What technology is right for your business? How can artificial intelligence improve operations? 

Technology is changing the senior living industry. The promise is that innovative solutions will boost operational efficiency and resident satisfaction. The risk is that technology can’t or won’t deliver on that promise because it doesn’t really work or quickly becomes outdated as new solutions emerge.  

Two thought leaders will address the promises and risks of new technology at the upcoming 2023 NIC Fall Conference. They will speak during the popular NIC Talks session. 

An attendee favorite, NIC Talks will feature four dynamic speakers. Each will give a 12-minute TED-style talk on innovative approaches to senior living. In addition to the topic of technology, attendees will learn about a radical and successful approach to customer service and how to leverage healthcare to improve occupancy and resident satisfaction.  

“NIC Talks is designed to challenge the status quo,” said Bob Kramer, NIC Co-Founder/Strategic Advisor and Founder at Nexus Insights. “Attendees will gain new perspectives that can truly jumpstart growth opportunities.”  

The 2023 NIC Fall Conference will be held October 23-25 at the Sheraton Grand Hotel in Chicago. NIC Talks will be a featured Main Stage session on Tuesday, October 24. Kramer will curate the session.  

The two speakers on technology recently previewed their talks for NIC. Former Apple executive Dhaval Patel will present a framework to help operators decide which technologies to deploy amid a growing and sometimes confusing array of options. Speaker Hahn Brown will detail how the arrival of artificial intelligence will transform the senior living business.  

Start with the End User

Necessity was the mother of invention for NIC Talks speaker Patel. The title of his talk is “Smart Technology Isn’t Everything. Believe Me, I’m an Apple Inventor.”  

Despite his work at Apple creating smart technology, Patel had his own ah-ha moment when he couldn’t easily get out of bed to turn off the lights because of a knee injury. That led him to rethink how technology products are designed.  

Patel is now an advocate for human-centered design. Technology should be designed to be used by everyone no matter their age or abilities. “Start with the end user,” said Patel, founder and CEO of Lotus, a company that has invented user-friendly smart home technology.    

The same thinking can be applied by senior living providers overwhelmed with new technology choices. How can they sort through the options to know which technologies are the best choices for their business, and for residents?  

Patel suggests that owners and operators first ask themselves what problem they’re trying to solve. What will help residents? “Think intuitively,” he said. A smart investment in technology results in a solution that addresses a problem or pain point.  

Attendees will learn what questions to ask to evaluate a new technology. Was it created for people with mobility or cognition issues? Is the technology going to work, and work easily? Will it be adopted by residents and staff?  

“Ask how the technology was designed,” said Patel. “That’s how you know what to look for.” 

The Promise of AI 

Artificial intelligence will have a profound impact on senior living. Hanh Brown, founder and CEO of ThinkAi6 and the Boomer Living Podcast, will explore the impact of AI on the customer experience, workforce, and sales and marketing. She will also provide key tips for getting started. Her talk is titled, “The Digital Transformation of Senior Living through Generative AI.”  

Hahn was a performance manager at General Motors working on Corvettes but her mother’s battle with dementia redefined her understanding of senior living. Now she’s focused on the cutting-edge technology that will change the senior living industry.  

In a preview of her talk, Brown highlighted how different stakeholders will benefit from the AI transformation.   

For senior living providers, AI can be used to personalize the customer experience by tailoring programming for the individual based on their preferences. Services and care plans can more easily be customized. Personalized programs can help increase customer satisfaction, sales, and brand loyalty. This approach will become more important as baby boomers who value independence and choice enter the senior living market. 

Smart tools will help boost staff productivity. For example, AI-powered language engines, such as ChatGPT, can answer resident questions quickly and improve response times.  

Employee training is another area where AI will make a big difference. Caregivers can have access to training modules tailored to their needs depending on their understanding of the job. AI generated training can also help set a career path for employees to progress into different or more advanced roles.  

