Best of all worlds!

The Cedars of Chapel Hill will celebrate its twentieth anniversary this Halloween and if there is one person most responsible for that celebration it is their long-term President, Bob Woodruff. Bob’s nature is to praise all those who have served during The Cedars’ history, to highlight the great strengths of The Cedars’ team, and to keep everyone’s focus on the families who have chosen The Cedars as their home. Those Members are the most important part of this special community.

As such, it was a bittersweet moment when Bob announced his retirement and my role as his successor. I am happy that Bob will enjoy more time to beat younger people at tennis and golf, to make his yard more beautiful, and to continue to make Chapel Hill a better place that laughs more often. I am relieved that he will continue to advise me on all his role entails.

I have focused my career on helping communities like The Cedars grow and thrive. I am grateful to him and the rest of The Cedars’ family for trusting me with this responsibility. It is exciting to be a part of a community that makes such a positive impact in the place my family has called home for over twenty years.

I am also thankful that this new role allows me to continue working with communities and programs outside the Chapel Hill market. It is a gift to be able to serve in this role and to continue my work with some of the brightest teams focused on bettering older lives. It is truly the best of all worlds.

Thanks to The Cedars and to Bob most of all.

Looking Forward,

Perry

Missing Y’all

I’m happy to have fallen in with a group of mentors who recently repeated a statement I’ve heard over the years about the AAHSA and Leading Age meetings … “You have to go to prove you’re not dead.” While I’m sad to miss this year’s gathering, I am happy to report I’m not dead. Looking back at those past gatherings there are some favorite things that don’t change to look forward to at one of the next gatherings:

Connecting new friends to old ones and learning something new.

Checking in on past projects, touching base with everyone you’re working with, and discussing new ideas. 

Staying up too late, getting up too early, and keeping everything moving forward while seeing everyone. 

Thankfully one thing has changed. After several off and on years of these gathering overlapping with Halloween, LeadingAge’s leadership recognized the higher value of giving the next generation of leaders the opportunity to enjoy that special celebration with their families and friends. Thank you for listening!

It’s easier to predict what will NOT change… than what will change. 

Thanks for all the good memories and well wishes.

Safe travels,

Perry

FROM LIFE CARE to MORE LIFE … LESS CARE

“Life Care” is the widely used term that is significant in the history of the field of age targeted communities and services. Some of the largest organizations that build and manage communities have taken that name as have some of the largest continuing care at home programs. “LifeCare” is also the common name for the “A” or extensive contract that was the predominate way that most customers came to these communities and services. Until recently choosing the lifecare contract at many communities was like picking a black Model T Ford (other colors were first offered in 1926.)

Many customers still purchase a lifecare agreement that includes a pre-paid medical expense (and deductions) for facility care offerings that are part of the on-campus long term care safety net. What’s covered by LifeCare contracts can be defined differently and new modified and fee-for-service agreements have multiplied. Even the communities that have LifeCare as a part of their names are seeing an increasing  percentage of customers buying these new lower cost and lower coverage agreements.

Continuing Care at Home Programs do not have the physical structures and legacy staffing commitments that communities have, and these customers are passionate about NOT moving to facility care. CCaH programs’ outstanding value proposition is that less than 5% of members ever use facility-based care. As data collection becomes more comprehensive, the difference between the health and health investments for this group as compared to the general population will accelerate change.

Skilled nursing is at the fulcrum of these trends and questions. Internal and external utilization for nursing care continues to drop by 3 percent or more per year. Regulations are increasing, staffing costs are up, occupancy is down and yet there is a promise to existing residents as well as greater socialization opportunities that must be considered. Similarly skilled nursing is a box that many customers want to check to consider a community as their future home. There are many questions for the board and management in these tensions…Can we attract and afford the right team of nurses? Can we fill and make a margin? Can we downsize and maintain operational and cost efficiencies? How can we provide better socialization opportunities in any model? Can or should we exit skilled nursing altogether?

I like adding a few more questions… What do our customers want? AND What do our residents want? Taking away anything, even if it is unused or unwanted, is usually not well received. Replacing something unwanted with something better may be the brighter path. More communities are adding “care coordinators” to their independent living teams and more CCaH members are keeping those relationships, their agreements, and moving into all types of communities. A new pattern is appearing that should be tested with residents and customers. It is much more than messaging to say there is a path forward to keep the promises of life care and lower the use of facility care while providing support and greater independence. More Life! Less Care!

