Kristine Theurer, PhD, founder and president of Java Group Programs, presented at both the American Health Care Association/National Center for Assisted Living and the LeadingAge annual meetings this year about a model to address mental health challenges such as loneliness and social isolation in senior living and other long-term care settings. She recently talked more about the model with McKnight’s Senior Living.

Q: Can you talk about the model and how it differs from the approach that some senior living communities might be taking now?

A: Typical in senior living is a model of entertainment and distraction — bingo, bus trips, bowling, movie nights, games. I wrote a paper about this in the Journal of Aging Studies, along with some other wonderful authors such as Dr. Robyn Stone.

I worked in senior living myself for many years. We thought that if you do enough of those activities and get enough residents into those activities, then we’d done our job. Meanwhile, residents were starving for real, meaningful connections.

The approach we talk about in the paper is peer mentoring and peer support groups — groups particularly, because they provide a sense of community that is missing in much of the entertainment and distraction programs that I mentioned. When a person engages in a peer support group, loneliness and depression go down. Not just a little bit, but a lot.

But peer support groups are almost nonexistent in senior living, so we put together this model and then researched the programs and looked at the outcomes of them.

Q: Could you share some of those results? 

A: We worked with the Schlegel-UW Research Institute for Aging in Ontario and Schlegel Villages. They implemented the first of our peer support groups, called the Java Music Club, in all of their communities. And they added Java Memory Care, which is a peer support group for residents living with more advanced dementia, and then they added our Java Mentorship Program, an outreach program where residents get together with volunteers. The combination of peer support groups and peer mentoring is really powerful.

We looked at loneliness using the UCLA Loneliness Scale and depression using the Geriatric Depression Scale, and we looked at how many of the socially isolated residents attended more programs. We had an average 15% reduction in loneliness, 30% reduction in depression and a 60% increase in those residents who don’t come to things leaving their rooms and getting engaged in the community.

Q: How did your interest in this area begin?

A: When I was a teenager, my older brother committed suicide, and as you can imagine, it was a terrible time in our family. In my 13-year-old brain, I decided that it was my fault that he died, because I wasn’t paying attention.

I carried that grief with me into adulthood. I tried some counseling, and I tried some therapy, and I got busy. I was working hard. And then a dear friend of mine said to me, ‘Kristine, you should go to a grief peer support group.’ And I said, ‘Why would I do that? I’m going to sit at a table with a bunch of other sad people, and we’re going be sad together. How could that possibly help me?’ 

But we went together to this support group, and it was so wonderful. I had no idea how great it was to talk to people who knew what I was going through. It changed everything. I healed in that grief support group.

It wasn’t as though my brother was coming back. The problem was not solvable that way. But what changed is that I was no longer alone with it, and that made what felt unbearable suddenly became bearable.

I was working in senior living at the time, and I looked around and thought, ‘Why don’t we have peer support groups? They’re so good.’

Q: In your presentations at the AHCA/NCAL and LeadingAge annual meetings, you shared some tips to help people foster peer support and mentoring. What are some of the steps that people can take? 

A: When I talk about peer support and peer mentoring, I’m often talking about Java, but anybody can do them. I would encourage providers, if they don’t already have peer support groups, to start them. I’m happy to help, because it’s so important.

Loneliness is such a terrible thing. There is no pill or vaccine for loneliness, but there is a cure, and it’s preventable. And that is through peer support and peer mentoring.

This is an abbreviated version of a McKnight’s Senior Living Newsmakers podcast interview. Listen to the whole interview here.

Q.  What are trends and challenges to watch in the senior housing industry in 2023?

A.  Things are improving, but in 2023, issues still will need to be addressed.

As we end 2022 and swing into 2023, it appears that the senior living industry will be dealing with many of the same operational challenges as in 2022, including availability of and cost of labor, increased operating expenses and inflation.

Occupancies are slowly increasing, and operators have achieved rent increases, but many communities are still dealing with less-than-optimum census. The good news is that the demographics are in our favor, and there continues to be future demand.

Some key issues that now are being addressed:

• Will younger senior cohorts (baby boomers) be attracted to senior housing? What do they want in terms of the physical product and lifestyle, and how do we get them to move into those communities?

• How can the industry address future affordability challenges or the middle-income market? This involves value-engineered designs, unbundled services, alternative service delivery systems, use of third-party home care companies and more.

• Will active adult housing expand the continuum of care and attract young seniors? It offers maintenance-free and service-free living with access to amenities and socialization opportunities to attempt to target a younger senior and affordability. Communities are built as freestanding developments or as an addition to an existing continuum of care.

