Competition & Reinvestment: the Future of CCRCs & Senior Living

Posted by CC Andrews

Jan 17, 2017 8:00:00 AM

No matter how often the stats about the impending wave of aging Baby Boomers are cited, it seems that senior living providers, policy makers, and even society as a whole have yet to heed them.QA Blog Photo future senior living.jpg

A session at the recent LeadingAge conference highlighted this fact, and the presenters’ message was clear: if you don’t do something now to shift your paradigm and focus on consumers’ needs and desires, among other things, you will miss out on a golden opportunity to not only thrive in the longevity economy but also stay true to your organization’s mission.

Mark Andrews, co-CEO of Irving, Texas-based Greystone Communities, led the session, which was aimed at identifying opportunities and challenges for providers while at the same time maintaining a margin that “enables long-term mission growth.” According to him, the current landscape of the industry is as follows:

  • High growth curve and a demographic shift;
  • A long economic recovery;
  • A strong real estate market and improved household wealth;
  • Low interest rates;
  • Increasing competition;
  • Evolving and changing customers;
  • Aging CCRCs; and
  • A growing number of providers.

Historically, Andrews noted, providers have had a paternalistic approach to their business model. “We knew what was best for the consumer and we would make it available when we thought they needed it.” With that, Andrews outlined some things that providers should do (and know) to ensure success going forward: 

  1. Your business model needs to change to be more consumer-focused and resident-centered. The new model, Andrews explained, must wrap the continuum around seniors’ needs and offer services “when they think they need it,” versus the provider making that decision.
  1. Communities with lifestyles of engagement, purpose, and connectedness will thrive. In addition, you will have strong demand if you have the right product, right location, and the right approach to services.
  1. Services need to be priced in a way that suits the consumers’ economic circumstances. It will require a different mindset and the ability to serve the upcoming generation of seniors, who will want much more flexibility and programming than the current model offers.
  1. The labor pool will be a significant factor. Movement to a $15 minimum wage will affect providers’ ability to recruit and retain staff. “It will have a profound impact on the economics of senior living and your ability to afford it,” which will lead to some stress, said Andrews.
  1. Reinvest and remodel your aging physical plant. One-quarter of all CCRCs are between 20 and 35 years old and 22 percent are between 15 and 25 years old, while 12 percent are more than 35 years old. Knowledge is power in this case, Andrews noted: if your CCRC is relatively young, you will have an advantage over most CCRCs in the country.
  1. A large number of replacement independent living units will be required over the next 15 years. Between 175,000 and 200,000 additional incremental and replacement independent living units will be needed between now and 2030 to keep up with replacing aging physical plants as the demand for them grows.
  1. Competition is on the rise. A growing number of providers nationwide are investing in expansion and repositioning and/or growth. Behind this development are the following factors: more capital availability, aging communities, and growth in for-profit rentals in assisted living, memory care, and more.

Whatever your tax status, it’s a good idea to consider how you might strategize and reposition your community—time may not be on your side if you wait much longer.

If you want a focused approach, facilitated by experts in the senior living field and honest feedback, contact Quantum Age today.

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Topics: senior living, longevity economy, CCRC, life plan community

New Payment Models Foster Care Innovations

Posted by CC Andrews

Nov 15, 2016 8:39:00 PM

Payment reform is the new driver of innovation in long-term and post-acute care, according to Laurence Gumina, CEO of Columbus-Ohio-based Ohio Living (formerly Ohio Presbyterian Retirement Services). He conveyed his message via a session at the LeadingAge annual meeting last month, along with his colleague, Wendy Price Kiser, executive director of Ohio Living Home Health & Hospice of Greater Toledo.

Gumina recently led the organization through a new strategy development and name change, and the results are indeed innovative. With 12 life plan communities, a home hePHOTO QA Blog innovations pexels-photo-143654.jpegalth and hospice care agency, and a foundation under its umbrella, Gumina says he wanted to step outside the boundaries of a typical model and create an innovative value proposition that would be effective in moving the organization into the new world of value-based purchasing.

What’s more, Gumina saw the writing on the wall; he knew he had to be proactive about adapting to the new payment reforms before it was too late. Another significant factor in Ohio Living’s drive to be more innovative is the impending SNF readmission measure that takes effect fiscal year 2019.

The most interesting of Ohio Living’s new models, in my opinion, is its successful home health and hospice services. Branded as the Home to Stay Program, it was created to improve quality and reduce hospital readmissions for patients.

In outlining Home to Stay’s highly successful relationships with two ACOs, Price Kiser noted that although it took their first partner six months to respond to her call, the care coordination model is now a valued component in the ACO’s continuum. “We told them that we wanted to work with them and that we would see all of the discharges coming out of the hospital,” said Price Kiser. Yes, she said ALL of their discharges. It was a risky offer to provide free transitional care to some patients but they bet on the fact that it would enhance their value proposition for the ACO--and it worked.

And like many creative and innovative models that are rooted in everyday common sense, so too is Ohio Living’s. As Price Kiser said: “It isn’t rocket science.” With some “basic clinical judgment” baked into the program, she pointed to a simple yet critical factor in their model: caregivers meet with the patients the very next day after they are discharged. In addition, they focus on two things: medication safety and medication reconciliation.

Here’s how it works:

  • Day 1-Coach Visit: The patient signs a consent form, the caregiver conducts a medication reconciliation, takes vitals, creates a personal emergency plan, does a fall risk assessment, confirms a follow-up appointment with (and transportation to) a primary care provider.
  • Day 8 – Coach Visit: Review any red flags, determine signs and symptoms and coach interventions, follow up on any issues identified during the first visit, review medication plan, and determine if any PCP appointments and medication changes are necessary.
  • Day 17 – Coaching Call: Confirm a PCP visit was made and discuss the results of the visit.
  • Day 22 – Coaching Call: Determine signs and/or symptoms and coach interventions, if necessary.
  • Day 30 – Coaching Call: Determine signs and/or symptoms and coach interventions and discharge from the program.

As of October, the cumulative hospital readmission rate was 3.6 percent, Price Kiser reported.

Also successful is Home to Stay’s involvement in a Comprehensive Joint Replacement model. Similar to its ACO model, tracking metrics and a focus on patient engagement and education are key to preventing avoidable readmissions under the CJR, Price Kiser said.

The two presenters offered some additional advice for providers seeking their own secret sauce for innovation: Create a value differentiator—something that makes your organization memorable; seek new and unique partnerships; and, last but not least, track metrics, analyze them, and share that data with potential partners.

If you want to create innovative new services or business lines, facilitated by experts in the senior living field, with candid feedback, contact Quantum Age today.

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Topics: home care, long-term and post-acute care, innovations, life plan community