Tag: Senior Living Trends

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.

Today I’m talking with Maura Z. Richards, Vice President of Business Development at Wohlsen Construction, a top-ranked construction company specializing in senior living. Prior to her current position, Maura spent more than 15 years working in senior living as a provider and consultant, giving her unique insights into finding solutions that are economically and operationally viable to increase occupancy.

Hello, Maura! Thank you for talking to me today! What do you view as the biggest challenge facing older adults in the middle market?

The affordability of senior living communities. We have not completely solved the middle market product challenges to serve the number of seniors that will need to move to — specifically  — an assisted living or memory care community. Seniors will stay home as long as possible — which more times than not means too late — due to the fact that they do not have enough money to afford a senior living community.

What are some common misconceptions about the middle market?

People get confused when you talk about the middle market. They think middle market housing is affordable, but it’s really not. It’s essentially less costly than a traditional senior community, but it’s still expensive. The middle market community is much smaller in size and has more of a model of two bedrooms sharing a kitchen and bath. This type of living arrangement is not one that a prospect seeks until there is a need.  Having been in senior living for many years, I can share that this is not what you want to hear when a prospect comes through the door. You want prospects to move to a community when they are independent  and not making a need-based decision so that they are content with the move and will take full advantage of the lifestyle a senior living community offers.

What are the biggest barriers to building for the middle market?

Building costs and land cost — with both being high, the financial model is hard to pencil out to be affordable for the middle market. Developers look for sites that are outside urban areas to keep land costs down. However, to make the community pencil out, there typically is less amenity space and an apartment layout in which two individual prospects share a kitchen and bathroom.

What is the biggest competition for middle market housing?

People’s own homes and technology. If people can stay in their home and install smart home technology for less than it costs to move to a senior living community, then they will always choose their own home. They will then wait until there is a need to move to a community. The struggle from a proforma perspective is that the higher the acuity level of the residents, the more staffing the community needs.  With that comes higher entrance fees and monthly fees.

Since studies have found that, by 2029, 54 percent of older adults will not be able to afford private pay senior living, how will the industry as a whole need to change? 

The industry will need to look to partner with other organizations to create a mixed-use development that taps several housing options to share in the cost of the amenity space to bring down the cost of senior living.

What types of organizations would be good partners for senior living?

Maybe there is an option for senior living to partner with intergenerational housing options to form a mixed-use development. For example, many universities need additional student housing yet are faced with high construction costs just like senior living. There could be an opportunity for developers to look at student housing and senior housing to share in amenity and community space to lower the costs for both. This would also allow both populations to take advantage of the educational opportunities.

Do you have any other creative ideas that could benefit the middle market?

Another idea I have thought about from a socialization standpoint is to build senior centers on or next to local public schools to leverage intergenerational opportunities and programs. High schools are being renovated all over the country and facing issues of getting funding passed. Why not look at combining the two? The more our younger population interacts with and understands senior needs, the more we will see solutions to take care of older adults in the future. To get youths to understand seniors, you have to put them together.

At the 2019 LeadingAge Tennessee Conference and EXPO, an entire audience of people sat together quietly, eyes closed, remembering how they felt on the first day of school.

After several minutes, the presenter had them open their eyes and share their feelings. Emotions ranged from fear and excitement to nervousness and anxiety.

Why did presenter Melissa Ward, PT, MS, RAC-CT, Vice President of Clinical and Regulatory Affairs at Functional Pathways, have the audience do this exercise? She wanted to evoke the emotions students and parents feel on the first day of school, which is very similar to the way residents and their loved ones may feel on their first day in a retirement community.

Trying to find your way around an unfamiliar place can be a tremendous adjustment, and the move can be just as stressful for families leaving their loved ones. But there are ways to help the transition go more smoothly, like the techniques described in this recent article in McKnight’s Senior Living. And now, new residents and their families have another powerful resource to draw on: a unique program developed by the Functional Pathways team.

According to Ward, the Transition Concierge Program began as a “what-if” idea about two years ago. “A client community was  struggling with having residents successfully age in place,” Ward said. “New residents came in and weren’t engaged in community life. They weren’t taking advantage of everything available on the campus. This issue was leading to increased risk for falls and residents requiring higher levels of care.”

That’s when the Functional Pathways Team, led by Beth Reigart, Clinical Outcomes Specialist, decided to create the new Transition Concierge Program. This collaborative approach brings together a powerful arsenal of tools, including social services, nursing, therapy, activities, wellness, resident programming, resident support groups, resources for the family, on-campus physician services and more. By making the transition smoother, the program helps residents successfully age in place.

How the Transition Concierge Program Works

When the resident moves in, a Navigation Team conducts in-depth standardized assessments. Then, an Interdisciplinary Team creates a plan of individualized support. Every element is geared toward giving the individual input into his or her own life.

Here are a couple of examples: If a resident has breathing problems, he or she may need a plan that addresses limitations in endurance to make it possible to get to the bistro. If a resident has low vision, apartment modifications or a plan to get and read mail may be needed. Every resident adjusts to resident living at a different rate, according to Ward. The program was designed to provide services and support that fit each individual’s unique needs.

