Nexus Founder and Fellow Bob Kramer will be presenting at the Leaders LIVE! in 45 at the Granger Cobb Institute for Senior Living May 10 at 2pm PT.
Join via Zoom.
Nexus Founder and Fellow Bob Kramer will be presenting at the Leaders LIVE! in 45 at the Granger Cobb Institute for Senior Living May 10 at 2pm PT.
Join via Zoom.
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 Lifespark 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. Lifespark 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 Lifespark senior living model will address.
Mullaney notes that Lifespark’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.
Joel Thiessen, CEO of Lifespark, 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.”
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, Lifespark 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.
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 Lifespark 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 Lifespark move.
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.
Are your residents truly known, valued, and seen as people by your staff? Are they known as more than the sum of their ADL needs or underlying health conditions?
Bob Kramer, Founder & Fellow at Nexus Insights and Co-founder and Strategic Advisor for NIC, talked with Jay Newton-Small, founder and CEO of MemoryWell and Nexus Fellow, about the value of data to deliver improved care and quality of life for residents of senior living.
A TIME contributor, Newton-Small developed the concept for MemoryWell from her own experience with her father. She wrote a narrative story of his life to help his care staff understand him better, and to provide better, more personalized care.
Now her company has taken it further, working with senior living communities to foster connections between residents and other residents, and between residents and staff, based on connections, interests, lifestyle, and historical experiences revealed by their life stories. The company is able to help communities understand what services are needed, and who would most likely use or benefit from those services.
“We shine the light to help you see who are the people you’re serving.” – Jay Newton-Small
“Where we are now is a shot in the dark,” said Newton-Small. “We shine the light to help you see who are the people you’re serving. So you can market, plan, sell and care for these people in a more focused way, that takes the guesswork out of it.”
The data has other powerful uses as well, which Newton-Small describes in the interview, which aired on Foresight TV. It can be used to get to the root causes of health issues. And, when aggregated, can be used in a predictive way, to help with prevention. “Right now our health care system is a reactive system. It’s an incredibly expensive system because we react to a problem,” said Newton-Small. “But if we know that a problem is coming down the pike and we can match people with resources that are available, then we can delay, defer and even sometimes prevent those problems from happening.”
Geriatrician Bill Thomas is renowned for his innovative thinking, which has helped transform the industry’s understanding of aging, aging services, and senior living. Dr. Thomas is a Nexus Insights Fellow and founder of The Eden Alternative, The Green House Project, and Minka. Not one to rest on his laurels, Thomas 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.
He took the insights gained during his travels to apply towards three important initiatives: Lifespark, Kallimos Communities, and Canopy. Each one designed to upend traditional approaches to senior living. Each one is designed to put the resident at the center of the solution.
Thomas has recently been named the Chief Independence Officer of Lifespark, a company taking a state-of-the-art approach to senior housing and services. This title reflects Lifespark’s approach to seniors, and their efforts to improve quality of life for seniors, by providing a more holistic and wellness-centered experience. Lifespark integrates housing with home and community-based services, and recognizes the uniqueness of each resident and their individual life goals.
Lifespark acquired Tealwood Senior Living, a Minnesota-based company with 35 senior living communities across Minnesota and Wisconsin. Included are three communities offering skilled nursing services, where Lifespark plans to test its innovative approach. The goal is to provide continuity of care, to make it possible for residents to receive care in their own homes, and to reduce the need for care at hospitals or clinics. The result will help seniors retain their independence longer, be healthier and lead richer lives.
“One-hundred percent of the people living in [senior living communities] need access to primary care, and over time an increasingly high percentage of them need access to supports and services,” said Thomas in an interview with Senior Housing News. “What if a provider of housing is able to wrap the housing access around to primary care and supported services? That’s what’s coming down the pike.”
Thomas’s second initiative is Kallimos Communities, an affordable multi-generational community. The vision for Kallimos is to improve wellness and reduce loneliness for its residents at an affordable cost, by encouraging neighborliness and multigenerational shared housing. “Some of the loneliest elders in America live at home on streets filled with houses but without friends, family, or neighbors as part of their daily life,” Thomas said. “Large senior living buildings offer a solution for some but can be expensive and often carry the stigma of being “old folks’ homes.”
“Let’s create a model that’s actually based on one of the oldest ideas we have, which is people living in their own homes.” – Dr. Bill Thomas
Each Kallimos community consists of “pocket neighborhoods,” which will have up to 50 small homes clustered around a shared green space. The communities will include public amenities, such as small shops for basic goods and services, gathering areas and swimming pools. Along with traditional administrative staff, the communities will include “weavers”, designated staff who have the job of encouraging connections among residents, and supporting residents in achieving their health and life goals. Additional staff known as “keepers” will maintain the indoor and outdoor areas, and may be responsible for cooking and gardening.
Two initial Kallimos communities in Colorado and Texas are in early stages of development. The design is based on a set of principles introduced by Thomas, and further developed by the University of Southern Indiana, called MAGIC (multi-ability, multi-generational, inclusive communities.) The homes will be compact, and designed with features and technology that will support aging in place.
