In retrospect, the purchase seems to support the adage about making wishes carefully. For by any objective measure, the time since has been a tough slog for the Brentwood, TN-based operator. And the company now finds itself in the fight of its life.

From the beginning, Brookdale struggled to integrate systems and cultures between two very different companies.

It hardly helped that many Emeritus facilities needed upgrades to command rates in line with other Brookdale properties. By some estimates, the firm had to pour $100 million into building improvements. Then there was an assisted living building boom that gave the company additional competitors to deal with.

As if on cue, predicted earnings then failed to materialize. Analysts were soon expressing skepticism. Stockholders were less stoic. One, an activist investor, started publicly pushing for a real estate spinoff. Initially, that effort only caused a C-suite shakeup.

Still, earnings struggled. And pressures only mounted. At press time, the nation’s largest senior living operator was in talks with Blackstone Group and others to sell some or all of the firm.

Although the discussions were at an early stage and a deal was not necessarily imminent, it appeared likely that major changes lie ahead.

A recent stock price bump should not encourage Brookdale to soften efforts to maximize value for shareholders, registered investment manager Jonathan Litt wrote.

Some insiders are predicting Brookdale is likely to emerge as either a smaller or acquired company. Because it currently has more than 1,000 communities across the United States, with more than 100,000 residents, either development could have major implications for the senior living sector.

It now seems safe to say that the first major effort to develop a senior living organization with a national brand has been a less than rousing success. That does not mean the effort ultimately will fail.

But it just might give other operators reason to think twice before attempting growth on such an ambitious scale.

Q: How do I increase move-ins?

A: Referrals from existing residents are a leading source of leads and move-ins. That’s because seniors trust and listen to their peers.

Here’s one way to do it:

Invite about 12 articulate residents and several immediate family members for a discussion session. Tell them the meeting will last about 90 minutes and they will be discussing how they went through the decision process to move to your community.

A typical example of group discussion of financial issues include:

1. First reaction when you discussed pricing?
2. How did it initially compare with your current cost of living?
3. Your initial reaction regarding pricing versus affordability versus value?
4. Did it change during your decision process?
5. How do you now define the “value” of your community?
6. Were you concerned about future monthly fee increases (then and now)?
7. Did you have to reduce your current savings portfolio, or did you use some of your newly acquired home sale proceeds?
8. Do you now consider living here a sound financial planning decision? Why?

Consider recording the session and create a 12- to 15-minute DVD as an innovative sales and marketing asset. You likely will be pleasantly surprised with the results.

Jim Moore runs a national senior housing and healthcare consulting firm based in Fort Worth, TX. He has written several books about assisted living and senior housing, including Assisted Living Strategies for Changing Markets. 

And don’t forget private social network pioneer Connected Living, which is on an ambitious crusade this year to connect one million seniors and their families together with public and private partners as it promotes an innovative platform that will help operators capture new revenue streams.

Then consider OptimizeHealth, a large information technology managed services provider, which recently found itself having to teach caregivers in a remote rural Texas community how to use a computer mouse during an electronic health record rollout.

No doubt, as senior living operators find themselves literally awash in ever-morphing tech from wearables and wireless monitoring to sophisticated medical software, widespread adoption of anything is understandably spotty. Which makes it even easier to understand the resolve of Connected Living’s CEO and co-founder Sarah Hoit, who proudly declares, “There is a mobile revolution, and we’re about to change the game significantly.”

Large players sign on

Make no mistake: Hoit and other tech leaders in this space are quickly winning over a large core of believers.

In its recent annual report, the LeadingAge Ziegler 150, aptly named for the 150 largest not-for-profit providers, declares a greater proportion of communities and operations (on average, 80%) adopted EHRs in 2015 compared with 2014. The report notes similar widespread adoption of electronic point of care/point of service documentation systems, care/case management and coordination software, personal emergency-response and wander and medication management systems. Other tech gaining traction includes telehealth/remote patient monitoring and telecare/telemonitoring/behavioral monitoring technologies, which the report attributes to burgeoning provider partnerships with accountable care organizations, hospitals and managed care plans.

