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Q: How and why did you decide to share your and Brookdale’s experiences in a book?

A: By sharing our behind-the-scenes information, we can help others learn from our experience. This is especially helpful for leaders who are navigating unchartered waters and trying to bring out the best in their teams for their companies or for society overall. And in addition, this is really both a keepsake for those who stepped up when it mattered most, as well as a guide to inspire other leaders to overcome whatever challenges they may be facing.

Q: Could you share some of the challenges you write about Brookdale experiencing during the pandemic and how the company met those challenges? 

A: What we learned, and what we knew, is that everyone had an important role to play in the crisis and beyond. We also learned that great ideas come from all levels of the organization. And as an organization, we are stronger together, working closely together to focus on what matters most.

Q: How did your pre-Brookdale life and career prepare you for the pandemic?

A: I was raised by a single mom, and I grew up dirt poor. After my mom had a near-fatal car accident, before I entered high school, I learned exactly what it meant to become a caregiver. I became the caregiver almost overnight. And so the experience that I had with my mom — thankfully, she recovered — really gave me a deep appreciation for the work that we do. And it’s really central to the person that I am today.

And I also really learned that there are times in life when you have to overcome incredibly difficult challenges. Stepping up for my mom gave me a resilience and a work ethic that were critically important during the pandemic.

I also learned if you focus on what you can do, virtually anything is possible.

Q: What changes do you see extending beyond the pandemic at Brookdale?

A: One of the things that I’m most excited about is telehealth and the opportunity to serve seniors where they live, which is in our communities. Healthcare changed tremendously during the pandemic. Providing as many healthcare services as possible at home is something that will continue. That’s an expectation of residents today, which is very helpful.

Technology also gave meaningful opportunities to engage with family and friends and to pursue life’s passions. We saw residents join a grandchild’s wedding during the pandemic via technology. That’s something that I don’t think we would’ve seen nearly as much of before. And that’s something that I think will always be a part of our business going forward. But perhaps most importantly, it’s being very intentional about the personal connections that mean most for resident engagement. I think our business is even more personal today than it was pre-pandemic.

Q: What other lessons did you learn that will be useful to leaders in the senior living industry?

A: Focusing on the mission is vital — giving people a sense of purpose and creating a culture that people want to be part of. I think that everyone wants to be part of something that’s bigger than themselves. We’ve learned that if there’s negative emotion, that really drains energy, whereas positivity creates energy.

It’s important to lead by example, to encourage gratitude, empathy and active listening. We have worked to do that as an industry, but we need to make sure that we become even more attractive for associates to grow, to fulfill their purpose, to earn competitive compensation and benefits and to grow professionally.

I also think that there’s more work that we can do to highlight what is unique about this industry, something I call the second paycheck, which is the benefit that you get from interacting with the residents in our communities. That is truly what makes our industry special, and I don’t think enough people outside of our industry really understand how wonderful that is.

Q.  Is the active adult apartment product successfully attracting and serving a younger and more active segment of the senior population?

A.  Active adult apartments are attracting an age profile that is 10 years younger than traditional independent living but still 20 years older than the qualifying age requirement.

Several active adult housing products exist across the country, but the freestanding active adult apartment building is the product that currently is emerging in many markets. Although these apartments are restricted or targeted to the age 55+ or age 62+ population, the average age profile of the current residents at those communities is 72 to 74 years old. This is a decade younger than the average age profile of the traditional independent living resident but almost 20 years older than the qualifying age requirement for active adult housing.

Baby boomers make up the next generation of younger seniors, and they currently range in age from 57 to 76 years. The younger boomers appear to be exhibiting the “I’m not ready yet” syndrome — they are resistant to moving into and paying for a service-enriched living environment, and they may not have a clear understanding of the active adult lifestyle. They want to live independently until a move is needed — whatever that means to them — and there are no signs this is changing soon.

Having a clear understanding of the needs and motivations of the different age profiles of this target market will be necessary in developing and communicating a specific definition and market positioning for the active adult apartment lifestyle.

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. Ms. Moore is responsible for all MDS market research-related projects involving all aspects of senior housing and health care. Lynne Moore can be reached at (817) 731-4266 or lynnemoore@m-d-s.com.

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

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.

1. Be mindful of acceptable practices as a guiding light.

Continuity is essential for resident comfort and privacy, said Mary Madison, RN, RAC-CT, CDP, clinical consultant for LTC and senior living at Briggs Healthcare.