For sales and marketing, AI can be used to segment audiences based on their preferences. “We can reach out to prospects with customized messages,” said Brown.   

New types of AI-generated content for marketing materials are growing in sophistication. AI-generated art has made huge advances providing images that resonate with potential residents and families.  

Brown emphasized that AI output is based on data input. AI algorithms work best with a large volume of data. “The heart of AI is your data,” said Brown. Though the thought of utilizing AI can seem intimidating, she noted that the technology is evolving so rapidly that providers cannot afford to ignore the possibilities. “We have to get on board. This is a great time of innovation,” she said. 

NIC MAP Vision released its latest Skilled Nursing Monthly Report on September 28, 2023. The report includes key monthly data points from January 2012 through July 2023.

Here are some key takeaways from the report:

Occupancy

Skilled nursing occupancy held steady in July after increasing in June. Occupancy has hovered in the 81% range since January and ended July at 81.5%. However, occupancy has increased 82 basis points since December 2022. There was positive momentum in occupancy throughout last year (2022) and it is up 668 basis points since the low (74.8%) point reached in January 2021. Although occupancy was relatively flat from May 2022 through September 2022, it did increase 277 basis points from January 2022 to January 2023. The staffing crisis in the sector is still a significant burden on many skilled nursing operators, especially as the acuity level of patients has increased along with the demand for nurses. As staffing and general inflation pressures persist, operations for many operators will be under pressure but the long-term demand for skilled nursing services is expected to grow over time.

Medicaid

Medicaid revenue mix increased 143 basis points ending July at 54.3%. It is up 218 basis points from one year ago when it was 52.2% in July 2022. One element of the Medicaid revenue share of a property’s revenue is revenue per patient day (RPPD) and that was up 1.1% from June. It is up 2.6% since last year in July 2022 and is now at $278. Medicaid reimbursement has increased more than usual as many states embraced measures to increase reimbursement related to the number of COVID-19 cases throughout the pandemic, but many states have continued to increase reimbursement. Medicaid has increased 7.4% since February 2020. On the other hand, covering the cost of care for Medicaid patients is still a major concern as reimbursement does not cover the cost of care in many states. In addition, the compounding impact of inflation growth since the pandemic and elevated interest rates have created expense pressure for many operators around the country.

Medicare

Medicare revenue per patient day (RPPD) decreased from June to end July at $589. This was a 1.0% decrease from its recent high of $595 in December 2022, which was its highest level since June 2020 when the federal government began implementing many initiatives to aid operators of properties for cases of COVID-19, including increases in Medicare fee-for-service reimbursements to help care for COVID-19 positive patients requiring additional care. Medicare RPPD is up 1.94% from one year ago in July 2022 and some of that increase can be attributed to the fiscal increase for 2022-2023. Meanwhile, Medicare revenue mix trended down in the month of July, decreasing 85 basis points from 18.0% to end the month at 17.2%. It is down 399 basis points compared to one year ago in July 2022, and it is down 7.1 percentage points from February 2022 which was when the country had an elevated number of COVID-19 cases, and the data suggests there was a significant uptick in the utilization of the 3-Day Rule waiver as COVID-19 cases increased last year. The 3-Day Rule waiver was implemented by Centers for Medicare and Medicaid Services (CMS) to eliminate the need to transfer positive COVID-19 patients back to the hospital to qualify for a Medicare paid skilled nursing stay, hence increasing the Medicare census at properties. As the cases decline, the Medicare revenue share declines, all else equal.

