The push comes as care demands continue to escalate among the aged. 

As Medicaid is one of the largest expenses facing most states, officials are looking to cut costs by trimming growth among the skilled care population. 

In 2013, $89 billion of the $146 billion that states spent on Medicaid in 2013 went toward care for the elderly, the AP reported.

In addition, some states are switching from fee-for-service to managed care payment systems. To address concerns, proposed federal regulations due this spring aim to strengthen consumer protections. 

A: Great question. The senior living business is becoming increasingly complex. The continuum of products and services is growing. There is a pressing need to optimize the financial viability of each individual product or level of care on your campus. 

Consolidated financials provide the big picture/summary approach, but to determine the true financial sensitivity of your organization, you must develop individual cost/profit centers within your continuum. Simply combining three or four businesses within a community into one overall consolidated income statement of revenues and expenses is not the best practice for the future. Just using consolidated financials can frequently mask unacceptable subpar performance of one cost center while penalizing the overall operation. Each individual major product and service offered should meet reasonable industry financial benchmarks of revenues, expenses including an overhead allocation, net operating income, profit margins and cash flow.

Each cost/profit center should have initial stand-alone income statements before being merged into consolidated financial statements. 

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. 

In fact, River Terrace closely follows contemporary guidelines by offering a full continuum of eldercare services with short-term rehabilitation and amenities such as a theater and game room, internet lounges, sitting rooms with fireplaces and chef-prepared meals in upscale dining areas. The four-story building has been completely transformed as the inside was gutted and reconstructed into a residential community for 105 residents — 57 in skilled nursing, 32 in assisted living and 16 in independent living.

“From a physical and visual standpoint, there is nothing like it — it is one of the nicest buildings in the region,” says Peter Massey, vice president of development for Trilogy. “To see it when it was a hospital, then gutted, renovated and finished, the change is remarkable.”

The former King’s Daughters’ Hospital, which Trilogy purchased in January 2013, is a registered historic landmark in Madison, a small close-knit community. City officials were hopeful that they would find an investor who appreciated its heritage and use it for a purpose that benefited the residents, Massy says.

“So many people of the town were born there, so there is a lot of history with the building,” he says. “They now have a facility they can be proud of.”

The short-term rehabilitation and long-term care areas of the campus, located on the first and second floors of River Terrace, also feature Trilogy’s Home Again short-term rehabilitation program, offering physical therapy, occupational therapy and speech language pathology. The fourth and top floor of the facility includes independent apartments, including one- and two-bedroom floor plans.

The Assisted Living Residence at River Terrace, located on the third floor, is designed to provide care and services to help residents remain active and engaged in a homelike environment. It features private suites with private baths and kitchenettes.

River Terrace overlooks the Ohio River, which flows through the downtown area a few blocks away. Madison is an arts and crafts center, so the senior living facility has incorporated local artwork into its interior as well as other visual references to the region, says Leslie Farr Knox, Trilogy vice president of communications.

“The first impression is a lodge feel, with lots of stone and wooden beams — it’s amazing,” she says. “There is an old map of Madison in the lobby and the building cornerstone is visible. The color scheme of blues, creams and browns mixed in with the artwork gives it a local feel.” 

Yet even among a highly ambulatory resident population, bathing will always pose challenges to senior living operators who need to be vigilant of the risks of falls and injuries from transfers in slippery environments. To answer those challenges, bathing and lift suppliers are responding with an explosive wave of innovations.

De-institutionalizing bathing

It’s all part of the baby boomer tide that demands hotel-like amenities, as well as the creature comforts of home they or their loved ones are leaving behind. A primary motivator is dignity.

Before building Newbridge on the Charles, a sprawling continuing care senior living community in Boston that includes a 268-bed health care facility, owners surveyed seniors and discovered that private rooms and bathrooms were at the top of their wish lists, said Anne Thomas, executive director. Thomas said designers worked passionately to develop “a home-like environment that feels warms, feels friendly, like a restorative spa-like environment.” 

Pressalit, which manufactures a line of vertical and horizontal adjustable track systems for lifts, sinks and toilets, outfitted the complex’s bathrooms, said Gary David Nowitz, president of Pressalit Care-North America. Pressalit was engaged with the architect early in the design process with “practically everyone from the executive administrator and rehab department to maintenance,” Nowitz added. 