Many communities try to maintain a dedicated group of bath aides, she said. When that’s not possible, consider moving to a team-based approach. Direct care staff have a more central role in directing that care, according to Patricia Howell, RN, BSN, WCC, CFCS, clinical support manager, McKesson Medical-Surgical. Another approach is to hire home care agencies to fill  gaps.

2. Consider accepted workarounds and “shortcuts.”

For instance, could walk-in tub/shower systems be retrofitted to improve safety and require less staff time for highly mobile residents?

“Nursing staff should be aware that patients/residents have varying preferences, and it is important to incorporate the patients’ preferences in the development of bed-bath practices,” Howell said.

3. Make prudent use of  accessories and tools.

Safer alternatives to basin baths include disposable, no-rinse bath wipes; bathing gloves; and a waterless, leave-on, skin compatible bathing system, according to Howell.

4. Remain vigilant.

Diminished staffing can be a recipe for bathing hazards that could cause resident and, ultimately, community harm. For example, regular use of bath basins with water and soap potentially can become contaminated with nosocomial pathogens. 

5. Enlist family members to assist.

“I have seen family members assisting with feeding, shampooing and styling hair and providing personal care, including toileting and assisting with brief changes for those who are incontinent,” said Howell. 

Madison, however, strongly warned against allowing any nonemployee to operate bath lifts.

» Apollo Bath recently unveiled new bathing products for senior living and skilled nursing facilities. Apollo Bath’s new offerings include Solares Spa, the Advantage Spa, and Essence Spa bathing systems. These bathing systems are designed with the safety and hygiene of residents in mind to provide a holistic, luxurious bathing experience, according to the firm.

» Consider three variables when determining a new tub purchase, Family Handyman magazine advises:

1) Size: Your available space determines a lot. With a smaller-sized space, some operators choose to have a dual shower/bathtub (an alcove tub), whereas those with ample space have the luxury of choosing a free-standing style.

2) Material and weight: Those tend to go hand in hand. A cast iron tub is more expensive and extremely heavy but durable. Fiberglass is lighter and stronger with low maintenance but can be prone to scratching or warping over time.

3) Shape: Are you looking at a traditional, classic rectangular alcove tub (paired with a shower, enclosed by three walls) or a freestanding tub, perhaps with a shower elsewhere? Those factors can influence the choice that works best for your community.

» Senior Strong recently released a guide on bath lifts to help older adults find the right medical assistance devices they need. The article was published on Senior Strong’s website to highlight the need for senior bath aids. “The publication analyzes the use and utility of bath lifts for the elderly. It helps seniors and senior caregivers by providing detailed information on the best devices for assisting seniors,” said William Rivers, founder and senior editor of Senior Strong. The article also sheds light on the general features to look for when purchasing a bath lift. For more information on senior bath products, visit https://www.seniorstrong.org/bath-chairs/.

“In the wake of the COVID-19 disaster in nursing homes and other eldercare settings, reform-minded organizations must band together to amplify their voices and cut through the ineffective rhetoric that has held back true change for decades,” said Susan Ryan, senior director of the Green House Project. “A Green House-Pioneer alliance is a vital step toward real systemic transformation.”

The alliance comes after a national report found that the way the United States finances, delivers and regulates nursing home care is ineffective and unstable. The study called for immediate action to bring meaningful changes to the system, and one of those actions included adopting less institutional settings such as Green House homes.

The groups said that once the combination is finalized, the joint entity will serve as a “full-continuum consulting, advisory and education partner for eldercare organizations looking to spark cultural, organizational and physical change.”

A Green House spokesman added that the new alliance will allow the combined organization to offer a deeper and broader set of tools to providers while also streamlining parallel sets of services.

“For instance, GHP and Pioneer have separately provided cultural transformation services at traditional institutional nursing homes. By coming together, we can create a consolidated source of knowledge and best practices based on experience gained through both organizations’ years of work on the ground,” the spokesman said. 

The duo also hopes the partnership will allow them to bring person-directed care principles to more elders while laying the cultural transformation groundwork for future generations of people who will need long-term care services and supports.

“Additionally, from an advocacy standpoint, we believe the time is right to combine our voices into a single — and hopefully louder — call for systemic change,” the spokesman said.

“Lawmakers across the country have the ability to transform the sector through both new investments and increased transparency and accountability. Together, we believe our message of change and transformation has more power than it did separately,” he added.

