SLIF Bob Kramer Crucial Questions for Senior Living

Senior Living Has Made It To ‘Broadway’ — But We’re Still Vulnerable

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The senior living industry has wanted to be in the spotlight for some time, and as I said in my talk earlier this week at the Senior Living Innovation Forum (SLIF), we’re finally there.

There are pros and cons on making it to “Broadway” after years of playing in “New Haven,” but I’ll highlight one potential drawback here: Greater attention has found senior living at a moment that the industry is especially ripe for disruption.

Here’s why we’re vulnerable:

  • There’s huge demand for our product right now.
  • Our product currently is costlier than nearly 90 percent of the market can afford.
  • Most customers dread having to use our product because of what it signifies about their life and their sense of independent agency and purpose.
  • Most significantly, most of our industry thinks we’re sitting pretty. Too many people seem to be thinking “Just watch them come to us. They have no choice.”

Our industry is at a crucial point. I hope you’ll watch my entire talk.

And I have a question for you: Are you a disrupter, or are you confident you can keep doing the same thing and not be disrupted? Let me know on LinkedIn.

Milken Future of Health Summit

Future of Health Summit: Reimagining Senior Housing and Integrated Care

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As the baby boom generation ages, expanding affordable housing and integrated long-term care options for our nation’s diverse older adult population has become increasingly urgent.

According to a National Investment Center for Seniors Housing and Care-funded study conducted by NORC at the University of Chicago, more than half of middle-income Americans aged 75 or older will not have the financial resources to access housing and care by 2029. Meeting the needs of this “Forgotten Middle”—an income group too wealthy to qualify for means-tested programs yet unable to afford private-pay senior living options—will require coordination from public and private sector stakeholders.

Recognizing the challenges of promoting and incentivizing innovation across sectors, this session hosted by the Milken Institute features industry leaders, providers, and policy experts discussing scalable housing and care solutions for this growing segment of the population.

Moderator:

  • Caitlin MacLean, Senior Director, Innovative Finance, Milken Institute

Speakers:

  • Lynne Katzmann, President and CEO, Juniper Communities
  • Bob Kramer, Co-Founder and Strategic Advisor, National Investment Center; Founder and Fellow, Nexus Insights
  • Nirav Shah, Senior Scholar, Stanford University
  • Elizabeth White, Founder, NUUage Coliving

Watch the recording: https://milkeninstitute.org/panel/14999/reimagining-senior-housing-and-integrated-care

Critical Resource for Older adults

Caregiving Navigation Hubs: A Critical Resource for Older Adults and their Families

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Coordinating caregiving for aging loved ones is a complicated and frustrating task for families. And the problem is growing.

According to a recent article in Next Avenue, “It generally starts with a crisis: Your parent shows signs of dementia…or is about to be discharged from a serious hospital stay…or requires help with daily activities of living. What do you do? Where do you turn? It’s the little-discussed part of long-term care that leaves many of the nation’s 22 million family caregivers for older loved ones bereft and befuddled.”

“We’re failing tens of thousands of older adults and their families,” said Bob Kramer, Founder and Fellow of Nexus Insights.

Nexus Insights is a think tank advancing the well-being of older adults through innovative models of housing, community and healthcare.

In early 2022, Nexus Insights brought together long-term care providers, caregiver advocates, tech-driven startups and policy experts in its first ‘Nexus Voices’ salon to discuss how to help older adults and their caregivers better navigate the complex and fragmented array of long-term care and aging services. The result was a report released in September 2022, “Where Am I, Where Do I Go: The Missing Entry Point to Long-Term Care Solutions for Older Adults and Their Caregivers.”

This report was the subject of the Next Avenue article, written by Richard Eisenberg.

Eisenberg spoke to several of the report’s authors, including Anne Tumlinson, CEO of ATI Advisory and a Nexus Fellow. “The primary challenge that most of my peers and friends and family were experiencing was entering into that phase of their lives when they were suddenly thrust into family caregiving roles and feeling like there’s no place to go,” Tumlinson said. “In the best-case scenario they’re getting a hospital discharge planner handing them a long list of organizations who are like, ‘Good luck. Here you go.'”

