Nursing Home Staff Vaccination

Nursing Home Staff Vaccination and Covid-19 Outcomes

The emergence of the delta variant of the covid-19 virus has raised new concerns about nursing home staff as a vector of infection among residents. This is especially true in facilities with low staff vaccination rates, but the actual relationship between staff vaccination rates and resident infection is not well studied. That is why a group of researchers used CMS data on more than 12,000 nursing homes to get some answers. That group of researchers included David Grabowski, Nexus Fellow and professor of public health at Harvard Medical School.

What they found is that in locations with high community transmission of the virus, low staff vaccination rates were associated with a 132% increase in resident cases, a 58% increase in staff cases, and a 195% increase in resident deaths. The relationships were not as strong in areas with low community transmission.

These findings were published in a letter to the editor in the December 2021 issue of the New England Journal of Medicine

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Senior Housing For Tech Enabled Population

How The Senior Housing Industry Is Dealing With An Increasingly Tech-enabled Population

Sarah Thomas, executive strategist in aging innovation, CEO of Delight by Design, and Nexus Fellow, shared her thoughts on the increase in technology adoption among seniors–and how senior communities are responding to the phenomenon. She points out that seniors are just like everyone else in that they have increasingly turned to technology in response to the pandemic. The main reasons for this are the increase in connectivity, more access to resources, and just plain convenience. 

“[E]ngagement with technology is on the rise in every age group,” according to Thomas. This holds true for seniors who are looking for “greater connection, greater resource access, and greater convenience.”

Senior living operators have had to respond to this change as well. According to Thomas, these groups recognized a need to “provide additional access to technology to leverage resources and connect with the community.” They also needed tech to increase staff efficiency and to disseminate information to residents and family. This led to an increase in partnerships so that things like tech support could be addressed. 

Read the full interview at Senior Housing News.

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housing for solo agers

What senior living providers need to know about Solo Agers

Adult children do many things for their aging parents, including helping them find a senior community. But what about “Solo Agers”? This term was coined by author and solo aging expert Dr. Sara Zeff Geber to describe those seniors who find themselves aging alone. Dr. Geber wrote the 2018 book, Essential Retirement Planning for Solo Agers.

According to Geber, “A significant number of Boomers will not have adult children to help them with care or relocation if living independently becomes difficult or impossible.” She cites geriatric specialist Maria Carney, MD, and colleagues, who determined in 2016 that “approximately 22% of older Americans had no one to turn to in a crisis.” 

In a recent article in the International Council on Active Aging’s The Journal on Active Aging, Geber points out that, while the COVID pandemic has brought into national focus the devastating isolation of those aging alone, it also made clear that there are opportunities for senior housing communities and the aging services industry to provide for the needs of solo agers. The important first step is to understand this cohort, and their unique needs.

“I noticed many of my contemporaries were starting to spend huge chunks of time and energy helping to care for their aging parents,” said Geber. “They were chauffeuring their parents to appointments, shopping for their groceries and other essentials, monitoring their medications, arranging for home repairs, and spending considerably more time on the phone and in person with them than they had in the past.” That got Geber wondering. “Who is going to do all the above for those of us without children? More questions arose. How many of us are there? What are our options? And how should we prepare?”

Among the differences she noticed that set Solo Agers apart:

  • Solo Agers (women and men) tend to be more highly educated and to have made a good living over their lives, making them excellent candidates for higher-end senior living. 
  • Congregate living offers the advantage of built-in community, to help Solo Agers make social connections, and avoid isolation and loneliness.
  • Choosing independent living that is connected to communities that also provide options for higher levels of care can provide peace of mind to Solo Agers, who want to prepare for greater care needs in the future.
  • Many seniors find comfort in moving closer to adult children or grandchildren. Solo Agers may likewise choose proximity to loved ones, who may be extended family or friends.
  • Solo Agers have typically been living independently, as “masters of their universe” their whole lives, and will want choices for how they live that allow them to continue to learn, develop, and pursue healthy lifestyles.

What are the challenges for senior living communities? According to Geber, “the first hurdle will be selling the concept.” This involves knowing how to sell directly to seniors who may approach the community alone, and make their decisions without the assistance, encouragement or “cajoling” of adult children.

