A. Several operators/providers are attempting to develop products to address this challenge.

Active adult apartments are an emerging product that is targeting a healthier, active and slightly younger segment of the Senior population who are searching for secure maintenance-free living, amenities and opportunities for socialization with their peers. For the middle market segment of this population, affordability will be a challenge.  Many operators are now designing active adult products specifically targeted to this segment of the population. The physical product is one of several areas of value engineering that could result in reduced development costs and assist in achieving a lower price point.

 Some of the physical characteristics that could result in reduced development costs include smaller living units, more one- versus two-bedroom units, fewer floorplans to accommodate stacking of units, more modest finish out materials and more efficient, multi-use common area spaces. In addition to new construction, many providers are also evaluating the acquisition and repurposing of older Senior housing or residential apartment buildings to achieve a lower price point.

Other housing products are also being investigated to address the middle market challenge. For example, pocket neighborhoods involving duplex or fourplex townhomes are being built around shared common spaces. Companion living (while not a first choice) and intergenerational living arrangements are also being investigated. Addressing middle market challenges will require creative thinking and innovative approaches.

This article appears in the August issue of McKnight’s Senior Living as “You’ve Got Questions, We’ve Got Answers” column.

Jim Moore is president of Moore Diversified Services Inc., a national senior living and healthcare consulting firm based in Fort Worth, TX, that has been serving clients for 50 years. He has written five books about senior living and healthcare, including “Assisted Living Strategies for Changing Markets” and “Independent Living and CCRCs.” He has published senior living bimonthly columns for the past 28 years. Moore may be reached at (817) 731-4266 or jimmoore@m-d-s.com.

Gayle Kvenvold is retiring from LeadingAge Minnesota at the end of the year after 40 years with the association, 32 of them as president and CEO. She recently spoke with McKnight’s Senior Living about the past, present and future of her professional life and the industry.

Looking back, what would you say are the big changes that have occurred in long-term care overall during your career?

You know, I think sometimes we get frustrated with the pace of change in our field, and sometimes it feels maybe more incremental than we would like it to feel. But some pretty sweeping changes have taken place.

I started this journey of mine as a nursing assistant way back in 1969. So in one form or another, I have been working in the field for even longer than my 40 years with LeadingAge Minnesota.

I can recall when nursing homes were the only option for seniors who needed any level of care and support. It wasn’t even a question of whether or not one needed 24-hour care and support; it was if you needed any level of care and support and you didn’t have family to do that for you and/or you didn’t have resources. Actually, you couldn’t really even buy those services very effectively four or five decades ago.

So what stands out to me is the concept of an array of care. It’s much more about the right service at the right time. That in itself is a significant change over the period of time that I’ve been doing this wonderful work.

We had the term rebalancing to describe seeking home- and community-based options and having our investment in those options be at least equal to or greater than the investment in nursing home care. The emergence of elderly waivers to help make that happen, and waiver programs under Medicaid. The entire concept of home- and community-based services and all of the varying services within that broad description. The emergence of assisted living. The emergence of concepts like hospital at home, the whole role of home care, adult day, the concept of person-centered care, which I like to think of as the customer experience or the consumer experience. All of that has emerged in the last four decades.

Senior living didn’t really even exist, or perhaps was its infancy, when you started.

That’s right. There was affordable senior housing. The [Housing and Urban Development] program was underway. But, really, in terms of residential options for seniors, it came down to the nursing home with its varying levels of care.

When I was a nursing assistant and a nursing home social worker after that, we had, of course, the concept of board and care and intermediate care and skilled care. And we’ve seen this incredible shift in the whole continuum; the individuals who were in those boarding care or intermediate care settings today are at home or in assisted living, and they don’t even touch the skilled nursing part of the array of services we have today. That’s an enormous change.

Looking back, you can see it. On a day-to-day basis, sometimes, I think we lose sight of that.

What drew you to nursing and long-term care originally?

