This piece is part of my series on the “Six Key Drivers” that will shape the senior living industry over the next 10 years. Read the series introduction and all six parts here.

My sixth key driver shaping the future of senior living is moving from siloed to seamless. What do I mean by that? We are moving from single-point solutions that are fragmented and partial to integrated solutions that are wholistic and person-centered. The drive is under way to connect data, people, and processes. This will fundamentally change senior living

The integration of business systems is already taking shape. Communicating and coordinating among different operating systems will be much easier for operators.

The big differentiator, however, will be our ability to provide the consumer with a seamless experience. After all, consumers judge us by the overall experience we provide. It’s the experience that counts.

This represents a great opportunity. Operators who give the consumer a personalized, integrated experience that provides housing, community and preventative healthcare will benefit in tangible ways. Residents will have a longer and higher quality of life. Families will have greater levels of satisfaction. And the staff will enjoy a more rewarding, productive working environment. That’s a huge competitive advantage.

The move from siloed to seamless will take time. A truly seamless consumer experience has a long way to go. The integration of business processes is further along, though operators still face a confusing array of software solutions.

There are single-point solutions to manage everything from back-office operations to financial performance. There are platforms to manage the workforce, sales and marketing, clinical data, and resident engagement.

As healthcare technology executive Manisha Gulati astutely points out in a recent article, more technology solutions often only create more dots rather than connections. Providers are overwhelmed.

This is true for senior living operators. They see new technology solutions as dots creating more siloed programs rather than providing an integrated seamless platform.

Operators wonder: Will the latest innovation be topped in a year or two by something better? Or by a solution that offers more integration? It’s hard to invest in a system that may quickly become outdated.

At the same time, we need to recognize that we are at an important inflection point in the evolution of the senior living industry. The first phase of innovation has been the development of these point-in-time or episodic solutions. The next phase of innovation will be connecting the dots, moving from these individual silos to longitudinal solutions that enable communication, coordination, and meaningful integration to provide a complete health and wellness experience for the resident.

Advances are being made in the integration of business systems and their data by companies such as Eldermark, PointClickCare, MatrixCare and Yardi. We are moving from siloed to seamless.

As senior living makes this transition, what is our top priority?

The first question we should ask is of the consumer: What matters to you? What do you want to experience in the later years of your life? The answer is our roadmap.

Older people in the years to come will expect a hassle-free, seamless experience. So will their families. The most valued service will be navigation to handle all the things the resident or family doesn’t want to deal with.

That includes healthcare. We cannot provide a seamless experience unless we recognize and proactively engage in the resident’s experience of and delivery of healthcare.

The average assisted living resident has 13 chronic conditions. As we discussed in Key Driver #4, healthcare is being reframed. The government is moving to a value-based care system. Taxpayers will not be able to fund the fee-for-service system as it currently exists as costs for the care of an aging population spin out of control.

Today’s consumer experiences a fragmented healthcare system, shuttled from doctor to doctor and to different settings with little coordination. Older people and their families are extremely frustrated. While healthcare talks about a continuum of care for the patient, the reality of the patient experience is the exact opposite. Patients, their data and their families get confused and lost as they’re sent from one silo to another.

How does senior living fit in?

We like to talk about the continuum of care, but our services are fragmented too. We often see other types of providers or settings as competitors instead of working together to provide a better experience for the older adult.

A recent hint of change came from the Aging Media Network. It just hosted a conference to connect executives from across the senior care continuum to discuss synergies. C-suite executives from different settings are exploring how to reshape care delivery to older and complex populations. Unfortunately, much of the discussion is focused on care competencies and business model requirements and not on what matters most to the individual—the older adult.

Senior living has a key role to keep people out of the hospital and to help manage their chronic conditions. If we want our residents to have more life in their years as well as years in their life, then how we provide for the management of their chronic conditions is essential.

This doesn’t mean senior living providers necessarily have to go into the insurance business or provide primary geriatric care services. But we do have an opportunity to see that our residents get those services. The move to home of healthcare services can and must include the home that is senior living.

How?

Companies are emerging that integrate the healthcare experience. I call them the integrators. American Health Partners is one example. Its business model is to provide a continuum of care that empowers people to obtain excellent healthcare that fits their lifestyle. The company seeks to deliver the right care at the right place through institutional special needs plans, senior living and rehabilitation, pharmacy for long-term care facilities, home health and hospice, among other services.