Demands for private baths are growing out of the person-centered care movement, adds Craig Coogan, president of Lift and Transfer Specialists, whose company recently outfitted track systems at Mount San Antonio Gardens in Pomona, CA, a CCRC designed by the Green House project. Among the key features in the community are two stand-alone homes, each with 10 private bedroom-bathrooms. Residents share common areas like open-air kitchens and dining.

Marketing luxury

Not long ago, it was a concept widely foreign in senior living, but now, operators are scrambling to outdo one another and bathrooms are becoming deal-breakers with resident decision-makers like the ubiquitous “oldest daughter.”

Phil Cunningham, business unit director for Invacare Corp., has been in the industry long enough to witness the sea change brought by the wave of Baby Boomers now entering senior living, or sourcing places for loved ones. In short, they’re seeking luxury. “When you think of high-end master baths now in homes, these are what kids are wanting for their parents in places like assisted living,” he says. The issue rings true even more with memory care, where familiar, homelike amenities resonate deeply, he adds.

“Residents in senior living facilities want to feel as ‘at home’ as possible,” says Greg Wells, director of marketing and communications for Bestbath. “Senior living providers want to set themselves apart by providing a living setting that is homey and tastefully decorated. The old adage ‘kitchens and bathrooms sell homes’ can easily be applied to senior living facilities. The care and comfort provided to residents when bathing is what sets many operators apart.”

As Lee Penner, president of Penner Patient Care, observes, “Many times when a facility is replacing a spa, they will do a complete room renovation, including flooring, wall and fixture upgrades to give the room a more appealing look. The spa room becomes a focal point of promoting their facility.”

To many, it’s money well spent. “If this is a new construction, the provider should not cut corners relative to the size of the room,” says David Anderson, national sales manager at Apollo Bathing Systems. “If it is a remodel, providers also should not cut corners relative to upgrading the décor to match the beautiful new spa tub.”

Even for seniors with enough mobility to live independently or in assisted living, navigating a low-level bathtub can still be treacherous. The key design element: the ability for seniors of all acuity levels to get in and out of tubs and showers without falling or tripping.

“Engineers across the globe have put on their thinking caps and come up with an amazingly diverse array of bathtub solutions for individuals experiencing difficulty getting in and out of a standard bathtub,” says Rhonda Bonecutter, founder and CEO of Homeability.com, and a career occupational therapist. “Thanks to the hard work of dozens of creative companies, the global market has been flooded with hundreds of different bathtub models across a range of different bathtub categories.”

Brisk demand, innovation

At the heart of the burgeoning bath business is residents’ fervent desire to do things for themselves.

“People want and expect independence,” says Wells. Even when assistance is needed, the ability to do things for ourselves promotes health, vitality, positive attitudes and longevity in people. The ability to bathe independently or with minimal assistance allows residents in a senior living setting to age in place as long as possible. Once a bathing disability is developed, that person is 90% more likely to escalate to the next level of care.”

That is why innovations like barrier-free showers with safety features like grab bars and attached seats are among the most in-demand systems in the market today, he adds.

Innovation is brisk. What was an extra just a year ago is now standard equipment. But as Anderson says of the bathing industry in general, there is an overriding mission to design and manufacture bath and lift systems that are not only attractive but dependable and safe. “The demand for these things has helped fuel design change among bathing system manufacturers,” he adds. “Virtually every bathing system manufacturer now offers a number of color options where only a few years ago, white was the only option.” Even the design and function of transfer systems have become “more sleek and easier to operate,” while providing increased weight capacities.

What are some of the most popular must-haves today?

Essential features for baths and spas include anti-scald thermoscopic/thermostatic mixing valves, a shower wand to assist with rinsing, and cleaning and disinfecting systems to facilitate infection control, says Anderson. “Features on centralized bathing systems can vary greatly,” he adds. “While assisted living facilities typically try to purchase systems that appear residential, the needs of assisted living residents are greater than those for people still living at home. If an assisted living facility installs a typical walk-in tub designed for home use, it may not have the features necessary for a centralized system.”