» Baxter’s recent acquisition of Hillrom is paying quick dividends. Revenue in the first quarter topped $3.7 billion, a 26% increase, according to the medical products firm.

Baxter paid $156 in cash for each outstanding share of Hillrom common stock, for a purchase price of $10.5 billion (based on Hillrom share counts at closing). Including the assumption of Hillrom’s outstanding debt obligations, the enterprise value of the transaction is approximately $12.5 billion.

“The Baxter-Hillrom combination unlocks the next phase of our transformation, presenting a new wave of potential to drive greater impact for patients, clinicians, employees, shareholders and other communities we serve worldwide,” said José (Joe) E. Almeida, Baxter’s chairman, president and CEO.

“Integrating our complementary capabilities introduces additional opportunities for growth across our broad geographic footprint and also creates remarkable new possibilities for connectivity with leading-edge digital health innovation focused on enhancing care, lowering costs and increasing workflow efficiency,” he added.

» The pandemic hasn’t slowed down furniture maker Uline. The Wisconsin-based company is in the midst of hiring 350 new employees and recently finished the expansion of its massive complex in Pleasant Prairie.

» Samuelson Furniture recently donated Allure, a Sound by Samuelson chair, to the Miriam Apartments at Daughters of Miriam Center, a local not-for-profit independent living community providing care and services to older adults in Northern New Jersey.

But a study published in JAMA Health Forum earlier this year showed that outcomes overall haven’t suffered since the transition, despite less hands-on therapy.

Skilled nursing patients received about 13% fewer therapy minutes after PDPM’s October 2019 launch. At the same time, researchers found the change had little to no effect on outcomes or rehospitalization rates.

“More attention is placed on the desires of the patient, which is excellent,” said Kristy Wikum, president and CEO of
Centrex Rehab.

David Tate, chief strategy officer at Reliant Rehabilitation, said that his company’s experience has shown “a gradual improvement in functional outcome scores for patients completing rehabilitation stays in SNFs over the past two years.”

Reliant developed clinical pathways that align with PDPM’s wide variety of case-mix groups.

Hilary Forman, chief clinical strategies officer at HealthPRO Heritage, believes PDPM gave clinicians more freedom to practice and prescribe. She said that it also has helped drive efficiencies in the pursuit of value-based care.

Jintronix co-founder and CEO Mark Evin added that clients are looking at therapy differently now. Instead of just valuing time spent with patients, therapists must emphasize imaginative solutions.

For example, he said, technology is becoming a more important tool.

“PDPM is freeing certain constraints while providing new ones,” he said.

Michael Smith, an independent therapy consultant for long-term care facilities and rehab centers, finds both viewpoints valid.

“The therapists have been able to use the clinical need to justify their care,” he said.“This is rather appealing to those who wanted more control to decide how much therapy was needed versus the need to meet minutes for reimbursement.”

HealthPRO Heritage says its Enterprise Partnership can help improve an organization’s net economic performance and create solutions to the challenges providers face today.

The company said the program builds on the therapy provider’s 20-plus years of experience in the industry and the strength of diverse and dedicated resources.

Clinical experts develop and implement customized programs to answer the needs of local markets to drive referrals. Consultative guidance supports strategic admissions and accurate coding to optimize reimbursement, whereas proprietary clinical pathways control rehab costs as therapists provide quality person-centered care.

Dementia residents in LTC suffered outsized pandemic mortality spikes

Older adults with dementia, especially nursing home residents and minorities, had significantly higher mortality rates during the pandemic than peers without cognitive impairment, a study in JAMA Neurology found. 

Investigators compared mortality rates in pre-pandemic 2019 versus rates in 2020 using data from 53 million Medicare beneficiaries 65 and older. Study cohorts included people with and without Alzheimer’s disease and related dementia living in the community and people with and without dementia living in nursing homes. They believe healthcare disruption — and not the COVID-19 illness alone — may be to blame for excess deaths.

AI could shape future rehab therapy

Artificial intelligence trained to interpret the words therapists use could unlock important clues about more powerful and effective treatments, researchers are finding.

The combination could lead to more people getting and staying healthy, authors Charlotte Jee and Will Douglas Heaven reported in MIT Technology Review.

“The idea is to use natural-language processing to identify which parts of a conversation between therapist and client — which types of utterance and exchange — seem to be most effective at treating different disorders,” they explained.