Another example is BrightSpring Health Services. It provides complementary home- and community-based health services for complex populations in need of specialized and/or chronic care. Services include supportive care, clinical and pharmacy solutions across many settings. A third example is Lifespark.

Aggregators play a role too. They aggregate the lives of high-risk Medicare beneficiaries in a local market and seek to integrate their care experience as they assume their healthcare dollar spend risk. Landmark Health, Lifespark, Curana Health, ChenMed, VillageMD, WelbeHealth, Aledade, and Oak Street Health are examples of companies doing this work. We provide an enormous potential value to them because we house the very high-risk, high-cost Medicare beneficiaries they seek to serve: their beneficiaries. They provide value to us because our residents need the healthcare they provide.

Operators can start by considering some basic questions:

• Who is providing medical services in my building? (This type of information is available through NIC MAP Vision.)
• Is any service in my market providing true care navigation and integration? Care navigators, sometimes called coaches or guides, coordinate the healthcare experience. They help the individual receive the right care, at the right time and in the right place.
• Which companies in my market are aggregating the lives of high-risk seniors who account for the most Medicare spending? They could be our partners.

Moving from siloed to seamless is a confusing and messy process. But as the future takes shape, the transformation will be worth the effort for operators, and especially for our residents.

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That brings me to the conclusion of my series on the Six Key Drivers Shaping the Future of Senior Living. I’d like to note that I’ve enjoyed getting your feedback and look forward to more of your comments. I’d also like to add that the Six Key Drivers identified in this series do not represent an exhaustive list but rather a work in progress. Other drivers, such as industry leadership changes, technology, innovation in capital structures, and environmental, social and governance (ESG) initiatives will also shape the future of the industry.

My key point is that ultimately, we must offer our next generation of residents an aspirational setting and experience. Otherwise, they will pursue other options to avoid the senior living setting. By adopting an aspirational dynamic, we can change the expectations and even the lived experience of aging, especially in our later years.

Lastly, I’ll conclude with one of my favorite quotes from Bill Gates that certainly applies to our industry. “We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don’t let yourself be lulled into inaction.”

Robert Kramer

Bob Kramer is broadly recognized as one of senior living’s most influential and high-profile thought leaders and connectors. With over 40 years of industry leadership, he has earned the reputation of “agent provocateur” in the seniors housing and care industry and aging services field. He has been described as an ice-cutter and scout in identifying industries and trends that will disrupt the future of seniors housing, aging services, and aging more broadly.

This piece is part of my series on the “Six Key Drivers” that will shape the senior living industry over the next 10 years. Read the series introduction and all six parts here.

Data and analytics are revolutionizing senior living. These critical tools, and the technology that enables them, are vital to manage information and drive better business decisions and resident outcomes. But how?

The use of data and analytics allows us to customize our product to meet the needs and preferences of our customers and other stakeholders. It’s important to note that investments in technology are critical to the future success of both individual companies and our entire industry. Technology will be key in the challenge to stay competitive. Senior living providers need a tech platform to capture data and deploy predictive analytics to create customized solutions. It’s these customized solutions that will drive real value for investors, owners, operators and customers.

I have identified three areas of focus where data and analytics will profoundly impact our industry:

• Data and analytics will drive the delivery of customized healthcare paths for the individual.
• Data and analytics will drive customized business strategies, including the formation of essential partnerships as well as strategic growth plans by market.
• Most importantly, data and analytics will drive a customized resident experience. We will be able to provide a superior product for residents, focused on the personalized experiences that make life worth living. We can turn senior living into what I describe as an “aspirational” setting. It can be a place where people prefer to live regardless of their age, mobility or cognitive condition, instead of a place they hope to avoid.

Let’s take a more detailed look at the three areas where data and analytics will shape the future of senior living.

1. Data enables preventative, predictive and participatory healthcare.

As we noted in key driver No. 4, healthcare is being reframed. We are slowly but surely shifting to a value-based care model that relies on data to produce better results at a lower cost. It starts with prevention and enhanced management of chronic conditions. The data we collect can be analyzed to help prevent and break the typical downward, and costly cycle of sick or injured residents who are sent to the emergency room or hospital, only to return to the community, and bounce back again to the urgent care setting.