The second hurdle is to develop models of housing that appeal to Solo Agers. One good example, Geber suggests, is to build residences, such as Garden Spot Village’s Cooperative Living House, that house a small number of unrelated roommates. The home provides private bedrooms and baths for the residents and shared communal space. Roommates in these residences maintain some privacy and independence, but they also have the opportunity to develop friendships and even family-like connections, and to provide one another with mutual support, much like what happened in ”The Golden Girls” TV show from the 80s).

Another example is cohousing. Geber describes it as “generally a grassroots effort by individuals who want to create a way to live together in an intentional community.” According to Geber, “Senior cohousing is one of the fastest-growing segments of the cohousing movement.” It’s also “extremely attractive to Solo Agers.”

According to Geber, the window of opportunity has arrived. Boomers have already begun to retire, and the number of Boomers who are also Solo Agers is large and growing. “Many of these individuals will have no real need to continue ‘aging in place’ in their single-family homes,” she said. “They will remain there, however, unless senior living communities demonstrate a viable and attractive alternative—one that meets Solo Agers’ needs to maintain their social networks and participate actively in their communities.”

Download the full article here.

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Innovation for Senior Living

Are We Being Bold Enough? Bob Kramer Keynotes SLIF 2021

Nexus founder and Fellow 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 SmartLiving 360 CEO 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.

 

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Best Senior Living Listing

U.S. News partners with Activated Insights, Launches Best Senior Living Listing

Big news for the senior living industry and for consumers. U.S. News & World Report, a company widely known for its health care rankings and consumer advice, has turned its attention to the senior living industry. The company, which has more than 40 million website visitors per month, has now launched a “Best Senior Living” listing.

To accomplish this, U.S. News has partnered with research firm Activated Insights

The company plans to launch the first listing in Quarter 1 of 2022. It will recognize senior living communities in four categories: independent living, assisted living, memory care, and life plan/continuing care retirement communities (CCRCs). 

In an interview with Senior Housing News, Jacquelyn Kung, CEO of Activated Insights and Nexus Fellow, said that participating communities might be recognized in tiers such as “Best” and “Recognized.” Those communities that offer different levels of care will be evaluated separately in each category. She said that the listings will help consumers, while also benefiting the industry.

“There are incredible providers in our field transforming people’s lives,” Kung said. “We want to help those communities get the recognition they deserve and help consumers find those communities that best match what they’re looking for.”

U.S. News also plans to cover the senior living sector more regularly, to help clear up consumer confusion about the different types of senior living communities and how they are distinct from nursing homes, Kung told Senior Housing News.

“We want to help communities get the recognition they deserve and help consumers find those communities that best match what they’re looking for.” – Jacquelyn Kung

“For consumers, it’s a wonderful opportunity to have such a highly regarded group of organizations taking a look at our industry and sharing information that they can trust,” said Juniper Communities CEO, Lynne Katzmann.

More than 2,500 communities have committed to participating, according to McKnight’s Senior Living. Communities that earn recognition in the U.S. News listing will benefit from high visibility, an independent quality assessment to which they can refer families, and branding elements that can be used in consumer marketing. “There are no downsides to participating in this inaugural survey,” said Kung.

The cost to participate is $995 for smaller providers and $1,495 for larger providers. According to Kung, this covers the cost of survey administration. Neither Activated Insights nor U.S. News intends to make a profit from the participation fees. 

Find out more.

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Experience Design in Senior Living

Glowing Older with Sarah Thomas: Focus on the Experience  

When discussing innovation in senior living, who better to call on than Sarah Thomas, an expert in senior living, technological innovation, and experience design. Thomas is the founder and CEO of consulting firm Delight by Design, a Nexus Fellow, as well as a 20-year veteran and leader in the aging services industry. She was recently interviewed on the podcast Glowing Older, Innovation in Senior Living. The conversation ranged widely from issues of design and technology, to resident experience in senior living. 

Here are a few highlights:

What is ‘experience design’?

Companies come to me to help them shift the narrative of the experience in aging. Our team is helping to redefine products and services as we know them, with this idea of designing for all, as we are all aging. The focus is on intentional, inclusive, inspiring designs that foster a sense of purpose, and look across all dimensions of wellness. We want to help our customers bring things to market in a non-discriminatory and inclusive way, that attracts people at a really emotional level, and that delights consumers at every age.

Who are the clients of Delight by Design?