Many new approaches to operations, marketing and communications and service delivery have resulted in favorable effects for the senior living industry. Use of and reliance on technology, digital tools and virtual communication are the kinds of resources that will be useful in communicating with this next generation of senior prospects. Telehealth services, partnerships with third-party home health and caregiver providers and delivery of on-site healthcare services increasingly are being used for the convenience of both the operators and the residents. All of those things also should be helpful in addressing affordability.

Continued future improvement and success will require staying focused on fundamentals and clearly defining and communicating your market position including a description of the lifestyle, amenities and benefits of this living arrangement.

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 48 years. MDS is a two-generation company – she is following in Jim Moore’s footsteps. Lynne Moore is responsible for all MDS market research-related projects involving all aspects of senior housing and healthcare. She can be reached at (817) 731-4266 or lynnemoore@m-d-s.com.

This column appeared as “You’ve Got Questions, We’ve Got Answers” in the December 2022 print issue of McKnight’s Senior Living magazine.

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.

Have a column idea? See our submission guidelines here.

Long-term care facilities have had to deal with material supply shortfalls since 2020 and through worker shortages that have worsened in 2022. But their biggest challenge yet finds them dealing with once-in-a-generation inflation. Concerns are palpable for some already cash-strapped facilities facing occupancy issues and closure fears.

“Rising inflation over the past year, compounded with the long-term impact of the pandemic, rising labor costs, supply chain delays, and rising interest rates, is certainly putting downward pressure” on operators, said Scott Thurman, who oversees Greystone’s FHA Production.

The nation’s 40-year-high inflation, which exceeded 8.25% in September, replaced staffing as a top concern of senior living communities and nursing homes, according to a new CNBC survey, as small increases in essential operating expenses are making a big impact — and aren’t easy to cut.

“I don’t think the rate of inflation has slowed down much in the last six months,” David Grabowski, PhD, professor of health care policy at Harvard Medical School, told McKnight’s. “I am also concerned about other rising costs from inputs like [personal protective equipment] to more general costs like food, energy services and gasoline.”

Some states countered the inflationary blow with token reimbursement increases, but many experts question whether continued pressures will be met with similar relief in 2023, said Jeff Binder, managing director at Senior Living Investment Brokerage.

Then, there are providers that took bridge loans at 0.25% to weather earlier storms, only to face the possibility of being shut out of new borrowing opportunities, added Bill Kauffman, senior principal, National Investment Center for Seniors Housing & Care.

The most obvious concern remains an unstable workforce. Long-term care facilities have hiked wages more than any other industry yet face the worst recovery numbers. In the end, such wage pressures threaten to permanently change the industry, NIC Chief Economist Beth Burnham Mace said. “Once inflation gets embedded in the heads of businesses and consumers, it’s very difficult to get rid of that expectation,” she said.

Greystone, national commercial real estate finance firm, ranked No. 1 based on dollar volume of multifamily and healthcare commitments issued by the US Department of Housing and Urban Development in fiscal year 2022. The firm originated and obtained commitments for 177 multifamily and healthcare facility HUD-insured loans totaling $3.6 billion, representing 14.2% overall market share. Greystone ranked highest based on dollar volume under the healthcare LEAN program, with $676 million in origination for 46 healthcare properties, which include assisted living communities and nursing homes. 

» Great Elm Capital, Berkadia launch joint venture healthcare financing group

Great Elm Capital Corp. and an affiliate of Berkadia Commercial Mortgage will form Great Elm Healthcare Finance in a joint venture to provide venture capital to companies focused on skilled nursing facilities and senior living communities as well as acute care facilities and specialty pharmacies, the companies announced.

Berkadia, according to GECC, will be a strategic minority partner in the joint venture.

Headquartered in Nashville, TN, GEHF will be led by Michael Gervais as CEO, Ray Zilke as vice president of portfolio and Chad Kerr as vice president of credit, along with a management team with “substantial” expertise in healthcare real estate.

GEHF also will be supported by Great Elm Specialty Finance’s existing infrastructure, according to the announcement.

» Medicare Advantage premiums to decline by almost 8%

Consumer groups applauded the Centers for Medicare & Medicaid Services for lowering Medicare Advantage plan premiums. Beneficiaries will see the projected average premium for MA plans decrease almost 8%, from $19.52 in 2022 to $18 per month next year. The announcement came before open enrollment, which runs from Oct. 15 to Dec. 7. CMS projects that enrollment will reach 31.8 million people in 2023.

The news followed warnings from LeadingAge, which told McKnight’s that provider pressure to accept low-ball contracts with Medicare Advantage plans would force some organizations into “a death spiral.”