Transformative effect

Indeed, technology slowly is changing both the business and care sides of senior living, in some remarkable ways.

John Shafaee, president of ALIS by Medtelligent, moved into an assisted living facility for two weeks while developing his company’s latest software tool. The experience taught him volumes about workflow inside the community. “I learned that time is everything in senior living, which focused us on integration and trust: between care facilities, across activities and procedures, and between clinical and non-clinical functions,” Shafaee says. “Lack of coordination and data visibility cost senior living facilities real time and real money, whether it is poring over incompatible records or not charging when care is provided.”

For some vendors, the landscape has a personal side. Glenn Paul, vice president of marketing for Gentell Inc., talks of two projects he hopes to one day produce. Paul and his wife have curated a gallery of 500 of the greatest paintings in history, which can be displayed on large-screen TVs with USB ports. Paul, whose father is a resident in an Alzheimer’s community, believes the gallery would be very engaging for many residents and is offering to test it in the first 50 facilities that request a copy. Another project is a website that enables residents’ children who live far from their parents to trade visits with other residents’ children who live nearby.

In January, MatrixCare announced that it will deploy its CareCommunity LTPAC Population Care Management and Care Coordination platform on Microsoft Azure, one of the first hyper-scale cloud computing platforms to achieve the coveted HITRUST CSF security certification. CEO John Damgaard says MatrixCare also hopes its new partnership with the computing giant will lead to the addition of powerful new analytics capabilities. The company also is looking into incorporating Microsoft’s artificial intelligence engine, Cortana, into its decision support tools. “One doctor can read a medical journal maybe twice a month,” he says. “Cortana can read every cancer study published in history before noon and by 3 p.m. is making patient-specific recommendations on care plans and improving outcomes.”

Greg Nicholas, managing partner of OptimizeHealth, has witnessed the transformative effect EHRs have had on the admissions and transitions processes, and how they have vastly improved care. Ironically, he also has learned how technology sometimes can be disruptive, literally. Recently, he piloted a new physician charting program at a large senior living provider. Physicians made their rounds at the facility and when done were invited to a private lounge where they used high-end voice recognition software to do their charting. It was a hit, saving physicians an average of 30% of their total time inside the facility.

“It wasn’t as expensive a solution as I thought it would be,” Nicholas says. “More important, it gave not only the patient but the doc a better experience. And the quality of notes and patient-physician interaction improved greatly when we removed the computer from the patient interaction.” Moreover, the physicians were more willing to refer patients to that facility because of the positive experience, he adds.

Competing for dollars

Although no data prove it, the pace of innovation today is dizzying. Some technologies such as EHRs, as well as many business office tools, essentially are viewed as “must-haves,” and for good reason. Other technologies, such as monitoring software, undoubtedly are making senior communities safer and thin staffs more efficient.

Still, a huge chunk of emerging tech is being driven by competitive pressures. Consider the relationship between resident mix and where operators are investing their tech dollars.

“Assisted living operators today are scraping the cream of the crop in terms of private pay,” Damgaard adds. “All of these communities are competing for private-pay residents, and they are pretty high-end products. If you walk through an assisted living community, they look like resorts.” This in part explains the healthy adoption among the biggest communities.

“The reality is the senior living market today is a real estate-driven market,” Damgaard says.

“Technology is starting to make a major impact in some of the most critical phases of the senior living industry by addressing marketing and communications, labor, resident care and satisfaction, and overall asset value,” says Gustavo Sapiurka, senior vice president of OneSite Enterprise Solutions. Such solutions are better at minimizing risk, increasing revenues, improving services and are a “major factor for owners that have a buy-operate-sell corporate strategy,” he adds.