The COVID-19 pandemic also cast a glaring spotlight on disadvantages of traditional senior living, with elders clustered together in one large building. This clustering put elderly residents, who were in the highest risk category for severe illness and death from the disease, at a much greater risk for exposure to the disease.
Deinstitutionalization of the nation’s nursing homes was a clear answer which led to Dr. Thomas’ involvement in Canopy, a joint project with Signature Healthcare. Canopy has many similarities to Kallimos. Canopy communities are a cluster of small, close together ADA-accessible houses, focusing on the importance of neighborhoods. Services, such as assistance with many activities of daily living, is typically a component of nursing home living. For people living in Canopy, services will be provided efficiently within the residents’ homes. And in many cases, neighbors can help neighbors.
“I’m saying, let’s go beyond, let’s move past the era of mass institutionalization,” said Thomas, in an interview with Politico. “Let’s create a model that’s actually based on one of the oldest ideas we have, which is people living in their own homes.”
In fact, funding for non-medical services, such as rides to the grocery store, help prepping meals, and meal delivery, have recently started being covered by private Medicare plans. The trend toward increasing coverage of home and community-based services (HCBS) is expected to continue. “The pendulum’s swinging to home and community-based services,” said Thomas. “And in order to make those services really work, we need better homes and better communities — and that’s what Canopy is designed to provide.”
“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.”
COVID-19 has been a tremendous challenge for everyone, but it has shone an especially bright spotlight on how underserved our aging population really is. We sat down with Senior Managing Partner at Longevity Venture Advisers, Jody Holtzman, to discuss trends, challenges and opportunities in the longevity and aging industry in this new world.
Jody is a well known leader in the aging and longevity world, having spent the past 15+ years in the field, preceded by a career in strategy consulting. His work in aging includes a 12 year stint at AARP where he ran research and was senior vice president of thought leadership and market innovation.
NEXUS INSIGHTS – You have spoken about Baby Boomers and their lack of interest in traditional long-term care communities, especially assisted living. Tell us more about that.
JH – First, it is hard to generalize when you are talking about a population of just over 70 million people, which is the current Boomer population in the US. That’s more people than in the UK, France, or Italy. So, let’s just establish that one size does not fit all and there will always be a segment of Boomers for whom traditional long-term care settings are attractive. However, even before the pandemic, occupancy rates across independent and assisted living already were at a low, while the age of new residents continued to climb well into the 80s. And the mental image and mental model of long-term care communities for Boomers was one of nursing homes where people are warehoused to die. Since the pandemic this image has only been deepened as Boomers saw nursing home death rates, as well as experienced such with their own older loved ones.
There also is something else going on when we look at how Boomers view long-term care. And that is, they simply do not see themselves in those settings. It does not jive with their own self-image. This came out in spades to me the first time I spoke to a LeadingAge conference and did this exercise with the audience. I asked everyone to stand if they proudly participate in the management of any type of long-term care community. Three hundred and fifty people jumped up. Smiles all around! Then, I asked them to remain standing “if you are looking forward to the day you live in your own facility.” And the overwhelming majority of the audience sat down. These were people on the front lines of senior living, committed to making life better for older people. But they also, overwhelmingly, were Baby Boomers. And they did not see themselves in senior living. So, something has to change.
There is something else going on when we look at how Boomers view long-term care. And that is, they simply do not see themselves in those settings. – Jody Holtzman
NEXUS INSIGHTS – You talk about how the pandemic has shaped how and where health and healthcare happen. Tell us about the trends that you are seeing.
JH – Trends over the past year, both within and outside senior living, have increasingly confirmed that the home is and will continue to be the focus of health, care, and connected living. The growing consensus across the healthcare community got a boost from the orientation embedded in the concept of social determinants of health (SDOH) which is encapsulated in the view that health is a function of one’s zip code and the conditions of life in a geographic area. Health is now, officially, “beyond medicine.”
In parallel with the new focus on SDOH over the past year, digital health has exploded. While the health benefits of home-based care were being proven, along comes COVID and people are told to lock down and remain in their homes. Telehealth, telemedicine, and other virtual communications, became the dominant market response in healthcare and society more broadly. All in combination reinforcing the centrality of the Home and further boosting demand for more home and community-based products and services.
NEXUS INSIGHTS – You work with a lot of healthcare companies in the aging space. How are they dealing with these new trends and market opportunities?
JH – In response to the pandemic, and to both longstanding needs and those recognized by looking at health through the lens of SDOH, CMS has added a growing list of non-traditional, supplemental benefits that may be reimbursed through Medicare Advantage, but not traditional Medicare. Startups and others have responded with an array of new offerings covered by new reimbursement codes. And MA plans have been increasingly adding them to services already offered in their plans. While payers have had the near-term benefit of attracting new customers through product/service-based competitive differentiation during Open Season, the longer-term health benefits and attendant cost savings have yet to be proven. And this brings us to a dilemma. While the need and availability of a growing list of technology-enabled products and services has been established, customer/patient adoption is still low, and returns on investment have been as well.
