Posts

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.

Subscribe to Nexus Insights

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

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.

Subscribe to Nexus Insights

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Seniors in group living situations are less lonely and more optimistic

Seniors in group living centers are feeling less lonely now and more optimistic

By Jacquelyn Kung, Robert G. Kramer and Ed Frauenheim

Contrary to popular opinion, recent studies show that older adults are not languishing in lonely isolation. “In fact, a large percentage of seniors in our communities are not lonely,” said Robert Kramer, Founder and Fellow of Nexus Insights and Strategic Advisor for NIC. “The common perceptions —  they’re wrong, ageist and miss the hopefulness of seniors in their finding a sense of community, even in the midst of the pandemic.”

In the past, we have seen people come together during national emergencies “to form communities around a common threat and a common need,” Kramer explained. “The one group we don’t expect it from at all are older adults in senior living communities —  but they are, and they are demonstrating it,” Kramer said.

Authors Jacquelyn Kung, Robert Kramer and Ed Frauenheim point to our elders as role models for healing the nation, and showing us how to live more fully than ever, in their recent column in the Dallas Morning News.


Our poor elders.

Given the COVID-19 pandemic, and media coverage of seniors, you might think basically all seniors today are traumatized and lonely, right?

Wrong.

The stereotype of isolated, forlorn elders belies recent surveys of older adults in senior living settings.

Just 20% of senior living residents are severely lonely, according to a new 64,000-person survey from software firm Activated Insights. In fact, this survey of seniors in assisted living and other congregate living settings reveals a potential decline in loneliness among elders in retirement communities from before the pandemic. Prior studies before the pandemic of community-dwelling older adults found higher rates of loneliness.

We would argue that we as a country have a biased — and potentially ageist — narrative when it comes to elders living in congregate settings.

In fact, we should learn from the resilience of elders in the face of formidable challenges.

The stereotype of isolated, forlorn elders belies recent surveys of older adults in senior living settings.

Granted, the recent Activated Insights survey does not include most nursing homes, where particularly frail elders live. And the number of older adults in senior living settings overall, roughly 2 million people, is a fraction of the total U.S. senior population.

Still, the new research offers inspiration to the rest of the county as we work to construct our post-COVID reality and battle what some have deemed widespread languishing.

A key lesson from our elders in this moment is the power of community, friendship and gratitude.

Consider Patricia Finick of Dallas, co-author Jacquelyn Kung’s mother-in-law. By any measure, the 81-year-old has been through a lot. Her husband of more than 50 years died in 2019. After sitting in an empty home for half a year, she chose to sell her house in Connecticut, 20 minutes from where she was born, and relocate to Dallas.

In January 2020, she moved into Highland Springs, a senior living community in North Dallas. Finick swapped a 2,200-square-foot home for a 900-square-foot apartment. And then COVID-19 swooped in, isolating her in her new home before she had a chance to meet new friends.

Despite a very difficult year, Finick doesn’t feel beaten down in this moment. No, life is looking more hopeful to her. And she’s excited about engaging in more activities. “As long as my legs will let me, I’m going to go out and do it,” she says. “And if my legs don’t work well, I can get a walker.”

A key lesson from our elders in this moment is the power of community, friendship and gratitude.

One key to her optimism is her Catholic faith. Another is her set of friends, both long-standing phone buddies as well as some new friends she has met at Highland Springs over the past year. She’s part of a breakfast club, a group of residents who gather most mornings. “They’re really, really friendly, and we have a lot of laughs together,” Finick says.

Finick’s contentment is echoed by other residents of senior living settings, according to the Activated Insights survey of residents and family members during the first half of this year.

Many elders in these settings expressed gratitude, both for the sense of belonging they experience and for the caring they received from staff members of their communities.

Consider these survey comments from seniors:

“I’m more than satisfied with life. I feel safe and am especially grateful for the careful response to COVID-19. Gratitude and blessings.”

“(I had) a feeling of safety during a time of great vulnerability. Having the opportunity to make new friends helps a lot.”

These aren’t cherry-picked quotes. Before COVID, when asked for comments about the best thing about the senior living community, 20% or fewer responses were about belonging, community, appreciating the staff and being safe. This year, though, 60% to 70% of “best thing” comments mentioned those themes.