Where it really gets interesting are the plethora of “extras” that literally transform bland and sterile bathrooms into exotic spa-like environments. The list is nearly endless. Some bath systems even offer built-in flatscreen TVs and exquisite cabinetry for storage.

Popular options include color upgrades to enhance the décor of the spa room, says Anderson. “Spas come with different entry options and sizes to accommodate any need and any space,” adds Penner. “Colors are also a huge option.”

Anderson adds to the list of extras like digital scales; so-called “air spas” that pump room air through jets in the tub bottom; upgraded infection control systems such as ultraviolet light water purification systems; reservoir systems that can fill and empty tubs more quickly; and upgraded, integral transfer systems in bathtubs.

Other extras, according to Wells: privacy curtains for tubs; “designer touches like recessed tile surrounds in a barrier-free shower”; chromatherapy in walk-in tubs; solid surface finishes on an automated seated showers; non-institutional-like disguising teak towel and grab bars, soap dishes and toilet paper holders.

Still other extras include towel warmers, heated seats and hot air blowers for walk-in tubs, which require the bather to be in the tub during filling and draining.

Stress relief

If operators have learned anything in this new world of luxury showers, spas and whirlpools, it’s ensuring that any system they invest in matches the acuity of their resident population.

“Too often I see providers focus on one design and not consider their resident mix,” Anderson notes. “Likewise, when I speak with assisted living providers at conventions, I ask them to provide me with a profile of their residents now, and then ask them what they expect in five years. That question has led many to change their mind on what system they eventually buy.”

The firm’s most senior project design and management specialist also is just old enough to remember how hogtied her peers were when it came to the materials and fabrics from which to work. “When I started in senior living some 20 years ago, fabrics were vinylized, so they’d take chintzes and cabbage rose quilted fabrics and pour a thin layer of vinyl on top,” she recalls. “People were sliding all over the place. The furniture was shiny. It was just tacky.”

No more. As Jackson and the rest of the industry have now discovered, furnishings today are not only as aesthetically pleasing and comfortable as those in the finest hotels, they’re also disguised to take a veritable beating. 

There is a ton of new technology in and under those fancy upholstered bournes and banquette benches. Even the most favored ebony and cherry woods can now be artfully mimicked by rock-hard faux finishes layered thick over case-hardened steel frames.

Forget ‘shabby chic’

If it weren’t for the “Greatest Generation,” designers would be nonplussed when it comes to demanding — some would even say “choosy” — baby boomers, who are largely driving transformations in everything about senior living, furnishings included.

“Many of us have parents in their late 70s and 80s,” Jackson adds. “They are the silent generation who grew up in the Depression and fought World War II. They were happy with anything they could get and still are. We’re just now dealing with the leading edge of baby boomers who are coming along with a very different world view. And they’re only going to get more and more discriminating.”

Adding to the challenge are the multiple “customers” that designers must appeal to simultaneously. 

“We’re designing for several people besides the resident now,” says Dean Maddalena, studioSIX5’s president and architect. “There’s the 57-year-old first-born daughter who’s assisting her parents with the selection; the grandkids, because you want it to be a cool place for them to visit their grandparents; the caregivers, so it’s easy to clean and move so they feel proud of the space and utilize it to its maximum potential; and even the local community, because more and more facilities are recruiting outside organizations and clubs to come and utilize their space for social gatherings and events.” Maddalena said his firm is working with one community that is selling outsiders memberships to their wellness center. 

Not only are senior communities grappling with the tastes of multiple audiences, but as many manufacturers suggest, they should view the big picture to avoid that cobbled look. “The most successful interiors will use a holistic approach to selecting flooring, furniture and finishes,” says Ridley Kinsey, director of healthcare and retail markets for Patcraft, who advises operators to simultaneously consider safety, ease of mobility, acoustics, durability/performance, ease of maintenance and repair, installation, design and initial and lifecycle cost when outfitting their communities.

“When we start a project, we visit a variety of local popular places, like hotels, country clubs and restaurants so we understand the vernacular and style of architecture that’s favored and use it as a springboard for the design,” says Maddalena. 