Data is required to prevent that cycle and avoid the flareup of chronic conditions that leads to acute care. But data alone is not enough. Data coupled with predictive analytics or algorithms can identify potential risks for a particular resident. In short, data and predictive analytics together can provide a healthcare roadmap customized to the individual.

A simple example is the burgeoning category of software products that use algorithms to predict when a person is at risk of a fall. We know that falls are one of the most expensive medical events suffered by frail elders that often start a downward health spiral. The CDC estimates that more than $50 billion is spent annually on medical costs related to falls among the elderly. New technology uses algorithms to marry resident data with data from hundreds of thousands of older adults to help spot problems and intervene before a fall takes place.

For example, we may determine whether the person has osteoporosis, making a fall potentially more dangerous. We can also analyze the person’s habit patterns and their gait. Are they getting up more times during the night? Is it taking them longer to return to bed? A change may indicate the need for more checks. The result is fewer fall-related visits to the hospital and a better overall experience for the resident and the family.

Resident participation is part of the solution. Self-monitoring can provide data to help prevent and predict health problems. For example, the Lively app from Best Buy available on the Apple Watch tracks the wearer’s daily habits. It can send out an alert if the person falls. But instead of wearing a pendant that screams “elderly,” the resident has a smart watch that looks cool. Apple is in a race with other companies to provide the most sophisticated healthcare monitoring and predictive devices. These devices can check your heart rate, oxygen level, and blood pressure. Again, the data is worthless if it is simply collected. Algorithms, sophisticated machine learning, or artificial intelligence (AI) needs to process the data in real time. It doesn’t do any good if it takes four days to get an alert about the condition of a resident who by then has already fallen.

New, game-changing data streams are also becoming available to the industry. NORC, a social research organization at the University of Chicago, in collaboration with NIC and NIC MAP Vision, has overlayed Medicare claims data with nine-digit zip code senior living property information. This allows us to pinpoint our resident populations by health status to determine chronic disease prevalence along with average healthcare spend in a building, and the average spend per resident. That provides the opportunity through NIC MAP Vision to get a complete, and anonymous, health profile of who lives in our buildings, how they compare to individuals in the wider market area as well as who are the top healthcare providers serving residents in our buildings. This kind of data is revolutionary to understand both who is in our buildings and who is providing healthcare services to them.

Recent research by NORC shows that residents of senior housing settings average over 12 chronic medical conditions. More than half of all senior housing residents have a mental and behavioral health diagnosis. As NIC MAP Vision adds more data to its platform over the next year, we will be able to determine the prevalence of different chronic conditions among our residents.

We can quickly find out whether the population in our building has a high or low Medicare spend, or a high rate of residents being sent to the hospital. The applications and implications for the future use of this kind of data is groundbreaking and will be transformative for the industry, which brings us to the second way that data and analytics will make a big difference in our industry.

2. Data is critical for partnering, risk bearing and strategic decision-making.

Healthcare data on building residents will be essential to form effective partnerships with payers and healthcare providers. Healthcare data can also be used to make strategic business decisions.
Medicare Advantage plans and other healthcare dollar risk-bearers have an incentive to reduce spending, particularly among high-cost residents in assisted living, independent living and memory care. According to NORC research, senior housing residents have annual healthcare spending of about $20,000-$30,000, with residents spending $3,000-$4,000 in out-of-pocket costs. This level of spending reveals tremendous opportunity to reduce healthcare spending and improve quality of life among these residents.

Whether by partnership with others or deciding to take on the healthcare dollar risk directly, senior living providers must have and understand this critical data about the residents in their buildings. Without it, senior living operators are at an enormous disadvantage in negotiating potential partnerships whether with Medicare Advantage plans or healthcare providers. And without this data, senior living operators are very unlikely to be rewarded for the contribution they are making to reduce the healthcare costs of their residents.

Risk-bearing entities want to partner with operators who can provide insights into the health conditions and the healthcare spending profile of member residents. Not only is this data essential to potential partners, but the information also gives operators insight into where improvements can be made to enhance the quality of life of residents.