“As much as we want to say it’s converted to a medical model, it’s not yet in the operators’ purview,” Damgaard says. “So technologies related to real estate upkeep and staffing are big deals, which is why things like point of sale technology ensures that ancillary revenues are getting captured to augment the rent. That’s a hot seller. You have salons, food service, concierge, extra activities, lots of things residents can tap into and a lot of times that revenue falls on the floor. With point of sale, you can make sure every dollar gets dropped in the bank.”

Richard Nix, regional director, senior living for Yardi, says the company’s RENTCafé Senior Living portal allows residents and family members to log in from anywhere and manage their accounts, make payments, review billing and see if their loved ones are participating in any wellness activities. “When communities introduce RENTCafé to residents and their families, it enables better communication and allows the community to respond quickly to requests and criticism,” he says. “Ultimately, this technology allows communities to improve the level of care they provide, which helps build revenue, retain staff and increase resident satisfaction.”

Garnering new business is at the heart of Connected Living’s Home Connect app.

“There are new emerging revenue streams and technology is positioned to capture them,” Hoit says. “Many CEOs are talking about extending services beyond the walls of their senior living communities, but I don’t think many have been able to actualize that yet.”

Connected Living is partnering with “best of breed” companies such as Sodexo, Philips Healthcare and ride-hailing service Lyft and inking other agreements to include them in its full technology offering, mobile app, and Home Connect to serve seniors living both in around senior living communities. Hoit envisions operators using the application to engage broader aging in place communities. One idea is to use the application to introduce “constituents” (including seniors, their families and vendors) to their senior living communities in various kinds of engaging activities and social events, services and dining.

The strategy also is a win for vendor partners. “Companies like Sodexo say they not only want our technology in all of their locations but also to have the app distributed to their constituents so people can have visibility into their services,” Hoit says.

Damgaard says MatrixCare’s high-end platform offers a “premium experience” to residents and their families, who, for example, can gain family portal access into the EHR and use it to see whether their loved one took his or her medications, attended activities or had a change in health status. Meanwhile, on the Medicaid side of senior living, technology currently is “an operational efficiency scale game,” where the focus is on driving down things like overhead and labor costs.

“What will happen and what is happening is, the market will eventually bifurcate,” Damgaard adds.

“There’s only so many people who can afford $6,000 a month to live in one and we’re going to run out of those places very soon.”

That doesn’t mean cash-strapped operators should hold off on key tech investments.

As more and more of the senior living landscape evolves under managed care, “the name of the game is keep them all as healthy as you can and keep them out of the hospital,” he cautions.

Putting it together

“Those senior living providers who haven’t invested in EHR technology will be caught with their pants down. They’re going to need those digital backbones to manage health and wellness or they’re just not going to be able to survive,” Damgaard says.

With so much technology competing for operators’ attention these days, it’s no wonder many heads are spinning.

That integration a key buzzword in the near future.

Bill Briggs, vice president of business development for Prime Care Technologies, says his company believes operators will continue to seek efficiencies of operation and care via suites of “super apps. More and more, they will need tools that connect the various disparate apps and consolidate them into one ‘pane’ of glass or view for leaders to maintain an accurate pulse of the business, allowing rapid and appropriate adjustments to the business,” he says. “Couple that with automation that will provide transparency and real-time visibility into both resident care and operations, and the industry really makes a steep jump skyward.”

Obviously, technology is no good unless a lot of people are using it. So accessibility will be key.

“We are going to keep breaking down barriers between all levels of senior living, from assisted and independent living to skilled nursing,” Shafaee says. This means common data, unified interfaces and the ability to adapt to different data formats and state regulations. A continuum of care requires a continuum of data, particularly as resident acuity levels continue to increase.”

Integration will continue to be paramount. “Skilled nursing facilities in particular are looking for technological advancements that will improve their facilities, but at the same time be seamless and integrate with a homelike environment,” says Maayan Wenderow, director of marketing for EarlySense.