As a nation, America could use a booster shot of resilience. Observers note a kind of COVID hangover, or apathy.

Seniors in congregate settings, who in some ways bore the brunt of the pandemic, offer guidance for a brighter path forward. These older adults may be more willing than younger Americans to acknowledge our interdependence as human beings, experiencing the support they receive not with resentment but appreciation.

Far from feeling fearful, sad and isolated, seniors are showing us how to live more fully than ever.

A few months ago in The News, we authors urged the country to rethink how we view senior citizens and engage elders in the work of healing the nation.

The latest data suggests seniors are already doing this work. Far from feeling fearful, sad and isolated, many of them are showing us how to live more fully than ever.

Patricia Finick, for one, looks forward to more dinners and concerts with her new friends. Together, they are eager to put the last vestiges of the pandemic behind them.

Says Finick: “There is a whole world out there to explore.”

Read the article.

Jacquelyn Kung is CEO of Activated Insights and a Nexus Insights Fellow.

Robert G. Kramer is a Nexus Insights Founder and Fellow, and Strategic Advisor & former CEO of the National Investment Center for Seniors Housing and Care (NIC).

Ed Frauenheim is co-author of several books on organizational culture, including “A Great Place to Work for All.”

Subscribe to Nexus Insights

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Transforming senior living

How Managed Care Companies are Transforming Senior Living

The senior living sector, which is experiencing a period of unprecedented disruption, has begun to show signs of a major transformation. Several weeks ago, Tim Mullaney, editor of Senior Housing News, wrote a fascinating article (behind a paywall) on the significance of the recently announced Lifesprk acquisition of Tealwood Senior Living. Central to Mullaney’s analysis is the recognition that the acquisition is an early sign of major changes taking place in the senior living sector. As Mullaney writes, the transaction suggests that the industry is “not just rebounding but transforming.”

I believe that Mullaney’s analysis should be required reading for every senior living operating company executive and every investor who has more than a two-to-three-year investment horizon. Here’s why. For several years, a number of us in the senior living field have been predicting that managed care companies would either acquire or build their own senior living platforms. Now, as Mullaney points out, this concept is no longer just a theoretical possibility but is happening – and is “about to become more commonplace.”

Mullaney sees the integration of the two platforms as a template for a new operational model of senior living that’s more integrated across the continuum of providers and payers. The model will also challenge the way real estate-based investors view value creation in the sector. Lifesprk is a home care provider whose model is rooted in home and community-based services (HCBS) and who contracts with health systems and payers, assuming financial risk and reward. Mullaney sees five pain points or shortcomings in today’s senior living product that he believes at least on paper, the innovative Lifesprk senior living model will address.

Enhanced consumer appeal

Mullaney notes that Lifesprk’s “life care manager” will help address the many frustrations of adult children who currently must connect all the dots of the health care and long-term care systems for their loved one. Typically, the eldest adult daughter must coordinate care for their parents even when they reside in a high quality private-pay senior living community. By communicating with the family and caregivers, as well as the different providers and payers, the “life care manager” will help address this common frustration of adult children, especially the adult daughter, when they’re paying $4,000 to $10,000 a month, but find themselves still heavily involved in coordinating care.

Too often, families are the point people for figuring out the right setting and the right care for their parent, and for ensuring that healthcare and senior care providers are communicating with each other. This is in addition to figuring out who will pay for the care, and how. Senior living options that leave the burden on the adult child or spouse to connect will be replaced by models that truly provide what the adult children think they’re paying for.

Affordability

Joel Thiessen, CEO of Lifesprk, believes that by bringing all the payment sources together under one experience, and by taking on global risk, savings will be generated – and could be invested in housing and services. The model opens the door for providers to improve the affordability of care without impacting quality. As quoted in Mullaney’s article, Thiessen says, “We think we can use both sides of a person’s wallet, their insurance or their Medicare/Medicaid benefit as well as their private pay and put those together under one experience versus one butchering the other.”

