Words frequently take on new or enhanced meanings as they relate to business and innovation. One of the most popular of those words currently is “disruption”. What does this really mean? The dictionary defines a disruption as to break apart, to throw into disorder. But of late disruption has also been defined as “a radical change in an industry, business strategy, etc., especially involving the introduction of a new product or service that creates a new market”. But considering the latest definition, what has that meant to the senior housing industry? Back in the 1990’s the emergence of assisted living was definitely a disruptor since it represented a new product resulting in fewer moves into the continuum of care (known as the Continuing Care Retirement Community or CCRC or Life Plan community). More recently, the increased availability and use of home care has caused many seniors to remain at home until much later, entering senior housing not only older but frailer as well. Traditional non-profit organizations might refer to for-profit players as disruptors given their propensity to focus on assisted living and memory care and to enter the market more swiftly than non-profits due to more streamlined decision making processes. And what might be called “senior housing lite”, independent living communities offering only minimal services may become a disruptor. Successful responses to disruptors requires the ability to be flexible, nimble, and to review and respond in a positive and productive way while strengthening your product and your brand identity. It also may require implementing new technologies that support staff, residents and family members. One of the great features associated with serving seniors has been the changes we’ve made to adapt to ”disruptors” as we continue to grow and improve.
The aging process does not necessarily mean that older adults won’t continue to contribute to the world around them, however they define that. Some may think of this as the “last hurrah”, but I believe it can be the best one. We live our adult lives encumbered by responsibilities. We go to college and graduate school and pay back loans. We get married, joyfully raise a family with all that entails. We work hard at our jobs and careers, climbing the ladder of success. We often have little time for self-expression, volunteering, giving back to the community, taking on a cause that has meaning. But for the older generation, time may open up to an array of possibilities. As Barbara Kleger wrote in her most recent blog “baby boomers aren’t retiring, they’re ‘rewiring.”’. They’re re-arranging their lives, homes, and plans in order to create purposeful years. Or, as Robert Kramer, the founder of NIC, describes it, a time of “the 4 e’s: engagement, enrichment, experience, and enjoyment.”
The limits are largely in your own imagination and, of course, the capacity to take things on. I’m reminded of Marc Freedman, the author of Prime Time: How Baby Boomers will Revolutionize Retirement and Transform America as I write this blog. Freedman contends that because older adults will have time, a precious commodity, they can “get involved in ways that have both personal meaning and make a significant difference to others.” Through his organization, Encore, Freedman was Founder of the Purpose Prize which transitioned over to AARP in 2016. The AARP® Purpose Prize® award honors extraordinary individuals who use their life experience to make a better future for all. You may not become a prize winner but there is so much you can do.
We are all customers when we go to the supermarket, the department store, a restaurant, you name it. We expect to be treated with attention and courtesy. When this is not the case, we can choose never to return to the place. Repeat business is a sign that an organization is doing something right. For example, my husband goes to the same Starbucks for the same latte every day and when he gets there, the staff greets him warmly and someone is already reaching out for his Starbucks mug and readying his beverage. He rewards them by not only tipping well but always returning. At Brecht Associates, we pride ourselves on customer service. We listen carefully to what our client is looking for, we ask probing questions at the start of the engagement and we interact with them throughout making certain that we reach concensus on assumptions like the market area definition and the age, income and market area draw to be used in the demand analysis. We deliver our reports on time and are always prepared to discuss the results of the analysis. As such, we enjoy a tremendous proportion of clients who return to us whenever they need our services. And they refer other clients which helps us grow our practice. Thanks to all of you who have contributed to our growth and success. We honor and appreciate you.