Our clients range across the spectrum from consumer brands to products that are disrupting the market on the technology side and the startup side. But we also see investors who are looking to understand the space. It’s a pretty noisy space–a lot of people are entering it. We help companies and products succeed, and we also help consumers and investors understand which products they should adopt.

Tips for existing senior living facilities:

It all goes back to the human-centered approach. We often forget that. If someone is living in their own home, they want to know they can preserve the quality of the lifestyle they currently have if they move into your community. They also want to enhance their life with the new, beautiful, and wonderful things that come from moving into senior living: the community, the amenities, and the support systems that are in place.

People want a sense of belonging, purpose, and community. They’ve had all those roles in their lives, with their families and friends and community, and we have to recreate those. We have to allow opportunities for creating and making, giving and caring for others, civic engagement, thinking and sharing. We can’t just offer passive experiences. We have to offer true and purposeful engagement. 

And subtle changes can be important. We can update colors to elicit emotional reactions we’re looking for. We can create a sense of focus or attention in the library setting, for example, or an area to energize or to calm. 

What are the technology trends in senior housing?

There’s the on-demand nature of our human experience and customer journey that we have every day, with Uber and DoorDash, for example. We’ve seen connectivity and the experience of our work environment shift with Zoom and Teams. Well, older adults have experienced these trends as well. There’s a variety of trends like these in the consumer space that we need to understand and to adopt in every setting, to improve the overall experience and to meet expectations.

Technology for its own sake is useless. But implemented technology can lead to better efficiencies, better outcomes, and a greater quality of care and of life, by automating some of the workflows we have. We have better business intelligence, better actionable insights, and we’re using data in a different way. This is going to improve our programming and our operational approach in senior living. 

How can senior living deliver on the wellness promise?

Wellness is not just fitness. Not only do we want to get people moving better, but we want them intellectually stimulated, socially and emotionally engaged with a focus on mental health. It’s important to foster spiritual growth of individuals and address their shifting and evolving spiritual needs as they age. And of course environmental: there are ways to add beautiful design to allow for environmental optimization. 

And the vocational side is often missed as well. People have this arbitrary notion of retirement, and then the vocational piece is done. But, in fact, we need to find purposeful activities for people. We need to really engage them in activities that give them a sense of purpose and meaning, and a sense that they’re contributing. What do they want to learn? What do they want to do to engage with the people in the spaces around them? Wellness can’t just stop with more exercise programs. We need to look at the human experience, and what people are craving and needing to feel fulfilled across all dimensions of wellness.

What gets you most excited these days?

It takes a really special group of people to want to be in this field, serving older adults. We’re hard on ourselves and on each other for not moving the needle fast enough, but I think this industry is really well-intended and really wonderful. What excites me the most is that we’re finally looking outside our industry for inspiration and motivation to make change. We can always improve. We need to learn from hospitality, from travel and leisure pursuits, and from brands that are helping to improve the consumer experience. I’m glad we’re picking our heads up a bit and looking beyond the walls of senior living and into other industries, to learn from their expertise and to enhance our own experiences.

Listen to the full podcast

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The Longevity Economy

What Exactly IS the Longevity Economy?

What is the Longevity Economy? It’s 8.3 trillion dollars. It’s 42% of total U.S. GDP. It’s equivalent to the third largest stand-alone economy in the world. It’s the rapidly growing market of products and services designed to benefit older adults, plus the multiplier effects of job generation, new businesses formation, and tax revenue across the U.S. economy. It’s a term that was coined by a new Thought Leadership team at AARP in 2009 to capture the full macroeconomic impact driven by the economic activity by and for older Americans.

At a time when common wisdom was leading to proposals to cut Social Security and to cut Medicare, the first boomers began to retire, and there was a sudden, rapid growth of startups in the health, digital health, and aging services industries, plus increasing interest by larger established companies.  

“AARP began pushing back against the notion that we can’t, as a society, afford all these old people,” said Jody Holtzman, Founder and Senior Managing Partner of Longevity Venture Advisors, and former Sr. Vice President of Thought Leadership and Market Innovation at AARP

Holtzman, who was recognized as a Top 50 Influencer in Aging by NPR/Next Avenue, was a guest of Phyllis Ayman on her podcast Seniors Straight Talk. The two discussed “The U.S. $8.3 Trillion Longevity Economy: Its Meaning & Impact.”