Caroline Pearson, another report author concurred. Pearson, formerly the Senior VP of Health Care Strategy at NORC at the University of Chicago, and now the Executive Director for The Peterson Center on Healthcare, and a Nexus Fellow. “Unfortunately, most people find themselves in these urgent scenarios that are sort of a call for help unexpectedly,” she said.

In fact, Nexus recently partnered with NORC to conduct a survey on this issue. The survey showed that 1 in 4 older adults needed long-term care services for themselves or a loved one in just the previous 12 months. It also echoed the report’s assertion that caregivers experience frustration and anxiety during the process.

The Nexus Voices report offers a powerful solution, according to the article, “A national, independent, trusted hub system of caregiving navigators who would be accessible to everyone and serve as a central doorway to long-term care services and supports.”

“For every single family to be creating a long-term care service delivery system is very inefficient from a societal standpoint and an economy standpoint,” said Tumlinson.

The solution would have to be national in scope. “There was broad-based agreement [among the salon participants] that creating the kind of awareness to make these hubs as visible as your local drugstore or post office was going to take a national effort, and a level of funding that was probably going to have to be federally driven,” said Kramer.

According to the article, a local example of such a hub was launched earlier this year in Ohio. The NaviGuide program, created by United Church Homes in Ohio, offers these types of services to its 166 clients. The program was inspired by a family crisis for its creator Terry Spitznagel, senior executive vice president and chief growth officer for United Church Homes. Spitnagel said, “I’ve been in senior services for three decades, but I just fell apart trying to help my father navigate the aging journey. I couldn’t manage it.”

The article sees the NaviGuide program as a positive step in the right direction. “If programs like United Church Homes’ NaviGuide are proven financially viable or federal or state governments earmark money for caregiving navigators, you may start seeing these experts pop up around the country.”

In fact, other recent reports echo the Nexus recommendations.

“There are real opportunities to move forward on this,” said Kramer. “But it’s going to take keeping the issue in the limelight and building momentum and seizing opportunities.”

And, the article suggests, “It may also require more people finding themselves thrust into becoming family caregivers or needing to coordinate care.”

Said Tumlinson: “You have to go through it and then be stunned. Then you say, ‘Why is this not being fixed? How is this possible?'”

Read the article at Next Avenue.

Read the Nexus Report
Read the Nexus Survey

Long Term Care Experience

NORC Study Shows Most Older Adults Experience Anxiety and Frustration While Selecting Long-Term Care

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Twenty-four percent of U.S. adults ages 50 and older say they, or a loved one needed long-term care in the past year, according to a new, national survey commissioned by Nexus Insights, a think tank focused on older adults. The research was conducted by the well-respected NORC at the University of Chicago. The findings illustrate the widespread need for information and guidance about long-term care services among an aging population and their caregivers, a need that experts say will grow exponentially in the future.

Nearly 1 in 4 older adults said they or a loved one needed long-term care in 2022

 

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Most older adults said the process of selecting long-term care caused anxiety (53%) and frustration (52%), while few said they felt confident (23%), at peace (23%), or happy (14%) while making a choice. Researchers say the survey findings suggest a need for more consumer-friendly resources to help families navigate care options.

Anxiety and frustration finding long-term care

 

“Making a decision about long-term care is a maze full of emotional twists and turns, dead ends, and setbacks,” said Bob Kramer, founder and fellow of Nexus Insights. “The lack of a consumer-friendly system to help families navigate the staggering array of decisions that must be made quickly during a healthcare crisis boosts families’ stress. It can result in making decisions that lead to poorly coordinated, lower-quality care.”

According to the survey, older adults said it was extremely important to have additional information about the cost of care and options to pay for it (69%) and the different types of long-term care services available (63%).

Nexus Insights released a report earlier this year detailing the often frustrating and confusing process facing many older adults when making decisions about long-term care for themselves or a loved one. It called for a national long-term care navigation hub to help older adults discover and assess options, educate them on available support and funding, select and connect with the option that is best for them, and continuously evaluate their needs as health and financial statuses change. Kramer said navigation resources are needed immediately to support the aging Baby Boomer population, many of whom not only serve as caregivers to older parents but will soon need long-term care themselves.

