By Dean Solden
In Part 1 Dean set the stage for what the New Frontier looks like. You can read it here.
Part 2: The New Frontier – Assisted Living 3.0
In Part One of this article, I described how the nursing home of the 1960s evolved into the AL revolution of the 1990s (Assisted Living 1.0) with a social and residential model while still providing mostly custodial care. In the 2000s and 2010s, the industry evolved into having a better quality of life for its residents with more vibrant activity programs and more social interactions (Assisted Living 2.0). Now, almost post-pandemic, I believe we are entering into what I call Assisted living 3.0.
Despite the progress we have made, we still have challenges in our industry. Staffing is the most notable and apparent right now. As we re-tool from the pandemic, trying to get our census back to normal or better, it is a good time to re-evaluate what the future of senior living may look like. In other words, Re-Imagine Senior Living.
As I mentioned in Part 1, there are three significant elements impacting senior living right now and will be even more so in the near future. They are:
- The COVID-19 pandemic and its ramifications
- A fresh wave of senior-specific technology
- Boomers starting to enter the senior living marketplace
These elements, especially the boomers entering the marketplace with completely different attitudes and expectations about life and how they want to live out their later decades, will transform the industry. I believe those who don’t adapt to these new realities will have a challenging time surviving.
Below are a few of what I believe to be the basic tenants of the industry we need to seriously explore in order to re-imagine the senior living industry.
This is the nasty little secret that no one likes to think or talk about. But we need to be honest with ourselves and realize that there is one thing inherently – should I say “odd” – with our entire industry. We segregate people by age. There is just something a little bit wrong about this. Maybe this is the element that makes many laypeople cringe a little every time they enter a nursing home or an assisted living or even a beautiful independent retirement community. It is hard to believe we were put on this earth to live a long and good life and then end up living in a small room with only other 80- and 90-year-old people. While it would be ideal if every family could live and care for their older senior, we know that is not possible. And there are good reasons to be in a senior community, from 24 hour supervision and care to socialization. However, the model of having older seniors all living together in one building with just each other is not ideal either.
As one who has always focused on people’s quality of life in our communities, I realized that it has been challenging to offer and create a great quality of life for people when they are only living with older people. So what even the best senior communities have done is to spend an enormous amount of time and energy compensating for the segregation and lack of intergenerational living we have placed on people. In other words, by solving one problem, (helping care for people who need twenty-four-hour supervision), we have created another problem (segregating people, which is a negative factor in creating quality of life).
Be clear, I am NOT advocating to get rid of our industry! I believe we just need to be more creative in figuring out how to have more intergenerational experiences for our seniors. Here are some examples of what we could do:
- Go back to having some caregivers live in the building with the seniors.
- Have some families live in our buildings.
- Create some units in AL and MC buildings for more independent people; even a few units for younger people.
- Look at “two-generation” buildings, as there are going to be two generations of seniors in one family.
- Consider models where caregivers and families at least live close by, so they can come by more often.
- Offer childcare, which would help our staffing issue and create intergenerational relationships.
The bottom line is, the more children, teenagers, adults, staff, families, and the outside community, live in closer proximity to our communities, the more we become real communities and less senior communities, which ultimately will provide everyone, especially our seniors, a higher quality of life.
I am also an advocate for providing more “real life” in our senior communities, even with segregation. As Jill Vitale-Aussem talks about in her outstanding book, Disruption the Status Quo of Senior Living, we have taken the concept of integrating the hospitality culture into our communities to an extreme. And many times, we provide one hundred percent of everything for people.
This, again, on a commonsense level, does not seem natural. I personally think most people would rather be having more participation in their own lives as they did for their entire life when they lived in their own home. We all do better when we all (residents, staff, families) contribute our talents as best as we can to as many as we can. In other words, we need to create:
- Cultures of interdependency, rather than cultures of complete independence or complete dependence.