“After that comes the challenging part — applying senior ergonomics. Hotels and restaurants may have low, deep seats popular with millennials that would never work in a senior living community,” Maddalena adds.

Blending style

Hundreds of manufacturers got the memo: operators are demanding furnishings that are equal parts contemporary and durable. There’s a world of aesthetically pleasing and easily maintainable materials on the market today.

Earnie Taylor, a sales expert for Assured Comfort Beds, takes a great deal of pride “producing a product that reminds customers of the many great years of their life, which in turn makes them happier when they are put in a situation of changing a style of life or a residence.” 

Taylor said his company’s goal with its adjustable bed line was to design a strong product “that no longer has that ‘hospital bed look,’ that looks like a designer bed that you bought out of an upscale furniture store.”

Direct Supply offers a line of veneer casegoods — a real-wood product similar to what most people have in their homes — but adds a laminate top to resist moisture and scratching, easy-to-use hardware to accommodate arthritic residents, and ventilated backs to promote airflow and reduce bacteria, says Jadi Endl, a senior product consultant.

Everyone today is talking about brawn as much as beauty.

“Operators want furniture that is strong enough to support the entire resident population, so the furniture should be steel-reinforced,” says Michael Zusman, CEO of Kwalu. “The design of seating in a community is important for all body types and strengths. The ergonomics and arm heights of a chair aid those who need extra help sitting or standing. Seniors who like to cat nap in a chair can benefit from the neck support that wing-back chairs provide. 

“Sturdy furniture that does not easily tip over is also very important. As people age, they may use the arms of the chair to stead themselves to lean on for support. That support should be strong and dependable.”

Higher density foam is critical in senior living seating, says Troy Rabbett, contract marketing specialist for Flexsteel Industries. “It’s a delicate balance,” he says. “For us, it’s all about comfort and durability, not just one or the other.”

High-tech tools

“Seniors can be very hard on furniture, says Maddalena. “They have walkers, electric wheelchairs and canes, in addition to using any furniture in sight for weight bearing. Long ago, it was difficult to find those kinds of materials that were attractive. Now it’s pretty much standard in the industry. Healthcare has been the hospitality driver for a while now. They want the attractive, in-demand fabrics that have commercial durability and strength and longevity.”

The combination of style and durability can impact a community’s marketability and resident satisfaction, according to Endl. 

“We have seen an increased demand for hospitality-inspired pieces like writing desks, hospitality stations that house a mini-fridge and microwave, media chests, stools and banquette seating for dining. Since these types of products were not typically found in senior living, accommodations have had to be made to ensure they will hold up under the demands of these environments,” Endl notes.

Even large design firms like studioSIX5 sometimes can’t find just the right piece for a particular community project. That’s when they partner with firms like Kwalu and Mannington Commercial Flooring for customized designs, some 40 to date. 

Its designers routinely use 3-D printing, which allows them to sketch out new designs and take small-scale prototypes to clients for approval.

They’re also blessed, as is everyone else is, with high-tech fabric technology that greatly extends the life of upholstered furniture, casegoods and millwork. “There’s a wonderful material that’s been around for 15 years that’s really evolved around the aesthetic and feel of fabric called Crypton,” Jackson says. 

“Today, beautiful jacquards, wovens and any kind of fabric is available in Crypton finish. It’s bulletproof in that it has a moisture barrier, it’s stain-resistant, and really holds up well to any kind of abuse you throw at it, in addition to the 50,000 double-rub criteria.” Other kinds of high-tech design materials are seen in vinyl floor planks that mimic the look of porcelain and wood.

Maximizing lifespan

The general rule of thumb with furnishings: If you buy quality goods, expect them to last 7-10 years, say Maddalena and others. 

Chairs are the first to go simply because they are the most used and abused. Endl advises operators to “invest in good quality, contract-grade furniture and fabrics, and educate staff on how to properly maintain them.” 

Taylor suggests investing in higher density seat cushions or stronger fabric as one way to extend chair life.

Finally, everyone advises operators to not pinch pennies when it comes to a furnishings investment. “I’ve visited many properties that outfitted their facilities with furnishings made for the general public,” says Maddalena. “I’d constantly see staff helping residents get in and out of seating because the ergonomics seniors specifically need aren’t there. If you’re in this for the long run, you’re going to be paying more in the long run to replace furniture all the time.”