More Than Just a Real Estate Transaction

The Functional Pathways team believes that moving into an independent living community should be “more than just a real estate transaction.” It’s fostering a true continuum of care through this innovative service.

New residents may still face those first-day-of-school jitters. Fortunately, this innovative collaboration helps ease the transition so they can find passion and purpose in their new environment.

How is your community helping resident transitions go more smoothly? Let me know at . I’d love to feature your strategies in an upcoming blog post.

A solution to occupancy challenges can come from someplace you never expected, like foster care.

When you think about it, it’s a natural combination: Youth aging out of foster care need a job and a place to stay. Senior communities have empty housing, job vacancies and caring mentors. But no one has thought to bring the two together — until now.

Rosemary Ramsey, the director of The Victory Lap, got this unique idea while she was employed at Brookdale Senior Living and volunteering with Monroe Harding, a nonprofit that helps foster kids that are aging out of the system.

How The Victory Lap Began 

“I was sitting at my desk at Brookdale, thinking about occupancy challenges. At the same time, I was volunteering with kids aging out of foster care. I saw their issues of finding employment, housing and connection to caring adults,” Ramsey said. “It kind of hit me that my worlds could collide in a productive way.”

“The truth of the matter is, a lot of these kids never get adopted,” she went on. “Twenty-two thousand kids age out every year in America. At least 30 percent of them will experience homelessness — and every one that bottoms out costs tax payers over a million dollars.”

In addition to occupancy challenges at communities, there’s also a nationwide labor shortage. “There are tons of entry-level opportunities in senior housing,” said Ramsey.

She also feels that great relationships can develop between residents and youths aging out of foster care. “There are three things older people universally love,” she said. “Mail, ice cream and young people.”

Cannonballing Into Community Life

John, the first participant, age 18, liked the idea right away. “It was an opportunity for him to have his own space. In the group home, you have to share a kitchen and a bathroom,” Ramsey said. “He also liked the idea of being around seniors because he was close with his grandparents. And he loved the pool.” That’s why, to celebrate John’s move-in, the local TV station shot a video of him cannonballing into the community’s pool. Watch it here.

John will attend college this fall while working part time and living at East Ridge Residence, an independent living community. He’ll receive oversight and counseling from a local nonprofit: Partnership for Families, Children and Adults.

Now that her program is up and running, Ramsey is looking forward to future placements. “This is not just a touchy, feel-good opportunity. It has real, practical economic benefits,” she stressed. “Retirement communities can not only fulfill their need for employees, and contribute with some living spaces not in use, but they can actually receive a stipend from the state for helping provide housing.”

In senior living, she said, “intergenerational” is a popular buzzword, referring to initiatives like Girl Scouts coming in to read stories, but Ramsey thinks that it can be taken a lot further. “I think it’s a marketing advantage — a place where older people and younger people live together,” she said.

Expanding the Program

Eventually, Ramsey would like to expand the program to populations beyond the foster demographic, such as veterans and people who are developmentally disabled. “Our industry is sitting on 100,000 vacancies. Let’s try to make a dent in our occupancy challenges and think outside the box,” she said. “These people can add life to the community, and residents have life experience and wisdom to impart.”

Right now, Ramsey is excited that the first participant has moved in. “John is doing great! He describes life in the retirement community as ‘way better’ than the group home,” she said. “He  has more freedom to come and go as he chooses. His job in the dining room is going well, and he has his own section now, so he is proud of that! He’s enjoying playing Bingo and cards, and the residents are teaching him new games.”

Has your community found unique solutions to occupancy challenges? Let me know at

Even after three days in the steamy summer heat, my excitement about everything I learned at the LeadingAge Tennessee 2019 Annual Meeting & EXPO is just beginning to heat up. The theme was: “What if we helped people find passion and purpose?” The individuals I connected with at the show are doing that in amazing ways. They’re bringing generations together, leveraging strategies from other industries and approaching their challenges with a fresh perspective.

Without further ado, I’m excited to report back to you my top five “what-ifs” at the show:

1. What if we could integrate former foster youth into senior living communities?

While I was walking the floor, I spoke with Rosemary Ramsey, founder of The Victory Lap, an organization committed to matching youth, 18 to 21, who have aged out of the foster program, with open apartments at senior living communities. The community would be paid $900 per month (funded by the foster program in Tennessee) and would be asked to provide a job for the individual (at least 10 hours per week). The program is intended to give former foster kids a boost — with stable housing, employment opportunities and support from caring older adults — while meeting workforce challenges, filling otherwise vacant units and fostering intergenerational friendships. Look for an interview with Rosemary in a future blog post!

2. What if we could bring the principles of doula care to hospice?

A session on creating a doula program for hospice created some serious conference buzz. The program follows the principles of birthing doulas to help guide the individual and family/loved ones through the dying process.

