Author: Varsity Team

A guest blog post by Brian Mailliard, CFO of St. Paul’s Senior Living Community

What does a community do with a prospective resident that is nursing home-eligible, does not need 24-hour care and yet can’t live independently? Up until now, the answer in western Pennsylvania has primarily been “personal care.” Unfortunately, Pennsylvania has many older adults who primarily live off of social security. These seniors do not have the assets to pay for personal care.

The problem is especially severe in rural western Pennsylvania. Here, the main industries of farming and manufacturing have taken a hard hit over the last 20 years. To make matters worse, affordable housing options for older adults are few and far between.

The good news is that, in the last five years, an alternative housing model has appeared. Share Care houses have been opening up in western Pennsylvania. This new housing bridges the gap for those with a low asset base who need assistance with activities of daily living.

A Neighborhood Solution

For-profit and nonprofit companies have been purchasing three-bedroom ranch homes in the community outside of their traditional campuses. The companies make small renovations, such as wheelchair ramps, wider doors and accessible bathrooms, to accommodate three residents. The residents utilize the Medicaid Home and Community-based Services waiver program,  plus their social security, to cover the cost of care. Once the home has three residents, the community can typically recoup the cost of the real estate purchase, plus renovations, in a 4–5-year time frame. At this point, the model becomes profitable. Since there are not more than three residents receiving services under the same roof, this model does not fall under personal care regulations.

The waiver will pay for an individual to get up to eight hours of assistance per day in a home in the community. Housing three residents, each optioned for eight hours of care per day, under one roof allows a company to have a care partner in the home 24 hours per day, seven days per week. Staffing is provided though a company’s home and community-based service providers, which now have the ability to offer staff the set schedules that are typically offered in home care. What I have found is that, in these small homes in the community, the staff and residents become their own little family. They grow close by doing activities together, such as shopping and cooking.

New Share Care Homes Opening

St. Paul’s Senior Living Community has opened two of these Share Care houses in the last six months. Wesbury United Methodist Community in Meadville, Pennsylvania, is also involved in Share Care. In addition to providing care at its campus, Wesbury owns and operates eight Share Care homes in the Meadville area. I have toured two of these homes. I’ve also met with Wesbury’s chief financial officer to discuss the community’s successes and struggles with Share Care.

Wesbury identified the need for a level of care for lower-income individuals that are not nursing home-appropriate. It first heard about the Share Care model from a local home care agency that operated a home. The Share Care homes are contributing to the entity’s bottom line and are operating at a profit. The impact on the outside community has also been very positive for Wesbury, with residents and staff getting involved in the greater communities in which the houses are located. That community involvement is something I plan to take back to promote at the Share Care homes within my organization.

Lessons Learned About Share Care 

Wesbury learned early on that, when making renovations, it is best to keep the house looking just like any other in the neighborhood. This way, neighbors do not get a sense that an outside organization is coming in and changing their neighborhood. One of the ways in which Wesbury combats this stigma is by putting the wheelchair access ramp inside the garage. That means the ramp is out of sight when people are driving through the neighborhood.

We have opened two of these homes in the last six months, and we are filling our second one with residents now. During this process, it has become obvious that, with any fewer than three residents, the costs outweigh the revenue. Because of this, filling the home has become a priority. When I asked Wesbury how it combats the cost of census turnover in its homes, I received a simple answer. Currently, they said, the only way to absorb the cost is by scale. The more houses you have to spread the costs of census turnover across, the better the model performs financially.

The Top Challenge Communities Face

What’s the number one struggle that Wesbury — and now St. Paul’s — has with this care model? It’s getting people approved for the waiver. Individuals who apply for the waiver wait, on average, six months for approval to be finalized. And, unlike the Medicaid benefit for the nursing home, there is no presumption of eligibility with the Home and Community-based Services Waiver. This means that someone in need of services cannot start receiving them until final approval is given.

As leaders in our communities, we have the ability to effect change. Organizations like ours and LeadingAge PA can advocate for change to the approval process for the waiver. Additionally, organizations such as mine that are just starting to offer Share Care can work with experienced organizations, like Wesbury, to learn how to navigate the current approval process. Share Care has proven that it can be an effective care model for low-income individuals who need help to live on their own. We just need to work together to make it easier to implement.