New and renovated facilities have added many of these boomer-friendly upgrades, but with memory care now a regular part of assisted living, operators also need to be cognizant of balancing resident protection and security with independence and privacy. Obtrusive cameras, constant alarms and visible surveillance tools can make residents feel like prisoners.

Security experts contend that the advancements in predictive technologies and discreet wearable devices are creating a more relaxed environment while still providing the protection that residents need.

“This is really not a new challenge, and there are many communities that successfully balance safety and independence,” says Steve Elder, senior marketing manager for Stanley Healthcare. “It is probably true, however, that the boomer generation will demand even greater performance, expecting highly personalized services, complete freedom combined with high levels of safety, and the use of technology that is unobtrusive, sophisticated and contemporary in design.”

Laurence Yudkovitch, senior living product manager for RF Technologies, agrees that promoting a home-like environment is “very important” for attracting new residents and increasing census, both in terms of appealing to residents and their families. 

“Aesthetics cannot come at the cost of safety, however, so the goal for facilities is to eliminate the institutional look and feel of its safety devices,” he says. “Fortunately, wireless life safety devices — including nurse call stations and wander alert systems — can blend into the facilities’ décor while providing exceptional protection.”

While the challenge may not be new, it is definitely “immense,” says Colton Zirk, sales and marketing manager for Wireless NurseCall Systems.

“Operators must first establish their identity and understand their residents,” he says. “Once a community truly understands its resident population and capabilities of their staff, it becomes easier for them to balance safety and the resident experience.”

Still, Zirk maintains that maintaining balance is a constantly evolving task due to the fluid nature of the senior living environment.

“As the community population ages, technology advances and staff turnover occurs, in order to stay balanced it is key for these operators to constantly self-evaluate,” he says. “They need to understand what they are good at and what they could be better at, where they have improved and where they haven’t.”

Evaluating technology

There are three main factors to keep in mind when evaluating technology for memory care in the senior living environment, Elder says. The first is to ensure that protection can be tailored to the individual’s needs, the second is that it not detract from the ambiance of the community and the third is it should empower staff with information at the point of need so that they can respond quickly and with personalized service.

“There are many solutions that assist communities in protecting residents from specific risks, such as wandering or falls, or to enable them to call for assistance on any occasion,” Elder says. “This kind of wireless locating technology is widely adopted, and it holds great potential for predictive applications.”

For example, monitoring data on resident movement can flag a change in activity that may indicate a health issue. At this stage, this type of application is still in its infancy but is being explored by many organizations that see the potential to anticipate changes in resident needs, he says.  

Richard D. Helstrom, founder, president and CEO of Wireless Nursecall Systems, points out that wireless technology is becoming the standard for security and notes three main device types:

• Wireless alarms that transmit a signal when the resident leaves the bed or wheelchair;

• Motion detectors that transmit a signal when the resident uses the bathroom or is moving; and

• Wireless watch-like devices worn by the resident that transmit a silent signal whenever the resident is moving.

“Prior to the current wireless technology, devices monitoring the activities of memory care residents were local only and alarms were so loud that they irritated the residents,” Helstrom says. “Initially, the wireless devices required fixed power sources because the battery consumption was too great. Now improved chips and batteries allow facilities to install wireless alarms or information devices with small batteries that will last for months, if not a year.” 

With current wireless technology, information about the movement of a resident can be conveyed without local alarms, which eliminates agitation and frustration, Helstrom says.

“At the same time, this information can be compared to normal expected movement,” he says. “If the movement happening at any time doesn’t match normal patterns, staff can be alerted silently to check on the resident.”

Inclusion, not seclusion

Perhaps the finest line in the balancing act of fostering independence without sacrificing protection is with dementia and Alzheimer’s residents in memory care units. Because some memory care residents are prone to elopement and agitation, facilities understandably need to have a system in place that prevents them from wandering while preserving their dignity.

“Residents with dementia or Alzheimer’s appreciate routine — sticking with consistent patterns and decreasing change helps reduce agitation and frustration,” Yudkovitch says. “Safely giving them the ‘freedom’ to move around a facility is also beneficial. That’s where wander prevention systems can really help. These systems can give residents the freedom to roam, but will prevent them from leaving the facility.”