“Many families reckon with a long-term care system that’s nearly impossible to navigate and provides little-to-no support for families making life-and-death decisions,” said Caroline Pearson, senior vice president at NORC at the University of Chicago, who also serves as a Nexus Insights fellow. “Most people will eventually have to make decisions about long-term care for ourselves or a family member, so creating a consumer-friendly long-term care navigation system should be high up on the nation’s list of to-dos.”

People likely to turn to family for long-term care advice

 

The poll was conducted between November 11 and 14, 2022, during a monthly Omnibus survey. It included 1,014 interviews with a nationally representative sample of adults age 50 and older (margin of error +/- 4.34 percent points). The AARP and NORC’s Foresight 50+ probability-based panel is designed to be representative of U.S. adults age 50 and older.

DOWNLOAD THE SURVEY: One in Four U.S. Older Adults Needed Long-Term Care for Themselves or a Loved One in 2022

READ OUR REPORT: Where Am I, Where Do I Go: The Missing Entry Point to Long-Term Care Solutions for Older Adults and Their Caregivers

Long-Term Care & Post-Acute Care

Navigating the Maze of Long-Term & Post-Acute Care: A Report by Nexus Insights

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When an older adult experiences a crisis that requires post-acute or long-term care services and supports, they and their caregivers must make critical decisions, fast. What awaits them, however, is a maze of dead ends and poor information that stand in the way of getting the help they need.

“Older adults and their families enter a maze of twists and turns, dead ends, and wrong way streets when a life crisis forces them to consider their care options. Critical decisions about long-term care must be made quickly, with scarce information or resources, let alone supportive guidance to assist them in their time of crisis.” – Bob Kramer, founder of Nexus Insights

In February 2022, Nexus Insights hosted their inaugural ‘Nexus Voices’ session with 18 leading experts in the fields of aging policy, long-term care, senior housing and caregiver advocacy to talk through and tackle this issue.

The Outcome: A Nexus Voices Report

The result is the recently published report, “Where Am I, Where Do I Go: The Missing Entry Point to Long-Term Care Solutions for Older Adults and Their Caregivers”. This comprehensive and actionable report highlights the lack of infrastructure to help guide older adults and their families to long-term care services. The report proposes “Navigation Hubs” to help families understand their long-term care needs and select the best options for them. These hubs would serve as central doorways to existing supports and services—whether it’s home-based care, transportation or meal services, senior housing or nursing home care. The hubs would have a national presence but a hyper localized focus with counselors, or navigators, who understand the resources available in their communities and how to help older adults and their families access them.

“The factors that shape care decisions vary from family to family, but all families need an easy-to-use, accessible hub of information that clearly communicates the options that are available to them in their community,” said Anne Tumlinson, CEO of ATI Advisory and a contributor to the report. “With a growing number of older adults needing care, we have to act now to build the care infrastructure families need.”

Discussion participants outlined four primary responsibilities of the Navigation Hubs. They are:

  • Discover & Assess the long-term care needs of older adults, their families, and caregivers.
  • Educate older adults, their families and caregivers on the housing and caregiving support available to them as well as funding sources.
  • Select & Connect older adults with the best long-term care setting, supports, and services that meet their needs.
  • Reevaluate the needs of older adults as their health and financial statuses change.

“You can’t solve a problem until you’ve identified it and defined it,” said Kramer.

“Then you’ve got to define what are the key components of any solution. And we’ve laid that out with the navigation hubs and their four functions. And then we asked what we could learn from the failures and the successes of programs to date, to create our criteria. Finally, the path forward must be a joint effort involving both the public and private sectors. We demonstrated that there are aspects of differing programs from government-funded resource centers to tech-enabled employer options to private-pay models that could be incorporated into this solution.”

An Urgent Problem

In its conclusions, the report urges quick and decisive action to build navigation services for older adults that put families in the center. The family in crisis needs help now and cannot wait for lawmakers and government agencies to overhaul the long-term care infrastructure. This requires a national commitment to increased funding and an openness to reimagine existing solutions. Existing public, private-pay and employer-based programs could work together to make these hubs a reality by combining their infrastructure, experience and delivery models.

