Building off the momentum, enthusiasm, and focus of NIC’s recently released Middle Market Study, NIC will open and close the 2019 Fall conference with two sessions dedicated to this topic. The study, funded by NIC and conducted by NORC at the University of Chicago, revealed there is a substantial market that private-pay seniors housing currently is not serving. This is the cohort who do not qualify for Medicaid but may not have sufficient resources to pay for private seniors housing as it exists today. More than half of these individuals are projected to have mobility limitations by 2029 and other health care needs.

In the first session to be held on Wednesday at 3:15 PM CT, “hackers” identified ahead of the event will have worked in small groups to design care and housing solutions for the nation’s middle-income cohort. This so-called “hackathon” event will focus on the practical elements of designing a property to suit this cohort, while meeting business goals. Their resulting proposed solutions will be presented to those in attendance at the session.

In the second session to be held on Friday at 9:00 AM CT, practical solutions from Wednesday’s Forgotten Middle hackathon session will be discussed and debated in a town hall format that will encourage a roundtable discussion among thought leaders and session attendees. Entrepreneurs with imagination and passion are encouraged to attend.

Meeting the care and housing needs of “forgotten middle” seniors will require practical solutions, in the design and construction of new properties and their associated services, as well as in financial structures and the capital stack. Both public and private sectors will need to work together to successfully bring solutions to this challenging opportunity. New thinking may assume greater flexibility from government—on both state and federal levels—on zoning, regulatory restrictions, and potential subsidies. Other factors may include technological cost-savers, more affordable designs, entrepreneurial approaches to public-private partnerships and financial incentives for capital providers. 

Expected discussion topics include:

• How big is the opportunity?
• How can the private sector provide care and housing to this growing cohort?
• Can the private sector do it alone or does it need government assistance?
• What are practical solutions to providing care and housing to this growing cohort?
• Will investment returns need to be adjusted to attract capital to this cohort? Is this a more or less risky opportunity?
• Do underwriting standards need to be adjusted to accommodate this evolving investment prospect? 

Sessions:

• The Forgotten Middle: Understanding a Growing Opportunity
  September 11, Wednesday at 3:15 PM CT
• A Growing Opportunity: Partnerships Working Together for The Forgotten Middle
  September 13, Friday at 9:00 AM CT

To learn more, please visit here.

In mid-July 2019, I had the pleasure of attending the 10th Annual NELS Summit in Washington, DC. NIC is a proud co-sponsor of the three-day event, where emerging leaders in health and aging services can connect with peers, develop their leadership skills, learn about advocacy, and network with industry leaders. The majority of NELS attendees hold Executive Director or Administrator positions at skilled nursing facilities, assisted living and independent living communities, CCRCs, rehabilitation hospitals, affiliated organizations, and home- and community-based services.

I was struck by the candor, professionalism, and dedication of attendees, organizers, and presenters. Their enthusiasm for improving the lives of residents, staff members, and families was truly moving and representative of the ideals that draw people to careers in health and aging services.

On the first day of the Summit, Dr. Kevin Hansen, Assistant Professor at Bellarmine University, and Director of NELS, introduced the history of NELS, the purpose of the summit, and data from a pre-summit survey. Michael Muetzel, President, Author, Leadership Development at Mx Marketing Management Solutions, provided insight focused on generational differences in the work force and the strategies and benefits of leading diverse teams and creating positive workplace culture. Attendees also shared best practices and perspectives on a range of topics like regulatory environments, staffing pressures like recruitment and retention, and culture in small round table discussions. These presentations and conversations provided attendees with new, practical strategies and ideas they could implement in their communities after the Summit.

On the second day of the Summit, attendees listened to a panel presentation and discussion of NELS alumni moderated by Dr. Douglas Olson, Professor at the University of Wisconsin Eau Claire, and Senior Advisor for NELS. The panel discussed what NELS meant to them and provided valuable lessons in their journeys in leadership— not only as leaders in their respective organizations, but also in their professional organizations and advocacy efforts.