Of course, we all think we know what is meant by Independent Living (IL). The major trade associations have defined it for us as has industry practice over the decades. But is it what it once was and if not, what is it now? We think of independent living as being residential units of varying types that offer services such as meals, transportation, housekeeping and activities and that it is designed to serve those who do not really need assistance to enjoy the activities of their daily life. But increasingly, we are finding that a measurable proportion (as much as 25-35%) of those who reside in IL are receiving varying degrees of assistance in activities of daily living (ADLs). They may need anything from medication reminders to help with more substantial things such as bathing and dressing. Yet they remain in their IL unit since they are not considered a danger to themselves or others and they are able to independently vacate their unit if needed. Over the years the age of entry has increased from the mid-70’s to the early 80’s which explains the rapidly increasing frailty of IL residents. On the other hand, we see an emerging IL product type in which virtually no services are provided. The latter are typically structured as rental communities. Tracking and understanding the changing product types known as Independent Living will be important for many reasons ranging from how markets are analyzed when considering a development opportunity to shaping plans for what to offer that will be attractive and competitive.
I have been involved in the senior housing industry for well over 30 years. There are two expressions from consumers that I’ve heard throughout those decades. The first is “I’m Not Ready Yet”. This reflects the belief that you have to be old and frail to move to senior housing. And we’ve created that impression in some ways, including the term “continuing care retirement communities”. The word “care” is a clear signal that you need care, so why move there if you don’t! Leading Age has addressed that by relabeling these communities “Life Plan Communities” which puts the consumer in charge. A much needed modification. But there is more to it than a name change. An increasing number of communities are learning that they can offer residents opportunities to do things they have always wanted to do, but never found the time. My sister-in-law who I wrote about in my last blog is a great example. After I published the blog and shared it with her she wrote to me and said “I forgot to mention one really important thing – opportunities!” She is in the choir, performing comedy routines and to use her word, having a “blast”! This is an important message that may not be presented in marketing communications and positioning. Delivering this message can help shift the perception of retirement communities. It starts with the website and should be reinforced by other collateral materials. And staff training is key. It may feel like you are turning the course of a major vessel that is steaming ahead in a tried and true direction, but I think it’s worth it! With success, more and more residents will utter the other expression I mentioned at the beginning of this blog “Why did I wait so long”!
I admit that I have a personal connection to the couple I’m writing about in this blog, but I think their story is a great illustration of making decisions to move to senior housing. My sister-in-law and her husband live in a Life Plan Community in the Philadelphia suburbs. They actually began thinking about this move when they were in their mid-60’s/early 70’s. They are eight years apart in their ages.
They spent 10 happy and healthy years living in what had been their second home at the Jersey shore. But recognizing that they couldn’t assume they would remain healthy they began the search for their next move. They did their research and narrowed the search down to three Life Plan communities. Two were under the same non-profit ownership and the third was too far away and way too expensive. So they visited the other two. One was ruled out for some very practical reasons: very narrow hallways, smaller apartments, an unattractive through-the-wall h/vac system and the fact that reaching the dining room and other common amenities required a walk outside!
Their ultimate choice was a community closest to their son (who they gave the shore house to so the family could still enjoy time together). It also had the advantage of being close to plenty of shopping. When they visited this community they had a very positive experience. First they attended a general meeting for future prospective residents in the auditorium where the sales rep gave a speech and answered questions. A lovely luncheon was followed by a tour of vacant apartments given by a resident of the community. They moved when she was 74 and her husband 82. And she says with great joy “it’s the best thing we’ve ever done”!
Many of our retirement communities are 20 years old or more. They benefit from an established reputation in their market and may even have enjoyed residents of more than one family generation. But as new communities are developed, offering updated residential units and contemporary amenities, how do older communities continue to compete successfully? Knowing how your community is positioned and perceived in the market is essential to continued success in the future. There are several steps that can be taken short of completing a full market study that will provide the needed information.
Conducting surveys of competitors is essential and visiting the major competitors is part of that process. It isn’t enough to call them to gather information. In addition, carefully reviewing their brochures and websites is an important step in identifying not only what they offer but how they position themselves. Other tasks that can provide valuable information include telephone surveys with lost prospects and recent movers. Lost prospects would be defined by someone who had actually visited your community, not just called for a brochure. Lost prospects should be assured of their anonymity, allowing them to speak freely about what they liked, what they didn’t like and why they decided not to move to your community. Recent movers can tell you what other properties they considered and the reasons why they did move to your community.