The Nexus Voices Participants

Nexus Insights Host Committee

  • David Grabowski, PhD, professor, Harvard Medical School, fellow, Nexus Insights
  • Bob Kramer, founder & fellow, Nexus Insights, co-founder, former CEO & strategic advisor, National Investment Center for Seniors Housing & Care (NIC)
  • Caroline Pearson, senior vice president, health care strategy, NORC at the University of Chicago, fellow, Nexus Insights
  • Sarah Thomas, CEO, Delight by Design/MezTal, fellow, Nexus Insights
  • Anne Tumlinson, CEO, ATI Advisory, fellow, Nexus Insights

Discussion Participants

  • Gretchen E. Alkema, PhD, former vice president, policy and communications, The SCAN Foundation
  • Alice Bonner, PhD, senior advisor for aging, IHI, and adjunct faculty, Johns Hopkins University School of Nursing
  • Ryan Frederick, founder & CEO, Smart Living 360, fellow, Nexus Insights (facilitator)
  • Lindsay Jurist-Rosner, CEO, Wellthy
  • Ruth Katz, senior vice president for policy, LeadingAge
  • Sean Kelly, president & CEO, The Kendal Corporation
  • Suzanne Kunkel, PhD, executive director, Scripps Gerontology Center, Miami University
  • Katy Lanz, chief strategy officer, Personal Care Medical Associates
  • Brian Petranick, group president, Neighborly
  • Cheryl L. Phillips, M.D., president and CEO, Special Needs Plan Alliance
  • Paul Saucier, director, Office of Aging & Disability Services, Maine Department of Health and Human Services
  • John Schall, CEO, Caregiver Action Network
  • Bill Thomas, chief independence officer, Lifespark, fellow, Nexus Insights

Read the Long-Term Care Access Report

Read the full report
Read the executive summary
Read the press release

Senior Living and Hospitality Industry

Senior Living – a Huge Opportunity for the Hospitality Industry

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There is a newly emerging market for new models of lifestyle-driven senior living, and it’s a “mammoth market that nobody owns,” according to Bob Kramer, Founder of Nexus Insights, and Co-founder, Strategic Advisor of NIC – the National Investment Center for Seniors Housing & Care.

With over 35 years of experience in the seniors housing and care industry, Kramer has long been recognized as one of the most influential and high-profile thought leaders in the field. In a recent article in the Boston Hospitality Review, he shared his thoughts on the changing market and the opportunities for the hospitality industry.

The market for senior living is growing rapidly, but the demand is for something different than traditional care-driven products. Kramer observed that baby boomers are the first generation to make housing and care decisions for their parents, due to lengthening lifespans. “And they didn’t like what they saw.” Rather than traditional assisted living solutions and nursing homes, boomers are looking for living situations that “appeal to their desire to remain engaged and fulfilled in their lives.”

“From 2020 to 2050, new models will be driven by a new type of customer, and a new way of thinking about retirement and aging,” Kramer said. “This generation of senior living products will attract younger seniors with products that deliver engagement, connection, and fulfillment, and will draw residents who still have decades to live. The business potential of such a market is significant.” Heavyweights as well as new entrants in the hospitality field, such as Disney and Latitudes Margaritaville, are already recognizing the business potential, and introducing novel housing developments aimed at seniors.

The opportunities are not without challenges, and Kramer identified several, including affordability for the growing middle-income market, sometimes called “the forgotten middle.” In order to be successful in this new market, it will also be important to address both lifestyle and care needs for senior residents. Kramer’s recommendation is “to leverage industry expertise to deliver what seniors want in terms of lifestyle choices, and what they need in terms of care.”

According to Kramer, the challenge for those entering the market, ”is to deliver personalized experiences that are metaphors for being alive rather than signals that meaningful life is over. The demand will be huge, but this product is yet to be delivered.”Read the full piece in the Boston Hospitality Review.

Housing For Middle-Income Seniors

Middle-Income Seniors – The Forgotten Middle

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When it comes to senior housing, wealthy seniors can pay their own way and low-income seniors often qualify for Medicaid. The real problem is for those in the middle. They aren’t wealthy enough for private pay, yet they are too well-off for Medicaid. To make matters worse, the number of people stuck in the middle will nearly double over the next decade. Senior housing operators and policymakers have the opportunity to serve this new market, but how and to what extent?

Nexus founder and Fellow Bob Kramer discusses “The Forgotten Middle” with Nexus Fellow Caroline Pearson, senior vice president health care strategy, NORC at the University of Chicago in an episode of Foresight TV hosted by Steve Moran of Senior Living Foresight.