Well, I would like to say that it was a very deliberate plan, but the truth of the matter is, I graduated from high school in need of a summer job. There was an opportunity to sign on as a nursing assistant at my local community nursing home. I went in and applied, and the next day, they said, ‘Come to work.’

There was no nursing assistant training, per se. It was all on-the-job learning. I found that I really loved work with older persons, and I felt a calling to work in that field. Nursing home social work was my first expression of that, and over the course of that work — I was about a decade as a nursing home social worker — I became really interested in why things were the way they were and whether or not there was an opportunity to shape policy, not as an elected official but as someone working with elected officials and state agency personnel around how we deliver services to seniors.

That led me to the association, that idea of coming together as a provider community and working with consumers and others to make change. If you look at the mission of LeadingAge Minnesota, it is that we are driven to enhance and transform the experience of aging. That’s been a lifelong calling to me.

What are the accomplishments you’re most proud of, trying to meet that mission?

It’s all about the partnerships that have been forged across four decades of work and what that has led to in terms of change. If I look at the most significant changes in the way an older person experiences long-term services and supports, if you peel everything back, at the heart of that is some type of collaboration or partnership, either among providers or with providers and consumers working together, or with policymakers. So I would say that that of which I am most proud is that I have been part of a spirit of community with a common vision to enhance the experience of aging for seniors.

No doubt COVID-19 was the first and only pandemic during your career. How do you think it will change the industry?

We’re still in it, so we don’t have quite yet the wisdom of hindsight, but I would say in terms of the unique threat to the population whom we serve, the demands on our workforce, the speed with which we’ve had to adapt and adopt new learnings and new practices, the teamwork that the pandemic has called on us to have — at least in my experience, we haven’t experienced a challenge quite like this.

Let’s hope that there are things that we’ve learned that are going to be new practices in our field, new ways of thinking about service delivery or teamwork or resilience. A CEO in long-term care told me, ‘I hate COVID, but I love what it did for my team.’ And, you know, that’s thinking about this profound sense of purpose that I think all of us working these last months have felt. Nimbleness, inspiration. We’ve learned we can sprint. We’ve learned about grace — that we do the best we can on any given day in any given moment, and then we give ourselves grace for what we weren’t able to get done, and we come back and bring our best again the next day.

The pandemic also really laid bare the depth of our workforce challenge. And in particular, it really called out what those of us working in long-term services and supports have long known about the societal standing of caregiving careers. It’s not where it needs to be. We talk about caregiving aspirationally as an honored and sought-after career, and it’s going to be incumbent on us, as we come out of this pandemic, to really make good on that. My own opinion is that while wages are only a part of the picture, they’re a huge part. We need to ensure that you can support a family as a caregiver. As providers, we’re going to be called to partner in new ways in the lives of our workers, whether that is housing or day care — which we’ve heard so much about during the pandemic — or healthcare or psychosocial supports that our workers are going to need. That’s an area I would be very interested in working on, that we can somehow recognize the complexity of these roles in caregiving, the unique combination of people skills and empathy and judgment that we need for those individuals, and value them as we ought to be valuing them.

What do you think the future holds for senior living?

We’ve just talked about the challenges of the pandemic, but I think the future is really bright. When you look at the number of people who are going to need some form of service and support and/or healthcare over the course of their aging, we are going to be so needed and so called upon to rise to the demographic that is before us.

And there are things we’ve learned through the pandemic that are going to guide us forward. The ways in which technology became part of our everyday experience, whether that was for healthcare purposes like telemedicine, or whether that was for connectedness. I don’t think we will return to a time when technology is not a part of how we deliver services and how we interact with one another. In fact, I think we’ve just scratched the surface there.

I also believe that we’ve learned so much in a hard way about the social determinants of health and the importance of community and connection. And so I’m pretty bullish on congregate living. I think we’ve learned a lot about our need for human connection and the role that that plays in our overall health and well-being. And I think we’ve only scratched the surface on ways in which we can configure housing and services.