Managed Care

Managed Medicare revenue mix decreased 38 basis points from June to end July at 11.6%. However, this is up 243 basis points from the pandemic low set in May 2020 of 9.2%, which was a time when elective surgeries were suspended and created less referrals from hospital to skilled nursing properties. Meanwhile, Managed Medicare revenue per patient day (RPPD) increased from $491 to $492 in July. Compared to its year-earlier value of $492, it is up 0.1% but it is down $120 (19.6%) from January 2012. It continues to create pressure on operators’ revenue as managed Medicare enrollment continues to expand its reach and coverage around the country. However, some operators see an opportunity to capture patient volume with the growth of managed care. The persistent decline in managed Medicare revenue per patient day continues to result in an expanded reimbursement differential between Medicare fee-for-service and managed Medicare. Medicare fee-for-service RPPD ended July 2023 at $589, representing a $97 difference. For context, the differential one year ago was $86 and two years ago it was $84.

To get more trends from the latest data you can download the Skilled Nursing Monthly Report here. There is no charge for this report.

The report provides aggregate data at the national level from a sampling of skilled nursing operators with multiple properties in the United States. NIC continues to grow its database of participating operators to provide data at localized levels in the future. Operators who are interested in participating can complete a participation form here. NIC maintains strict confidentiality of all data it receives.

New research from NORC at the University of Chicago, funded by a grant from the National Investment Center for Seniors Housing and Care, sheds light on older adults’ vulnerability to declining health outcomes before and after entering a senior housing and care property.

The results of the study provide insights into understanding current and growing demand for senior housing. The study is the first in a four-part research series that assesses the health and well-being of seniors housing and care residents. Subsequent studies will provide insights on access to health care providers, longevity, and health outcomes of residents in senior living settings.

Research findings show that vulnerability – as defined by “frailty levels” of residents – rises in the months leading up to a move into a senior housing and care community. Approximately three months following move-in, however, vulnerability plateaus and thereafter improves. These outcomes are consistent across all senior housing and care property types – independent living, assisted living, memory care, nursing care, and continuing care retirement communities (CCRCs).

While conclusions from this study show that vulnerability improves following a move to senior housing and care, findings do not specifically identify the direct causes for the improvement. Senior housing offers supportive services that can lead to greater resident vitality and quality of life. Indeed, non-medical services provided within senior housing and care settings – social engagement, community involvement, balanced nutrition, transportation, and access to exercise – are likely vital contributors to improving resident health.

The change in vulnerability shortly after moving into a senior housing and care property speaks to one of the many value propositions provided by senior housing settings that are offered to residents.

The findings from this research are foundational and set the table for subsequent studies to examine the impacts of access to healthcare providers, the role senior housing and care plays in resident longevity, and how health outcomes for older adults differ from congregate to non-congregate settings.

Other findings from this study confirm what many operators already understood – vulnerability to declining health outcomes, as defined by “frailty levels” of residents, is highest in communities with the most intensive available support services. Put another way, the proportion of increasingly vulnerable residents increases with expected community acuity.

Vulnerability of older adults is an important concept in senior housing and care research, because it suggests that vulnerability is not a permanent condition, but rather a temporary state of being that can be corrected with the proper interventions. Senior housing and care operators routinely assess residents to mitigate risk and improve health, as even older adults who are relatively healthy could be one incident away from needing higher levels of care.

The methodology for the study utilizes an academically-designed data linkage approach which ties property information from the NIC MAP® Data Service, powered by NIC MAP Vision, with Medicare Current Beneficiary Survey (MCBS) data and comprehensive administrative and claims data. These data sets, combined with Harvard University’s Claims-Based Frailty Index, provide valuable insights into the health and well-being of seniors housing and care residents.

With few data sources available to analyze the health needs of senior housing residents, this nationally representative survey allows senior housing and care stakeholders to better understand the changes in vulnerability that occur after moving to a congregate setting.

To view the complete slide deck of findings, including methodology, vulnerability levels by property type, common conditions, illustrative vignettes, and future planned research, download the Research Report.

CLICK HERE TO ACCESS THE RESEARCH REPORT

Session speakers kickstart inspiration.  

Radical customer engagement can drive business growth. Healthcare and senior living can co-exist to open new possibilities. 