 In an industry valiantly defending itself against the pandemic, personal protective equipment shortages and antibiotic resistance, there’s one thing that has brought many providers to their knees: an AWOL workforce that has shown few signs of coming back. 

Crippling staffing shortages are beginning to feel permanent to some. 

“Staffing shortages, exacerbated by burnout stemming from the pandemic, have left many providers scrambling to fill schedules and have led to additional, increased burnout” among remaining staff, PointClickCare President Julieann Esper Rainville said. “This has impacted the delivery of care tremendously, as there are simply fewer providers for the amount of [people] who need quality care.” 

The historic staffing shortages continue to limit new move-ins and reduce access for older adults, CenTrak General Manager of Senior Care Deric Blattenberger noted. The number concerned about possibly having to close their doors has continued to grow, he added. 

 Wellsky Chief Clinical Officer Tim Ashe reports seeing many agencies and organizations turning away admissions due to capacity constraints. 

Perhaps now, more than at any other time in recent history, information technology could be the thing that keeps the long-term care industry vibrant and vital. It never gets sleepy, grows bleary-eyed or calls out. 

At the center of IT’s heart are powerful machine learning and artificial intelligence mechanisms. 

One example of innovation suited to long-term care are powerful algorithms that can precisely predict the number and kind of workers needed, and where and when, on any given shift, based on residents’ needs. Such a feature could help ensure that staff resources are allocated precisely while saving money and preventing mistakes and burnout. 

Providers also are adding automated functions to help with back-office functionality, as the labor crunch hits there, too. 

What does the near future look like? 

“One in which technology has gone from a ’nice to have’ to a ‘need to have’ in terms of boosting efficiency, experiences and overall care,” Rainville said.

The healthcare sector set records for the level of costs and recovery times following data breaches for the 12th consecutive year, according to IBM. The industry as a whole has the longest breach cycle of any industry, according to the firm’s “X-Force Cost of a Data Breach” report. Providers average 11 months to identify and contain security incidents, with average costs exceeding $10 million, up 9.4% from 2021, according to IBM. 

» NY rolls out robot companions for seniors 

A tabletop robot designed specifically for older adults is making its way into the homes of 800 older adults, including some in congregate settings. The NY Office for the Aging partnered with Intuition Robotics to place artificial intelligence-powered robotic companions that communicate with older adults in a way similar to Amazon’s Alexa. It can empathize with humans and respond to voice and body movements, according to the company. The technology could offer relaxation cues, physical exercises, nutrition conversations and medication reminders. 

» Netsmart adds Zimmet’s CORE Analytics 

Netsmart added Zimmet Healthcare’s CORE Analytics claims data solution to its suite of electronic health records and related service offerings in early August. Netsmart said the integration made its solutions the only in the market capable of calculating quality measures and Five-Star ratings leveraging Minimum Data Set, Payroll-Based Journaling and UB-04 claims data. 

Netsmart provides technology and services to more than 50% of US long-term care facilities. 

The CORE solutions includes CORE Reimbursement, which identifies Patient-Driven Payment Model revenue opportunities; Value-Based Post- Acute eXchange, VPAX, which measures clinical and financial outcomes to partners; and Medicare Advantage Post-Acute eXchange, MAPAX, which quantifies clinical and financial performance. 

“We can expand the capabilities of our comprehensive tools to unite the clinical, claims and staffing data to provide a holistic view of an organization. Our clients will be able to rely on the same tools and support they’ve come to expect, with the ability to leverage solutions across the Netsmart CareFabric platform,” Zimmet Healthcare President and CEO Marc Zimmet said. 

For much of 2022, lockdowns and other restrictions tamped down the usual resident security concerns in the nation’s long-term care facilities. Still, workforce shortages meant fewer vigilant eyes and ears to ensure resident safety, meaning 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 antipsychotic medications.

In a recent report, STAT News asserted that gains in resident safety have stalled over the past decade, noting a federal study released earlier this year found “rates of patient harm remain disturbingly high.” In late August, for instance, the Centers for Medicare & Medicaid Services warned nursing homes and other providers 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 (which includes disaster preparedness) 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. 

Already, Szpytek said he is seeing critical weaknesses in life safety and emergency readiness. As have several national long-term care associations, he is warning providers to begin preparing.

A good place to start, he told McKnight’s, 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, 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 was simply 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,” Kevin Hill, general counsel for Avamere, told McKnight’s. “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 pandemic effects.

The survey found 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 long-term care facilities in 30 states, including ones affiliated with the Green House Project, the Pioneer Network, the Eden Alternative and the Live Oak Project.