Liz Liberman, Senior Analyst Manager at Bulletin Intelligence, and Dr. Kevin Hansen discussed legislative policy advocacy. Liberman detailed how NELS attendees and others can comment on potential legislation from the executive branch to make their experiences and voices heard on topics impacting their communities. Hansen also discussed advocacy strategies that NELS attendees can implement with the support of their communities to impact potential legislation. NELS attendees finished the day by traveling to Capitol Hill for a meeting with Wisconsin Congressman Ron Kind and his staff.

On the final day of the Summit, attendees met leaders of several major partnering organizations including LeadingAge, Argentum, NAB, ACHA, and ACHCA. The group of leaders presented a panel discussion covering topics including their paths to their current positions, what their respective organizations do and offer members, valuable resources and research for leaders, and current issues affecting health and aging services. Attendees also had the opportunity to speak with leaders in small breakout group sessions to learn more details about their organizations and membership.

Interspersed between the presentations over the three days were group exercises designed to develop attendees’ connections with each other and areas of interest, culminating in final teams. Teams developed ideas for projects for the coming year with the support of Dr. Hansen, Dr. Olson, Mr. Muetzel, Dr. Keith Knapp, Associate Professor, Bellarmine University, and Lindsey Creapeau, HCAD Practicum Coordinator, Health Care Administration Program at the University of Wisconsin – Eau Claire. The attendees of this year’s summit will work in teams throughout the year on the projects— all with the goal of “developing solutions to enrich lives.” Summit proceedings, outcomes, and key conclusions from each year are published in a white paper that is available for download on the NELS website.

If you are interested in attending or know someone you think would be a good candidate, applications for the 2020 NELS Summit will be open on nelssumit.org starting in the Spring. We highly encourage you to send your best and brightest to this excellent opportunity for leadership and professional development in 2020

The seniors housing resident profile has changed since the industry’s early days in the 1990s. Seniors are generally choosing to enter a community later in life as better medical care and quality of life continues to increase life expectancy. Americans are staying healthier for longer, so it’s not surprising that the industry has observed a gradual increase in a resident’s average age as many are now choosing to enter seniors housing well into their 80s. According to a 2013 study conducted by American Seniors Housing Association and ProMatura Group of 6,858 IL rental customers, only 6% of IL rental customers were under the age of 75.

Why does it matter that residents are moving in later? Simply put, the Baby Boomers. Baby Boomers are one of the largest demographic cohorts (74 million in the U.S.) and have begun to reach the age of 65 and older. As shown in Figure 1, the growth in Americans aged 75 and older will accelerate over the next 15 years and comprise 15% of the overall population by 2029 (up from 11% in 2019) as the Baby Boomers age. This unprecedented wave of future demand will have lasting ramifications on the seniors housing and care industry. That said, determining when this will occur has become a moving target as Baby Boomers are waiting longer than prior generations to consider seniors housing options.  

The Baby Boomers are very different than their Silent Generation parents. First, the Baby Boomers will have a much longer retirement. The first of the Baby Boomer generation was eligible to retire in 2012 and will likely enjoy 25 post-work years. The oldest Baby Boomer is turning 73 years old this year and remains largely independent and active. They are potentially a decade away from requiring any assistance with daily activities that seniors housing provides. Second, Baby Boomers grew up in a period of economic expansion and social progress, and as a group, they are more educated, wealthier, and more physically fit than past generations. Boomers want what they want and many will have the financial means to maintain their desired lifestyle. Their health is a priority – both physical and mental – and Boomers are committed to staying active. They desire a community where they can make new friends and be social. They value convenience and want easy access to healthcare, shopping, dining, cultural events, and more.   

While seniors housing is already prepared to offer tailored services to a new Baby Boomer resident, we may need to patiently wait a little bit longer. 80 is a new 65, which has created a void between Americans who are turning 55 years old and Americans who require independent living services where there are not many choices available. This has resulted in some industry players getting creative because while Baby Boomers may not have any need-based care demands at the moment, they certainly have many want-based demands that remain underserved. The most traditional alternative remains home health, although the sophistication of the business has increased tenfold since its inception. More recently, the biggest disruptor that has come onto the scene is active adult. The biggest players in the space so far are making big bets on what they think the Baby Boomer consumer is looking for and have been first movers in trying to tap into this deep market.  