Health and Wellness

As Mullaney points out, wellness was already a hot topic before the pandemic. Consumers and value-based care providers and payers alike are demanding engaging and healthy lifestyles. With their “electronic life record” which records not only medical-based and care-based key data, but also lifestyle-related information, Lifesprk is in a better position to address this trend. Integrating lifestyle data into the record enables ongoing preventative health, management of chronic conditions and an increased emphasis on vitality and staying well rather than sick care only once one is sick. This approach reflects the likely model of healthcare delivery of the future that is predictive, preventative, and participatory, rather than reactive, curative, and after the fact.

Changing Capital Structures

While real estate investment returns have been high across the sector, capital structures are in need of change. Pointing to problems such as oversupply, and to heavy regulatory criticism of private equity ownership, as well as the fact that Lifesprk promises a more competitive offering, Mullaney argues that REITs will quickly recognize the need to adapt. He highlights examples of this recognition, such as Welltower’s joint venture acquisition of HCRManorCare with health system ProMedica, and the new Formation Capital strategy, which bears some resemblance to the Lifesprk move.

The Home Care Threat

Finally, Mullaney suggests that the recent boom in home care need no longer be viewed as competition with the senior housing and care industry. Instead, Mullaney argues, “senior living providers should emphasize that they are HCBS settings, while also finding ways to extend their services beyond the walls of their buildings.” Rather than be distracted from the mission of providing better care for the growing population of older adults, leaders such as Thiessen see an opportunity in the home care business. The moves they make now should be watched closely. They may, indeed, define the industry for years to come.

Subscribe to Nexus Insights

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Nexus Insights Fellows News 2021

Nexus Fellows Flash Bulletin: June 2021

The Nexus Fellows are leaders in the aging industry, helping to shape public policy and redefine aging and aging services. From books to podcasts, here’s a sample of some of the work they’ve been doing in the past month:

  • Jay Newton-Small, CEO of MemoryWell, is wrapping up a second year of their joint contest for Hilarity for Charity, Seth and Lauren Miller Rogen’s Alzheimer’s charity and Humans of Dementia Storytelling Competition. It’s a competition for high school and college students to write the best profile of someone living with Alzheimer’s. Winners will have the chance to meet Seth and Lauren Rogen during the virtual celebration. Additionally, MemoryWell has added three new members to their team.
  • Jacquelyn Kung, CEO of Senior Care Group at Activated Insights, was interviewed by Skip Lineberg, host of The Main Thing Podcast, about elder care, and her passion to improve the aging experience. “The main thing I’ve learned in my lifetime so far is that getting older is what you make of it. And I see it as full of good news. Socially, we get happier as we get older, and the research shows that.”
  • Jill Vitale-Aussem, president and CEO of Christian Living Communities, sat down with Senior Housing Investors Podcast to talk about her book, “Disrupting the Status Quo of Senior Living: A Mindshift.”
  • Sarah Thomas, CEO of Delight by Design, delivered the keynote on designing products and services for the aging population with Chief Medical Office of AARP, DR Charlotte Yeh. Additionally, she moderated two panels featuring the important work of seven agetech startups at the Rehab Tech Summit mini-Summit. Thomas was an expert judge at the AOTA 2021 Inventors Showcase, where 11 startups pitched their innovative products designed to serve people across the lifespan. The winner designed a novel gait belt that improves the safety of caregivers and residents in senior living and beyond.
  • Dr. Bill Thomas, founder of The Eden Alternative, The Green House Project, and Minka, recently traveled the country, talking with elders and their care partners in more than 125 cities. He learned about their hopes and fears, and listened to their stories. What did he discover? That people want better alternatives for senior living. “It turns out that older people pretty much want what everyone else wants: to belong to a community that includes people of all ages and remain connected to the living world,” Thomas said.
  • Nexus Founder & Fellow, and NIC Strategic Advisor, Bob Kramer, has joined the Edenbridge Health Board of Advisors to help expand access to comprehensive, integrated, community-based and person-centered care for the frail elderly through innovative applications of the PACE Program.
  • In the blog post, “Just Move It,” CEO of SmartLiving 360, Ryan Frederick talks about the importance of physical exercise for older adults. “Inactivity is the fourth leading cause of death and about 1.5 billion people in the world are inactive to the point that it risks their long-term health. At a health care conference several years ago, four recent surgeon generals were asked for one tip for successful aging. They coalesced on one word: move.”
  • Nexus Fellow Kelsey Mellard, CEO of Sitka, sat down with Sanjula Jain Jo on Her Story for a candid conversation about being a healthcare leader and her transition from the Midwest to DC to Silicon Valley, building a resilient team, and overcoming challenges.
  • Longevity economy expert, Jody Holtzman, formerly of AARP is proud to be on the advisory board of Intuition Robotics, which is mitigating loneliness among older adults with the companion robot ElliQ. “The growing mismatch between the number of people in need of caregivers and the availability of caregivers is a multifaceted challenge for individual families and society more broadly. Technology must be part of the solution. Companion robots like ElliQ and others in this space, like my friends at Joy for All/Ageless Innovation, have an important role to play.”
  • Caroline Pearson, Senior VP of Health Care Strategy at NORC at the University of Chicago, announced the release of new research from NIC and NORC that looks at the impact of the pandemic on seniors by care setting. “Mortality rates increase by complexity of care, but, in lower acuity settings such as independent living communities, they are comparable to surrounding populations.”