Some questions for your consideration:

  1. Should you review and/or renew your actuarial study?
    • Should you ask how the length of stay in different levels of living is changing over time?
  2. Is there a financial concern about a reduction or delay of entrance fee revenue due to longer independent living residency?
    • Has this already started and how might it be addressed going forward?
  3. Should you consider Continuing Care at Home programs and Early Acceptance programs?
    • Whether through partnerships, vendor agreements, or direct sponsorship; might these channels give customers more appealing choices, increase overall occupancy and revenue, and serve more lives?
  4. Should you consider consumer research with your wait list, residents, and other members?
    • Are there pricing and packages of services that can be adjusted to give the customers a price-agnostic way to show their preferences?
    • Can you make the same or greater margin?

Thanks to all the organizations who include me in their search for answers to these and other good questions.

Math

A system CFO was leading the search for something different, something new for several projects: filling a new community, maximizing the value of an expansion, and vetting the redevelopment plan for the oldest campus. We met over a screen to talk over those projects, and he asked, “How are you different?” … part of my response was “Marketing is math.” That comment continues to resonate with me on many levels. Creating compelling stories about the underlying customer value for communities and services is one of the best part of work in this field. Planning for a program, community, or system to operate in perpetuity is one of the challenges that makes it rewarding.

Markets Math:

Market studies show the depth and levels of opportunity in a specific geography. Often the financial criteria used to describe potential customers are too low. While many organizations wish to serve the missing middle, the price points and customer behaviors are often above the $100K per year an 85+ year old can earn and still be counted in that “middle (page 7 at link above).” How big can an expansion or a start-up be, and at what price point will it sell quickly enough to reduce risk while feeding mission and margin are great questions. The answers begin with which customer households and local competitors count, as well as the migration patterns of older adults (that have changed so rapidly in the past half decade.) There are great partners out there that can do these studies quickly and affordably… but doing the right study is the most important part. There is still some art in the pricing, presentation, and offering that is creative and fun. For that organization, the market demand was double what was planned  for their remaining land. Adding density, even if it needs to be delivered in phases, is good math!

Development Math:

This field makes a difference in people’s lives, and it is complex and challenging. It is NOT easy to develop things, to operate any form of long-term care services, AND to be in the hospitality business (with the same customers every day!) Sorting through the rental, entrance fee, and ownership models as well as which care services and coverages to include is creating or rebuilding a pretty complicated system. Matching customers’ desires within the local competitors in the market to build a strong business that will last generations is so exciting. Most Life Plan Communities’ (CCRCs’) struggles comes from poor modeling. Those failures stunt trust and hurt the adoption rate for communities and services right when customers need them the most.

Bankruptcies in newer communities are increasing as are affiliations driven by financial challenges. It is worth getting second opinions to confirm development or redevelopment models are right for the long run. The big nursing homes that were the norm fifty plus years ago are organizations’ most frequent challenge today. Internal and external utilization for nursing care is dropping by roughly 5% a year despite the oldest baby boomers turning 76 this year. Construction, financing, and staffing costs are high. The right sizing path requires difficult conversations, compromises, and perhaps some fundraising. Memory support or the flexibility to swing households to that service provides flexibility and usually matches a significant market need. The math of those trend lines shows how customers are changing and how to better plan and invest.

Right sizing, changing refund options (moving away from 90% refunds!, as well as modifying agreements’ long term care coverage adds the actuarial tribe to these conversations. Translating actuarial tables into customer benefits simplifies something complex and makes it appealing. Continuing Care at Home programs highlight this part of the math. There are great successes and stories in the entrance fee and life care models, but they require customer education and initially appear expensive. Would there be more programs and services if the predominate models were more familiar?

Marketing Math:

This is the math most people think of first. Marketing spend by channel tracked into deposits, memberships, or move-ins. Amazing creative companies focus on this field and new ones are learning quickly and bringing fresh voices to these stories. Everyone gets excited when a family make a choice before it is too late…or when they find the service they desperately need. Meeting and beating financing and revenue goals are signs of offers that are so compelling that customers understand and want to invest in them. A growth key is to build fluency to explain how these offerings work and how they work for customers. That is my kind of markets, marketing, and math!

Our space is getting hot and alternatives and new offerings are multiplying. This proliferation of choice can make it harder for customers to decide so we need to present simple positive exchanges of value. Customers give us much more than just their dollars…they give a significant part of their lives. We earn their trust to know things will be taken care of, trust that they can enjoy their homes free from anxiety, and trust that they will have more time with the people they love.