And then the other thing, which has been a bit of a soap box for me for a long time, is long-term care financing reform. I think we were beginning to see a little bit of momentum before the pandemic in some thinking about leadership that states could do on this front. But I hope that we really, really can embrace this in the years we have ahead and leverage the public will to be able to find a way to pay for these services across our populations in new ways that leverage private investment but also public support. That’s a quest that I believe lies ahead for us.

Do you think the arrival of the baby boomers to long-term care will bring more urgency to the issue of long-term care financing?

I absolutely do. I love the metaphor of our demographics being like a jet plane that’s taking off, that we’re just now gaining altitude, and then the reality will hit us when we oldest boomers begin to turn 85 and 2031, which isn’t very far away. I think that will bring a sense of urgency that perhaps has been lacking, even though the wisest among us have been seeing for a long time, ‘We need to act now to prepare for the future.’

I’ve had many mentors over the years, but I had a mentor who talked about the blast furnace of change, that we change most fundamentally when our backs are against the wall, when we’re in the heat of the furnace, and I think that the demographics before us will create that sense of urgency that can bring real action. Fortunately, all the work that’s been done, it’s not for naught. The great work that’s been done by LeadingAge in their Center on Aging and UMass Boston and the SCAN Foundation — a lot of good minds have been thinking about this challenge, and I think maybe the boomers provide some of that critical mass. All generations will benefit from that when it does happen.

And what’s next for you?

As I’ve been saying to friends and family, I’m going to stand still for a little while, maybe 30 days or so. But I see myself still involved in some way in the field of aging. I’m passionate about governance. I’ve been blessed all of these years to work for and with an outstanding board of directors, and our mission-driven members work with those community stakeholders in their communities. I think it is also a wonderful calling to be a part of a governing community of an organization.

I’m also really keenly interested in combating ageism, to be honest. I will turn 70 before this year is out, and I’ve experienced ageism on a personal level, like being handed a magnifying glass along with a menu in a restaurant.

One of the troubling things that I see coming out of the pandemic is that we rarely refer to the senior population that we serve in our settings anymore without using the word vulnerable to describe them. COVID-19 poses a unique threat to an older person, but still, we’ve used that term vulnerable over and over and over to describe seniors in the last 16 months or so. I think that has implications for our willingness as a society to have informed risk as part of our reality as we grow older. I think it has implications for our agency in our seventh and eighth and ninth decades of life.

I feel myself somewhat called to that as well. Is there an opportunity to underscore that, as we grow older, a key part of our engagement in life is our ability to make our decisions? I think there’s work to be done on that front, and in some small way, I could see myself contributing there, I hope.

An abbreviated version of this interview appears as “A Few Minutes With…” in the August 2021 issue of McKnight’s Senior Living magazine.

Over two days of virtual festivities, attendees from across the country feted the 2021 class of honorees with a celebrity-filled awards show and educational panels on a range of timely topics.

Devin and Jason McCourty, twins who played defensive back for the New England Patriots for the past three years, sent a “huge congratulations” to senior living and skilled nursing staffers for their work throughout the pandemic at the May 18 online awards presentation. “All of the sacrifices you’re making, just the things that you’re doing to help others, it is just tremendous. Keep up the good work and keep it going,” they said. 

This year’s distinguished class included 19 Hall of Honor inductees, 17 Rising Stars and, in a new category, 15 Veteran VIPs. Winners were nominated by their peers and selected by a national panel of judges consisting of long-term care stakeholders.

“We congratulate these truly deserving industry veterans,”
McKnight’s  Editorial Director John O’Connor said. “Their hard work and unrelenting dedication has helped make life better for countless residents. They are an inspiration to us all.”

Just as the McCourty brothers did, many of this year’s nomination forms — as well as speakers who later praised the winners — homed in on valuable contributions the industry’s female leaders made during the COVID-19 pandemic.