“To support the claim that we can’t afford all these old people – although no one would put it that bluntly – everyone would point to Medicare and Social Security as evidence, saying the programs were unsustainable. They were making an economic claim that we as a society can’t afford something, but their evidence and arguments weren’t economic. Their evidence was a design function of these two programs.”

Those arguments were based on an “ageist attitude toward older people and their usefulness,” Holtzman argued, “combined with an ignorance of one of society’s most important economic assets – older Americans.”

“Just 35% of Americans drive about 42% of US GDP, and over 50% of US consumer spending.” – Jody Holtzman

He and his team at AARP hired Oxford Economics, who found that consumer spending by older adults generates a GDP of $8.3 trillion. At a time when the economy was lagging, “This was the one enormous growth market.”

It didn’t take long for the market to catch up with reality. “The market moves faster than the culture,” Holtzman said. “In fact, the market recognized the value and potential value of this demographic shift across every asset class; venture capital, private equity, public companies, real estate. And brokers responded by making it easier to invest with new ETF’s, REITs, and portfolios designed to benefit from this demographic wave. It cuts across industries.”

In fact, older adults are a powerful economic driver. “The economic impact analysis showed that a population of just 35% of Americans drive about 42% of US GDP, and over 50% of US consumer spending,” Holtzman said. “What other segment of the population generates such a positive disproportionate impact?”

Instead of arguing that we can’t afford to support older adults, Holtzman said, “It’s that we can’t afford not to because they are driving economic growth. And it’s having multiplier effects that benefit society and people of all generations.”

Listen to the podcast.

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Jacquelyn Kung and Bob Kramer discuss surprises about Senior Living during the pandemic

Foresight TV Recap: The Counterintuitive Way to Attract More Move-Ins

The media has gotten it wrong when it comes to its coverage of senior living, particularly during the pandemic. 

“There’s a stereotype that older adults, especially those living in any type of senior living community, have lost all independent agency. So that feeds the perception, the sense that in the midst of COVID, they’re desperately lonely, desperately afraid,” said Bob Kramer, Founder and Fellow of Nexus Insights. “There’s no common perception that they, too, could rise to a crisis, just like we see other people in society do.” 

Senior Living Foresight publisher Steve Moran hosted Kramer and Jacquelyn Kung, Nexus Fellow and CEO of Activated Insights, in a recent episode of Foresight TV entitled “The Counterintuitive Way to Attract More Move-Ins.” 

“Media tends to write stories that reinforce what journalists feel, or what they believe their audience feels, and add facts to magnify those feelings,” said Kung. 

But it’s more than just the media, according to Kramer, “All of us quickly fall into believing in stereotypes, and parroting them. That narrative doesn’t get it right at all. And that’s what we’re trying to address, with the rich data that Jacquelyn and her team have collected at Activated Insights.”

Activated Insights has been surveying senior living residents and their families since 2018. These surveys provide insights into the actual experiences that residents and their families have with congregate living. Their experiences during the COVID pandemic and shutdown are surprisingly different from the national perception. 

One of the surprising findings: When looking at the incidence of loneliness in congregate settings, specifically senior living, the Activated Insights research found that just under 20% of seniors counted themselves as very lonely. 

“I think the image over the last year-and-a-half is that everyone in a senior living community is feeling trapped and lonely,” reported Kung. “But 4 out of 5 seniors are not feeling like that.”

Even more surprising? Prior to COVID, the incidence of loneliness among senior living residents was 26-27%, higher than what was found during the pandemic shutdown.

“It’s not that we’re saying there aren’t some very lonely and scared seniors in our senior living communities,” Kramer added. “But the perception that all seniors are feeling terrified, trapped and lonely isn’t borne out by what the data show. We’re all quick to jump onto stereotypes, and sometimes those stereotypes miss what’s truly going on. We want to get that contrarian message out.”

“Providers believe they know how their residents feel, because they hear from them every day,” she added. “But do they hear from everybody? No.” – Jacquelyn Kung

According to Kung, prior to the pandemic, resident survey responses frequently focused on “the usual: the food, the seasoning, the staff.” But during the pandemic, “The comments were an outpouring of community and belonging,” as well as gratitude for being in the community, and gratitude for feeling safe. “This isn’t what the media is covering about the pandemic,” she said.

