A: Many of these issues have been influenced by the COVID pandemic, and it appears 2022 will be another year of transition. The pandemic still is with us, and operators continue to deal with challenges, including availability of staffing/turnover, higher labor costs, increased operating expenses and inflation. Although census reportedly was on the upswing during the last half of 2021, many communities still are dealing with less-than-optimum occupancy.

Although operators initially were forced to make changes in response to the pandemic, new resources and approaches to operations, marketing and communications and service delivery are resulting in favorable effects. There is increased reliance on and use of digital tools and virtual communication, including Zoom meetings/marketing encounters, FaceTime visits, and Facebook and other social media communications. Everyone is becoming more experienced with the use of this technology, including staff, residents and their families, prospective residents, and service and healthcare providers.

Partnerships with third-party home health and therapy providers are resulting in on-site service delivery. Primary care health services also increasingly are being delivered on-site and via telehealth.

All of these things are reducing resident exposure to the outside world and helping to reduce burdens on their adult children and other family caregivers. Other creative opportunities are continuing to be identified in the areas of physical design, approaches to staffing, service delivery options and resident management that, we hope, will start to neutralize the significant challenges that senior living will face during 2022.

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 healthcare. Lynne Moore can be reached at (817) 731-4266 or lynnemoore@m-d-s.com.

This column appears in the February 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.

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Harley Tabak will retire at the end of the year after two decades at the helm of Jewish HomeLife in Atlanta. In April, he’ll transition to the role of CEO emeritus as Chief Operating Officer Jeffrey A. Gopen, recruited to the organization more than five years ago as part of a long-term plan, succeeds him. Tabak recently spent a few minutes speaking with McKnight’s Senior Living about succession planning, service line diversification and vaccine mandates.

Q: Jeffrey Gopen was recruited more than five years ago as part of a long-term succession-planning effort. Did Jewish HomeLife know for five years that he would be your successor?

A: He had to prove that he was up to the role, and he has. When he was recruited, he was our first COO, and we created that role for two reasons. One, importantly, our organization had grown and really needed one. And secondly, the board realized we really needed to have a succession plan.

Q: Could you talk more about the succession-planning efforts — how they began and the steps that the organization went through?

A: We created a small group of our board and our management team to assist me in the process, and then we hired a national search firm, which guided us through a list of qualities that we thought were important for the role. We began receiving applicants based on the screening that the search firm had conducted, and then we would review those summaries of individuals that had been sent to us. And from that, it came down to six or seven people that we thought were really qualified and that we had an interest in. We met with all of them, and then we boiled it down to two, and then went through another round of review with both the board and management. I ultimately made the decision, but by the time we had completed that, it was clear that Jeff was the best candidate.

Q: Many other organizations are facing the same kind of situation, where they need to do some succession planning. Do you have any advice for them, based on your experience?

A: Every organization, especially in the field of senior care, is confronted with unprecedented challenges with recruitment and retention. The best advice I can give is, for everyone in a key role, there should be somebody that you think has the potential to be your successor.

That has become an expectation with all of the key leadership roles in management in the organization here. There is not always that right fit for someone to succeed, but there is a conscious effort to find that person. And it’s not always successful, but quite often, it is. And that’s a great reassurance, for everyone in management to know that we’re planning that. And I think it helps with retention as well, because the really good people want to know that there is some opportunity for them. So I think it’s a win-win.

Q: You’ve been there for two decades, and during that time, Jewish HomeLife has grown from a skilled nursing facility to a full network of nine communities. What factors went into the decision-making involved in those efforts, and what do you believe are the benefits of diversifying the offerings of the organization?

A: When I came to Atlanta about 18 years ago, I had already had about 20 years of experience in the field, in various leadership roles, primarily in the Washington, D.C., area and throughout the state of Virginia, where I’d worked as an executive for a big hospital system in the Northern Virginia area, where I had managed all of their post-acute care businesses. I’d also run a small nursing home chain with multiple locations in Virginia. So I came from a background that included multiple sites.

I would say that one of the critical strategic needs I saw when I got here was, we were too dependent on one source of revenue: skilled nursing home revenue. And that, from my perspective, long term, would have been a very risky situation to be in, given my experience with skilled nursing homes and constant challenges with reimbursement. So I encouraged and got the support of the board to diversify for that strategic reason.

Also, we’re a nonprofit organization, and our mission is to serve the entire continuum of care, not just the very frail who go to a skilled nursing home. So there was an alignment from a business perspective and a mission perspective to get into multiple types of businesses, to have different revenue streams. I know it seems strange now, since it’s so common, but we didn’t even have a distinct rehab program within our skilled nursing home; that was one of the early moves, to significantly grow that.

Q: What are some of the changes that have occurred over the years?

A: I had a lot of experience in developing assisted living communities in Virginia. In fact, I had worked early on, when Paul Klaassen first started Sunrise [Senior Living] and knew him well. He, of course, became very, very successful with Sunrise, and I stayed in the hospital world at the time. I developed assisted living within the hospital system I was part of in Virginia. And then when I came to Atlanta, I knew that that was very important. Assisted living, at least in Georgia, doesn’t have any government payment — there is no Medicaid. It’s all self-pay, so it was consistent with trying to diversify revenue streams and become less dependent on government reimbursement, whether it be Medicare, Medicaid or HUD — and we have all three.