This new active adult product is nothing like the traditional communities developed by Del Webb. The current offering is a blend of multifamily and independent living. Similar to multifamily, these communities emphasize an independent lifestyle where Baby Boomers are self-sufficient. But like independent living, active adult offers residents a welcoming community with amenities and targeted activities and events.  

While it’s still too early to tell if active adult housing will successfully grab a sizeable piece of the Baby Boomer market, this definitely won’t be the last option we will see. We should expect more disruptor options to emerge as business entrepreneurs try to grab a piece of the Baby Boomer residential market. We are already starting to see this. While the first active adult investors were multifamily developers, some seniors housing veterans have also since entered the space. While it remains to be seen what format of housing and amenities Baby Boomers ultimately will want, they will need access to healthcare, which the seniors housing and care industry has expertise in providing. Our industry has remained nimble as we’ve adapted to our evolving resident, and we will continue to be at the forefront as we figure out how best to serve our aging Boomer.  

Health isn’t just determined by eating right, staying fit and getting regular check-ups. Evidence is growing that other factors—the social determinants of health—have a huge impact on well–being and healthcare outcomes.  

The social determinants of health include variables such as income, educational opportunities, social support, access to housing, and neighborhood conditions and the physical environment. These social circumstances are now thought to underlie ailments such as obesity, heart disease, diabetes and depression.  

Amid recognition of the impact of the social determinants of health, alliances are being formed between healthcare systems and senior living providers.  Take, for example, the recent joint venture between WesleyLife, a seniors housing and service provider, and Genesis Health System, a $1 billion hospital and healthcare network. Both serve the Quad Cities of eastern Iowa and western Illinois.   

The new partnership creates a comprehensive health and wellness network for seniors called WellSpire. It began operations July 1. 

The goal is to bring a new type of senior living to the Quad Cities. “Health systems are starting to understand the social determinants of health,” said Rob Kretzinger, president and CEO at WesleyLife, Johnston, Iowa. “We can have a big impact.” 

WellSpire, for example, can provide comprehensive follow-up care to elders returning home from the hospital. This can be a vulnerable time for elders, especially those who may live alone, and not have access to transportation and food.  

These social determinants of health are particularly prominent among so-called dual-eligible beneficiaries, seniors who qualify for both Medicare and Medicaid, according to Kretzinger. Social and nutritional support can help prevent rehospitalizations, he added, a goal of the new value-based healthcare system.  

WesleyLife has been moving toward a model of integrated care.  

The organization operates 12 life plan communities. About 10 years ago, WesleyLife repositioned itself as a health and wellness organization. It expanded its network of services to include home health, hospice, adult day services, transportation and private duty home care.  

WesleyLife impacts about 8,000 seniors a year in a variety of settings. “Care coordination acts as the stickiness between the services,” said Kretzinger. 

WesleyLife owns 60% of WellSpire, and Genesis owns 40%. WellSpire has assumed management of two senior living communities owned by Genesis. Plans are underway to upgrade the properties.  

WellSpire plans to break ground later this year for a new senior living community in Iowa, The Summit of Bettendorf. The group is also considering a project in Moline, Illinois.  

WellSpire is also offering a variety of services. Home health and hospice services will be provided by Genesis which already has robust operations in these areas. WesleyLife will provide private duty home care, adult day services, nutrition, and transportation. Other service partners may eventually be added.  

Care coordination 

Details on how WellSpire will implement care coordination across its properties and customer base are still being worked out. “We have just started the conversation about care pathways,” said Kretzinger. “We believe we can leverage each other’s strengths by coordinating care for seniors.” 

