Category: Technology

Guest post by Mary Muñoz, Senior Managing Director, Ziegler

This is certainly an interesting time for senior living — we’re moving away from COVID-19, although we’re not quite past it yet. The pandemic has taught us a lot about where we’re headed in the future, but there are also a lot of industry trends that have remained constant through it all. Let’s take a look at what’s trending in senior living right now.

Industrywide Growth and Consolidation

What hasn’t changed with COVID-19 is the population wave we have coming, with a surge in the 75- to 85-plus cohort. And with that, we still have many drivers that make our business an attractive one. For starters, there are those still living at home who don’t have anybody there to take care of them during the day. We have the dangers of social isolation among older adults. And there are those who can’t afford caregiving.

In addition, we’re seeing a consolidation trend across the industry. Why is this happening? Almost every transaction we’ve seen has involved a CEO retirement. We’re facing a labor shortage in care and dining, along with a shortage on the C-suite side, as fewer people are coming into the senior living business, although larger organizations have some advantages in recruitment and career path offerings.

Ongoing Labor Market Challenges

Speaking of which, let’s talk about the labor market a bit. The U.S. Bureau of Labor Statistics is projecting almost 1.2 million annual job openings in senior living. Worldwide, we’ve already crossed the line in the past couple of years that there are fewer people under 5 than there are those 65 and older.* That means we literally won’t have the bodies to do things the way we’ve done in the past. So, we have to find ways to reinvent how work is getting done in our communities.

The pressures are coming from many different directions. We’ve got financial struggles, and the changing demographics of who’s coming into the workforce. Government reimbursement is under pressure, which in turn affects health care worker wages. The pandemic caused clients to lose employees because they refused to be vaccinated or simply burned out. Immigration was disrupted and a lot of the caregivers we get from across the border were affected. And then we have the lasting issue that senior services isn’t exactly a sexy line of work.

Stressors in Skilled Nursing

For post-acute care, I want to highlight the compounding challenges in the skilled nursing environment. COVID-19 definitely exhausted and burned out employees. There’s also the need for private rooms, which many communities did not offer pre-COVID. And a lot of the nursing communities are old, with declining occupancy, in part because we didn’t have assisted living and memory care until recent years. So, there were some people who didn’t need to be there and could be taken care of in a less acute setting.

All of these factors are leading to a downsizing of skilled nursing, and in some cases the transition of skilled nursing rooms to high-acuity assisted living. In fact, we’ve counted 35 Life Plan Communities around the country that have eliminated skilled nursing from their continuums in favor of high-acuity assisted living.** And there are many new communities being built right now that have no skilled nursing.

Technology as a Partner for Smarter Aging

There are many developing technologies that serve seniors in various ways. We’ve certainly had a dramatic rise in telehealth during the pandemic. Beyond that and electronic medical records — which most already have in place — there are resident engagement technologies, including dining reservations, menus and activities. There’s also been a focus on predictive technology, not only tracking footsteps but also predicting falls by tracking gait. That’s in addition to cognitive brain solutions, smart home technology and even robots. While robots probably won’t cure the labor shortage, we have seen communities using robots to deliver plated meals and bus plates in dining venues, for example.

These four takeaways are just the beginning of what’s trending as we emerge from the pandemic. For more information, feel free to subscribe to the Ziegler e-newsletter, refer to our white paper about health care technology or message me at .

*Source: U.S. Census Bureau, Percentage of World Population Under Age 5 and Aged 65 and Over: 1950-2050

**Source: Ziegler Investment Banking

At our 18th sales and marketing roundtable, communities contributed ideas and talked about changes on their campuses. This week, Adam Grafton, vice president of culinary for Morrison Living, shared his tips for elevating environments while keeping communities safe.

Here are some tips from Adam’s discussion:

He and other Morrison Living employees live by this motto: “Through compassion and dedication, creating an equitable approach to memorable experiences.”