Going mobile

People like Hoit and Steve Robertson, chief technology officer for CareWorx, see mobility as the leading driver in tech innovation going forward. “We are now seeing mobile devices being used in foodservice, maintenance, activities, nursing care and administration, to name a few, and a significant increase in demand for tech support and guidance on how to build a roadmap for new initiatives,” says Robertson, who also believes senior living app development “will touch every area of caregiving and convenience.”

“I really believe in five years everyone will have mobile devices, and shame on you if you don’t, because there’s no reason not to,” Hoit says. “If my grandmother is in the advanced stages of dementia, there’s no reason an iPad isn’t next to her bed so kids are sending pictures and inspirational messages. We see so many technologies where people are building different boxes or wheeling in the same old stuff. Talking to people instead of with them. Mobile is what can bring all of these emerging suites of technologies alive — whatever stage of living you’re in.”

Reaching that goal can be challenging, but those committed to the task agree their efforts deliver substantial rewards. Dementia affects not only memory, motor skills and sensory abilities, but also visual perception. As dementia progresses, language and overall communications skills also diminish. Such deficiencies may increase agitation and confusion and the need for psychotropic drugs. Additionally, they may up the risk for isolation, falls and elopement, and subsequent illness.

Innovative practices and solutions geared toward residents of all levels of cognitive decline can help mitigate those risks, improve quality of life and allow residents to age in place longer.

“Well-developed memory care programs are important to market because they offer a competitive advantage, but more importantly, they are tied to reduced hospitalization and other health and wellness benefits for the resident,” says Charles de Vilmorin, CEO of Linked Senior.

New challenges

New learning and delayed dementia progression can occur when those with mild cognitive impairment are supported through targeted programming; however, they aren’t the only ones to benefit. Even those with severe dementia can stay connected and positively engaged if there’s a facility-wide commitment to delivering person-centric programs and services.

Today’s most enriching and successful resident engagement approaches combine hands-on, human interaction with innovative, intuitive and easy-to-use technologies that are scaled to each resident and facilitate positive exchanges between caregivers, loved ones and residents.

Digging deeper

“We believe that the most effective way to help caregivers better engage with dementia residents and acclimate them safely and effectively to their surroundings is to facilitate closer and more constant contact and communication,” says Neil Sullivan, chief operating officer at Connected Living.

Getting to know each resident well is a critical first step to successful, ongoing engagement. Previous roles, interests and values help care- givers tap into a resident’s procedural memory — which remains an area of strength for many people living with dementia. “Procedural memory is the way we do things that are unique to each of us,” says Loretta Bartz, ORT/L, VP of clinical training and program development at HealthPRO-Heritage. “Tapping into those memories and using tasks that are meaningful to the individual allows us to support the person’s ability to remain engaged. It doesn’t mean that they will continue to do the same level of complexity of tasks as they had previously, but we can find a means to modify the activities so they can still participate in a more simple, but meaningful way.”

It’s also critical that the care team understand who each resident is now — every day and in that very moment, reminds Jenni Dill, life engagement director at Chelsea Place, an Anthem Memory Care community.

“While it is important to know and draw on people’s past likes, interests and strengths, it is also important to expose residents to new and novel things in their world and make space for spontaneity,” she says. Layered questioning also can lead to richer relationships between residents and caregivers, and more purposeful communication and programming. One of the best lessons Dill learned from a colleague was to always ask one more question. This is especially important when learning about a person’s occupational history, she says. Instead of asking about his or her occupation, she recommends asking the resident whether he or she enjoyed it — and whether it is something he or she wishes to continue in some capacity. “Ask, ‘What are your interests now? Is there something you’ve wanted to do that you haven’t tried yet? How can I help make that happen?’ The questions can go on and on.”

Baseline and ongoing assessments are equally important to ensure residents are always met at their current levels of cognitive ability. Unfortunately, free and accessible tools, such as the Global Deteriorization Scale, which assesses primary degenerative dementia, aren’t always used to their fullest, de Vilmorin says.

“We need to know where each person is cognitively. Are they only mildly cognitively impaired or [severely] impaired? Tools like the GDS can help determine if a resident can be part of a larger group activity, for example, or would do better in a small group or one-on-one for only brief periods of time,” he explains. “We need to meet residents where they are and avoid doing too much or too little.”