This kind of feedback can inform your decisions on what needs to be done to remain competitive in your market and is extremely useful as your leadership team plans for the future.
Happily, it is getting much more difficult to write off older adults in terms of what they continue to contribute to society. At a recent ASHA meeting we discussed how important it is to ask residents what it is that they still want to accomplish in their lives. A number of years ago, a friend in the industry told me that when a new resident moved to his community that was one of the first questions he asked of them as he got to know them. An older gentleman responded “well, I always wanted to be a teacher, but I had to do something else to make more money for my family”. That prompted my friend to go over to the local high school to see if they needed any tutors or mentors and the response was an enthusiastic “yes”! So shortly after that, the resident found himself spending time with students at that school. Also, all you have to do is look at the world of the arts to see further examples. Writers such as Joyce Carol Oates and James Salter continued to publish novels in later life. In fact, Salter’s last novel was published at the age of 88, just two years before he passed away. And no one can convince me that Mick Jagger has lost his “mojo”. Just take a look at the film of his latest concert tour in Cuba which attracted nearly a half-million fans!
It is important to integrate the belief that seniors or older adults are not “the other” or “them” – they are us. How this segment of the population is portrayed is directly influenced by the words that we use to describe it. After all, older adults are rapidly becoming the largest market segment in society and will possess the most purchasing power of any demographic group according to a task force at the International Longevity Center in New York. So it’s important that we “watch our language” when advertising products and services, not to mention just talking to older folks.
We still suffer from the use of condescending language when it comes to the aging process. Using terms like “the old” or “the elderly”, homogenizes a widely varied and diverse segment of the population. And language can fan fear with terms that sound apocalyptic like “gray tsunami”, “demographic time bomb” and “age quake”. Euphemisms like “golden age”, “umpteen years young”, “you haven’t changed” or “you don’t look it” are also ways to devalue people who have simply grown older, as we all hope to do. Another term that I think is offensive is calling someone who is older “eccentric”. What does that mean? And then there is the cosmetic industry using terms for anti-aging products like “advanced night repair” as if something is broken, or “mature skin corrector” as if aging is a mistake.
Take it from an “old” English major. We have a lot of work to do!
In the past few years, we’ve been discussing the impact of changes in the healthcare system on the skilled nursing market. It seems others have too. Since last year, NIC, Ziegler and Senior Housing News have released excellent reports about the fate of skilled nursing beds, particularly those that are stand alone. As a result of declining occupancy and revenue across the country (NIC Skilled Nursing Data Report/Ziegler Post-Acute Activity CFO Hotline), the number of skilled beds is being reduced and some facilities are closing. At the same time, skilled nursing services are being provided at other levels of care, where possible, such as assisted living. Rehab discharges from hospital to home are bypassing skilled nursing facilities altogether.
Some skilled nursing providers are fighting back by investing in technology to improve the quality and efficacy of care; partnering with hospitals to improve referrals; and adding ancillary services (such as therapies, home healthcare and hospice) to spread financial risk. The renovation and redesign of nursing facilities is also occurring, particularly in CCRCs, now thriving according to Senior Housing News (CCRCs Gain Luster as Standalone SNFs Fade). Flexible architectural design will decrease costs as the need for nursing beds changes and the development of households will increase nursing facility attractiveness. CCRCs are at an advantage today due to a renewed emphasis on a continuum of care. Their residents will benefit from the services connected with skilled nursing such as physical therapy and nursing oversight even when residing in independent or assisted living.
At Brecht we are excited about the future for our CCRC clients. As new ways to configure assisted living, memory care, skilled nursing and hospice are created, Boomers will be drawn to campuses that provide quality aging services in non-traditional ways.