Stay connected and engaged with our Nexus Fellows. Subscribe to our newsletter.

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

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).

Subscribe to Nexus Insights

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Update on Nexus Fellow May 21s

Nexus Fellow Flash Bulletin: May 2021

As the United States shifts gears from pandemic crisis management to a new post-COVID normal, we must now deal with the aftermath and identify what went wrong and what we can do better. Issues of transparency and loneliness in nursing homes linger. Large corporations that once were oblivious to the older population have found a new market. How will we address the age-old problem of social connection for those who are still isolated, a problem seniors have faced for decades? The entire industry, the way we view older adults, the options for living independently and the implementation of technology, must all be urgently addressed and thoughtfully designed into an actionable plan for the future of aging and longevity.

Our Fellows continue to strive for innovation and reform. Here’s what they’ve been up to:

NEWS:

  • Nexus Fellow David Grabowski, was quoted in an article by the Associated Press on nursing homes’ requirement to report COVID-19 vaccinations at nursing homes. “This is an important development that is months overdue,” said David Grabowski, a Harvard health policy professor who has tracked the industry’s struggles with the outbreak. “Many of us argued that this information should have been published starting in December when the federal long-term care vaccination effort began.”

 

  • Dr. Bill Thomas, Nexus Fellow and creator of The Eden Alternative, Minka, and the Green House Project, is helping value-based care innovator Lifesprk (which acquired Tealwood Senior Living.) Dr. Thomas will be leading the efforts to combine the two companies’ operations. He has also created Kallimos Communities, new multi-generational communities with small dwellings clustered around shared green space. Additionally, he has a new project he’s working on with Signature Healthcare — currently called “Canopy” — a cluster of small ADA-accessible houses built close together.

 

  • Bob Kramer, Founder and Fellow of Nexus Insights, was interviewed by Nancy Griffin for SeniorTrade Blog. He defines 5 Boomerville Segments likely to flourish in the future: Wellnessville, where residents will focus on healthy lifestyle, diet and exercise; Margaritaville, resort-style independent living (Minto Communities’ Latitude Margaritaville has three wait-listed locations with more in development); Serviceville, where the emphasis is on volunteerism, mentorship and giving back; Collegeville, where residents focus on continued learning in a communal living environment, and Changeville, for those concerned with making a difference in the world and creating a legacy.

 

  • Preordering is now available for “Right Place, Right Time, a book by Nexus Fellow and CEO of SmartLiving 360, Ryan Frederick. “Place plays a significant yet often unacknowledged role in health and happiness. The right place elevates personal well-being. It can help promote purpose, facilitate human connection, catalyze physical activity, support financial health, and inspire community engagement.”

 

  • Nexus Fellow Kelsey Mellard, CEO of Sitka, sat down with Sanjula Jain Jo on Her Story for a candid conversation about being a healthcare leader and her transition from the Midwest to DC to Silicon Valley, building a resilient team, and overcoming challenges.