Gaining insight into a resident’s past experiences and preferences helps the care team develop meaningful activities and programs. “All humans have an inherent drive to remain engaged and have purpose. This does not vanish with the onset of dementia,” Bartz says. “They continue to have strength that caregivers must recognize and learn to champion.”

Plugging into tech tools

A wide range of technologies can help residents with dementia connect with caregivers, interact with family members and other residents, and safely adapt to their environment. Computer- and web-enabled solutions, in particular, are bringing useful applications to the masses, and many can be uniquely tailored to a community’s broader memory care and wellness programming.

Brookdale Senior Living’s Clare Bridge Memory Care program relies on technology to assist with person-centered engagement content. The tool, named InTouch by Brookdale and created by It’s Never 2 Late, lets caregivers and residents pull customizable content at the touch of a fingertip that supports each domain of well-being. Juliet Holt Klinger, senior director of dementia care and programming for Brookdale, says she receives stories from communities almost daily on how the technology has improved resident lives. There are instances where the technology brought someone closer to a relative via video chat, for example, or brightened a resident’s day when he or she was able to read the home- town newspaper again after many years. One resident’s anxiety and behavioral expressions diminished by playing drums on the virtual drum kit, she says.

One of Holt Klinger’s biggest surprises with the technology was how successfully it was adopted by residents with later stages of dementia. “In fact, our residents living with moderate to advanced dementia were the earliest adopters of resident-use technology at Brookdale,” she notes.

Jack York, president and co-founder of IN2L, says successful memory care programming hinges on operators’ and caregivers’ understanding that people with dementia still have so much to give and live for — and that technology tailored to the individual can provide the ability to reach a resident where he or she is and at the appropriate level. “Once the mindset changes, caregivers and family members are open to solutions, like technology, that are outside the box of traditional thinking.”

Even residents who are not self-directed can enjoy the programming features of computer technologies if they have some assistance, stresses Nancy Allegrezza, RN, director of sales for Telikin. “Staff can use computers to provide both individual or group activities.”

When considering how technology will be incorporated into a community, she recommends selecting computer technology with a user-friendly interface, meaningful software applications and a touchscreen to help remove usage barriers.

Also essential is a technology’s ability to provide exercises that precisely match a user’s ability at that moment in time. This allows individuals with dementia to receive cognitive stimulation without the fear or frustration of failure, explains Dan Michel, founder and Executive in Charge at Dakim Inc.

“When caregivers observe individuals with dementia performing on Dakim BrainFitness above their expectations — say, in language, computation or visuospatial orientation — it forces caregivers to reassess their overall perception of the potential and capabilities of the individual,” he says. “You can imagine the profound impact this shift in perception has on the [person’s] care and quality of life.”

That’s certainly been the case for Prestige Care communities. The operator’s robust and activity-rich memory care programming program, named Expressions, received an Innovators Award in 2012 from the International Council on Active Aging. At its heart are innovative care techniques and treatment approaches that turn daily activities into memorable and meaningful events for residents with dementia. Programming focuses on learning, the arts, spirituality and the development of new skills. Technology plays an important role, explains Hollie Fowler, senior director of product and brand development at Prestige Care. The same is true of Prestige’s lifestyle program, Celebrations, which uses a wellness-based curriculum that emphasizes cognitive exercises to strengthen brain health and decrease the risk of degenerative brain diseases.

“We chose a solution that could offer customizable programming and be tied to our programming,” she says of the Linked Senior platform, which allows the care team to align computer-based content to its wellness themes. For example, for Prestige’s heart healthy programming, Linked Senior content provided food demonstrations as well as music and trivia geared to the theme. The platform’s interactive touchscreen kiosks and tablets let Prestige custom-design interactive therapy for each individual. Fowler says they also use the dashboard to track and monitor progress, and see how communities are using the tools.