We had a small hospice, which we’ve grown significantly since I’ve been here. We had one affordable housing building. Now we have two. We expanded into private home care. We didn’t have any type of home care service. Now we’re trying to do more in people’s homes, not just with home care. We have something called JHL Medical Services, where we send in nurse practitioners to deliver medical care in people’s homes. That’s something that will grow even more in the future, with nurse practitioners or through telemedicine. We’re doing some telemedicine now. I think the time will come where we have our own physicians providing care in our own clinics or in people’s homes.

Q: Are there any other ways that you see potential diversification in the future?

A: One area that we haven’t done that exists in many states is a PACE program. At least in Georgia, the revenue from Medicaid, at least in our initial analysis, didn’t seem adequate to make it viable. But that’s something I’d like to see reevaluated when I’m gone.

We did not do a Medicare home healthcare company. We just did private home healthcare. I’ve done Medicare home healthcare in the past. The certificate of need in Georgia prevents that from happening unless you can get one, so we didn’t do that.

I think affordable housing will continue to be a focus in the future. It’s a way of helping those who can’t afford the market rate. There are many, many options for market rate — independent and assisted living — but we have an inadequate number of affordable housing for independent and, certainly, assisted living as well. That’s a frustration, that we just haven’t been able to do more. And I think, certainly, there needs to be some additional HUD support for that to make it possible.

Q: What are some of the other ways the organization has changed?

A: Our governance board has become more strategic and smaller. When I got here, we had a very large board. In the nonprofit world, it was thought some years ago that having a very large board was good for fundraising. But good governance has changed significantly to having a smaller board, people who are fully engaged and involved and understand everything about the business, because they have a fiduciary responsibility.

Q: Everyone who is eligible is fully vaccinated at Jewish HomeLife, and the organization has a vaccine mandate for employees. Do you think that the company will mandate boosters at some point?

A: Yes, I definitely do. Like every other organization that is challenged with finding healthcare workers, it’s obviously a very sensitive issue. We do the administration of the boosters and the vaccines ourselves now. We have that capability, so it makes it easier to do it. But I am firmly of the belief that, in healthcare, just as the flu vaccine is a mandate within our company and within many healthcare organizations already, COVID will be like the flu. And if you’re not vaccinated, then you shouldn’t be taking care of our most vulnerable population. It’s as simple as that.

An abbreviated version of this interview appears as “A Few Minutes With…” in the February 2022 print issue of McKnight’s Senior Living.

By expanding the number of private rooms for its Johanson Wing, life plan community Smith Village is serving the wants of the community on Chicago’s South Side, which includes the CEO’s parents.

A $23 million modernization of the 30-year-old building includes a three-story,10,204-square-foot tower at the south end of the structure, featuring a therapy gym on the first floor and dining rooms on the second and third floors. Finished six months ahead of schedule, the project capped off a 15-year, $74 million transformation of the larger campus.

CEO Kevin McGee grew up in the working-class Irish neighborhood where Smith Village is located. His parents both reside in the community, his mother in independent living and his father in skilled nursing. They were among the community members and residents who offered their input about how Smith Village should go about the modernization project. Focus groups established the project’s blueprint, McGee says.

“Overwhelmingly, people wanted private rooms in skilled care,” he says. “Hospitals started doing it, so that became the expectation from the community.”

The new Johanson Wing has 66 private rooms and six semiprivate rooms (which are divided by a wall) for skilled nursing residents and short-term rehabilitation patients. Michael Martin, managing partner of RLPS Architects in Lancaster, PA, says that a dedicated entrance and “front door” to the health center is an integral part of the redesign because “previous access to the wing was from the independent living community’s main entrance that went through a labyrinth of corridors.”

A dedicated physical therapy area is adjacent to the main lobby, with access from the new entrance as well as the private rehab resident rooms on the first floor.

The rooms for short-stay rehab care patients have been modified to include bathrooms with fully accessible, European-style showers, allowing people to stay in their rooms for bathing.

The upper floors for skilled nursing residents feature a contemporary dining venue and new living and gathering rooms. Renovations for both upper floors include the circulation spaces, common areas and resident rooms. The footprint of the first floor was larger than the upper floors, providing the opportunity to expand the volume in a portion of the therapy gym.

The risk of death for COVID-19 is not only rare among the vaccinated, but also among those most at risk: adults aged 65 years and older with comorbidities or immunosuppression.

That’s according to a recent study by the Centers for Disease Control and Prevention. Investigators analyzed data from 465 facilities, examining the prevalence of severe COVID-19 outcomes, including respiratory failure, intensive care unit admission and death.

Among more than 1.2 million people who completed an initial vaccination series between December 2020 and October 2021, these outcomes were rare. Severe outcomes occurred in 189 of these patients, and 36 of those patients died, reported Sameer S. Kadri, M.D., of the National Institutes of Health, and colleagues.

Older adults with mild dementia can improve their ability to complete everyday tasks and enhance quality of life by using smartphone memory aids, a new study finds.

Investigators coached 52 older adults with mild cognitive impairment or early dementia on how to use a digital voice recorder application and a reminder app on their smartphones. After four weeks, study participants reported improvements in performing daily tasks that they had intended to accomplish, according to Michael K. Scullin, Ph.D., of Baylor University in Texas, and colleagues.

The more often participants used the digital recorder or reminder apps, the better their measures of memory and improvements in activities of daily living. Notably, when assigned tasks by the investigators, they tended to favor the reminder app in week one of the study, but by week four there was a preference for the digital voice recorder app.

The findings suggest that there is unexplored opportunity to develop technology with interfaces and user experience that is geared to older adults, Scullin said. Participants also appeared to like using the apps, he added.

The study was published in the Journal of the American Geriatrics Society.