A: This is a question that we are being asked frequently when conducting senior housing market studies.

A decline in age-55-to-64 adult children households is being observed in many market areas and largely is due to changing demographics. Baby boomers currently are the largest senior cohort and represent 21% of the total population. In 2030, all boomers will be aged 65 or more years and, for the first time in history, older adults will outnumber their adult children.

Due to a significant decline in birth rates after the Baby Boom from 1946 to 1964, the generation following the boomers is a smaller group of households. Gen X, which consists of 19% of the total population, will represent the age 55 to 64 cohort starting in 2030. As a result, there will be an overall decline in the number of adult children households due to the shifting of generations through the various age cohorts.

Those demographic trends are going to have significant implications for older adults, their adult children and the senior living and healthcare services industry. The demand for housing, in-home caregiving, health and long-term care services is going to increase dramatically and put increasing pressure on service delivery systems, Medicare/Medicaid and an already strained staffing/work force situation. If the industry is going to be prepared for the coming wave of older adults, new and innovative service delivery systems and flexible living arrangements need to be explored.

And, although we are very focused on developing products and services for the boomers, we need to keep an eye on the upcoming future generation. Members of Gen X are or will be helping their boomer parents with future housing and healthcare decisions, and they are going to have their own unique preferences and expectations. The key to staying relevant in this constantly changing industry will be understanding the consumer’s existing and future needs and identifying flexible, efficient and cost-effective ways to satisfy those needs.

Lynne Moore is president of MDS Research Company Inc., a national senior living and healthcare consulting firm based in Fort Worth, TX, that has been serving clients for more than 50 years. MDS is a two-generation company — she is following in Jim Moore’s footsteps. She responsible for all MDS market research-related projects involving all aspects of senior housing and healthcare. Lynne Moore can be reached at (817) 731-4266 or lynnemoore@m-d-s.com.

A version of this column appeared as “You’ve Got Questions, We’ve Got Answers” in the October 2023 print issue of McKnight’s Senior Living.

The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.

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Staffing shortages that have decimated long-term caregiving also have hit laundry departments especially hard.

“There used to be dedicated staff for each unique job around a community,” observed Quentiel Jamerson, senior product consultant for Direct Supply. “Nursing cared for the residents, maintenance staff fixed building issues and housekeeping kept everything clean. Today, a [certified nursing assistant] may now have additional chores around housekeeping and preparing meals.”

Managers must be more “strategic,” and thoughtful of “a universal care worker mentality that has now unofficially become somewhat of a norm,” Jamerson added.

In a December survey of linen, uniform and facility service companies, TRSA concluded a universal truth: Paying higher wages is necessary to maintain service, said Ken Koepper, the organization’s director of member and industry relations.

A focus on processes they can control “is the single most effective way for operators to create efficiencies,” Jamerson added. “Having every step of the process defined, scheduled and assigned minimizes confusion and saves time,” he added, noting that operators with strong process controls had fewer pandemic service interruptions.

One key is better training, said David Groth, industrial laundry specialist for
Spartan Chemical. He also emphasized the value of standardizing processes such as loading and underloading.

Monitoring production productivity is another, Koepper added.

“Setting simple staff rules for process operations helps to increase efficiency, while educating on how to best prevent cross-contamination when processing both clean and dirty textiles,” said Paulo Rocha, sales manager for Miele. “When employees feel safe and use equipment that is simple to operate, operators realize their best chances of keeping [full-time equivalents].”

One way to avoid common mistakes is to incorporate more intuitive controls, said Randy Radtke, content and media relations manager at Alliance Laundry Systems. “It’s one of the best ways to deliver quality results and meet daily throughput requirements by leveraging intuitive controls.” 

A Textile Rental Service Association white paper for long-term care readers cites increasing political scrutiny of the Medicare and Medicaid systems as one reason to outsource laundry. TRSA said that programmatic cuts, added workplace safety challenges, and wage and regulation uncertainty all add pressure on laundry operations. In recent years, long-term care injury and illness rates did not fall faster than the rate for all industries. The sector has a total incident rate at twice the level of all businesses, and days away from work, reassignment or transfer in the 2.5x range. Accordingly, TRSA warned that long-term care managers will have to devote substantial resources to injury prevention if they keep laundry in-house. 