Accutech, which has been manufacturing wander management systems for 30 years, has become attuned to security for individuals rather than for the aggregate population. Through smart technology that reads wearable tags, individuals who present a flight risk will cause exit doors to automatically lock when they are in the vicinity, says Chris Konicek, Accutech sales and marketing director.

“In terms of design, we cover every point of egress that is considered open,” he says. “Because we have seen a shift where more assisted living facilities are adding memory care, residents of those units don’t have to be segregated from the general population.”

Predicting events

A new generation of technology is using predictive analytics to anticipate sentinel events before they happen and security experts believe it will proliferate in the future. But while having information that could prevent an accident from happening is a positive development, there are also potential pitfalls, says Steve Redeker, president of PalatiumCare.

“A bevy of new devices will be flooding the market in the next few years to discreetly monitor resident behavior that will be beneficial in helping caregivers engage their residents, armed with information to support any concern they may have,” he says. “The software to interpret this information, however, is still in its infancy. Regardless of how good this technology gets at predicting resident behavior and flagging potential problems, it can never replace the insight and instinct that is an important part of the relationship between a caregiver and a resident.”

The goal at PalatiumCare is to make it easier for caregivers to engage their residents when necessary, but also “to offer the dignity of privacy when the resident chooses,” Redeker says.

Overall, automated wander management systems with real-time locating technology are effective, safe and unobtrusive, says Chad Ries, director of strategic partnerships at CenTrak.

“Whether the solution prevents residents from wandering into potentially hazardous areas or alerts staff during health emergencies, advanced locating technology can ensure community safety,” Ries says. “By providing families with the peace of mind that their loved ones are secure and protected, senior living communities can stand out among others, helping to accelerate their residential growth.”

Ultimately, though, technology should complement personal interaction, not replace it, says Marcia Conrad-Miller, senior director of business transformation for Philips Healthcare Home Monitoring.

For instance, a tablet that communicates with resident tags could show caregivers each memory care resident’s profile as they enter the room.

“Knowing residents’ names, histories and their occupations could really help engagement,” she says. “Most memory care residents have really good long-term memories. If staff knew a resident was a teacher, bringing up those experiences could be very powerful.”

Q: What kind of feedback have you received on the new name, Argentum?

A: It’s all been positive. We’ve explained to people where the name comes from, the notion that it means silver and the fact that that’s a standard of measure historically. Part of what we’re doing is creating standards for the industry, helping the industry become more professional, so that’s highly relevant. Once you explain it to people, at least in my experience, they seem to get it. But at the end of the day, the name itself is less important than the work we do and, in my conversations with people, that’s what seems to be really ringing true with them.

Q: When the Senior Living 2025 Roadmap was announced earlier this year, after your six-month listening tour, memory care had been added to four previously identified priorities. What was the thinking behind that?

A: We always knew that memory care was going to be a critical issue for the industry. As we started talking to industry, residents and policymakers, memory care just kept bubbling up as an issue that is a critical focus for the industry and the country as a whole, in terms of an emerging long-term care issues.

We decided to pull it out as its own imperative for the industry so that it would be a clear focus for us as we’re developing proposals and programs and services around memory care. We’ve got a memory care track at the conference this year that we’re pretty excited about, and we’ve got some research under way around memory care. I personally think there’s no segment in the long-term care space, or even the healthcare space, that’s better served to care for folks with cognitive decline than senior living.

Q: Will Argentum be making any big announcements at this year’s annual meeting?

A: We’ll be announcing new board members and our officer slate for the following year. We also will be launching a refresh of our magazine. But our announcements will be nothing like last year, when we were talking about branding and standards and credentialing.

Q: Is there anything new to report with the certification commission and its first program, for assisted living community executive directors?

A: We’re on track to have the test available in the third quarter of this year. We’ll be beta-testing in June or July.

At a time when many senior living providers are taking a stand against proposed minimum wage increases across the country, Juniper Communities is taking the opposite approach. April 1, the Bloomfield, NJ-based company implemented its new 15X20 program, which has the goal of increasing hourly minimum wages in its communities to $15 by the year 2020.