As the clock ticks down to 2020, we look back on another exciting year for the Varsity blog! Here’s a countdown of our five most popular posts for 2019. It’s a grab bag of hot-button topics, from groundbreaking wellness ideas to intergenerational brainstorms.

5. 18-year-old Jumps Into Life at Senior Community

In this interview with out-of-the-box thinker Rosemary Ramsey, she reveals her inspiration for The Victory Lap, a one-of-a-kind program that pairs youth aging out of foster care with senior communities. Read about an intergenerational program that could change senior living.

4. Overheard at LeadingAge TN: What if…

Our VP of Client Services Derek Dunham takes us inside the “what-if” moments of the 2019 LeadingAge TN Annual Meeting & EXPO. Explore “what-if” moments.

3. Disruption in Senior living — Opportunity or Threat?

From shrinking staff to the growing middle market, Derek Dunham disrupts our world with the highlights of the 2019 PAHSA conference. Get disrupted.   

2. 10 Leadership Secrets From LeadingAge PA

This series chronicles the year-long journey of LeadingAge PA’s Fellows in Leadership program. In this post, Brian Mailliard and Sakkara El share what they’ve learned at the halfway mark of their adventure. Learn the secrets of leading well.

1. When It Comes to Wellness, Nothing’s off the Table

Our most-read post of the year was a fascinating conversation between Becky Anhorn, the inspirational wellness director at Meadowood Senior Living, and Rob Smith, Varsity’s creative director. Read about a groundbreaking approach to wellness.

That’s our countdown of top posts for 2019! Stay tuned for more fresh content in 2020, and please contact us if you’d like to do a guest post or be interviewed for an upcoming blog.

‘Like it’ or not, we’ll never know, thanks to a new update being rolled out by Instagram that will prevent you from seeing how many likes the accounts you follow are receiving on their accounts. To see what this means for your brand, check out this infographic.

As we head into 2019, we look back on an exciting year for the Varsity blog! Here’s a countdown of our most popular posts for 2018. It’s a potpourri of topics, from serious to humorous to touching. One common thread: innovative ways of helping people age well, from a world-renowned village for people experiencing dementia to LEGOs.

5. Older Adults Experiencing Homelessness Inspired by an experience our president Wayne Langley had passing an underpass in Los Angeles, this three-part series provides insights into how older individuals experiencing homelessness are treated. Read the first installment here.

4. Difficulties in Diagnosing Parkinson’s Disease  In this guest post, Rebecca Evans of geriatric nursing.org discusses the second most common age-related disease after Alzheimer’s, including the lack of a precise screening test and why early diagnosis is so important. Read it here.

3. Remembering Sal J. Molite, Jr.  Derek Dunham, vice president of client services at Varsity, pays his respects to Sal J. Molite, Jr., former president of Edenwald Communities in Towson, Maryland, who sadly passed away in January 2018. He was a true friend and colleague, who had a passion and dedication for the aging services. Read the post.

2. American Hogeweyk — an Interview with UMC’s Larry Carlson Varsity spoke with Larry Carlson, President and CEO of United Methodist Communities, on his fascinating experience visiting Hogeweyk, the world-famous memory support community in The Netherlands. Read the post.

1. Playing with LEGOs Could Help Older Adults Our most-read post of the year came from Robinson Smith, Varsity creative director and lover of all toys and games. Rob discusses Adult Fans of Legos (AFOLS), many of whom are older adults who use Legos to engage in a creative exercise for the mind. Read the post.

That’s our countdown of top posts for 2018! Stay tuned for more fresh perspectives in 2019, and please contact us  if there’s a topic or issue you’d like us to cover.

Larry Carlson of United Methodist Communities is known as a thought leader in the aging services space. He’s always pushed his team and his communities to be more resident-focused and to come up with creative ways to meet their needs. Recently, Larry spent some time in Europe. While there, he visited the world-famous Hogeweyk memory-support community in the Netherlands. Profiled by CNN, Hogeweyk has become a model for dementia care that many American providers have dreamed of reproducing in the States. Its community-based design, open and spacious amenities and focus on daily living have made it a model for the rest of the world.