Similarly, operators need data on the healthcare needs of residents to evaluate the feasibility of potential partnerships, especially in a risk-bearing arrangement. If you are in discussions to partner with a physician practice or a healthcare system, you need to understand the healthcare spending patterns of your population. Our industry has been focused on what people spend on rent and services. But we have never before had insight into what the government, and the resident themselves are paying for their healthcare. If we don’t have this data on hand, potential partners may not recognize the value we are bringing to the table. With healthcare data in hand, you can demonstrate your value to help manage healthcare spending. Senior living providers should be recognized as a partner to lower the healthcare spend and to help keep people healthy.

As an example of how data can be used, NIC Analytics has issued a white paper and blog post that looks at the opportunities for senior living in chronic disease care. I urge you to read them. Perhaps an operator can partner with a chronic kidney disease care provider and offer on-site service in a way that is far more consumer friendly. Bear in mind, as we’ve discussed, the customer wants to get services where they live.

New streams of data, coupled with analytics, can also improve our business strategies. How? In senior living, we’ve traditionally used data in terms of supply and demand to create market feasibility studies. How much supply is there in a particular market and what is the demand? How many people are over age 75 and what is their income? What is the prevalence of adult children and what is their income? How many buildings and units are in the markets, and what are the rental rates? But what other data might help us improve our feasibility studies? Here’s an example. NIC MAP Vision can provide the rate of Alzheimer’s disease and other dementias in the Medicare population in the top 30 largest MSAs in the country. Miami has the highest incidence at 8.3%. Portland, Oregon, has the lowest at 2.7%. This is pretty important to know if you are deciding where to locate a memory care building.

A 2021 white paper published by NIC Analytics provides more information on dementia and how to utilize CMS Medicare data and NIC MAP Vision supply data when evaluating local conditions. Another resource is NIC’s article “Access to Capital in the Nursing Home Industry” on utilizing dementia Medicare data for more informed underwriting.

3. Data is critically important for the purpose of engagement matchmaking.

Data can be used to engage residents and match them with experiences that give them a sense of purpose, belonging and connection. If we’re going to avoid the medicalization of private pay senior living, it won’t be because we have medical history data and know how to use it. Rather, it will be because we have what I call “life data” or “life values data” and know how to use it to create an engaging environment for our new customers.

Senior living is very good at asking certain questions, but we overlook the most important questions. We are good at finding out the person’s need for help with the activities of daily living, or the instrumental activities of daily living such as balancing a check book. We are good at finding out how many prescriptions people take, and the over-the-counter medications they use. And we are especially good at understanding the resident’s ability to pay and for how long.

But none of this information defines the identity of a person. In fact, every person resists being identified by those markers. We are not asking the questions that matter most to the individual and their quality of life. Most people in assisted living are moving in with us for the last two to three years of their lives.

The key questions that we should be asking relate to what is most important for the person to be able to experience in the remaining time they have left. That should drive how we think about the resident, instead of coming up with a game plan based on the fact that they have 18 prescriptions, and 10 chronic conditions. What is important to the person? Maybe she wants to see her grandchild walk across the stage at college graduation. Or maybe he wants to live long enough to meet his first grandchild. We should be asking what moments in life have given you the most sense of joy? What is something new you would like to learn? What gifts, interest or talent would you like to contribute to this community?

It all comes back to what matters to the residents, what’s most important to them.

For example, Lifespark, a complete senior health company in the Twin Cities is a pioneer in whole person senior care, focused on helping people build a pathway to live their best life. Lifespark has created an Electronic Life Record (ELR) that uses artificial intelligence (AI), machine learning, and proprietary algorithms to capture not just typical medical inputs, but also thousands of additional data points that can be highly predictive for recommending not only the best care solution but also the best way to engage an older adult and enhance their experience of daily life.

Another example: The John A. Hartford Foundation funded the Age-Friendly Health Systems initiative in partnership with the Institute for Healthcare Improvement, the American Hospital Association and the Catholic Health Association, which is now in over 2,800 care locations nationally and internationally. The goal is to help spread the reliable delivery of age-friendly care—based on the 4Ms framework (what Matters, Medication, Mentation, Mobility)—to all health care settings.

The Foundation has also provided a grant to the Age-Friendly Institute, based in Boston. It operates AgeFriendly.org which features user reviews and expert advice for older adults on where to live, work and get care. The consumer reviews are akin to Yelp for care of older adults.