“We’ve always been committed intellectually to a living wage and have always known that the people who work for us often struggle, that many of them work multiple jobs to make ends meet for their families and that that then creates issues for them on the job,” Juniper Communities Founder and President Lynne S. Katzmann, Ph.D., told McKnight’s Senior Living in an exclusive interview.

The national drive toward a $15 hourly minimum wage prompted the company to act on its commitment, she said, adding that Juniper expects to see the plan through as long as “the stars align in the way we expect.”

“We’re in favor of a living wage, which is not necessarily $15 an hour in every location, but $15 is where we think national legislation will go over the next couple of years,” Katzmann said. “While there is no $15 minimum wage in our markets at the moment, we believe it’s inevitable.” New Jersey, one of four states in which the company operates (the others are Colorado, Florida and Pennsylvania), probably will follow neighbor New York’s April 4 action to raise the statewide minimum wage, she predicted, and legislation also has been passed in California and proposed in Pennsylvania.

“This is going to happen whether we want it to or not,” Katzmann said. “If we don’t start looking at it now, it could have serious financial repercussions down the road. You can’t just make this happen overnight.”

So company leadership set the wheels in motion about eight months ago, researching living wages and reviewing starting wages and wage scales in all of Juniper’s buildings. The 15X20 program went into effect April 1 in all but three of the company’s 20 buildings (although it may be implemented in one of those three later this year), and employees could see increases ranging from 50 cents to $2 depending on their geographic area beginning July 1. The program is tied to a larger workforce development effort to reduce turnover, call-offs and overtime and increase buy-in into the company’s culture, however, Katzmann said.

“It’s not all about the money,” she said. “It’s also about the culture, and it’s about purpose at work and being clear that the people we hire are valued for their commitment and their passion to making lives better for the people they serve.”

New employees at Juniper Communities now have the opportunity to earn a pay increase after 90 days if they meet certain criteria, and existing employees are eligible based on a 90-day look-back period, too. “You can’t have a higher starting wage than people who have been working with you for several years,” Katzmann said. “We had to address that as well.”

To obtain a raise, employees must not have had unexcused call-offs or excessive absenteeism, cannot have been tardy, must have abided by the company’s code of conduct, cannot have been written up for any infraction, can’t have been the subject of a complaint from a family member or resident, cannot have committed a safety violation, and must have worn their uniforms and name tags at all times while on the job.

Additionally, employees must have completed Juniper’s onboarding program as well as electronic training for mandatory requirements with a minimum score of 80%. Also, because Juniper caregivers receive consistent assignments, each must be able to prove that he or she knows 10 things about one resident designated as a “best friend.”

All in all, Katzmann said, “What this says is, ‘We’re going to pay you more, but we’re going to expect more.’ ”

Juniper found funds for the increases by switching to a lower-cost benefits plan, Katzmann said, but in the future, the company hopes to realize savings through the reductions in turnover, call-offs and overtime that it hopes result from the program.

Juniper introduced the new program at town hall-type meetings in each location, where a corporate leadership team member also met with managers to explain how to administer the program and hold workers accountable. Reaction from staff members, Katzmann said, has been “superb, superb, superb.”

“People are thrilled, not only for the prospect of higher wages,” she said. “We call ourselves innovative at Juniper, but this is proof for them that it applies not just to our residents and our programs but also to the people who do the work.”

Time will tell whether the program accomplishes its intended goals, Katzmann said, adding that she hopes that it offers Juniper a competitive advantage, not just over other senior living providers but also over employers such as Walmart and McDonald’s. “Whether you like it or not, that’s who we compete against,” she said.

“A lot of people are pretty pessimistic, and they say, ‘Well, you’re just raising the base for everyone,” Katzmann added. “And our point is, it’s going to get raised anyway. We’re not trying to make life more difficult for our competitors. What we’re trying to do is build a workforce that provides high-quality care and service, because that’s what we do. And when you do that, your beds are filled.”