Simpler may be better

Sometimes, technologies’ greatest benefits come in their more basic offerings. Computer-based technologies that give residents with dementia easy access to photos from their past or images of their various interests can provide comfort and help them relive happy moments in their lives.

“A senior living community’s directory of residents and staff can also help seniors with dementia remember the names of caregivers, or make new friends,” says Ashlee Bartko, marketing manager for Touchtown Resident Engagement Solutions. Touchtown’s Community Apps also can help family members stay informed about the community and loved ones.

Connected Living’s CL Mobile App allows for private family and friend networking and the sharing of social pictures that can be turned into a digital memory box in slideshow mode. The application also offers an activity tracker and has geolocation features that allow seniors, caregivers and family members to set a specific location and receive an alert when anyone comes or goes from that location.

“The experience of seniors, families and caregivers being connected all the time, not just for one hour of service, is a game-changer,” Sullivan says. “With a mobile device, the socialization, reduced depression and isolation and ability to have meaningful, two-way conversation becomes immediately available.”

Whichever approaches a community takes to reach its residents with dementia, the community must stay committed to helping caregivers understand and respond to each resident’s wants and needs, and then use that understanding to engage meaningfully with residents.

“Effective engagement doesn’t need to be a complicated process. If we know a certain resident takes coffee with two sugars and a creamer, for example, that can go a long way toward improving communication and building trust in the moment. The resident may not remember the caregiver from the day before but will know that the caregiver knows who they are,” Sullivan adds.

The rate of falls in senior living remains at a high level, and a substantial portion occur on the slippery surfaces of the bathroom, according to research from the Journal of the American Medical Association and the National Center for Injury Prevention. Among the numbers:

• 50% to 75% of residents fall annually.
• 30% of residents experience falls within the first 48 hours of moving in.
• Fall-related injuries account for up to 15% of rehospitalizations in the first month after discharge from the hospital.
• 34% of male and 25% of female residents who fall with a fracture injury have a one-year mortality rate.

It all adds up to a call for vigilance and security on the facility operator, with part of the responsibility also shared by manufacturers of bathing equipment. Hillary Marshall, Joerns Healthcare’s global product manager, patient lifting and repositioning, concedes that bathing issues are ongoing and that operators can address them with a healthy dose of empathy.

“It is important to know not only residents’ physical capabilities, but also their comfort levels,” she says. “Dignity and comfort are also important. While it is easier to undress residents in their rooms before wheeling them to the bathing suite, a robe or covering does not always provide a level of discretion for them. The comfort issue concerns how cold residents can get if they have to stay in the tub while the water drains.”

Operators also need to consider the effect on staff and how to best use them on a case-by-case basis, says Tiffany Rayback, vice president of operations at MasterCare Patient Equipment.

“Staff may have difficulty getting individuals into and out of the bath if it doesn’t meet the level of care needed for that particular individual,” she says. “Most tubs can be used by most individuals, but some are better suited for different levels of care. To make the process safer, there should be a care plan for each individual, and if necessary, assistance from other staff to get the individual into and out of the bath safely.”

Dementia an issue

Although physical limitations should be a prime focus, cognitive impairments also are significant — especially because they are not as obvious, says Carolyn M. Gatty, regional clinical director for Genesis Rehab Services.

“Because people are living longer, the population of cognitively challenged residents is growing, and their conditions need to be addressed,” she says. “Even if they are physically intact, as the brain deteriorates, it impacts vision, movement and perception so that information can be misinterpreted. So it is essential that caregivers do everything possible to convey every step of the process to the residents so that they don’t get confused and act out.”

To help caregivers understand the challenges of dementia residents and develop bathing techniques that correspond with a more comfortable experience, free online training is available through Bathing Without a Battle.

The training program is based on a 1997 research project conducted in North Carolina and Oregon that explored ways to make bathing a more pleasant experience for both residents and staff who live and work in seniors housing and other settings where people need assistance with bathing. It provides practical, relevant information about how to easily and safely adapt the bathing process to meet the needs and desires of residents, particularly those with dementia.