So, what do we do with the life data we collect? It can be used to customize the resident experience which is how our industry will thrive in the next decade. Let’s look at several other sectors that are way ahead of us to see how they are customizing the consumer experience.

The retail sector is a good example. My wife, Diane, was shopping online before the holiday rush for dolls for our granddaughters. But not just any dolls. Diane has very high standards for dolls and wanted unique, authentic dolls. She was checking her emails one morning and suddenly exclaimed, “How did they know?” I thought she’d been hacked until she said, “They sent me exactly what I’m looking for.” Diane had received emails from three doll manufacturers with just the kind of dolls she wanted. I said, “Diane, you have just been mass customized to have a personalized shopping experience.”

There is a ton of data out there on us and our shopping habits. Someone put together an algorithm to find the kind of dolls that would interest Diane Kramer, who likes to holiday shop before Thanksgiving. The doll companies bought the data and knew early November was the right time to send Diane an email, so she had a super convenient shopping experience. It’s an example of how to take massive amounts of data and use it to create a customized consumer experience.

Healthcare is another example. Heather Cox, the chief digital health and analytics officer at Humana gave a presentation at the Consumer Electronics Show (CES). She said that the next evolution of Humana would be to focus on leveraging analytics to drive new digital personalized experiences to extend care delivery to members when and how they need it. Her message: Differentiating on price isn’t the way to win on healthcare. Differentiating on experience will be.

Humana is a huge player in the Medicare Advantage payer universe. Since Cox gave that speech Humana and United Health Group, another big payer, have been buying providers, physician practices and clinic-based settings, not expensive hospitals. Payers are seeking settings where their members can receive preventative care and assistance to manage chronic conditions to avoid the hospitals. In other words, the payer is becoming the payer and a provider, or a payvider. These big insurers are developing their own alternative care networks, and the missing piece by design is the acute care hospital.

These examples raise a question for senior living providers. What personalized experiences that are metaphors for being alive will we offer our customer? Data and analytics will enable us and our partners not only to practice true preventative healthcare but most importantly to design opportunities for our residents to have the experiences they want most in the last years of their lives. This is a completely different approach from the activities director who runs herself ragged to schedule lots of activities to appeal to everyone. Or the activities director who takes a one-size-fits all approach and hopes people show up.

We can’t create customized experiences if its up to the staff to figure out what each individual wants and then deliver a solution. That’s where a number of new companies are focusing on how to customize the experience to engage residents.

Sentrics has developed an integrated suite of platforms to customize the resident experience from what she watches on television to specific activities. Continual feedback from the resident helps to tailor the experience.

Connected Living is another example. At the center of the Connected Living ecosystem is an enterprise content management system with links to programs and services.

Again, if we are going to be a place that people are attracted to rather than one to avoid, the key will be to provide personalized or customized experiences. But to do this, we have to be able to collect data and use it quickly to personalize preventative healthcare and also to engage our residents. Rather than being a place to disappear, we will be settings that are metaphors for being alive. It’s true that our customer may have chronic conditions and may only be given three years to live by the doctor. But she wants to feel alive and have experiences that are meaningful to her.

This will be a challenge for senior living that has grown accustomed to marketing care to meet needs. But the reality is that people want to feel alive, and we have to figure out what makes them feel alive. We must reframe the aging experience and engage our customers. The smart use of data and analytics will help us meet that challenge.

Next up — Key Driver No. 6: Moving from Siloed to Seamless. We will see a shift from the current fragmented, single-point healthcare solutions and technology applications to integrated longitudinal solutions that are setting, disease, and payer agnostic.

Robert Kramer

Bob Kramer is broadly recognized as one of senior living’s most influential and high-profile thought leaders and connectors. With over 40 years of industry leadership, he has earned the reputation of “agent provocateur” in the seniors housing and care industry and aging services field. He has been described as an ice-cutter and scout in identifying industries and trends that will disrupt the future of seniors housing, aging services, and aging more broadly.

This piece is part of my series on the “Six Key Drivers” that will shape the senior living industry over the next 10 years. Read the series introduction and all six parts here.

Over the next 10 years, it is essential to our industry’s success to recognize that a new senior living customer is arriving with a different take on longevity. This means we must rethink our approach to the next generation of senior living residents.