» York Capital-backed Healthcare Linen Services Group acquires Linen King

Healthcare Linen Services Group, a portfolio company of York Capital Management’s private equity group and a provider of healthcare laundry services in the Midwest and Central United States, announced that it has acquired Linen King, the largest independent provider of healthcare laundry services in the South Central part of the US. HLSG said that the acquisition expands the company’s operations into “attractive” markets and adds new major customers.

Following this transaction, HLSG will operate 21 linen processing plants across six premier regional brands  — Logan’s Linens, Logan’s Uniform Rental, Superior Health Linens, Textile Care Services, Reino, and now Linen King — that process approximately 350 million pounds of healthcare linen on an annual basis for almost 1,000 customers in 19 states.

» Alliance Laundry Systems closes on purchase of Laundry Equipment Services

Alliance Laundry Systems, a leader in commercial laundry equipment, has expanded on an already strong direct distribution base with the acquisition of Laundry Equipment Services. Alliance closed on the purchase at the end of 2022.

The acquisition is Alliance’s latest move in a strategy to bring what it called “extraordinary service and factory support to expanding markets where there is an opportunity to partner with exceptional people.” This is Alliance’s fifth distributor asset acquisition in the past two years.

For much of 2022, lockdowns and other restrictions tamped down the usual resident security concerns in the nation’s long-term care settings.

Still, workforce shortages meant fewer vigilant eyes and ears to ensure resident safety, meaning that thinned staffs had to be even more vigilant than usual. Among the risks: upticks in instances of workplace violence and ransomware attacks, as well as ongoing fall risks from a notable increase in the use of antipsychotics.

Although the situation in senior living differs from that in skilled nursing, looking to the nursing home experience can be informative for senior living providers. In a mid-summer report, STAT News asserted that gains in long-term care resident safety have stalled over the past decade, noting that a federal study released earlier this year found “rates of patient harm remain disturbingly high.”

In late August, the Centers for Medicare & Medicaid Services warned nursing homes to prepare for the end of the public health emergency. Although the agency reminded that the end date was a moving target, it promised a “more resilient healthcare system that can better adapt to disasters and emergencies.” Meanwhile, CMS has more than hinted at plans to put emergency planning front and center in its ongoing reform agenda. For those interested in how it could affect resident security, changes cannot come soon enough, especially in the wake of lockdowns and worker shortage turmoil.

“We have sophisticated, automated inventory systems to keep track of our equipment and supplies. Why don’t we have similar systems to keep track of our precious residents and staff members?” said Stan Szpytek, president of the national consulting firm, Fire and Life Safety Inc. 

Szpytek said he is seeing a significant increase in the number and severity of E-tag violations and weaknesses in life safety and emergency readiness. He is warning providers to begin preparing, and a good place to start is with the lessons from the pandemic.

“COVID-19 taught us that the management of emergent or emergency situations can produce a long list of consequences that may not be immediately apparent until they are actually experienced,” he said. “The reality of a public health emergency like COVID-19 should have taught healthcare providers that emergencies and disasters come in all shapes and sizes.” 

Attorneys representing residents and employees of Avamere Holdings have filed a class action suit accusing the long-term care provider of failing to protect its residents and staff from a massive cyberattack. The lawsuit stems from a data breach believed to have affected more than 380,000 people across the company’s 96 healthcare sites.

An unauthorized individual gained access to a third-party-hosted network between Jan. 19 and March 17, 2022, according to the HIPAA Journal.

An August court filing faults “Avamere’s failure to protect its computer systems from unauthorized access by cybercriminals,” despite numerous industry warnings and earlier breaches. It also alleges Avamere waited more than two months to notify people of the breach, which included theft of names, birth dates, addresses, Social Security numbers, lab results and information about conditions and medications, according to the company.

A representative for the Oregon-based provider said it simply was being careful when it notified potentially affected individuals. 