Skills in the Aging Services Industry

A Guide for Cultivating CEO Skills in the Aging Services Industry

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In December, Jacquelyn Kung, Bob Kramer, and Ed Frauenheim published a column in McKnight’s Senior Living discussing the 5 critical CEO skills needed for the future of aging services. These included personal depth, operational savvy, industry awareness, government smarts and megatrend acumen. In response to the column, many readers asked for advice on how to develop these skills. Here are three things to keep in mind if you want to develop the CEO skills needed for the future of aging services.

Know thyself. Know what you’re good at and what you’re not good at. And not just “hard” skills like finance or technology. You must know your emotional self. This emotional intelligence helps to create caring communities that people want to be a part of. It also helps you relate to and inspire all the people in your organization, top to bottom. 

Know others. Create a large, diverse network of friends and colleagues, especially those outside of aging services. It’s very handy to know thinkers and experts in other fields who you can call on for instant wisdom.

Know thy world. Keep up with developments in areas outside of elder services. There’s good reason to think big changes in culture, technology and economics will also have big impacts on senior living in the years ahead. The article provides three concrete takeaways in regard to the above three tenets. Read the full article here at McKnight’s Long-Term Care

Innovation for Senior Living

Are We Being Bold Enough? Bob Kramer Keynotes SLIF 2021

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Bob Kramer set the tone of this year’s Senior Living Innovation Forum by kicking off the first day of the conference with a provocative keynote speech. “Are we being bold enough?” asked Kramer. “No. The industry demands a significant shakeup.”

What does innovation mean for the next generation of senior living customers? Will they be our customers? Is increased longevity a blessing or a curse? Will the boomers be a vast resource that is both unwilling and unwanted as contributors to our society and economy? What does senior living have to do with it? And what about those who have been left behind in the longevity revolution?

According to Kramer, the upcoming generation of senior living customers “wants nothing to do with senior living” because the image that comes into their minds when they think about senior living is a negative one. It is our job, he said, to reimagine and redefine what senior living can mean for the next generation.

His keynote set off some lively conversations and debates, with several following speakers referencing and adding further insight to Kramer’s remarks.

Other highlights of the event include a talk from Nexus Fellow and Here founder Ryan Frederick about his book, “Right Place, Right Time: The Ultimate Guide to Choosing a Home for the Second Half of Life” and Fellow Sarah Thomas’ interactive session on experience design.

 

Watch Bob Kramer’s entire speech:

 

Photo courtesy of Influence Group.

 

long-term care infrastructure op-ed in The Hill

America’s long-term care infrastructure: A road to nowhere – Op-ed in the Hill co-authored by Nexus Insights

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In a recent op-ed in The Hill, Nexus Insights Fellows Anne Tumlinson, David Grabowski and Robert Kramer, raise an important point that has been missing from recent discussions around transforming long-term care following the pandemic. The Biden Administration has proposed a $400B investment in home- and community-based services (HCBS). We assert this investment is necessary but not sufficient. Without additional spending on services to help families navigate and manage long-term care services, this HCBS investment is basically a “road to nowhere.” We argue for the need to create a network of long-term care service hubs across the country to help families navigate services.

As you know, there have been A LOT of thought pieces around improving long-term care going forward, but we have not seen this point made elsewhere. Thus, we believe it would be an ideal time to make this point as policymakers consider the Biden proposal.

Excerpt:

Long-term care is complex. Few Americans plan ahead and most wait until a crisis pushes them into a frantic search for solutions. It doesn’t have to be this way.

Every day older adults lose their ability to care for themselves. Often, they are discharged from the hospital too weak or confused to be left alone or care for themselves. Now what? Who will take care of them? Is home- or facility-based care the best option? How much will it cost and who will pay? Does Medicare cover it? Does Medicaid? If home care is the answer, how do you find a qualified and affordable caregiver? Where do you even start? Life-changing decisions must be made, and fast.

Read the full op-ed in The Hill.

Anne Tumlinson is CEO of ATI Advisory and the Founder of Daughterhood. David Grabowski is Professor in the Department of Health Care Policy, Harvard Medical School. Robert Kramer is the founder of Nexus Insights, and the co-founder and Strategic Advisor & former CEO of the National Investment Center for Seniors Housing & Care (NIC).

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