We need to do more than just reinvigorate or even recast our product for this new customer. Rather, the challenge and the opportunity for us is to fundamentally reframe our expectations around aging itself. We must offer a vision to the new senior living customer of what it means to age well. We must adopt an aspirational model and language focused on personal growth and engagement. That is our challenge for the next decade.

Our new customers are the first generation in history to have witnessed their parents living longer than anyone had anticipated. They have also witnessed how society reacted to and provided for their elders. That experience has profoundly shaped what these customers want for themselves, which stands in stark contrast to what was offered their parents.

The first generation of private pay senior living customers, the residents we’ve served for the last several decades, experienced what I call accidental longevity. They never expected to live as long as they did. They were grateful to survive and took whatever society provided for them during their unexpected old age.

Take, for example, my father-in-law, Sam. He was a World War II U.S. Army veteran and New York school teacher who retired after a heart attack at age 62. He died 31 years later at 93. When he was 89, he said to me, “Bob, can you believe I’m still alive? Isn’t it amazing?”

Sam represents a group, our current customers, who have experienced accidental longevity. But what they were offered and accepted was a declinist view of aging. What do I mean? It means that your experience of aging and retirement is defined and shaped by inexorably ever-increasing deficits, by continually losing what makes life worth living.

When you retire, you disengage and disconnect from your office or work, and colleagues. That starts an inevitable period of decline as you gradually disappear from life, people, and importance with the ultimate disappearance being death. It’s not a cheery, optimistic hopeful view but a declinist view.

The medical doctor and bioethicist Zeke Emanuel wrote at age 57 an article, “Why I Hope to Die at 75,” for The Atlantic. His argument was that society, families and the older adult would be better off if nature took its course swiftly and promptly. He says he’ll be finished then, and better off leaving society because he can no longer make a positive contribution. His unsentimental argument attracted wide attention.

I once gave a talk to students and brought birthday cards designed for people at age 40, 50, 60, and 75. In this talk, I showed them the cards, which are funny, but highlight the progression of the declinist view of life. The card for the person at age 40 featured black balloons and black crepe. The message: You’re starting to lose it. After age 40, it’s all downhill from here. You’re losing the qualities that made life fun and worth living. Each card was more depressing than the last. This attitude is part of the basic notions of our culture, nowhere better seen than in Hallmark birthday cards for people as they reach successive milestones.

Our society is, frankly, built for people to retire and die in their 60s and 70s.

Our norms and expectations around retirement and aging, not to mention our social insurance system, are not designed for the longevity reality that we’re facing today as a society.

What Do Baby Boomers Want?

The declinist view stands in contrast to what our new customer wants, expects, and will demand. This new customer is among the first generation ever to experience purposeful longevity, not accidental longevity. They know they’re likely to live a long time, but they’re not going to approach longevity the way their parents did. My wife and I are great examples. Having gone through this process with our parents, we’re asking all the questions now about the next steps around where and how we want to live.

Purposeful longevity means our new customers are determined to thrive. They are looking for community and a sense of connection. I call it the “engagement” concept of retirement and aging which focusses on purpose, experience, and enjoyment. Paraphrasing a report by the McKinsey Health Institute, which I’ll reference again later, our customers aren’t just looking to add years to their lives but add life to their years.

Joe Coughlin at MIT’s AgeLab asks: What will I do with the next 8,000 days of my life? The average American at age 65 has nearly two decades to live (82 for men and nearly 85 for women). Those with a college education are likely to have 22 or more years (nearly 87 for men and 89 for women). That’s 8,000 days. What are you going to do with those days?

Baby boomers want to know how what you’re offering is not just going to enable them to age longer but to age better.

Our new customers want “next stage” living, not “end stage” living. “Next stage” living is about possibility. It’s about growth. It’s about the opportunity presented by living longer. In contrast, “end stage” living means being put in a place by society that takes care of me and keeps me safe because I’ve lived longer than I was supposed to.

That won’t cut it with the baby boomers. They want their health span to, as nearly as possible, match their lifespan, or as Lynne Katzmann at Juniper Communities describes it, they want “wellspan.”