These are just two of the provocative topics to be explored during the NIC Talks session at the 2023 NIC Fall Conference. Four dynamic speakers will each give a 12-minute TED-style talk on innovative approaches to senior living. Other topics include the effective use of artificial intelligence and how to sort through technology offerings.  

“Attendees will hear ideas that challenge established ways of thinking,” said Bob Kramer, NIC Co-Founder/Strategic Advisor and Founder at Nexus Insights. “Innovative perspectives can create new opportunities.”   

The 2023 NIC Fall Conference will be held October 23-25 at the Sheraton Grand Hotel in Chicago. NIC Talks will be a featured Main Stage session on Tuesday, October 24. Kramer will curate the session.  

Two speakers recently previewed their talks. Caroline Pearson will relate a personal experience to explain how connecting healthcare and housing can boost move-ins and margins. Speaker Gerard van Grinsven will detail how to create a hospitality-inspired strategy—an experience blueprint—to outperform customer expectations and deliver superior results. 

Van Grinsven, renowned for his extensive luxury hotel industry experience, passionately emphasizes the importance of crafting an irresistible value proposition that renders customers indispensable. He articulates his unwavering customer-centric philosophy, by urging businesses to embrace a paradigm-shifting mindset. 

With executive stints at the Ritz-Carlton organization, the Henry Ford West Bloomfield Hospital, and the Cancer Treatment Centers of America, van Grinsven unveils the key to his remarkable success: a resolute departure from conventional thinking, guided by his steadfast commitment to satisfying customers’ unexpressed desires. 

During his tenure at Henry Ford Hospital, van Grinsven dedicated an immersive six-month period to personally visiting local families before the hospital’s grand opening, unearthing their deepest healthcare preferences—unlike conventional focus groups which often fail to capture the subtleties of unspoken aspirations. Instead, he embarked on in-home journeys with prospective customers, unearthing their needs and true desires. The outcome catapulted the hospital to the pinnacle of national rankings for patient engagement scores. 

Moreover, van Grinsven underscores the importance of extending this ethos of engagement to the employees, an imperative made even more pressing in today’s challenging workforce landscape. He strongly encourages organizations to earnestly explore avenues to enrich workplace culture with unwavering trust, respect, and dignity. 

As he embarks on the launch of a visionary luxury lifestyle boutique hotel management company, van Grinsven reiterates the importance of valuing team members, a commitment that both curtails turnover rates, and engenders a deeper emotional connection with customers. 

Van Grinsven anticipates his NIC Talks presentation will inspire attendees to vigorously reassess their modus operandi, by severing the shackles of conventional thinking and embracing innovation and dedication to customer-centricity.” 

Housing and Healthcare Can Co-Exist 

NIC Talks speaker Pearson has long been puzzled by the divide between healthcare and housing in the senior housing market. She is currently the Executive Director of the Peterson Center on Healthcare. Pearson is already familiar to the NIC audience. She was formerly the Head of Healthcare Strategy at NORC at the University of Chicago, a research organization, and led the seminal NIC study, “The Forgotten Middle.”  

Based on her work on the middle market, Pearson views healthcare as an integral component of the senior housing value proposition. “It’s particularly true for those who do not have the resources to easily afford senior housing,” she said.  

Many older people believe they want to age in place, but they reconsider when health, cognition, and mobility issues arise. The stairs are hard to climb. It’s difficult to get to the doctor’s office. “The industry continues to sell lifestyle, community and purpose, which are critically important, but we should embrace what people also need which is a safe caring environment to help them live well.”  

For senior living providers, specific changes might include creating a clinic space on the property for healthcare providers to see residents, and a system to easily handle virtual doctor visits. “Those are huge value adds,” said Pearson.  

Healthcare services, in some form, represent a huge opportunity to broaden the senior housing market, she added. Also, the healthcare system will benefit by closing its gaps in care. The healthcare workforce isn’t large enough to deliver healthcare individually to people in their homes. “Senior housing operators have the geographic efficiency of having residents together,” she said.  