Elevating Experiences in the Next Normal

• Assure Safety
  • It’s obviously more important than ever
  • How are we communicating this to current and future residents?
• Deliver Care
  • Care of associates and residents
  • Focus on wellness
• Take Action
  • Look at opportunities to create innovation now and for the future

Culinary

Take Action:

• Wellness
  • Set snack time with fun vibes (music and dancing)—all while social distancing
• Flexibility
  • Residents have been introduced to different styles of service and food

and will want flexibility moving forward

Consider creating a marketplace for groceries for purchase or delivery

• Cognitive health
  • Superfoods—virtual demonstrations through community channel (e.g., health benefits of citrus)

Technology

Take Action:

• Wellness
• Equitable food solutions
  • iPads with menus
  • Self-order kiosks
  • Residents able to view nutritionals
  • Technology connects directly with POS at community
• Flexibility
• Cognitive health

Innovation

Take Action:

• Independence
• Variety and flexibility
  • Takeout becomes more important, as well as other styles of service
  • Heavy on tech side with automated machines
    • Takeout lockers
    • Automated salad makers
    • Automated barista coffee machine
    • Virtual teaching kitchens
    • Robots to help assist with service
  • Experience
  • Socialization

Training + Engagement:

Take Action:

• Retention
  • Let residents know that you’re thinking about them during this time with a takeout/delivery menu
  • Alcoholic/nonalcoholic drink kits to coincide with current events (e.g.,mint juleps for Kentucky Derby—which will be held on Saturday, September 5, this year)
  • Note that takeout items must be carefully selected as not everything will travel well
• Safety
• Pride of ownership

 Additional discussion:

• Social distancing
  • Distancing of tables
  • Encourage reservations and staggered seating times vs. everyone attending at 4:30 p.m.
  • Dining rooms won’t be filled since there will be so many different types of services (market cafe, takeout, sit-down dining, etc.)
  • Staying 6 feet apart will be the new norm
• Signage
  • Essential signs (floor/reminder to stay 6 feet apart)
  • General signage that assures residents, staff and visitors of the extra precautions your community is taking to keep them safe (washing hands/hand sinks)
• Dining updates
  • We’ve reopened our dining rooms, but only at 25% capacity. They are being used at all hours (7 a.m.–7 p.m. for bistro and 5–8 p.m. for fine dining)
  • Our bistro is open with limited service times

Join the next sales & marketing roundtable on July 30!

• Please join our next roundtable discussion on Thursday, July 30, at noon ET.

Mark Ingram from SenioROI will join us to share his thoughts on direct marketing and list procurement in the time of COVID-19.

For log-in information, contact

As more areas open up, communities met virtually for roundtable #14 to discuss this week’s reopenings and answer one another’s questions.

Check out the recap of our discussion below. Please also join us for our next sales and marketing roundtable, coming up this week.

Questions from attendees:

What can our resident panel talk about in an upcoming Zoom call?

Ideas discussed:

• Ask residents to share what they’ve been up to on campus (and the fun they’re having)
• Talk about dining and activities
• Discuss safety protocols in place
• Talk about how the administration communicates with residents and keeps them engaged
  • Were you respected as a resident and individual?
  • How did the community try to keep life as normal as possible?
  • Do you have any regrets or wish you were still at home? (Use caution on this one; make sure you know what the resident will say)
• Contrast social engagement vs. social isolation

One participant asked about struggling with visually interacting with prospects since they can’t meet in person. How do residents interact with people? Is a Zoom meeting better than a Zoom webinar platform?

Ideas discussed:

• Webinars are good for larger conferences, and meetings seem to be better for more personal interactions with fewer than 10 to 15 people
• Zoom meetings allow for breakout rooms and more personal conversations
• Strive to book a private Zoom meeting in the days following a presentation to have a more personal conversation

We will explore this topic more in next week’s roundtable.

Join the next roundtable on July 2!

Come kick off the holiday weekend at our next roundtable discussion on Thursday, July 2, at noon ET.

You don’t have to be a client to join — all are welcome. For call-in information, email .

Communities in different parts of the country came together last Thursday to share their thoughts and challenges as shutdowns continue. Jackie Stone, VP of sales at Varsity, joined our general discussion to share insights on virtual event topics and processes during social distancing.

Check out the takeaways below. You are also welcome to join our next sales & marketing roundtable, coming up this week.