“Out of an abundance of caution, Avamere Health Services recently notified certain individuals whose information was included in a security incident involving unauthorized access to a third-party hosted network utilized by Avamere,” said Kevin Hill, general counsel for Avamere. “We remain committed to protecting the privacy and security of personal information.”

» Culture change efforts survive if established before COVID: survey

A survey of long-term care administrators has concluded that facilities that had well-established “culture change” efforts in place before 2020 more successfully weathered the effects from the pandemic.

The survey found that about 60% of facilities operating under the principles of culture change before the pandemic have maintained or expanded their efforts to focus on resident quality of life and person-centered care. The survey, conducted by the nonprofit entity Altarum, recently was featured in a special report, “The Sustainability of Person-Centered Care During a Pandemic.”

It included 62 facilities in 30 states, including facilities affiliated with the Green House Project, the Pioneer Network, the Eden Alternative and the Live Oak Project. 

Move over, nursing homes. Assisted living communities nationwide increasingly are embracing a more comprehensive approach to resident care and wellness that incorporates rehabilitation services. It’s quite a shift from days gone by, when senior living operators often saw themselves as a lifestyle option with maybe a few concierge-type services thrown in.

Increasingly, however, communities are taking a broad-stroke approach that prioritizes emotional, mental and especially physical well-being. As operators become increasingly sensitized to the physical challenges that typically accompany the aging process, they are viewing rehab services as a way to both upgrade care and compete
for residents.

Physical therapy often has been at the fore of this shift. At many senior living communities, residents seeking to retain their mobility or improve their recovery are accessing tailored exercise regimes designed to maximize
their independence. Increasingly, trained therapists are working closely with residents to tailor plans and execution. This holistic approach is fostering a sense of empowerment and encouraging residents to take an active role in their well-being.

For many providers, it comes down to finding the right rehab partner. Tucson, AZ-based Watermark Retirement Communities now partners with HealthPRO Heritage to offer Hyperice compression and pulse technology to residents. The various therapies use temperature, vibration and compression to try to increase range of motion in joints, reduce muscle soreness and improve blood flow to enhance mobility.

The trend is being driven in part by senior living’s growing recognition as a healthcare player. In some areas, operators are competing head-to-head with skilled nursing operators for the same
hospital discharges. By offering an increasing array of rehab services, senior living players are positioning themselves as a legitimate post-acute option, particularly for residents with memory care challenges.

It’s good for business and also good for residents, fueling improvements in overall outcomes, rehospitalizations and longevity.

The Association for Professionals in Infection Control and Epidemiology has launched a series of downloadable playbooks that can be customized for use in individual healthcare facilities.

Created by APIC’s Emerging Infectious Diseases Task Force, the pathogen-specific guides outline recommended practices for outbreak responses, starting with pathogen identification, prevention of transmission, safe work practices, considerations for providing resident/patient care, discharge, occupational health and outreach to healthcare stakeholders. Links to clinical guidance and references are included throughout.

“We tapped our top infectious disease experts to develop these consolidated playbooks so that IPs and epidemiologists would have an advantage for future threats,” APIC President Patricia Jackson said.  “We do not want to repeat the experience of COVID-19, where IPs lacked a set of standard instructions and had to search through numerous websites on a daily basis to find guidance. It’s critical that we use what we learned during COVID-19 to improve infectious disease outbreak response.”

Playbooks for invasive group A strep and polio are available on APIC’s Emerging Infectious Disease web page, with similar documents coming for measles, Candida auris, highly pathogenic avian influenza, Marburg disease and Ebola virus disease, diphtheria, norovirus and RSV and more.

» New national infection prevention forum aims to foster collaboration in LTC

The National Infection Prevention Forum is a new national forum for infection preventionists and infection prevention champions in long-term care to share lessons learned and resources and get questions answered.

The national forum will provide a mechanism to rapidly disseminate federal updates and resources about infections in long-term care as they become available from the federal government.

The American Health Care Association has partnered with the Association for Professionals in Infection Control and Epidemiology with funding from the Centers for Disease Control and Prevention Project First Line to set up the NIPF. It is open to all long-term care professionals focusing on infection prevention.

Download the 2023 On the Money supplement (PDF)