The senior living industry doesn’t want to be seen as the sick care industry. They want to be the place where the vibrant last stage of life can take place. But, Pearson noted, “Those two ideas do not have to be in conflict if operators embrace the integration of housing and healthcare.”

Like so many executives, Ryan Galea was motivated by a personal experience to jump into the senior living industry. He was working on Wall Street investing ​in the healthcare and technology sectors. But when his grandmother became ill, he saw that she didn’t have the best care experience before she passed away.

So, he decided to improve the aging experience by creating a better all-in-one communication and engagement software for organizations that support seniors. Galea consolidated several software platforms in the senior care space and named the company Icon. 

NIC Senior Principal Ryan Brooks recently talked with Galea, CEO at Boston-based Icon. What follows is a recap of their conversation about Icon and its commitment to revolutionize the aging experience by engaging, informing,​ and uniting all stakeholders in the community. 

Brooks: To kick off, can you tell us a little bit about Icon? 

Galea: Before my grandmother passed away, she told me to grab opportunities when you can. That advice had a big impact on me. Based on her disappointing care experience, I came up with the idea to consolidate some of the software platforms in the senior care space. The available platforms were single-point solutions that really didn’t talk to each other. So, in 2021, we acquired VoiceFriend, a cloud-based communications platform. Then, in 2022, we acquired CareMerge, a provider of engagement solutions. We renamed the combined company Icon.   

We reimagined the mission of the company. In our view, Icon is more than a tech platform. We are focused on innovation to equip providers with the tools needed to communicate and engage with the entire community including residents, families, and staff efficiently and effectively. 

Brooks: How many senior housing and care communities is Icon in currently? How do you anticipate that changing in the coming years? 

Galea: We are quite sizable. There wasn’t a lot of overlap between the footprints of VoiceFriend and CareMerge. We’re in more than 2,000 communities in the U.S., and several in Canada. We’re looking to expand there and in Europe and to increase the depth of our offerings. 

Brooks: Users can face a steep learning curve with some technologies. Can you tell us about Icon’s user experience? 

Galea: This is one of the areas where we excel. Last year, we received the “Best Ease of Use” award in our category from Capterra, a highly regarded software review website. That speaks volumes about our design philosophy. We designed our platform with users in mind. They all have smartphones and understand mobile workflows. Older platforms were not built on the new age architecture experience and that’s a big roadblock. We have adoption ​success because our platform feels like all the other applications people are using today.  

Brooks: Data is such an important part of managing the health and well-being of the seniors living in our communities. Can you tell us about the ‘Reporting and Analytics’ solutions that Icon provides? 

Galea: We gather community-level intelligence from the data on the platform to refine the overall resident experience. Operators can gain insights into program effectiveness, engagement, resident and family feedback, and other key indicators. Our new enterprise dashboard allows a central multisite operator to view all of their properties in one place. They can compare properties to see why one has a higher satisfaction score than the others. They can get solid insights into usage patterns to implement best practices across the portfolio. We’ve developed the tools to make that easy.   

Brooks: Socialization is seen as one of the key value propositions in senior living. How does Icon encourage socialization and a sense of belonging? 

Galea: Socialization is the cornerstone of the senior living experience and also a cornerstone of our platform. There are different ways that the platform encourages socialization. We empower residents. There is no better way to foster a sense of belonging than to give seniors the tools they need to make connections themselves. So, we give them the tools to organize their own groups and events. For example, one woman moved to a community after her husband passed away and wanted to meet people. She had liked to watch NASCAR with her husband, so she created a NASCAR group. It turned out that lots of other people in the community liked NASCAR, joined the group, and organized a watch party. We also give the community the data to personalize the resident experience. We can track resident interests so the staff can recommend programs to drive attendance. We can also offer personalized programming suggestions to seniors based on their interests.   

Brooks: What makes an iconic aging experience different from a great aging experience? 