I participated on a panel on aging at my Harvard 50th reunion. As part of the planning group and in response to the panel, we’ve had fascinating discussions. Almost all of the people have graduate degrees, and some said if they have to go through the experience of their parents, they’d rather not live that long. It’s staggering and it’s not about money. They have plenty of money. It’s rather about their life expectations and what that life looks like ahead of them.

If you’re interested in some of the research on this dynamic, I would refer you to the “New Map of Life,” a report by the Stanford Center on Longevity on planning for the 100-year life.

Another resource is the newly launched McKinsey Health Institute, which I mentioned previously. Their first study is titled, “Adding Years to Life and Life to Years.” What’s insightful is that their target audience is Gen Z because they will live the longest, and could otherwise be condemned to functional irrelevance, if attitudes don’t change.

Yale psychologist Dr. Becca Levy recently released a book, Breaking the Age Code: How Your Beliefs About Aging Determine How Long and Well You Live. It spotlights a revolutionary paradigm shift in how we think about aging. She has pioneered research that reveals how our mindset and beliefs shape our behaviors, our ability to heal, and our lifespan, in invisible but powerful ways.

This new mindset speaks to our new customers who have a different take on longevity. Our current value proposition has been that we have the care you need when you absolutely can’t live any longer without our help. There will always be a market for that.

However, the vast majority of baby boomers won’t be needing care-dominated senior living properties until their late 80s.

To borrow a phrase from Marc Freedman, the founder of Encore.org, which helps people 50+ find meaning in new careers, retirement for boomers will be one part purpose, one part passion, and one part paycheck, in varying combinations, depending on their position in life.

Some boomers will have to work because a paycheck will be a necessity. Others will seek a sense of purpose, perhaps to make a difference in people’s lives by volunteering. For others, they will be driven by passion as they explore new or delayed interests, such as learning to play a musical instrument.

We must change our value proposition. The options for our products are as varied as the interests and affinities that will attract new customers. But we need to ask ourselves: What personalized experiences that are metaphors for being alive or make life worth living will we offer our customers? That is our challenge for the next decade as a new customer arrives.

Next Up—Key Driver No. 4: Reframing Health and Healthcare. The focus will be on well care, not sick care. Senior living, healthcare providers and insurers will partner to proactively keep our residents out of the expensive acute care system.

Robert Kramer

Bob Kramer is broadly recognized as one of senior living’s most influential and high-profile thought leaders and connectors. With over 40 years of industry leadership, he has earned the reputation of “agent provocateur” in the seniors housing and care industry and aging services field. He has been described as an ice-cutter and scout in identifying industries and trends that will disrupt the future of seniors housing, aging services, and aging more broadly.

This piece is part of my series on the “Six Key Drivers” that will shape the senior living industry over the next 10 years. Read the series introduction and all six parts here.

The pandemic has had a major impact on the senior living industry. Beyond lower occupancies and added expenses, the crisis has changed the way the industry is perceived and operates.

Certain trends have been accelerated such as the greater use of technology. At the same time, the pandemic has exposed the limits of our healthcare system, dramatically worsened the labor shortage, and underscored the crushing effects of isolation experienced by many of our elders.

The wide-ranging consequences of the pandemic will play out over the next decade. Here are six ramifications of the crisis that will change the senior living industry:

1. A loss of consumer trust in our setting, leading to a demand for transparency.

The loss of trust is not the same as the consumer who hopes to avoid senior living altogether. Rather, there is a real concern about the health threat of a congregate setting. Is it dangerous for me to put my mom in your building? We’ve never experienced that before. Transparency is key to reestablish trust. We must obviously provide transparency around health, infection control and prevention. This should include COVID-19 vaccination and booster rates in our buildings. More transparency in other areas is needed too. For example, operators should consider posting details on pricing and be prepared to share information on staffing levels, especially for night and weekend shifts. Consumers are also starting to ask about wage levels for the hourly staff. They want to know how you care for your staff because that serves as a proxy for how you will care for them or their loved ones.

2. Forced entry into the 21st century world of digital.

Healthcare has notoriously lagged behind other major sectors in its adoption of technology and senior living has lagged far behind the healthcare sector. COVID-19 quickly forced senior living into the 21st century digital world. The old ways of doing things didn’t work anymore. Modes of communication with residents, families and staff changed. We couldn’t ship residents out to hospitals or take them to doctors’ offices. Those were dangerous places that didn’t want them. So, we had to learn new ways to deliver care. Our multipurpose room was closed. Our van was going nowhere. So, how were we going to engage our residents when they were in their rooms? What about sales and marketing? The tours, lunches, and in-person appointments couldn’t happen. The change impacted pretty much every aspect of the business with the emergence of telehealth, Zoom calls, and virtual programming and tours. We were forced to enter the 21st century digital world and there is no return.