 

  • Will seniors continue to buy groceries online post-pandemic? Nexus Fellow Jody Holtzman, longevity economy expert, formerly of AARP, thinks seniors will split their shopping, using online for staples such as canned goods and going into stores for fresh foods. Some senior consumers claim it’s a social outlet for them. “As the necessity imposed by the pandemic lessens,” Holtzman says, “retailers will have to start to play the price game.” Read more at Blomberg.com.

 

Out and About:

  • Jill Vitale-Aussem, president and CEO of Christian Living Communities, and Nexus Insights Fellow, recently spoke at a session, “Finding success in increasing diversity and inclusion,” at the 2021 Women of Distinction educational webinar. We’d also like to congratulate Jill on joining the SeniorTrade Advisory Board.

Jill Vitale-Aussem joins SeniorTrade Advisory Board

  • On June 30, Nexus Fellow Sara Zeff Geber will be joining experts and thought leaders in the areas of aging, retirement and thriving for the “Boomers Thriving After the Pandemic” virtual summit, hosted by Wendy Green from Hey, Boomer. Other speakers include Helen Dennis and John Tarnoff. Part of the proceeds will go to Meals on Wheels Greenville and The Walk to End Alzheimer’s. For more info visit the virtual summit’s Eventbrite page.

Sara Zeff Geber on Hey Boomer

  • Sarah Thomas, CEO of Delight by Design and Nexus Fellow, recently presented at the Rehab Tech Summit sponsored by AARP Innovations Labs. She spoke about designing for all, including age tech, universal design, living with purpose and designing beautiful products for everyone at every age.

 

COMPANIES ON THE MOVE:

  • Jay Newton-Small, CEO of MemoryWell, is growing MemoryWell. After a successful capital raise, she’s been adding some amazing new talent to her team including Sarah Jones from Healthsense, GreatCall and Best Buy Health.

 

  • Jacquelyn Kung, CEO of Senior Care Group at Activated Insights, is working with her team to create recognition programs for senior care providers, based on their resident and family surveys. The goal is to tie the data to outcomes and impact metrics, and to use machine learning to identify patterns in those who improve to apply across a broader population of providers.

 

NEW RESEARCH:

 

 

VIDEO DISCUSSIONS:

 

 

Stay connected and engaged with our Nexus Fellows. Subscribe to our newsletter.

Bob Kramer and Anne Tumlinson discuss HCBS

Foresight TV: Bob Kramer & Anne Tumlinson – What Does HCBS Mean For LTC?

With the federal government considering an investment in the country’s infrastructure, a new light has been shed on the importance of infrastructure. And from the resulting discussion, a broader understanding of what is vital infrastructure is emerging. That infrastructure necessarily includes a system of long-term care for the nation’s aging population and a trained workforce to deliver that care.

“We have an outdated, crumbling infrastructure in nursing homes. We have non-existent infrastructure in home and community-based services (HCBS). And we have millions of older adults living longer, many of whom will need services and supports,” said Bob Kramer, Founder and Fellow for Nexus Insights, and Co-Founder and Strategic Advisor for the National Investment Center for Seniors Housing & Care (NIC).

Kramer recently interviewed long-term care expert Anne Tumlinson about the importance of long-term care and changes needed in how it’s delivered and how it’s paid for. Tumlinson, the Founder and CEO of ATI Advisory, and Founder of daughterhood.org, offered recommendations for the policy changes needed to make long-term care financially viable for more seniors and their families. Her recommendations also addressed the critical need for a living wage for the shrinking pool of caregivers who work in long-term care, and the important role of HCBS in helping seniors thrive.

“We don’t have a system; instead, every single family has to create their own system, over and over again. What is out there that could help me? How do I find it, set it up, coordinate it? There is currently no system or function in our society to handle that,“ said Tumlinson.

The interview was hosted by Senior Living Foresight. View the entire discussion.

Subscribe to Nexus Insights

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

long-term care

The Future of Long-Term Care Depends on Trust, Transparency, Liability Relief – Bob Kramer

In a recent op-ed with Morning Consult, Bob Kramer, Nexus Insights founder and Fellow, argues for the importance of transparency in nursing homes. But the situation isn’t a simple one, as he points out. With transparency comes the need for liability protections, and policy makers must look to history to understand the unique risks and requirements of the skilled nursing industry. 