Galea: Successful brands are very focused on the consumer. Apple is an example, or the online pet supply store Chewy. ​Chewy sends each customer a​​ ​handwritten letter on their dog’s birthday. We have an obsession with the consumer that is rare in senior living. Our platform delivers that phenomenal experience to help providers understand what the customer wants.  

Brooks: How do residents’ families view the communication tools provided by Icon? 

Galea: We take an omni-channel approach. Our philosophy is to meet stakeholders where they’re most comfortable. We have a family phone app to show what their loved one is doing day to day and to provide feedback to the community or talk to the staff. We give adult children visibility into their loved one’s day without having to make a lot of phone calls.  

We also provide communication by text, phone call, ​Amazon Alexa, ​or email. ​We can even translate the message if the family member is a non-native speaker to sidestep language barriers. We don’t impose the way we want to communicate with the family. We meet them where they’re comfortable.  

Brooks: How does Icon improve communication with the caregiving staff? 

Galea: We continue to build out this area of our platform. The staff experience is essential to the senior aging experience. A happy staff makes happy residents. We facilitate the ability to communicate with staff and families one-on-one or in group conversations. Senior living has a lot of immigrant labor. Our platform is inclusive and its translation capabilities make it easy to communicate with staff. We have a new employee portal, a hub where the staff can see everything happening from employee events to training sessions. Our awards recognition platform is coming out later this year to drive staff retention. It will provide more instant recognition for the hard work the staff is doing.  

Brooks: Staffing and retention challenges that were prevalent before the pandemic have unfortunately been exacerbated. In what ways does Icon make it easier for staff to be efficient and resourceful in their jobs? 

Galea: A big part of our platform is giving the staff the tools to make their lives easier. Our goal is to streamline data entry, so the staff only has to input information at one point. The data is then pushed to every channel, from PowerPoint slides to printed newsletters and other means of communication. We also store resident bio information to help optimize programming to include the most common interests in the community. ​We make it easier to communicate with residents and family. 

Brooks: One of the key performance metrics for skilled nursing communities is reducing readmissions for discharged patients. How do Icon’s communication tools reduce the likelihood of a discharged resident being readmitted to the hospital? 

Galea: We have a robust workflow automation engine. One of the first big issues we addressed with this platform was post-discharge management. Our tool lets the community design a ​multi-day cadence of messages. On day one, ​for example, ​the primary contact could get a ​message​​ ​“​How are you feeling?​”​ It’s automated, customizable,​ and tracks responses. Anything that is concerning generates a flag alert for a staff follow-up. It’s a scalable system to make sure communication is happening. ​It saves time and promptly identifies the need for treatment.  

Brooks: Are there any other new features or upcoming releases that Icon plans to introduce?​​     ​  

Galea: Yes, we are introducing the employee engagement platform with rewards and recognition programs. We looked at peer-reviewed literature to improve employee satisfaction and retention and built that into an automated platform. We are also introducing a Smart A​​ging platform to improve wellness. Unlike a lot of today’s platforms which are very passive, our platform engages residents to improve their well-being. We use artificial intelligence to design unique programming to help residents set goals, track their progress,​ and boost overall well-being.   

Brooks: Is there anything else you’d like our audience to know? 

Galea:  At its core, Icon is more than a collection of technologies. It’s a testament to creating a seamless ecosystem to manage the resident experience. ​Our goal is not just to solve problems. We are really helping to sculpt those experiences that inspire growth, foster connections,​ and touch the hearts of residents and family members. Icon is like a digital bridge for connections, transcending the boundaries of what is physically impossible in a physical setting.  

Brooks: AgeTech is a focus for NIC. Can you leave us with your final thoughts on innovations in AgeTech? 

Galea: Innovation is not just doing something new but making a difference with what you are doing.​Innovation is about elevating the human experience. When we think about innovation and AgeTech our goal is for the platform to make a difference. Technology is the means to make a noticeable, measurable impact. That is the future of AgeTech.