3. Mental and behavioral health emerged from the shadows and will not fade away.

The pandemic has exposed issues around mental and behavioral health. This is true for society at large, as well as for our workforce and our residents. They have suffered greatly from stress, anxiety and fear. Many residents, in particular, have endured isolation and loneliness, a risk factor for cognitive disorders and other mental disturbances. The need to address mental health issues will not recede. Programs to address mental and behavioral health for staff and residents will be necessary.

4. The moat around our buildings has collapsed.

What do I mean by that? During my entire career in the industry, particularly in private pay senior living, and especially with lawmakers in Washington D.C., a moat has encircled our buildings. We didn’t admit that any healthcare happened inside our buildings. Therefore, there was no need for the federal government to take an interest in our industry and regulate us. After 30 years of advocating that position, the two largest private pay senior living associations quickly did a 180-degree turn when the pandemic hit. They pointed out the frailty of our residents and that senior living is the front line of defense of the entire healthcare system in the face of a virus to which frail, older adults are the most vulnerable. If the government didn’t help us to meet our residents’ healthcare needs, the hospital ICUs would be overwhelmed.

It was a tough sell at first because Members of Congress said, “We just thought wealthy, healthy, older seniors lived in your buildings, played golf and had fun. What do you mean they’re frail, and have all these ADLs and chronic conditions?” Senior living is now considered part of the healthcare continuum, which will impact the industry.

5. Infection control and prevention are the new table stakes.

The bar has been raised. It will never be lowered again. People won’t move in because of your infection control and prevention programs, but they will not move in if their concerns about infection control are not addressed. So, good infection control is necessary, but not a sufficient condition for a move. There’s going to be a flu season every year, complicated by the ongoing pandemic. Consumers want to know what protocols are in place. How does the community plan to handle mom’s engagement in the middle of flu season or when a new wave of COVID hits?

6. COVID has punctuated the end of the 2nd generation of senior housing and care.

From 1960 to 1990, we had the first generation of product. Primarily, these were not-for-profit retirement communities or board and care homes, driven by a mission. The Great Society legislation of 1965 launched Medicare and Medicaid. The explosive construction of nursing homes took off, and half of those homes are still in operation today, some with three and four bed wards. From 1990 to 2020, we saw explosive growth of independent living, assisted living and dedicated memory care properties driven by the entry of countless for-profit providers into the industry.

A few senior living pioneers opened properties in the ‘70s and ‘80s, such as Bill Colson at Holiday Retirement and the Klaassen’s at Sunrise. But the industry really took off in the ‘90s because of baby boomer daughters. Prior to this time, long lived elders were cared for by their adult children, usually their daughters. But for the first time, most of these daughters were in the workforce. The Klaasen’s, for example, realized they weren’t marketing to the mother. They were marketing to the daughter, and she wasn’t going to put mom in a nursing home. The daughter saw the chandelier, the Queen Anne furniture, the curved stairway and assisted living took off.

The 3rd generation of senior living, from 2020 to 2050, will have new products and new leaders. About 70% of all not-for-profit providers in the country expect their leadership to change in the next three to five years. The for-profit space will see a lot of acquisitions and changes in operational leadership. The 3rd generation of senior living will also have a new kind of customer. This new consumer is one of the “Six Key Drivers Shaping the Future of Senior Living.” A future blog post will detail our changing customer profile and what these consumers expect from senior living.

Next Up—Key Driver #2: The Endemic Staffing Crisis. The labor shortage will continue. How can providers recruit and retain the best workers?

Robert Kramer

Bob Kramer is broadly recognized as one of senior living’s most influential and high-profile thought leaders and connectors. With over 40 years of industry leadership, he has earned the reputation of “agent provocateur” in the seniors housing and care industry and aging services field. He has been described as an ice-cutter and scout in identifying industries and trends that will disrupt the future of seniors housing, aging services, and aging more broadly.