told McKnight’s Senior Living, include the Golden Inn and Village, the Rona Barrett Foundation’s affordable seniors housing community in Santa Ynez, CA; Encore at Avalon Park, an assisted living and memory care community in Orlando, FL; and Linn Community Nursing Home, part of a CCRC in Linn, KS. More than 250 residents have been involved, using the equipment to take them through several different interactive environments.

“Our next step is to hold clinical trials that include brain scans to show how our unique content and technology creates emotional connections and establish the basis for prescriptive digital therapy,” said Chris Brickler, co-founder and CEO of MyndVR.

In addition, the company has been curating a library of licensed and original virtual reality content specifically designed to interest seniors. Shawn Wiora, co-founder of MyndVR, said the company’s content creation efforts are being guided by a scientific advisory board that includes technologists and brain scientists from the University of Texas at Dallas and several other research institutions.

“We curate licensed content and produce our own — which includes casting and filming just like a real movie — to give older adults relatable and enjoyable experiences,” Brickler said.

To create original content, company employees travel across the country filming nature, cities and venues such as a New York night club. The content is customizable and can specifically target certain physical or cognitive conditions such as Alzheimer’s disease or Parkinson’s disease.

MyndVR’s name is a play on “mind,” substituting a “y” for the “i” to demonstrate possessiveness, Brickler said.

The technology is in the pre-sale stage, but ultimately, MyndVR plans to make it, as well as training, available not only to senior living communities but also to home healthcare agencies. Eventually, consumers should be able to buy it directly.

Three Texas metropolitan areas are among 11 U.S. markets that have experienced gains in seniors housing inventory of more than 10% in 2017 relative to existing inventory in that market, according to National Investment Center for Seniors Housing & Care Chief Economist Beth Mace.

The Texas metro areas on the list include Austin, El Paso and San Antonio, Mace shared in a blog posting about key messages from NIC’s third quarter seniors housing data release. Additionally, Dallas, not on the list of 11 markets, has accounted for 7% of all new seniors housing inventory in the past 12 months, Mace wrote.

Other markets that have seen gains of more than 10% over the course of the year, she said, include Baton Rouge and New Orleans in Louisiana; Charleston and Greenville in South Carolina; Ogden and Salt Lake City in Utah; Albuquerque, NM; and Jacksonville, FL.

“In total, more than 38,000 units were added to the stock of seniors housing inventory among the primary and secondary markets in the past year,” Mace wrote in her blog post.

The seniors housing annual inventory growth rate in the third quarter of this year was 4.1%, NIC said earlier this month. That rate was down 0.1 percentage point from the second quarter, when it had reached its fastest pace since NIC began reporting the data in 2006, the organization said.