By Steve Moran
Hard, Scary Conversations
In 2013, senior living couldn’t have been better. We were past the 2008 collapse, every senior living operator and developer looked like a genius. Operators with very ordinary buildings and programming looked like geniuses. This was particularly true in memory care, with much of the industry believing the need was so great that it was IMPOSSIBLE TO BUILD ENOUGH COMMUNITIES.
Then . . .
In the middle of 2013, ProPublica started writing about the horrors of senior living in America with a laser-eyed focus on Emeritus Senior Living. Immediately Emeritus and the whole of senior living began to circle the wagons, complaining about how unfairly Emeritus and senior living were being treated. And they were partly right.
In fact, the industry was completely baffled about why anyone would question the nobleness of what they were doing.
But there was this one little upstart publication that most people in the senior living space had never heard of called Senior Housing Forum (today Senior Living Foresight) that, while acknowledging the terrible unfairness of the reporting, also spent a lot of time talking about how maybe there were some truths in what was written and some lessons to be learned.
At the time it was pretty easy for me to take these positions because I had only a few friends in the industry, I had nothing to lose, I still had another full-time job and so it was pretty easy to go “if it blows up, it blows up”. And honestly, there weren’t all that many readers.
It was probably, more than any other single thing, that turned Senior Living Foresight into what it is today.
Scared to Death
Today, Easter Sunday, I am sitting here at my desk thinking about resurrection, redemption, life, and death. I am feeling compelled to spend some time talking about lessons learned, honesty, and transparency. I am scared to death because I know you, some friends will think I am being unfair and disloyal. They will think that now is not the time.
But this is the time, it will impact how we think about what we are going through. The inputs are nearly overwhelming, but here are the themes I am thinking about:
- While there is no doubt things the Kirkland Nursing Home could have been better, they simply had no idea. Think in terms of battling an alien invasion, who could possibly know how to prepare for or fight an alien invasion.
- Every day we are seeing heroes in action. They come to work, putting themselves at risk, putting their families at risk
- Regulators, at least on the skilled nursing side, are making things worse by approaching this crisis as an opportunity for enforcement rather than support.
- Nursing homes get inadequate reimbursement for providing care under normal circumstances. Some cite complaints about inadequate care. That may be true, but I would argue that government payors are ultimately responsible for this disaster.
- As states and federal government leaders have stepped up to provide resources for people staying at home or in the hospital, they have done zero or near zero for individuals in senior living settings.
- The shortage of PPE is a huge problem and no doubt has led to the death of residents and staff. This is a systemic problem caused by over-dependence and reliance on cheap stuff from China. It has been made worse by redirecting resources to hospitals and not to senior living.
Yet . . .
- There are some, probably most, senior communities that have zero infections.
- There are some senior communities where the virus has run rampant.
- There are some senior living communities that have had infections and been able to carefully and thoughtfully contain those cases.
- It is impossible to 100% ensure that any given community will not have a case; there is no such thing as 100% airtight.
- Right now more than 10% of all COVID-19 deaths were residents of senior living communities, mostly skilled, but because reporters don’t seem to be clear about the differences. It may include assisted living or it may actually be that the numbers are worse for senior living. We need to be willing to ask what we could have done differently to reduce this number.
- There are communities that are pushing their teams to work while sick.
- There are communities that are still doing unsafe things.
So . . .
I have zero interest in playing the blame game. It is grossly counterproductive.
I believe in the face of what is happening, we will prove the value of senior living in modern society.
I believe that many, many older people are better off in senior living than at home.
I believe we need to be talking about what we are learning from this experience to make us better.
I believe some organizations will come out stronger than others.
I am hearing lots of optimism from the senior living community where the idea seems to be that in a few weeks or a few months, we will be back to something that approaches the old normal. I don’t believe this is true.
I believe this will be a dividing time where we will see some senior living organizations flourish as they adapt and others go down to blinding defeat as they try to recreate the old normal.
I believe there will be great opportunities that emerge from this horrible human and economic catastrophe.
We will come out of this better positioned to lead in the care of older people, but we need to start by being honest about what we can do better.
These are my thoughts, and you may have different, better ideas. You may think I am wrong. If you want to share your thoughts, send me an article. Within the context of our submission guidelines, I would love to publish your thoughts.