For startups, this is concerning because, in many cases, they are being directed by investors and others to build their channel strategies around Medicare Advantage. Even if the deals with payers are all gain-share arrangements without requiring cash outlays by the payers, they still are making an investment in time and dedicated resources, if only to track progress. The question needs to be asked and monitored – how long will MA plans include offerings that garner limited customer uptake? If nothing else, the current terrain calls for a diversified go-to-market strategy that is not solely dependent on Medicare Advantage.
If you’ve seen the movie A Christmas Story, you likely remember the scene in which 9-year-old Ralphie is helping his dad change a tire on the side of the road on a dark snowy night. Ralphie is so excited to help but he drops the lug nuts and loses them in the snow. In frustration, he yells out “Fuuuuudggge!” Ralphie then explains through narration, “…only I didn’t say fudge. I said THE word. The queen mother of all dirty words – the F-dash-dash-dash word!” Ralphie ends up being punished with a bar of soap in his mouth.
That’s how we should view the word ‘facility’. As the queen mother of all dirty words: the F-bomb.
Do you dream of living in a facility? Of course not! Facilities are cold institutions where humanity and the human spirit wither and die. Why then do we use this awful term to describe the places older people live and receive support? It denigrates residents and team members alike, yet it’s sprinkled generously throughout the narrative of senior living – by government regulators, by leaders in the field, and even by people living and working in communities.
At Christian Living Communities-Cappella Living Solutions, we’re on a mission to ban the F-bomb because, as Dr. Bill Thomas, Founder of the Eden Alternative, has said time and time again, “words make worlds”.
Our words drive our beliefs and behaviors. Call a building a facility and people will act like they live and work in a facility. Call it a community and the seeds of change are planted.
Community is a word filled with promise, with hope, and with citizenship. In a community everyone is valued and has a role to play. This is the type of culture we strive to build in each CLC-Cappella community. Yes, we provide excellent care and services, but we also purposefully create environments where each person has autonomy, a deep sense of belonging, continued growth and meaningful purpose.
It’s time to eradicate “facility” from our vocabulary and start using words that honor elderhood. So, bust out the soap, implement a “swear jar” if you want. Let’s start changing our world through the words we use.
Originally posted in Christian Living Communities.
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“We’ve all learned lessons, painfully, during this pandemic,” said Bob Kramer, Founder & Fellow for Nexus Insights, and Co-founder and Strategic Advisor at NIC. “Let’s seize the opportunity from the crisis so we can say we learned from it, and we won’t be here a year or two from now saying that nothing is different.”
Kramer was speaking as part of a panel at Living Well, a forum to advance important aging-related issues that is hosted annually by A.G. Rhodes. This year’s event, which was held virtually for the first time, addressed the topic Aging and Senior Living Post-COVID-19. A.G. Rhodes is a top nursing home provider of senior rehab services and long-term care in Atlanta and Marietta, and one of Atlanta’s oldest nonprofit organizations.
Kramer was joined on the panel by Becky Kurtz, Director of the Atlanta Area Agency on Aging, Elise Eplan, Founder & Principal of The Eplan Group, and Deke Cateau, CEO of A.G. Rhodes. The panel was moderated by Jocelyn Dorsey, Former WSB-TV Broadcast Manager and Member of the A.G. Rhodes Board of Directors.
The discussion addressed a number of important issues facing senior living administrators today, including the role of leaders in managing the crisis, response to issues of safety and social isolation and how to balance the two, the challenges of aging infrastructure for infection prevention in skilled nursing facilities, as well as the importance of transparency in addressing problems spotlighted by the pandemic.
The discussion also highlighted some of the silver linings from the pandemic, such as the impact of vaccines, and the new spotlight on the issue of loneliness. “One benefit of this horrible pandemic is that it has brought empathy to the issue of social isolation and loneliness for older adults. I can now talk to any college student and they will get it, because they too miss getting together with their friends,” Kramer observed.
“Out of the tragedy of COVID, there are a lot of silver linings, a lot of good things we’re learning,” said Bob Kramer, Founder & Fellow at Nexus Insights and Co-founder & Strategic Advisor at NIC.
Kramer was featured in a session entitled, “How COVID-19 Has Impacted Our Industry, a Conversation with Bob Kramer” as part of The Big Connect 2021, presented by HumanGood. Kramer spoke with John Cochrane, President & CEO of HumanGood, California’s largest nonprofit provider of senior housing and one of the 10 largest nonprofit senior living organizations in the nation.
“The worst may be yet to come in terms of public perception,” Kramer observed. “We’re just now starting to rev up for countless investigations, task forces, hearings, research studies, and so on that will ask one question: What went wrong and how do we prevent it in the future?”
The Big Connect is an annual event that brings together HumanGood’s leadership team, board members and strategic partners to showcase how they are designing experiences that inspire their residents, team members and prospective customers to live their best lives possible.
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