“The minimum wage increase will negatively impact the entire assisted living industry, but it will be especially devastating to those caring for low-income seniors and disabled individuals who rely on supplemental security income and have not received a SSI rate increase in over nine years,” ESAAL Executive Director Lisa Newcomb told McKnight’s Senior Living. “With a frozen SSI rate of $40 per day for each resident, many of these facilities will simply be unable to pay the higher wages and will be forced to close their doors. The end result will be lost jobs and many low-income residents having to face unnecessary and much more costly placement in a nursing home. And for the SSI facilities that manage to stay open, they will be forced to reduce staffing, services and programs to minimum levels in order to survive.”

New York Gov. Andrew M. Cuomo signed the legislation, as well as a 12-week paid family leave policy said to be the most comprehensive in the country, April 4 as part of the 2016–17 state budget. “These policies will not only lift up the current generation of low-wage workers and their families, but ensure fairness for future generations and enable them to climb the ladder of opportunity,” he said.

The minimum wage increase, which the state expects to affect 2.3 million workers, will be implemented in stages:

• Businesses with at least 11 employees will be required to pay a minimum of $11 per hour by the end of this year, then another $2 each year after that until paying $15 an hour by Dec. 31, 2018. For smaller businesses, a minimum wage of $10.50 will be instituted by the end of this year. It will increase another $1.50 each year afterward until reaching $15 on Dec. 31, 2019.
• For businesses in Nassau, Suffolk and Westchester counties, the required hourly minimum wage will increase to $10 at the end of this year, then $1 each year afterward until reaching $15 on Dec. 31, 2021.
• For businesses in the rest of the state, the minimum wage will increase to $9.70 at the end of this year, then will increase another 70 cents each year after until reaching $12.50 on Dec. 31, 2020. After that time, it will continue to increase to $15 on an indexed schedule to be set by the state budget division director in consultation with the Department of Labor.

Also, beginning in 2019, the state budget division director every year will analyze the economy in each region, as well as the effect of the minimum wage increases statewide, to determine whether a temporary suspension of the scheduled increases is needed.

The 12-week paid family leave policy, funded through an employee payroll deduction, will be phased in beginning in 2018 at 50% of an employee’s average weekly wage, capped to 50% of the statewide average weekly wage, and fully implemented in 2021 at 67% of an employee’s average weekly wage, capped to 67% of the statewide average weekly wage.

As much as the new minimum wage legislation will affect senior living providers, the effect could have been worse, LeadingAge New York President and CEO James W. Clyne Jr. told McKnight’s Senior Living. Under the legislature’s original proposal, he said, costs for nursing homes would have increased $600 million, and the increased cost for home care and personal care providers would have been $1.72 billion, the organization had estimated. The provision to implement the wage increase more slowly in upstate New York will lower those cost estimates, Clyne said.

The organization also supports the provision to temporarily suspend increases, as needed, after 2019, he said.

“The legislature actually made it a little better and put in some money to recognize some of the cost” to providers, Clyne said of state funding to help offset costs. “The real question is going to be, is the government going to continue to reimburse for the new cost?”

Cuomo signed New York’s legislation the same day that California Gov. Jerry Brown signed into law a plan to ultimately increase the hourly minimum wage to $15 in that state.

The data come from Senior Housing Analytics, the report notes. Other nations, such as the United Kingdom, Japan and China, also will see large increases in demand, according to PGIM.

“For the first time in recorded history, the old will outnumber the young,” said Taimur Hyat, PGIM’s chief strategy officer. “Our report demonstrates the profound impact global aging will have on individuals, businesses, governments and investors around the world.”

Around the world, aging will reshape consumer spending for decades into the future, according to the report, “A Silver Lining: The Investment Implications of an Aging World” (PDF). In the United States and the United Kingdom, real estate currently represents more than 40% of the gross assets of 65+ households, the authors say. U.S. baby boomers increasingly are attracted to active urban lifestyles and centrally located housing, they add.

Healthcare and technology also will expand substantially, driven by people aged more than 85 years, who spend four times as much on healthcare as those aged 45 to 64, according to the report. Dementia, Alzheimer’s, Parkinson’s, stroke and cancer are targets of venture capital firms’ operating companies, they say, and new businesses are creating, distributing and using technology-enabled medical services and devices to help older adults live more independently.