The following originally appeared in Morning Consult. Reposted with permission.

No one is arguing that America should be satisfied with our current nursing home system. But we can expect to hear a cacophony of arguments on how to fix it over the coming months and perhaps year.

Nursing home operators will rightly point to chronic underfunding and the failure to address the real costs of long-term care for poor, frail seniors on Medicaid. Their critics will demand more regulation and enforcement, higher staffing requirements and better wages. Some will argue that any additional funding for long-term care should go to home and community-based services. If unfunded increases in requirements for nursing homes lead to increased rates of bankruptcy — and closures — across the sector, so be it.

It would be careless and unrealistic to argue that the skilled nursing industry is without value. Harvard’s David C. Grabowski, among other experts, has argued that it is necessary, and requires increased investment. Studies show that Americans are growing older and more frail; many have no family or are beyond the capabilities of those that they have, increasing numbers are homeless and millions will require 24/7 care, often in specially equipped and staffed facilities. Furthermore, as highlighted in the landmark “Forgotten Middle” study conducted by NORC at the University of Chicago, a giant influx of middle-class seniors is coming. Neither qualifying for Medicaid nor being able to afford private-pay seniors housing, many will “spend down” their resources and rely on Medicaid. That is simply not a tenable solution.

Twenty years ago, another industry crisis precipitated a dramatic decrease in the availability of skilled nursing facilities. Lawsuits had become so damaging that nursing home operators began to flee certain states in which plaintiffs’ attorneys, seeking insurance-mandated settlement payoffs, triggered a feeding frenzy. Insurance for operators became either unaffordable or unobtainable. As a result, many families who found themselves unable to care for an elder at home were left without appropriate options, unable to secure care for their loved one at any price.

In response, nursing home owners and operators began to develop limited liability partnerships in increasingly complex — and opaque — business relationships, all designed to shield assets from trial lawyers. That system exists today in many places, particularly with respect to larger, multi-facility operators. It enables these businesses to exist — but it also raises questions as to where the money is going.

This is why I have been advocating for even greater transparency throughout the long-term care industry. To be entrusted with a greater investment from government, owners and operators of care facilities must open up their books and allow regulators and policymakers to see that their investment is going to increased staffing, pay and benefits for those on the front lines, as well as toward improvements in technology, and enhanced infection prevention and control. In short, they need to build trust in order to gain dollars.

But should skilled nursing providers provide real transparency into their financials, without liability reform or relief from lawsuits? It would only benefit the same attorneys who benefitted from transparency in the 1990s. It would quickly become impossible or prohibitively expensive to get insurance again — and again, operators would seek to protect themselves. And again, dollars intended to go to the care and housing of our low-income seniors would go instead to ever more expensive legal actions or insurance premiums.

This is where policymakers must step up. Without liability protections, increased transparency will lead only to increasing costs, as opposed to improving the wages and benefits for front-line workers. The real losers will be the millions of poor, frail, complex-care residents who need 24-hour care, and the staff to care for them. Operators will have to agree to greater transparency and accountability. Advocates will have to understand that targeted liability relief is essential. Policymakers hold the keys to both sides working together.

Bob Kramer is broadly recognized as one of senior living’s most influential and high-profile thought leaders and connectors. With over 35 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.


Bob is founder and Fellow at Nexus Insights. He co-founded the National Investment Center for Seniors Housing & Care (NIC), where he now serves as strategic advisor. Nexus Insights is a think tank that brings together a diverse group of researchers, policy experts, entrepreneurs, and executives, each of whom are distinguished and well-established thought leaders on aging and aging services.

Read the op ed

Subscribe to Nexus Insights

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

meaningful reform in nursing homes

Seize the moment: Bob Kramer lays out path for meaningful reform in nursing homes in new Health Affairs blog

“The American long-term care system, particularly in skilled nursing facilities, has been exposed as deeply flawed, chronically underfunded, and in need of reform.” This bold statement is from Robert Kramer, Founder and Fellow of Nexus Insights, and Co-Founder and Strategic Advisor for NIC. It’s the opening line of his recent blog in Health Affairs.