Trust is hard to build when the math does not work. I am proud to be a part of making the math work for so many programs and services!

Thanks, and happy spring!

Advantage …. Early!

Honored to be included in a presentation at the LeadingAge meeting in Denver this October. Even better, I get to work alongside the team that leads one of the communities closest to my heart, Westminster Canterbury Chesapeake Bay. They were the first community in Virginia to have me as part of their team and more importantly the first in the Commonwealth to start an Early Advantage program. These official (approved by state oversight bodies) programs started a little over 10 years ago in North Carolina and have been growing steadily since. South Carolina and Florida’s first programs were approved this year, and more are coming and should be! No construction, very light staffing needs, and wonderful mission and margin extensions. These offerings are a subset of the Continuing Care at Home offerings that are growing more rapidly in their third decade.

Hope to see you in Denver! Safe travels.

GROWING at Home

We have all heard the stories of the overnight successes that took decades to come to fruition AND Continuing Care at Home programs seem to fit in that narrative well. Congrats to the programs for building their memberships, giving those who refer to stay home an elegant solution, and banding together to learn and grow faster. Cudos to LeadingAge for sponsoring the first CCaH Network to gather that tribe and share those lessons learned.

I was humbled to be included as one of the speakers at the first CCaH Network conference and wanted to thank that team for pulling off a great virtual conference. Thanks as well to Brad Paulis from Continuing Care Actuaries for presenting with me on how to GROW Continuing Care at Home programs. It was good to hear voices from the programs, AV Powell, Love & Company, and Varsity echo the suggestion to better connect the long-term care risk pools. Creating new agreements that serve the families living at communities can give them the choice to have the same benefits as the program members…mainly that 95% of people never move to facility-based care. People who move to senior living communities have same desire to stay in their homes as long as it is safe and wise financially. The sooner we connect these services and risk pools the better our customers and our balance sheets will be served.

It is exciting to work with so many new programs and communities… and with so many who are ready to embrace and find ways to try these new concepts. Thanks to all those good presenters and good organizations.

Safe travels and stay well.

Looking forward,

Perry

Profitable Perspectives

Conference season is finishing up. I feel a great sense of gratitude that we can gather safely again. We are reminded of the value of things when they are taken away. I wanted to give a great job shout out to the Leading Age North Carolina team! Way to go Tom Akins, Leslie Rosboro, Trina Thompson-Johnson, and Pete Thompson. Thanks as well to all my co-presenters. David Segmiller thanks for shepherding us and the good topic of “Learning from the For-Profits”. David Ammons of Retirement Living Associates thanks for your eloquence on both sides of the non- and for-profit perspective. Last but not least, Richard Conway of Choate Construction shared his perspective from deep relationships from both catagories. This panel of contributors shared some of the for-profits strengths…which are oversimplifications and certainly apply to some non-profits too:  

  • a bias towards action, and
  • a willingness to break the continuum apart to attract a younger and more diverse demographic.

The myth of non-profits access to capital was still raised but many from the financial world have shared that the non-profits actually have the same access as to funds as the for-profits as well as few additional ways. A good project with a good financial outcome can find good credit.

At the end of the day there are great non-profits and great for-profits (and the contrary is true for both as well) and all of us are trying to find people with a passion to serve older people and find more ways to give those customers what they want. It is my opinion that a larger tent that is open to everyone with those good intentions and purposes will multiply our voices and impact!

Here’s to more profitable perspectives!

Looking forward,

Perry

Spring Forward !

After a long cold period of separation and darkness the earth is turning, warming, and the color is returning to life to remind us of all the good things in this world. This spring is full of hope that we can make the world a better place.

One lesson that stands out from last year is that each day is a gift that everyone is not given. It is not much of a leap from seeing each day as a blessing to realize that aging itself is a multitude of gifts and is also a proof of grace and resilience. Working with older people to launch and grow communities and programs is a great way to honor those who are ahead of us on the path of life. They have plenty of lessons to share with us about planning ahead, generosity, and altruism…those extra trips around the sun provide the best education!

The loss we have all felt from not being with those we love is a strong motivation to overcome those distances as we move forward. Whether that’s a continuing care at home program building more connections and opportunities for socialization, communities finding new ways to keep members better connected to those who do not live on campus or making the most of our communal crash course in technology to find new ways to connect us, rather than more ways to keep us apart.