We took a minute to sit down and chat with Larry about his experience and what he thinks the future of memory-support communities might look like.

Varsity – How did you first hear about Hogeweyk and become interested in the work being done there?

Larry – In 2013, CNN profiled the community in an excellent 20-minute segment. Since then, I’ve always wanted to visit and see the community firsthand. (For reference, here’s a link to that piece https://www.youtube.com/watch?v=LwiOBlyWpko&app=desktop.)

Varsity – We know that Hogeweyk is centered on memory-support services. But, it seems it would be difficult to create such an environment for those with severe memory loss.

Larry – On the contrary! Residents don’t come to Hogeweyk because they are just mildly confused. Every person living in the community has a severe memory issue. Forty percent of the residents utilize some kind of mobility assistance. This isn’t a community created for those with onset dementia issues. It’s built to help those that are living with severe dementia.

Varsity – Wow! That’s not what would we would have expected at all. How can they care for such a population in a free and open environment like Hogeweyk?

Larry – Residents live in homes with six or seven other people. There are 23 such homes at Hogeweyk. Each resident has their own bedroom, sharing a kitchen and general living space with others. Team members are only in the homes between 7 a.m. and 10 p.m. each day. As the residents move about the community, every team member is there to assess their needs and ensure safety. At night, residents are monitored with advanced technology. Rather than keeping a team member in every home overnight, they utilize microphones to listen for movement and issues, deploying staff as needed.

Varsity – It seems like Hogeweyk takes the idea of ‘person-centered care’ to a whole new level. Can you describe the environment and vibe within the community as you toured?

Larry – While ‘care’ is important, it’s not the most important phrase in the lexicon at Hogeweyk. The entire team is focused on a single mission: ‘normalize life.’ Every team member’s goal is to provide as normal a daily living experience as possible for every resident. If a resident wants to go grocery shopping, help with laundry, clean the house or just go for a walk, they are allowed to do that. No one chases after a resident who wanders away on their own. Within the community, residents are safe and allowed to explore as they like. At Hogeweyk, they care for their residents by ensuring their independence.

Varsity – This sounds like an amazing community but also one that would be a regulatory and risk management nightmare here in the States. How do they handle these issues?

Larry – Communities like Hogeweyk are mostly government funded and heavily regulated. That provides some layer of protection. The Dutch have a saying, ‘Don’t shoot the bear until you see the bear.’ This means that you don’t restrict an activity or area because it could be a problem in the future. For instance, there was a balcony with a regular height handrail. My inner administrator was immediately fearful that someone could fall over such a railing. When I posed this question to my Dutch counterpart, he noted that no one has ever fallen, so why would they change it now? It’s definitely a different mindset than what I’m used to.

Varsity – With this in mind, do you think there’s a way to bring a Hogeweyk-type community to the United States?

Larry – Absolutely! It’s become my goal to do so. We’ve reviewed the staffing requirements and realized that Hogeweyk’s staffing is within a single FTE of the staffing we would provide for a similarly sized community. Also, the monthly cost to reside at Hogeweyk is nearly identical to what UMC charges in many of our communities. Yes, there will be some regulatory hurdles, but the model is completely viable, and we want to make it happen at UMC.

Varsity – Thank you so much for sharing your experiences and thoughts with us and our readers! Do you have any final thoughts you’d like to share?

Larry – I really appreciate this opportunity as well! I’d encourage all of my colleagues and counterparts to learn more about Hogeweyk. Even if they can’t create a replica of the services offered, I’d implore them to think beyond person-centered care when it comes to memory support. Think about how you can normalize life for each resident. That simple change in thought process is the first step in the Hogeweyk model.

This article is a guest post by Rebecca Evans of GeriatricNursing.org. As we approach Older American’s month, we thought it was an appropriate time to discuss one of the most challenging diseases that an aging adult might face – Parkinson’s. We thank Rebecca for her input and we hope you enjoy the piece!