Kramer delves deeply into the urgent problems facing nursing homes that have been spotlighted on the national stage by the pandemic and its tragic death toll among nursing home residents and staff. Kramer predicts the likely responses we can expect to see from nursing home operators, federal and state regulators and policy makers, and seniors and their families. But he urges, instead, a more thoughtful, complex and multi-faceted approach to solving the challenges of long-term care in nursing homes that involves dispensing with out-of-date assumptions, acknowledging the problems, and aligning the different stakeholders involved.

The problems he sees stem from undervaluing and undercompensating the work of caregivers, and the too-narrow focus of regulatory metrics on physical care needs, rather than the personal goals and aspirations of the residents themselves, and their quality of life. Other challenging problems include the long-term shortage of caregivers for a rapidly growing population of seniors, the lack of financial transparency, inadequate reimbursement models that incentivize the wrong behaviors, the age of nursing home infrastructure, and the financial impact of the COVID-19-related lawsuits that are certain to hit the beleaguered industry as the pandemic winds down.

“Every stakeholder must understand that this is a disruptive moment.” – Bob Kramer

The solutions Kramer proposes will require thoughtful cooperation and coordination among all the players in the industry, including industry providers, organized labor, consumer advocates, investors, and regulators. And it won’t be easy. But as Kramer points out, “Every stakeholder must understand that this is a disruptive moment. SNFs and long-term care are, for a moment, center stage. Those of us who care about this sector, and the millions of Americans it serves, must seize this moment.”

Link to full blog

Subscribe to Nexus Insights

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

 

Events

Foresight TV

Foresight TV with AgingChoices Founder & CEO Terri Sullivan and Nexus Founder & Fellow Bob Kramer

Join AgingChoices founder & CEO Terri Sullivan and Nexus founder & Fellow Bob Kramer for this episode of Foresight TV on Friday, September 24 at 2pm ET.

ziegler logo

Ziegler Senior Living Finance & Strategy Conference 2021

Bob Kramer will present the closing session, “Future of Senior Living & Care” at the Ziegler Senior Living Finance & Strategy Conference.

SLIF 2021

2021 Senior Living Innovation Forum (SLIF)

Join Nexus Fellows Sarah Thomas, Ryan Frederick Bob Kramer as they present at this year’s Senior Living Innovation Forum October 3-5 in Palm Springs, CA.

 

More info: https://seniorlivinginnovationforum.com/live/

Ziegler Link-Age

Ziegler Link-Age Symposium 2021

Nexus founder & Fellow, Bob Kramer, will serve as a panelist on “The Role of technology in the future of the senior living & care sector” from 3:15-4:15 pm CT on September 9 in Chicago.

McKnights Senior Living Webinar

Don’t restart until you reset: Thinking differently about engagement

In 2020, senior living operators completely altered engagement strategies and gained a deeper understanding of what drives residents’ feelings of joy, purpose and willingness to try new things. Now, many prospective residents are hesitating to move in as they re-evaluate their own definitions of well-being and sense of purpose. Before we start filling activity calendars and returning to previous norms, let’s pause and redefine true resident engagement: A personal and purpose-driven journey that keeps residents connected to the things they cherish while supporting their well-being.

Resident engagement geek and strategist Sara Kyle and agent provocateur Bob Kramer challenge the engagement norm and introduce a framework for a more expansive engagement strategy that could move your engagement programs from cliché to a true competitive differentiator. They will provide the guidance and tools you need to start your engagement revolution today.

Attendees of this webinar will:

  • Discover the three reasons that the engagement programming on which you’ve relied no longer will work
  • Learn the five steps for creating a roadmap to build a more sophisticated and effective resident journey experience
  • Explore the variety of measurements you can use to determine whether your new strategy is working
  • BONUS: Create a compelling message to help you sell your leaders, residents and families on a new engagement model


By attending this program in its entirety, you can earn 1 CE credit!

More info and to register

Foresight TV with Anne Tumlinson & Bob Kramer

Join Anne Tumlinson, CEO of ATI Advisory, and Nexus Fellow, and Bob Kramer, Nexus founder & Fellow, on a special Wednesday episode of Foresight TV hosted by Senior Living Foresight. Steam live via YouTube.