Most of us have also learned some lessons about the balance between autonomy and safety. While there are still those who question whether vaccination is right for them…when the evidence is shared… with the downsides along with the upsides… more are making the choice to help everyone get back together safer and sooner. Organizations that work with older adults have experience navigating the boundaries between autonomy and safety. Those who served on the front lines see the suffering from crossing those boundaries and that experience helps removes some of the grey areas and allows more freedom AND more safety. Those professionals are being celebrated in this time and they should remain high on our list of people to admire and respect.

Most people, programs, and communities did a good job of keeping people connected AND protected…and most of them are doing quite well now that things are settling into this normal. It’s exciting to be a part of the teams launching new communities that are breaking records… 300 families in almost as many months!!! Perhaps even more admirable are the teams who launched during hardest times that are seeing a rush of new people coming in. Many of those older adults share that they would rather be a part of a community than alone if life offers more storms for us to weather.

It is humbling to sit at the table with those who are navigating these lines, and those on the path of life before us. There is a lot of gratitude in being a small part of their stories. It is special to be a part of launching and growing the places and the programs that are listening well and giving customers what they want to make their lives longer, better, and happier too! So, our charge is to spring forward, and venture out into the world again and make something new and better in it!

Looking forward,

Perry

Finding revenue opportunities

A friend called last week to say she needed some outside perspective on her marketing and sales… there have been many of those calls in the fourth quarter. A close call or missed bond covenant ratio, a tough initial fill due to COVID, stalled pre-sales, or a review of creative investments…there are many motivations and benefits to a fresh look at your marketing. That’s Marketing with a big “M”, your market, your offering, your process, and how your prospects see and experience your community/service.

Sometimes a quick call is all that is needed…other times there is more to work through. Below are some tips and questions for when you find yourself on this path:

  1. Who is your audience? Investors, governance, leadership, residents/members, all the above?
  2. Invite your leadership team, including marketing, into the partner selection process to increase understanding and trust and to improve transparency, and results.
  3. Do not be afraid (or create fear… perhaps do not call it an audit.) If you are doing what you can with your team and budget, there is nothing to fear.
  4. Refresh your budget to actual, your CRM data on source of leads and move-ins, and data on what agreements your customers have been choosing.
  5. Are your challenges market, marketing, or sales driven? Do you have a recent marketing/demographic study for your market area?
  6. Are your challenges financial in nature? Are they largely due to refunds due on highly refundable entrance fees? Do you have a recent actuarial report?
  7. Consider your potential partners’ main business lines… do they mainly do creative, management, development, accounting, advising? Does their focus match your needs?
  8. Focus on the best first actions for early wins to build momentum on marketing, sales and occupancy… the revenue will soon follow.

Stay At Home

Most market demand research studies project that between 4% and 6% of the age- and income-qualified households will move to a senior living community. There are exceptional markets like Philadelphia, Chapel Hill, and others that enjoy much higher percentages; and there are many areas with low to zero percentages. Some opportunities to serve a greater percentage of age qualified households have been accelerated by COVID-19. It is right to pause, reflect, and pray for the families who have lost loved ones, lost earnings, or lost their businesses in these uncertain times; but, as with any historical crisis, COVID-19 is accelerating change and some of those changes will stick.

One change that seems likely to stick and accelerate reflects a longer-term trend that can be labeled with one powerful word, “HOME.” Tech companies and legacy businesses have learned that the battle for the customer is fought in the home. The beginnings of this same trend are in the senior housing and healthcare services niche too. “Hospital at home” programs get people out of the hospital sooner and help them recover more quickly and with better outcomes at home. PACE programs keep the frailest poorest members of our society safely in their homes. Continuing care at home programs have been around for 30 years and currently serve over 5,000 members through over 30 programs. The most striking fact about these programs is that historically only 4% of their members have ever needed facility-based care.

That’s right, these programs keep 96% of their members out of assisted living and nursing homes. Recent conversations with several program leaders indicate that new membership growth is accelerating during COVID. It should come as no surprise that when people, especially older people, are told they are safer staying at home, that customer desire increases for programs that offer a coordinated plan to stay independent at home. It is worth note that a super majority of these customers are a new slice of the age qualified market…meaning these programs are not taking people away from residential offerings but rather opening a new demographic.

If you would like to learn more about these programs and whether they might be a good fit for your organization and market, please connect. Longevity Markets has helped launch 20% of all the Continuing Care at Home programs and an even higher percentage of the newest programs.

Thanks for the grassy home picture.