“Thank you for your tireless work to provide our loved ones in long-term care facilities with high-quality care,” said Sen. Bob Casey (D-PA), chairman of the Senate Special Committee on Aging. “Despite so much loss, women working in senior living and care communities will help us bring light to the darkness of the past 14 months, so I thank you for that good work.”

Honor of a lifetime

Mary Ousley, RN, chief strategy officer for long-term care giant Pruitt Health and a past chair of the American Health Care Association, was named the 2021 Lifetime Achievement Award winner. The award recognizes her contributions to long-term care over the course of a decades-long career.

Ousley is a former facility owner and the namesake of AHCA’s Mary K. Ousley Champion of Quality Award. She has held top management positions at several care chains and was an architect of the Omnibus Budget Reconciliation Act of 1987, the landmark nursing home reform law.

“Beyond her decades of experience and accomplishments, what makes her such a phenomenal leader is her compassion, intellect and charisma,” PruittHealth President and CEO Neil Pruitt Jr. said. “She has the unique ability to take very complex business problems and break them down to understandable steps to a clear solution.”

Ousley is seen as a uniter. She is credited with getting AHCA and an alliance of secession-minded chains to continue as one, and with unifying providers and governing regulators to form new quality initiatives.

“She has not only led the sector in our quality efforts; she has often pulled us to places we needed to be but were reluctant to go,” said Mark Parkinson, president and CEO of AHCA and its sister organization, the National Center for Assisted Living. “Her work has benefited millions of staff and residents, and providers have learned that great quality is also great business.”

In accepting her award, Ousley said she was “almost speechless” as she reflected on how fast the years in senior care had passed.

“I thought that perhaps they have gone so fast because,
with very few exceptions, I
have enjoyed every day of
being a part of the post-acute and the long-term care profession,” she explained.

Expert guidance

Ousley was one of several winners to take part in a series of educational webinars intended for everyone in the industry, not just women, on the second day of the event. She joined four other industry leaders in sharing “Secrets to career success.” 

In a wide-ranging conversation, the women offered personal stories and tips for success, ranging from mentorship to succession planning and establishing organizational culture.

Being a risk-taker, critical thinker and someone who values evidence are keys to success, said Robyn Stone, DrPH., Leading Age’s senior vice president of research. “To my mind, critical thinking around every process that you are engaged in is really important,” she said. “We are in a world where we need to be able to differentiate between homegrown things that get pulled out of the ear and processes that really have an evidence base and strong data and knowledge behind them.”

In another session, providers shared how they’ve launched successful diversity, equity and inclusion efforts, addressing a key cultural awakening that has affected senior living and skilled nursing providers, their staff members and residents.

“You just want to make sure this doesn’t become a ‘check-the-box’ program,” Kai Hsiao, CEO of Eclipse Senior Living, said during the session, moderated by
McKnight’s Senior Living Editor Lois A. Bowers. “You really want to put some meat on the bone,” he added.

President and CEO Cindy Baier noted that women make 80% of healthcare decisions for their families. When she started at Brookdale, however, the board had just one woman and no minorities. Today, she said, the board is 40% female, and 14% of members consider themselves racial minorities. The organization is working to be more inclusive throughout its ranks, she said.

“I believe it’s a business imperative … because diverse teams have higher creativity, they have higher profitability, they’ve got better employee engagement, and they have better company reputations,” said Baier, a 2020 McKnight’s  Women of Distinction honoree. “If you think about what that does, it gives you a more collaborative working environment. It speaks volumes to your employees and your customers, so they can see themselves reflected in your leadership team and your associates.”

Finally, long-term care executives presented “Addressing pandemic challenges with success,” during which they provided a top-level view of how their organizations have met COVID-19-related hardships and shared best practices.