- More family interaction. Another way to increase interdependency and intergenerationality is to create cultures where families are more a part of our existing communities. While many people do this already, we could develop different cultures where families – especially where there are two generations of seniors in the family – are a part of daily activity, mealtimes, and more a part of the overall culture. Many of our family members are now retired or semi-retired and have the time and resources to use their individual talents and energies to help all the members of the community, not just their loved ones. I would also like to see more interaction between our staff and our families. They could contribute so much to each other. The communities of the future could be a true extension of a family’s home, not a separate entity.
- A culture for “the people who work in our communities” (in other words, our staff). This, I believe, is not just our greatest challenge, but, honestly, has been one of our biggest failures as an industry. The concept of caregiving has not evolved nearly as much as other disciplines over the past sixty years of our industry.
Speaking of Staff
Our staffing problems are understandable. It is hard work to care for people 24 hours a day, seven days a week – for management as well as staff. It is also understandable why many people would not want to be a “nurse’s aide.” It is hard physical work, difficult emotional work, and sometimes without the respect or emotional support staff deserve. Maybe as an industry, we have not had enough empathy – and subsequent strategies – for how people are living and what they are going through. Many of our staff are single moms and dads, many people are working two jobs, some people are working and going to school, and some amazing people are raising a family, working, and going to school – all at the same time!
I believe we need a full-blown re-imagining of staffing in our industry. Here are some concepts and ideas we have worked with and developed over the years, and I believe are worth exploring more fully:
- Para-professionals – We could talk about caregivers as being “para-professionals” and talk to them, treat them, train them, and provide benefits to them as the professionals they are.
- Better pay – The pay most communities pay caregivers is just too low. I know many of our business models are based on such low wages. To get the dysfunction out of our business, we need to pay more and figure it out. Period.
- Stepping stone positions – We could strive to make a good percentage of the resident assistant position a “steppingstone” position for further healthcare careers, especially nursing. Think of it as a best first job, rather than a last, “worst” job. We all know that being a CareFriend (what we call caregivers), is a fantastic job for people who are entering the healthcare field as a career. It is also a great job for students. It is tremendous training for future nurses, physicians, management, and any job in the healthcare arena. There are ways of creating a culture where people want to come and work for you.
- Career ladders – For those who want to make a career of caring for people, career ladders within organizations are excellent ways to recruit and retain people and give people hope for advancement. Having a care positions, med techs, team leaders and then mentor/trainers are excellent ways for people to grow in the organization, earn more money, and become leaders.
- Partnering with learning institutions – Partnering with high schools, community colleges, and local universities with coordinated work-study programs is an excellent way to recruit and retain staff. It is very difficult for an individual to schedule work and school at the same time. Something always has to give, which is usually their shift in your building. Coordinated programs between employers and educators makes sense.
- Child care – We need to re-think our attitudes about child care. It may be time that child care in our communities should be the norm, not the outlier. And that would help create more intergenerational relationships as well.
Are You Ready?
Ultimately, we need to re-imagine the senior care industry. Even before the boomers dominate our buildings in the coming years, there are things we can do now. Not only to improve the quality of life in our buildings for the people who live and work there, but to create more census and revenue to owners. We can provide better and healthier food, more robust activities, and better individual IT experiences for each person both in communications and entertainment. We could have more family interaction and change the way we think about staffing, creating steppingstone work-study programs, and child care in our communities. We could be thinking in terms of interdependency, not just dependency. We could use more real life in our communities with a greater focus on quality of life, not just quality of care. We could think about being communities and not just senior communities.
Finally, in just a few short years there will be many more models than just the IL, AL, and MC we know of today. People will be staying home, living with their families with four generations living and working together. People will be living with their friends and sharing care, not just in our communities. We need to seriously think about whether segregating seniors into one living environment is the best solution for providing excellent quality of life in one’s later years. As boomers always have done in every phase of their lives, they live life to the fullest. They changed the world in the sixties, and they are going to change the world again in their senior years.
The question is this: Are you ready for them?