Jackie leads a discussion on virtual presentations:

• Presentation objectives
  • New lead generation
    • Use the purchased email list and lead base
    • Select universal topics of interest to anyone
    • Ensure that the presentation represents the lifestyle at the community and reinforces the established brand
  • Sales presentation
    • Target the lead base
    • Address common objections
      • “I’m not ready yet.”
      • “I want to stay independent.”
      • “I’ve lived here for 50 years; I don’t know where to start.”
      • “This apartment is so small.”
      • “I don’t want to live with all old people.”
      • “How would I even go about selling my home?”
      • “The economy/stock market is unstable.”
    • Personalize to the prospect
      • Customized to each individual prospect — what he or she values in life and in a community

• Potential presentation topics
  • New lead generation
    • Mindfulness — Putting Your Practice Into Place
    • Healthy Aging: Achieving Wellness in All Dimensions
    • Living a Big Life
    • Dispelling the Myths of Retirement Living
  • Sales presentations
    • Decluttering Your Life to Make Room for Experiences
    • Living a Big Life
    • Bridging the Gap Between “I’m Not Ready Yet” and “I Wish I Had Done This Sooner”
    • Protecting Your Nest Egg
    • Does a Life Plan Community Make Sense for Me?
    • Selling Your Home in a Virtual World
  • Personalizing to the prospect
    • Presentation of the community’s services, amenities, residences and benefits
    • Video walking tour of the community
    • Happy hour Zoom call

• Marketing automation
  • Targeting prospects
    • Email seminar invitation
    • Confirmation and login instructions
    • Resending of seminar invitation to those that did not open the original email
    • Reminder email two days prior to the event
  • Communicating with those who did attend
    • Post-webinar “Thank you for joining us”
    • Survey
    • What other topics might interest you?
    • Schedule a private appointment?
    • Next seminar invitation
  • Communicating with those who did not attend
    • “We missed you” email
  • Schedule a private appointment?
  • Next seminar invitation
• Typical attendance expectations
  • We’ve seen anywhere from 7–10, 25–30 and close to 50, so it can really vary.

Where are you doing to go from here with marketing?

• It depends on your community.
  • Examples:
    • One community is stretched for dollars because of the current bond market.
    • Other communities may have more money to spend, with cancelling in-person marketing events.
  • You may need to move dollars around in your budget. The focus will need to be on engaging prospects in blue sky projects. If you don’t use the money this year, you won’t have it next year! Spend it wisely, and don’t let it go.
  • An AL community in New York has online events/speakers every week. It’s very buttoned up and structured — link to check out: https://inspireseniorliving.com/events.
  • I think we’ll be Zooming for a long time.
  • Follow these virtual call tips.
    • Do a roll call.
    • Ask what participants miss during this time of quarantine. If they say Starbucks, deliver a coffee to their doorstep.

Join the next sales & marketing roundtable on June 4!

We thank everyone for participating, and we invite you to join the next session on Thursday, June 4, at 12 p.m. ET.

You don’t have to be a client to join — all are welcome. For call-in information, email .

As COVID-19 continues to impact senior living, we held another virtual roundtable to see what sales & marketing tactics are working now — and what will change at communities after restrictions are lifted. Check out the highlights below.

All are welcome to attend our sales & marketing roundtable next week. Details below.

Join the next sales & marketing roundtable on April 30!

We thank everyone for participating, and we invite you to join the next session, Thursday, April 30, at noon ET.

Kim Lehman, Varsity’s PR director, will join us for part of the session to share tips and trends on PR/crisis communications.

You don’t have to be a client to join the session — all are welcome. For call-in information, email .

‘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.

One major myth about older adults and technology is that they don’t use it because they don’t understand it. But that idea is as outdated as a flip phone. From social media to online banking, older Americans are adopting tech at the speed of light.

Recent findings by the Link-Age Connect 2019 Technology Survey of Older Adults Age 55-100, also featured in Senior Housing Forum, bear that out. Smartphone use in particular has been skyrocketing. Among people ages 70-74, it shot up from 54 percent to 81 percent. That’s in just the past three years.