The integration of the two organizations is a challenge, admitted Kretzinger. Sharing information is key to care coordination. WesleyLife recently transitioned to PointClickCare, an electronic health records software, which was already being used by Genesis. “The timing was perfect,” said Kretzinger.   

Culture is a bigger issue, according to Kretzinger. “The importance of the cultural match cannot be underestimated,” he said.  

WesleyLife and Genesis share many of the same values. They are both performance driven, transparent and concerned about the health and well–being of customers as well as employees. Both groups are market leaders with good local reputations.  

The partnership was recently highlighted at the American Hospital Association meeting where WesleyLife and Genesis co-presented a program on their new venture. Asked about the potential of other partnerships that can leverage the social determinants of health, Kretzinger said, “We are an example of how that can happen.”  

In NIC’s upcoming Fall Conference, attendees will have the opportunity to learn how to use consumer insights from other industries as they formulate strategies to address some of the challenges facing the seniors housing sector today. The session titled “Activating Consumer Insights: Lessons from Other Industries” is taking place on Thursday, September 12th at 2:15 to 3:30 PM CT and promises to be thought provoking and insightful.

Consumer insights and feedback are routinely used to guide product development and marketing in industries such as hospitality and consumer goods. The seniors housing sector, however, has yet to widely adopt this approach to addressing its own product development and marketing challenges.  This session is designed to help industry participants think about marketing as a feedback loop in which consumers’ input and behavior inform product development and lead to greater innovation.   This is particularly relevant for today’s operators and capital providers since the seniors housing sector faces numerous challenges, including evolving demographics, changing consumer expectations and demands, and, for many potential residents, a lack of familiarity with the product.    

Moderated by Maria Nadelstumph, VP, Organization Development & Program Excellence at Brandywine Living, the discussion will be focused on solutions relevant and appropriate to the seniors housing and care sector. Nadelstumph will use her first-hand experiences to ensure that the discussion is useful to session participants. She has direct experience with the development of Brandywine’s high-end hospitality model, which features numerous innovations designed in response to shifting demographics and consumer demands.  

The discussion will hone in on how the tools and processes used routinely  in other industries can be employed to gather and make use of consumer feedback  in the development cycle for seniors housing and care. Techniques for borrowing successful innovations from other industries will also be shared.  

Jennifer Rasmussen Windbeck is a Managing Vice President in Capital One’s Retail and Direct Bank, leading the national Capital One Cafes and the Louisiana and Texas branches; as well as Customer Experience, Operations, and Physical Network Management for all branches and cafes. She leads the frontline cafe and branch teams and operations. In addition, Windbeck has responsibility for in-store customer experience and market engagement strategy, including innovating and executing upon customer guidance and transactional capabilities; associate experience and development; local community engagement; and scaling digital-first communications and operational processes.  Windbeck has leadership experience guiding experiential design, investigating customer behavior and change, and how to create something really unique in the market. While confined to the brick and mortar of their branches, Capital One has found a way to change the experience within those four walls to meet the myriad shifting tastes and demands of their customers, ranging from millennials to boomers. 

Heather Reavey, Head of Innovation Delivery at EPAM Continuum, will speak to product innovation. She thinks about where innovation is going and shapes EPAM Continuum’s people, practices, and processes to be there first. Reavey’s career has been dedicated to innovation since she began consulting in the role of Envisioner, focused on designing new-to-the-world ideas and strategies, and demystifying complexity through storytelling to catalyze organizations to take action. Over twenty years, Reavey has led teams and helped launch game-changing ideas and strategies for Procter & Gamble, Insulet, Tetra Pak, American Express, and UnitedHealthcare.  

Reavey will share ways to identify what is a good insight for innovation. She will discuss how to re-frame a challenge for innovation, and how to translate and activate novel ideas into new innovation across an organization and in a business environment.  

This exciting session promises to continue the NIC tradition of applying insights from other industries to bring fresh ideas for product development, and help leaders address the challenges facing today’s seniors housing and care businesses. It will take place in Ballroom VIII, Thursday, September 12, from 2:15 PM to 3:30 PM.