The two pointed out that now, when the industry is particularly stressed, the data provide insights into how to attract people to live in a congregate setting. The important stories to tell are those about the sense of being safe, of belonging, and being part of the community. “It’s contrary to the perception,” said Kung.

“Providers believe they know how their residents feel, because they hear from them every day,” she added. “But do they hear from everybody? No. And providers are often surprised at the results when they finally survey everyone. When you don’t actually ask people, then you may be working on the wrong things. You may not be working on things that actually matter to your customers. How do we delight and provide quality experiences for our customers and their families? It’s by hearing from everyone, and not just a few who come to you.”

Listen to the full episode.

Jacquelyn Kung is the CEO of Activated Insights and a Nexus Insights Fellow. Bob Kramer is the Founder and Fellow of Nexus Insights. He is the co-founder, Strategic Advisor, and former CEO of NIC. Steve Moran is Publisher of Senior Living Foresight.

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Experience design in senior living

Experience Design for the Often Undervalued Longevity Market 

For Sarah Thomas, CEO of consulting company Delight by Design, and a Nexus Insights Fellow, “experience design” is about creating “an engaging experience that brings value to the consumer and delights them throughout the customer journey.” This is especially true in the longevity market, a market Thomas says has been undervalued in the past, and which is where her company is focused.

Delight by Design works with firms that are looking to design more accessible products or more inclusive services, and investors who are looking to expand their portfolios. These organizations may need assistance in understanding the wants, needs and market opportunities for the older adult consumers. That’s where the Delight by Design team truly shines.

Thomas was featured recently in an article entitled, “How Tech and Common Sense is Bringing Experience Design to Senior Living” on the Senior Living Innovation Forum (SLIF) blog. “Applying my background as an occupational therapist,” Thomas told SLIF, “I focus on human-centered design to create environments and experiences where residents are living their best lives, not defined by age.”

According to Thomas, experience design can “help companies foster a sense of purpose, encourage community engagement, improve mental health, elevate physical activity, increase healthspan and lifespan.”  

“We want it at the touch of a button with on-demand functionality, and we should be expecting the evolving consumer to want the same in senior living.”

Technology plays an important role in experience design, not for its own sake, but for how it can improve efficiencies and help consumers. “In Silicon Valley, we design products to replace the greatest caregiver of all—Mom!” Thomas said. “Bring me food, clean my house, make my bed, and drive me! We want it at the touch of a button with on-demand functionality, and we should be expecting the evolving consumer to want the same in senior living.”

Thomas predicts that tech-based experience design innovations will bring improvements across the entire senior living experience. She predicts that seniors, who are used to living in a high-tech world, will come to expect it. “We need more availability of basic tech-enabled experiences; we need to offer technology that reaches families beyond the walls of a resident’s community, includes more telehealth, counseling, dietary support, and increased access to other resources that improve quality of life across all dimensions of wellness,” she said.

Read the full article.

Sarah Thomas will discuss the importance of experience design at this year’s Senior Living Innovation Forum in October. Nexus Fellows Bob Kramer and Ryan Frederick will also be sharing their expertise as speakers.

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Nursing home strike in Pennsylvania

Understaffed, underpaid and unsafe: Nursing home strike in Pennsylvania

David Grabowski, Professor of Health Care Policy at Harvard Medical School, and Nexus Insights Fellow, was recently interviewed by The Times in a story about 12 nursing homes in Pennsylvania that have voted to authorize strikes

Nurses, nurse aides and other caregivers have authorized issuing a 10-day strike notice at 12 nursing homesIssues include “a growing crisis involving the COVID-19 pandemic, chronic understaffing and low pay, and industry regulations in desperate need of reform,” according to the workers’ union, SEIU Healthcare PA.

Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, cites two major issues affecting the industry, a shortage of workers and declining Medicaid reimbursements.

A statement from the union states that the workforce has been, “Stretched to the breaking point after decades of understaffing, lack of investment in a workforce that makes poverty wages, and a pandemic that took an unimaginable physical, mental, emotional and financial toll on caregivers who have dedicated their lives to our most vulnerable.” There were more than 13,000 COVID-19 nursing home deaths in the state.

Owners and workers both express a concern for the health and safety of residents.

Read the full article.

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