I can hear you wondering: How is it hard to diagnose Parkinson’s Disease? After all, aren’t the characteristic symptoms rather distinctive?

Well…yes and no, unfortunately.

Yes, Parkinson’s disease symptoms are rather distinctive (for the most part, anyway; there are a few diseases and drug reactions that can mirror Parkinson’s symptoms)…but they take time to develop. In the early stages of the disease, in fact, it can be incredibly hard to diagnose.

After all, there are no precise tests for Parkinson’s. As often as not, it is mistaken in its early stages for another disease—which in turn delays appropriate treatment.

Most common diagnosis difficulties

For instance, there’s data that actually suggests that as many as 25% of Parkinson’s patients are misdiagnosed. That is, they may be receiving treatment for Parkinson’s, and not actually have Parkinson’s. Or they may be receiving treatment for something else, and actually have Parkinson’s disease.

A big part of this goes back to the fact that there is no precise test for Parkinson’s, and different diagnosing doctors treat different indicators differently. For instance, some of the most common tests given to potential Parkinson’s patients are CT scans, blood tests, urine samples, and more. None of these tests are definitive, however (remember, no precise test?), and so it is up to the doctors reviewing these tests to decide what to make of them.

For some doctors, inconclusive test results may cause them to lean toward a Parkinson’s diagnosis. For other doctors, those same inconclusive results may cause them to lean away.

So what are more accurate predictor tests?

In particular, because Parkinson’s is a neurological disorder, you probably want systematic neurological assessments to play a role in your diagnosis. For instance, neurologists familiar with Parkinson’s will know to test your reflexes, balance, muscular strength and responsiveness. Additionally, it is not uncommon for a neurologist looking at the possibility of Parkinson’s to say they aren’t yet sure. They want to run more tests, or want to run more tests in the future to see if your symptoms develop further. Parkinson’s is not an easy diagnosis to make. As such, neurologists familiar with the disease will likely not rush into such a diagnosis.

Similarly, there are a whole range of neurological disorders that can present many of the same symptoms as Parkinson’s. As a result, a neurologist may want to be careful to eliminate or rule out some of those other neurological disorders.

As a general rule, the more careful and thorough your neurologist is in testing you,  the more comfortable you can be in their diagnosis.

Please do note, however, that you can always get a second opinion from a neurologist you trust if you don’t feel comfortable with your original neurologist.

Why is appropriate and early diagnosis so important?

Quite simply, because it is the key to better treatment. When earlier caught, treatment can begin earlier, and adjustments can be made to help preserve independence and a high quality of life. This might mean developing an early exercise routine that works, finding the pharmaceutical regimen that gives best results, and determining what level of physical therapy works best for you and your current symptoms.

What diseases are most often confused with Parkinson’s disease?

In particular, if you suspect you or a loved one may have Parkinson’s disease, these are some of the other diseases that may regularly be confused with Parkinson’s. You will want your neurologist to rule them out in testing:

Benign essential tremor
Brain tumor
Huntington’s disease
Multiple sclerosis
Multiple system atrophy
Striato-Nigral degeneration
Supranuclear palsy

Other diseases may also be confused with Parkinson’s, obviously, but the above list is some of the most common.

So ask your neurologist to be thorough. It’s more important that you are appropriately diagnosed, so you can get the care you need, than that you are diagnosed quickly.

Multiple Sclerosis – An infographic by GeriatricNursing.org

We are proud to announce our participation in this year’s LeadingAge PEAK leadership summit, held March 18–21 in Washington, D.C.

The Varsity team has gone all-in this year, hosting a basecamp at zone 5 of the event. The theme of our basecamp is “Telling your story: connecting with tomorrow’s discerning customer.” All of our presentations will cover topics that relate to how aging services providers will need to grow and adapt their messaging in the coming years.