Unexpected  Choices

What’s even more surprising than the speed at which older adults are adopting new technologies? The reasons why some are unplugging from tech completely. Or at least using it less. Seniors often make this change, not because they’re confused about technology, but because they’re making a conscious choice to live offline. Here are some of their very smart reasons:

1. 1. Older adults prefer human connection. As smartphone penetration spikes ever higher in people of all ages, we’re all on our phones, all the time. Even when we get together, we’re logging on to check social media or our daily step count instead of talking to one another. Older Americans have the wisdom of knowing that time on this earth  is precious. It’s important to spend it with family and friends instead of glued to a device. One quote from the study proves the point. “I think technology is taking over people’s lives and it takes away from relationships with people.” – Female, age 95-99.
   2. They’re simplifying their lives. Older adults often have a desire for minimalism that goes hand in hand with human connection. The survey states, “As people age, they simplify their lives, allowing more time for personal interaction and less time for things that ‘busy’ them or take them away from time with family and friends.” Another quote adds,“It isn’t necessarily about teaching older adults to use a technology. It very well could be that they have used it and walked away from it because they do not want it in their lives any longer.”
   3. They’re watching their budget. Those on a fixed income struggle to pay for technology. For instance, only 25% of affordable housing residents have in-home WiFi , compared to 90% of the greater population. Even when older adults can afford to spend more, they follow the principle: “If it works, don’t fix it.”  Sure, marketing campaigns are persuading other generations that they need to spend hundreds on the latest Smartphone. But older Americans often aren’t interested in updating just to get the latest bells and whistles. If it’s a “want” instead of a true need, they’ll keep the device that still works just fine.

 Personality Trumps Age 

The study also found that technology adoption relates more to personality than age. Comments from two different survey participants underscore that point: “I L-O-V-E technology.” – Female, age 84. “I prefer to use it when I want to and not be run by it or tied to it.” – Female, age 95-99. At Varsity, we’ve expressed our opinions before about not lumping everyone 65+ into one category. This new research has driven home, once again, that people of ages need to be seen as individuals — when it comes to technology or anything else.

Eaton Senior Communities is home to 164 residents and, occasionally, a socially assistive robot called Ryan, now being developed at the University of Denver. In a series of posts, I’m talking to people involved in this fascinating project and getting their perspectives on how this lifelike “companionbot” could benefit seniors living with depression and dementia.

Today, Sarah Schoeder, wellness director at Eaton Senior Communities, shares some of her favorite stories about resident interactions with Ryan.

DW’s Story: Reengaging in the Community

DW struggled with depression after the loss of his wife earlier this year. We no longer saw him smile, and he had begun to isolate, no longer taking meals in our dining room or attending holiday parties. At 93, he had limited access to technology in his lifetime — and certainly not to a robot! What transpired was the old DW returning to us. He smiled and laughed again and was always on time, never missing a session. His daughter was thrilled that her dad was once again engaging in the community, and it lessened the stress she felt when she was away on business. DW will tell you that it “was fun” and that “Ryan helped take my mind off the constant thoughts of my wife. It gave my mind a new direction, you might say,” he said. He felt valued, helping the interns achieve their goals and receiving the opportunity to engage with younger adults.

LW’s Story: Overcoming Depression

LW was another unexpected success. As a younger resident with a higher level of education, I was not sure what to expect. She surprised me when she said that “Ryan understands me; she knows what I am going to say before I do.” LW struggled with depression that was intensified by her recent move to the community. Over the course of the trials, she began to report that moving here had improved her mood, and she looked forward to her sessions with Ryan. She is anxious to further participate in clinical trials and recognizes that Ryan helped her overcome the deep depression she felt earlier this year. I am happy to say that she is now an active community member, participating in many social events and helping her neighbor regain her love of art.

PN’s Story: Making a Friend

PN was thrilled when invited to participate with Ryan. He frequently commented on how beautiful her smile and facial features were. He recalls how he asked her out to dinner, but she declined, saying she was not hungry! PN commented on the variations in facial expressions and quality of speech. He was aware of these features and how it affected his relationship with her. PN looked forward to his interaction with Ryan, and the excitement that followed after his sessions was priceless!

