Better Older Lives

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

“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.

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.

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

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

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

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.