Keynote presentations will include:

• “Positioning the Mission,” with Varsity President Wayne Langley
• “Connecting with Consumers,” with Rob Smith, creative director, and Jackie Stone, vice president of sales consulting — both of Varsity
• A panel discussion, hosted by Derek Dunham, Varsity’s vice president of client relations, where he will interview marketers to get their respective takes on how to get the most of an agency relationship
• Kevin Purcell, of WildFig, who will demonstrate how data-driven decision-making can change the way you do business

In between these sessions, the Varsity team will be on hand to meet and discuss these topics and more with all of the attendees. We invite you to stop by and say hello!

Following PEAK, we plan to make a selection of our presentations available via videos on our website, so if you can’t attend in-person, be sure to check back to catch the highlights of the event.

Earlier this week, Mozilla and Google announced changes to their internet browsing products and user accounts. These changes are empowering users who don’t want to see remarketing advertisements, such as display banners that are used to target advertising to previous website visitors. These changes are coming as a direct response from users who have shown a desire to have more control over their web browsing experience. By giving users the ability to control their ads, these companies hope to maintain their market share.

Of course, any time major changes like this are announced, blogs and writers try to look at the story from all angles, including from those who claim the sky is falling and that remarketing advertising is going to die out. After taking a look at the facts of the changes, we at Varsity are confident that this remarketing remains a viable means of reaching the right market for our clients.

First, let’s look at the actual announcement from Google:

Reminder ads like these can be useful, but if you aren’t shopping for Snow Boot Co.’s boots anymore, then you don’t need a reminder about them. A new control within Ads Settings will enable you to mute Snow Boot Co.’s reminder ads.

This position makes total sense. If someone isn’t interested in or shopping for an advertiser’s products anymore, then he or she should be able to turn off the remarketing ads. As an advertiser, this actually makes us very happy, because it means that our ads are getting smarter. Rather than serving an ad to someone who may no longer be interested, there is now a way for the person to opt out of the ads, ensuring that our ad dollars aren’t being spent on someone who we have no chance of converting.

This change is about quality over quantity and how organizations measure success. Ad impressions are one way to measure success, but they concentrate on quantity. If your key performance indicator (KPI) is serving more ads, then yes, this change is going to hurt your KPI, as your ad will be served less.

But, at Varsity, we believe in quality-based measures of success. If 1,000 people see your ad but don’t act on it, was it worth it? Or would you rather have 10 people see your ad, and three people make a connection with you? Of course, you’d prefer to have three out of 10, rather than zero out of 1,000.

By giving users the ability to say no to your ads, Google and Mozilla are actually helping organizations spend their ad dollars more efficiently. So, don’t let the reports fool you — this is an important change, but not one that you should be worried about. Remarketing ads will continue to be an effective way to keep your brand top of mind with your target audience.

Many aging services providers use Facebook as a means to engage with their current and future residents, families and supporters of the community. The platform has become a powerful tool for communities and marketers alike. But, after several years of building a quality Facebook presence, providers are now being warned about upcoming changes to how Facebook works, which can and will affect their accounts.

In a January 11, 2018, post to the Facebook blog, Adam Mosseri, head of News Feed at Facebook, announced that changes to the News Feed are being implemented. Says Mosseri, ”With this update, we will also prioritize posts that spark conversations and meaningful interactions between people. To do this, we will predict which posts you might want to interact with your friends about, and show these posts higher in the Feed. These are posts that inspire back-and-forth discussion in the comments…We will also prioritize posts from friends and family over public content…”

Obviously, these changes are going to be felt the most by organizations that operate a Facebook Page as part of their outreach efforts. Facebook expects that Pages will see their reach, video watch time and referral traffic decrease. While people will still see posts from pages they follow, Facebook will prioritize content that prompts conversation and interaction between users.

So, what can you do to ensure that your posts will still be seen by your target audience? Here are our top tips for keeping your content in front of your followers:

1. Make your content engaging. We can’t stress this enough. The days of just posting a pretty picture or trying to promote an upcoming marketing event are over. Your content needs to elicit a response from your audience. Before you make a post, ask yourself, “Does this post inspire me to leave a comment or share it?” If it doesn’t, then you should go back to the drawing board.
2. But don’t beg for engagement. Facebook announced that it will algorithmically degrade content that asks for engagement. This means that you shouldn’t end your post with, “Please leave a comment” or “Make sure to Like and share.” Again, your goal is to inspire this behavior organically.
3. Use a mix of words and media to garner a response. Every post you make should have a picture or video attached. Studies have repeatedly shown that text-only posts receive far less engagement. However, this doesn’t mean that you can ignore the words that go along with the post. The corresponding text needs to be descriptive enough that someone who has no knowledge of the topic being presented could be moved to engage.