BC’s Story: Seeing His Dream Come True

This resident had studied psychology in the 1950s and had particularly enjoyed the area of artificial intelligence. In his 90s, and highly educated, BC enjoyed seeing the “future” that, years earlier, he could only dream of. After his sessions, he would smile and talk at length about the interactions. It was great to see his mind stimulated and the smile he was well known for return when his health was failing him.

See Ryan from her inventor’s perspective in another blog.

Eaton Senior Communities is home to 164 residents and, occasionally, a breakthrough, socially assistive robot called Ryan — created at the University of Denver — which could soon be available to the general public. In a series of posts, I’m talking to people involved in this fascinating project and getting their perspectives on how this lifelike “companionbot” is helping older adults who are living with depression and dementia.

Today, I’m speaking with Sarah Schoeder, wellness director at Eaton Senior Communities, who is a liaison between the residents and the team of scientists developing Ryan. Sarah has been serving the geriatric community for 38 years, including 20 years as an LPN in a skilled nursing facility.

Wayne: Sarah, what was it like trying to get residents to participate in the robot pilot studies?

Sarah: I would visit them and drop this idea in their lap, and they’d look at me like I was crazy. I’ve approached a lot of residents whom I didn’t expect to get involved — some of them in their 90s. To see them go from giving me a look like, “You’re kidding me” to becoming excited, looking forward to the sessions and wanting to be involved in the next set of trials, it’s been amazing.

Wayne: Did the residents have input about the changes in the robot?

Sarah: Yes, residents would give feedback about what they’d like the robot to look like and sound like — what they’d like it to say. Then, the team would make changes.

Wayne: How has the robot changed over time?

Sarah: Ryan’s facial features appear more natural, and the improvement in the movement of her head has given her a “softer touch.” Her smile is beautiful, and she makes me want to smile back!

Wayne: Were you concerned that residents might not want to finish the project?

Sarah: Yes, but all residents in both trials of 2018 completed all sessions, which spoke highly of the project goals. Some residents were hesitant and perhaps a little fearful, but after spending time with Ryan, their attitudes completely changed. Ryan has touched the lives of Eaton residents by providing unconditional companionship and interest in their lives. The improvement in mood and cognition was apparent as residents were exposed to educational opportunities and stimulating interactions.

Wayne: Does Ryan have a sense of humor?

Sarah: Yes! I’ll give you an example. One resident who was hosting Ryan in her room was walking down the hall, and she said to me, “Can you believe what that crazy thing just said to me?” She went on to say that she and Ryan were talking about how the Denver Broncos were competing against the Patriots in the Super Bowl, and Ryan announced that she was a Patriots fan — in the heart of Bronco country!

Wayne: How will this new technology help people age in place?

Sarah: One of the biggest reasons people move into assisted living is that they can’t manage their medicines. If Ryan reminds me to take my medicine, that might be the defining moment that keeps me home.

Wayne: How has this experience changed your views on robotics?

Sarah: If someone told me five years ago that I’d be sitting here telling you robots could be valued members of a health care team — that I’d be endorsing them as part of the health care model — I would not have believed it, but I’ve learned that the robot is not replacing me as a nurse and caregiver. It’s just empowering me to be more successful in senior living.

Sarah will share stories about resident interactions with Ryan in next week’s blog. 

Soon, older adults will have access to a breakthrough new tool to improve their quality of life. Mohammad Mahoor, PhD, director of the computer vision and social robotics laboratory at the University of Denver, has spent the last decade working with his students to create and refine an amazingly lifelike, socially assistive robot named Ryan, which can provide deep social interaction and companionship to people living alone.

Designed to address challenges of aging — like dementia, depression and loneliness — this “companionbot” can recognize faces and emotions, express feelings, hold conversations and remember individual comments for future interactions to build a relationship over time. Ryan’s face is expressive and lifelike; she can turn her head to react to voices and movement, and her torso contains a screen for playing music and games, watching videos, looking at photos and doing other activities. Ryan’s next iteration will also have active arms so she can coach people in light exercises to improve their physical fitness.

