Aging in place challenges assistance in IL.
A human drama is unfolding in independent living communities across the United States. It's one that can have an enormous impact on the future of your continuing care retirement communities (CCRC) or independent living (IL) community. That's because responding to your existing residents' growing aging-in-place needs while remaining fully market-responsive is frequently viewed as a no-win situation.
"Aging in place" is a commonly used term in the senior living industry today. Most sponsors feel they basically understand what it means. But as a community ages, sponsors and owner/operators have begun to realize the aging-in-place concept represents huge operational and marketing challenges.
Aging in place typically involves the gradual health deterioration of seniors in senior living communities. It is one of the most predictable trends in senior housing today. But it is also the most difficult to deal with effectively and compassionately. Average annual resident turnover rates range from 25 to 35 percent IL, and 50 percent or higher for many assisted living (AL) communities. CCRCs have lower off-the-campus turnover because residents typically transfer within a comprehensive continuum.
Sponsors and owner/operators have a natural tendency to increase the level of services to reduce some of this significant turnover. But as aging in place becomes a dominant trend within an IL community, practical, effective and consistent responses to this dilemma often elude even the most experienced and innovative sponsors and owner/operators.
The issue is easy to define, but difficult to address. The issue simply stated: To what degree are you willing to deliver health-related assistance in living services to those residing in the IL section of your community?
Don't answer this question quickly. First consider two key questions: 1) How and when--specifically--should you facilitate a resident's move to a higher level of care? 2) Should you embrace or avoid a naturally occurring AL community?
Let's take a sobering look at the implications of aging in place from the real world perspective of four very involved groups:
I. Existing residents who are experiencing the growing complications of aging are obviously trying to cope with their physical afflictions. They frequently experience fear, confusion, frustration and insecurity. Many either refuse or fail to understand the real implications of their changing health condition. In other words, they're acting human.
II. Family members generally fall into one of two broad categories. They either deny that changes are occurring in their loved one's condition, or else they hope their loved one (and your staff) will miraculously cope with the situation. Some, but not enough, also recognize it's time to make some very difficult decisions.
III. Peers and neighbors of ailing senior living residents who have not yet experienced serious aging complications themselves don't want to be constantly reminded of the inevitable.
IV. Professional staffs frequently find themselves facing three aging in place challenges.
1) Provide love, patience and compassion while addressing the changing needs of the residents.
2) Work with some family members who simply will not realistically deal with bad news.
3) The community's top management must strike a delicate balance between delivering increasing levels of care into IL, while facing complex and costly operations and marketing issues.
There are alternative approaches to deliver assistance in living (AIL) assistance to seniors. Meeting this enormous challenge is more than many owner/operators originally bargained for when they initially planned their high ambience IL community.
The chronic aging process of seniors has caused many older, conventional apartment buildings and condominiums to gradually transition into what is called a "NORC," a naturally occurring retirement community. This same aging process is resulting in a growing number of IL retirement communities evolving into marginally efficient, less attractive naturally occurring AL operation.
The AIL concept: Dealing with aging in place in IL is, at best, extremely complex. There is a strong temptation to either procrastinate or to make shortsighted, short-term operational decisions. Many astute operators have created distinct living and care continuums that include active adult housing, IL, AL, special Alzheimer/dementia units, and nursing.
Others are implementing AIL strategies, which offer as-needed assistance with the residents' activities of daily living (ADLs) within their existing IL units. The theory is that care is portable and we can do great things with technology. But are these AIL decisions strategically correct?
Short-run tactics--the quick fix: The quick fix sounds good because in the short run, providing AlL services benefits the residents being served. It also appears to solve immediate and growing aging in place problems. If properly priced, the AlL concept can also provide the sponsor with a hedge against operating expense cost creep. But this short-run solution frequently triggers serious long-range problems.
Some sponsors are using licensed, third-party home health agencies to deliver the "medical component" of service delivery, while they continue to focus on the "shelter component."
Properly executed, this can appear to be a viable, reasonably seamless concept. However, the strategy is frequently not truly market-driven or resident-centered. Home health or assisted living charges passed on to the resident frequently appear fragmented, excessive, inequitable and sometimes confusing.
Long-run impacts--The self-selection process: If you deliver this assistance into your IL section long enough, a large percentage of seniors will become AL residents. Also many will experience various stages of cognitive impairment. To compound this challenge, the profile of new residents moving in will likely change.
New prospects visiting communities that offer extensive AlL services in their IL units increasingly judge all residents there as "older, frailer people." Many prospects and their families tend to make move decisions based on their observations of the existing resident population.
In this scenario, it is more common for older, frailer seniors to feel that the particular community is right for them. Thus, new move-ins tend to be the result of a self-selective process. This compounds and accelerates the cumulative aging in place process of the community's resident population.
The first step in attacking this problem is to address the six tough questions outlined in the chart on page 20. If you've responded objectively 0to these questions, you probably recognize some potential problems.
Don't fret. Viable AIL strategies do exist. While your long term prospects may appear dim at first after answering the questions listed on page 20, there is some light at the end of that long, dark tunnel.
ANSWER THESE SIX QUESTIONS
To avoid getting in trouble down the line as a result of delivering assistance in living (AIL) services in existing independent living units, ask yourself six tough questions now, and answer them from the perspective of the years 2005 through 2010:
1. What is your optimum resident profile, for both your existing independent residents and new move-ins?
2. What will be your future business model and market positioning --moderately need-driven independent living or high acuity assisted living? Or both?
3. Will you have the capability to properly measure levels of care actually delivered to each resident in order to recover your increasing AIL costs?
4. Will your community be fully market-responsive if residents are charged for incremental increases in the assistance with activities of daily living (ADLs) as they age in place?
5. As resident care needs intensify, can your delivery of assistance with ADLs be implemented cost-effectively to randomly distributed independent living units throughout your community?
6. Are all of your care-level policies in independent living consistent with (and will not "cannibalize") your other living arrangement options on your campus?