The techniques explained in the program instruct bath attendants on how to respond to resistive behaviors such as hitting, biting and yelling. Following these methods can help reduce stress and anxiety in the bathing process, program trainers said.

Easing the transition

The critical entry and exit phases of the bathing process are where most problems occur, and having the proper equipment can dramatically reduce the number of injuries during these junctures, bathing specialists said. Among them are lifting devices, which range in size, shape and function.

The ceiling lift is a stalwart in transition assistance. Installed in bathing areas, the lifts are ideal for tight spaces and are designed to transfer a resident from a wheelchair or chair into the tub with ease. They also can work for tubs with side doors because bathers can be lifted from the water and wrapped in dry towels before they have a chance to get cold.

Because ceiling lifts eliminate the need for residents to stand on their own, they minimize the risk of sliding on a slick surface and the anxiety that accompanies the fear of slipping. A variety of track and accessory design solutions can be customized to fit any setting, and the sturdy appearance of a ceiling lift affixed to the building’s structure can bring residents comfort and ease.

Mesh slings also are compatible for use with ceiling lifts in bathing suites, providing rapid draining and drying, and Joerns offers them in several sling styles, Marshall says.

A sit-to-stand lift can be another solution. For residents who have some trunk and leg control, sit-to- stand lifts are designed to improve their dignity and comfort, and they encourage or prolong mobility and independence in performing activities of daily living.

“Instead of wheeling residents to the shower or bathing suite with a covering, residents can arrive at the bathing suite fully clothed and use a sit-to-stand lift while the caregiver undresses the resident,” Marshall says. “The lift can be placed near a shower chair so the [resident] can be easily positioned for bathing. And since the bather’s feet are placed on the lift’s foot pad, they do not come in contact with a wet floor.”

Penner Patient Care has approached the transfer system in a different manner. Instead of elevating the bather during the transition, the Penner system enables the transfer from a wheelchair to the tub chair at the same level — 19 inches off the floor.

“Senior living communities are looking for a transfer system that promotes safe [resident] handling,” says President Lee Penner. “This swivel system reduces transfer risk while also relieving back strain for bath attendants.”

Gaining traction

Reducing falls related to slippery surfaces requires removing water and keeping the environment as dry as possible. Some tub models have casual water drains to reduce the amount of residual water that ends up on the floor, Rayback says.

Accessibility is paramount as well, she adds, recommending tubs with wider door openings, integrated seating and readily available grab bars, to minimize risks.

Slick surfaces also can be remedied with non-stick strips, resins, placemats, “and if all else fails, slip-resistant footwear for bathers and attendants,” Gatty says.

Even with all the attention being placed on making the transition process safer and the tub or shower experience more enjoyable for residents, a certain percentage of the senior living population always will be resistant, physically unstable or constantly cold. Gatty recommends that alternative options be given to residents who simply cannot be bathed in a conventional manner.

“I think bath time should be eliminated for some residents,” she says. “For them, there should be a waterless bathing option, where they could be washed in bed, with no rinsing necessary.”

Q: What was the impetus for ASHA?

The discussion probably started in 1990. The American Association of Homes and Services for the Aging (now LeadingAge) represented the not-for-profit side of the business, and the American Health Care Association at that time was focused on skilled nursing. The Assisted Living Federation of America (now Argentum) hadn’t been started.

Several primarily for-profit companies wanted to have an organization that would do work on Capitol Hill on behalf of owners and operators. There really wasn’t a group doing that. ASHA started at the National Multifamily Housing Council as its seniors house committee, because many of these companies had interests in both multifamily as well as senior housing. I was really in the right place at the right time. They were really a tremendous organization to get us started.

There was never a desire to create a huge organization or an organization that was going to be all things to all people. It was very focused.

Q: How has the seniors housing industry changed over the past 25 years?

A: The industry has become much more professional and much more sophisticated, at the corporate level and at the property level.