In a pilot study, six residents at Eaton Senior Communities in Lakewood, Colorado, had 24/7 access to Ryan in their apartments for a period of 4–6 weeks. Ryan was customized for each participant, with photos for an album, daily schedules, favorite music and topics of interest for YouTube video searches. Participants could call Ryan by the name of their choice.

Observations, interviews and analyses revealed that the residents established rapport with the robot and greatly valued and enjoyed having a companionbot in their apartment. They also believed that the robot helped them maintain their schedule, improved their mood and stimulated them mentally. One user shared that, “She [Ryan] was just enjoyable. We were SAD to see her go.”

After the staff at Eaton Senior Communities told me how thrilled the residents were with their experiences with Ryan, I spoke with Dr. Mahoor about his invention.

 Wayne: Why did you create Ryan?

Dr. Mahoor: We wanted to address the needs of older people living with dementia, loneliness and depression. There is a shortage of caregivers, and care is expensive — Ryan is a great form of companionship. She can help seniors lead better lives at home.

Wayne: Can you talk about the testing process?

Dr. Mahoor: The first round of testing, in 2016, was a six-month, piloted study at Eaton Senior Communities. All of the features were not ready, the cognitive games were simple, and the speech recognition had some glitches — but we received very positive feedback. After making changes, we did two more pilot studies this year. One focused on how Ryan can help people with dementia through cognitive behavioral therapy. The second pilot study was totally autonomous. Users had half an hour of interaction with Ryan for 3–4 weeks to test the emotion recognition technology.

Wayne: Were there any surprises when people first began interacting with Ryan?

Dr. Mahoor: At first, we had a fear that people wouldn’t like Ryan. But even in the early stages, they reacted very positively. We noticed that the more time they spent talking with Ryan, the more they enjoyed it, and they wanted her to tell them more stories and jokes — even gossip! When we took the robot away from one of the residents, he literally cried. The bond was so strong that he was very sad. It was really surprising for me that a robot could make such a huge impact on people’s lives. I didn’t expect that much of a connection between machine and human.

Wayne: What challenges did you face when test-driving Ryan?
Dr. Mahoor: One of the challenges is that you have to be patient because multiple people cannot talk to Ryan at the same time — you have to take your turn so that she can listen and understand you.

Wayne: What kinds of results have you had?

Dr. Mahoor: When we measured mood and depression before, during and after phase one of our study, we found that Ryan significantly improved users’ moods and lessened their depression.

Wayne: What’s next for Ryan?

Dr. Mahoor: We received a National Institutes of Health (NIH) grant for phase one, and now we are in transition to phase two. NIH has approved our next grant from a scientific perspective. Now it just needs to approve the budget. Phase two would be a grant of over a million dollars to help us study Ryan’s impact on the progression of dementia.

Wayne: How unique is Ryan?

Dr. Mahoor: There are other robots out there, but this is the first one developed with features customized to help with depression and dementia through social conversations, games and other interactions.

Wayne: When will Ryan be available on the market?

Dr. Mahoor: We are very close; I’m hoping by the end of the year. We’ve started working with investors to begin production. Users love Ryan, the feedback has been positive, and we’ve made improvements. It’s time to go to market to fulfill our mission of helping the health care industry.

Wayne: How much will she cost?

Dr. Mahoor: Manufacturing each Ryan costs thousands, so to make her more cost-effective, we have a subscription-leasing plan in mind. The cost would be about $400 per month for individuals, but if a corporation wanted to lease multiple Ryans, the rate would adjust. One Ryan can be reprogrammed to serve multiple residents.

Wayne: What would you say to people who worry that robots will take over the world?

Dr. Mahoor: Ryan is going to complement the time and support of caregivers and help make their lives easier — not take over and replace them.

Wayne: Are you surprised at where you are today?

Dr. Mahoor: Yes. When we first started several years ago, I didn’t think we’d be in a position to commercialize the invention; I didn’t think we’d be a startup meeting with investors. I’m so happy about our progress. For us to be in a position to bring a robot to market that’s going to improve health care and impact people’s lives for the better is amazing.

Learn more about Dr. Mahoor’s companionbot, Ryan, at Dreamfacetech.com.