David Pomeranz, chief operating officer of RiverSpring Living, noted the challenge of adapting to ever-changing guidance, protocols and expectations.

Losing workers to quarantine requirements presented a major challenge that required constant communication, he said.

“It was the moment your worst fears were realized,” Pomeranz said. “We had a daily huddle to see who we had and figure out what everyone could do that day.”

This year’s Women of Distinction event was supported by Diamond sponsor PointClickCare and Paycor, which hosted additional sessions on workforce development and lifting up the next generation of  industry leaders. 

Prevention and early intervention are the best way to head off potential wounds, rashes, infections, inflammation and other skin disorders, and this approach requires only a dose of common sense, along with TLC.

The American Academy of Dermatology has issued a list of guidelines designed to keep residents’ skin healthy, thus maintaining their quality of life.

One of the biggest culprits in dermal disorders is dry, irritated skin. Heat and humidity are prime causes of skin irritation, which can lead to shear and, ultimately, pressure ulcers and wounds. SPF 30+ sunscreen offers protection from the sun’s radioactive rays. Broad-spectrum sunscreen provides protection from both UVA and UVB rays.

Cleansers are effective in keeping skin moist, but antibacterial and deodorant soaps and body washes actually can dry the skin. Warm baths and showers are preferable to hot ones, followed by application of fragrance-free moisturizer.

“Because moisturizer works by trapping water in the skin, it needs to be applied within five minutes of taking a shower or bath,” the AAD recommends.

Sunburn and melasma are two conditions caused by direct sun exposure. Because many senior living communities are located in sunbelt locations and have ample outdoor areas, the risk for sunburn and melasma (gray-brown skin patches) is high — especially in residents.

The AAD recommends avoiding direct sun and that residents sit in shaded areas. A wide-brimmed hat, sunglasses, long sleeves and pants should be worn, when possible.

Apply enough sunscreen to cover all exposed skin. Most adults need about one ounce to fully cover the body.

Important areas to cover include tops of feet, neck, ears and top of the head. When outdoors, sunscreen should be reapplied every two hours.

Prickly heat, or heat rash, can be a painful condition caused by blocked sweat glands. Because the sweat cannot get out, it builds up under the skin, causing a rash and tiny, itchy bumps.

Franklin Park spared no expense in the dining experience at properties in South Central Texas. Its newest community in Alamo Heights is no exception. Upon walking through the spacious lobby, visitors view an entryway that features a grand staircase reminiscent of a historic San Antonio estate.

With room for 117 independent living and 64 assisted living residents, Alamo Heights is the fifth Franklin Park community in the San Antonio area, a district that CEO Luke Classen concedes has become highly competitive. Attracting prospective residents requires a truly distinctive feature, and he believes Crescendo is it.

Offered through FLIK Hospitality Group, Crescendo is a food service program designed to elevate resident dining beyond the ordinary, says FLIK Division President Jack Silk.

“Today, elevated experiences with a restaurant-style approach are a must,” he says. “High-quality, white-glove service from the dining staff is no longer ‘nice to have,’ but a ‘need to have’ to remain competitive.”

Crescendo — an exclusive program for Franklin Park — is named after a musical term because its designers want to create “a symphony for the senses” with its special meals. Classen reasons that if décor’s purpose is to provide a sensory experience, then food service also should be a critical part of that environment.

“We know that dining is not what most companies dedicate extra resources to, so to beat the competition, we focused on the sensory experience of dining — what does the resident see, taste, smell and hear?” he says. “Food is the common denominator of all our services. If we get the food right, the rest falls into place.”

Professional chefs prepare the gourmet-level meals, and FLIK’s team of food service experts includes nutritionists and clinicians familiar with the special dietary requirements of each resident. FLIK’s food philosophy is to make all meals from scratch, sourcing sustainable ingredients from local purveyors, with “nothing out of a box or can,” Silk says. 

“This is a food-first approach. We operate restaurants inside senior living communities,” he adds.