Facebook has a history of making changes to its platform that are initially resisted by the user base but, over time, have proven effective, making for a better user experience. We believe this round of changes will be in the same vein, requiring us to adapt to a changing paradigm that will make us smarter and more effective marketers in the future.

Since the 1990s, divorce among adults 50+ has doubled, according to a Pew Research poll. People under the age of 50 have seen declining divorce rates, but later-in-life divorce (often termed “grey divorce”) continues to climb. Many researchers are studying why this is occurring, while families and senior living communities are on the frontlines, dealing with the real-life fallout from the ending of marriages.

Before we can understand how to handle grey divorces, we should probably understand the reasons why they are happening. An article on HuffPost, dated September 2015, actually laid out a pros and cons list for those who are “di-curious” and considering a divorce after 50. Reasons cited in favor of divorce included the ability to more easily meet new people (such as when moving into a retirement community), rediscovering of one’s sense of self, new sexual experiences and a freedom to engage in new hobbies that the previous spouse may not have been interested in. Of course, the cons list included issues like loneliness, feeling out of place among married friends and having to handle all of life’s challenges alone after many years of interdependent marriage.

With all of this in mind, we generally see a couple of trends for the reasons that people get divorced after 50. First, as attitudes toward divorce have changed in America, so have the attitudes of those growing older. The stigma of divorce used to be strong; today, it’s become more normalized. As such, older adults now feel less social pressure to remain in relationships that aren’t working for them. Of course, these divorces are enabled by “irreconcilable differences,” the modern catch-all phrase for when couples can’t seem to get along anymore. With children out of the nest, and the daily grind of work coming to an end, many couples find that spending so much time together in retirement is much harder than they had anticipated. They realize just how far they’ve grown apart and start to consider life beyond the marriage. Of course, these kinds of conversations can and do happen after a couple moves into a retirement community, creating a very murky situation, indeed.

Another sad trend that directly affects grey divorce and senior living is financial issues. There are more than a few instances where being divorced leads to a better financial situation for those involved. When nursing expenses become income-based, and one spouse was the breadwinner for years, the couple can be left holding a bill they weren’t prepared to pay. If divorced, those costs could be significantly reduced. What a terrible option this must be — pay to keep your marriage alive or divorce and keep yourself out of the poorhouse!

So, with all of this in mind, what can aging services providers do to help?

First, recognize that just because a couple has been married for 25, 30 or even 40+ years, there may still be issues in that relationship that you can’t control or understand. Everyone loves to say, “Awwww!” when they see an older couple holding hands, but for every couple like that, there is another that struggles to stay together every day. Having your pastoral care staff and social workers prepared to deal with marital issues in retirement is a great first step in providing resources for your residents.

We also advise that directors, admissions and marketing associates have a standardized plan in place for when a couple decides they are going to divorce after moving into the community. How will you handle the finances? Who moves out? What happens to the apartment or cottage? Taking a little time to think about these issues before they arise not only helps your organization better manage the situation, but it makes the transition easier and more respectful for the residents in question.

While the grey divorce trend can be unsettling for community managers, adult children and other residents of a community, it is an issue that is on the rise. We would like to think that every relationship will be able to grow and mature into retirement, but we know that not all will. It behooves aging services professionals to understand and plan for these changes now, before they are presented with them.

Sources:
http://www.griswoldhomecare.com/blog/3-reasons-why-seniors-are-getting-divorced/
http://www.huffingtonpost.com/barry-gold/gray-divorce_b_8045840.html?utm_hp_ref=fifty&ir=Fifty
http://www.pewresearch.org/fact-tank/2017/03/09/led-by-baby-boomers-divorce-rates-climb-for-americas-50-population/