3. What if we could find and retain top talent?

One of my favorite sessions, led by Matt Thornhill, stressed the need for transparency and inclusion when hiring. It was all about finding and retaining top talent. One example Matt referenced was the innovative 30/40 program by LifeSpire of Virginia in which certified nursing assistants are paid for 40 hours but are only required to work 30.

4. What if new residents could feel at home more easily?

I heard several people talking about a unique continuum concierge program discussed by Melissa Ward, vice president of clinical & regulatory affairs at Functional Pathways. The program promotes successful transitions and helps people stay in their current levels of care. Its tools include new resident orientations, resident-driven support groups, physician services, collaboration across the care continuum and more. Stay tuned for a future blog post about this innovative program.

5. What if we looked beyond a prospect’s age and income?

Last but not least, I’d be remiss if I didn’t mention our session with co-presenter Robbie Voloshin of United Methodist Communities (UMC). Robbie celebrated her birthday that day! The talk covered an in-depth research study on which we had partnered with UMC. In short, the study shows how going beyond superficial demographics to interests and values can help organizations connect more deeply with the right prospects. Discussion centered around the core aspects of the study — the values statements and how they were ranked.

Have you had any what-if moments of your own? If so, drop me an email at . I’d love to hear about them.

At Varsity, we take every opportunity to get into the mind of the mature market, so we thought, “What could be better than using the social media phenomenon, FaceApp, on one of our own, James Schorn, resource manager at Varsity?” I decided to capture a few of James’s reactions to seeing himself aged several decades.

Q. Did seeing yourself aging change your perceptions about growing older?

A. It was refreshing to see myself aging like fine wine, as opposed to aging like milk…All kidding aside, I did feel that my spirit remained resilient, and that confirmed the many experiences I’ve had with older people ever since my first job working in the dining room of a retirement community. I think what I have always enjoyed about the mature market is seeing how happy and active this generation is. I love hearing about their life experiences. Sometimes it seems as if the world classifies our older generations as weak and fragile. Based on my experiences, this couldn’t be further from the truth. Nothing is more inspiring than a couple that has been married for 50+ years and still loves each other, day in and day out.

Q. What are your responsibilities at Varsity?

A. I’m in charge of quotes, scheduling and planning of projects. Through my career, I have overseen hundreds of projects of all different scopes. This has allowed me to use knowledge from past initiatives to ensure that our future projects run efficiently while giving our clients the best possible return.

Q. Are there any myths that still need to be debunked about aging, and the senior living industry specifically?

A. The overall perception of senior living needs to change. From my visits to communities, I have seen personally that they are built on friendship, trust and care. From residents to staff members, everyone looks out for one another. This generation is made up of strong individuals, and they should be respected for their impact on this world.

Two very different leaders have just reached the halfway point of their journey in the LeadingAge PA Fellows in Leadership program. For all those who aren’t able to attend, we wanted to share ten unexpected things they’ve learned about leadership along the way.

Brian Mailliard is the CFO at St. Paul’s. Sakkara El is the Director of Personal Care at Masonic Villages. As they hit the halfway mark of their journey, here are 10 invaluable insights Sakkara and Brian have gained about leadership so far:

1. Shake up your thinking. “I came into the program with my own ideas on leadership, much of which was inculcated during my youth,” said Sakkara. “Now I realize that there’s so much more to it. My overall thinking has expanded.”
2. Be aware of your impact on others. “The program is teaching me to be more aware of myself, and how my actions and reactions can have an impact on those I’m tasked with leading,” Brian said.
3. You don’t have to have all the answers. Brian has been amazed by the sheer volume of leadership information that is out there. “It’s not always about knowing all the answers,” he said, “but having resources to reach out to and learn from other individuals that are experiencing similar situations.”
4. Praise your team. All of the Fellows underwent a DISC profile, a test that assesses personality styles. “It was eye opening reading page after page about my leadership style,”  Sakkara said. She has made a conscious effort to implement some of the leadership suggestions that came from the profiles, such as praising the team she directly manages more often.
5. Be an advocate. The Fellows visited the Capitol Building in Harrisburg to gain a deeper understanding of the importance of advocacy, including interacting with government officials and their office staff.
6. Execution is key. Sakkara found one presentation on the work of leaders enlightening. “The lecturer explained the importance of crafting a vision, building alignment and championing execution,” she said.
7. Look outside yourself. Both Sakkara and Brian were inspired by a visit to  Messiah Lifeways in Mechanicsburg. “The community is very innovative and 100% resident focused,” Sakkara said.
8. Look inside yourself. “”It has been an introspective journey in terms of continuing to learn, grow and evolve in my leadership style,” Brian said.
9. Build relationships. Current fellows, past fellows and LeadingAge PA staff attended a mixer at the LeadingAge PA offices. “Meeting new people you can learn something from is always a plus,” Brian said.
10. Don’t wait to be a better leader. What would Brian tell people who are thinking about participating in Fellows in Leadership? “The sooner you can do it, the better.”

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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.