We began trying to collect financial and operational performance data around 1992, in part to convince the capital markets that this was a business that people could be profitable in. In the mid-to-late 1980s and early 1990s, plenty of companies were unsuccessful. Bill Colson from Holiday Retirement, John Erickson from Erickson Retirement Communities, Chuck and Karen Lytle from Leisure Care and Bill Sheriff at American Retirement Corp. — these were people who were successful and were extraordinarily helpful to the industry because they were willing to share data. The data and showcasing the successes — which was one of the things that I think ASHA really did well in that early period — was crucial for the industry.

I don’t think the industry is where it ultimately will be on the data side, but it’s much, much more sophisticated in terms of what we know about the business, the residents and their families.

Q: Going forward, what do you think the industry will need to do to ensure that it meets the needs of today’s and tomorrow’s older adults?

Seniors housing, being primarily a private-pay industry, has to continue to try to understand the desires and needs of prospective residents and, in the case of more frail seniors, their families. That will be a constant challenge both for those trying to serve the more active and independent senior as well as those that are serving the more frail who need more services. You have to provide a product that’s perceived as a good value and as providing great care. It’s not a given. The industry has a very bright future, but the industry will need to continue to innovate and be appealing and provide value to the customer.

Q: How are things progressing with the Where You Live Matters consumer education campaign, which was launched in early 2016?

A: When we look at some of the metrics, we definitely see some very positive things happening.

Many companies saw the benefits of trying to better educate the consumer. We don’t serve more than maybe 8% or 10% of the population that we could be serving. If the campaign can help somebody make a decision three to size months earlier, then the impact on the business is enormous.

This resource helps the industry as a whole but also helps the person at the property level who is trying to lease units or market a community. We’ve worked on a toolkit to help people in the industry learn how the site can be used. It’s at www.JoinWYLM.org. We’ll continue to add videos and other content that is useful to consumers.

Q: What other initiatives are underway at ASHA?

A: We’ve put about one-third of our budget into funding research to better understand who lives in our buildings and who doesn’t but should. Currently, we are funding a couple of different university studies that we think will be extremely helpful to the industry. One is looking at strategies for developing collaboration between families and staff in assisted living settings. The other is focusing on strategies that help seniors transition into senior living.

Also, we recently started a program called Rising Leaders to help nurture the development of about 90 people who have been designated by executive boards or company representatives as next-generation leaders. Programming involves our members who have had remarkable careers and experiences.

The grounding force of ASHA, however, is advocacy. We are up on Capitol Hill almost every day trying to provide a voice for the industry on any type of issue that would impact the ownership or operation of this type of product. 

We’re really very focused on the federal piece. Although we don’t see ourselves leading the charge on the state issues, we believe we can be helpful there on a selective basis.

Newly published research in the International Journal of Human-Computer Studies indicates that senior living communities will want to choose the type of robot they use based on the goals they seek to accomplish with it.

Communities looking to help residents with everyday tasks, such as the dispensing of medication, will want robots that convey a cheerful demeanor, according to the study, which was conducted by researchers in the United States, Singapore and Hong Kong.

If, however, communities wish to offer emotional support to residents by having a robot serve as a friend or pet, then they will want a robot that conveys a more serious demeanor.

The investigators reached their conclusions after studying how 51 residents at a Central Pennsylvania retirement home reacted to serious and cheerful robots performing assistant and companion tasks. Two vocal recordings were used to manipulate robots’ perceived demeanors. A higher-pitched voice was considered more playful, whereas a voice deemed to be serious had limited changes in inflection and tone.

“We were actually surprised to find out that they wanted companion robots to be serious and assistant robots to be playful,” said lead author S. Shyam Sundar, Ph.D. (pictured), the Distinguished Professor of Communications and co-director of the Media Effects Research Laboratory at Pennsylvania State University. “But it’s pretty clear from our data that a serious demeanor adds credibility to a companion robot, whereas a playful demeanor softens the tension when interacting with an assistant robot.”