Charting a course for the future of every senior care community (and the industry as a whole) requires thinking about tomorrow — today. Every provider is facing a number of questions: How do resident and family expectations translate into the digital community experience? What technology investments will deliver the ROI that gives an edge in the competitive space? How will staffing shortages be addressed? When will interoperability and EHR for resident care be commonplace? Which is most important: remote monitoring, mobile devices or telehealth?
For our latest Q&A we decided to pick the brains of three owner/operators in the senior care space to find out where they think senior care is headed and what technology they believe will be instrumental, and to define what the 21st century community will look like before we know it. They are:
- Chris Guay, President and CEO, Vitality Senior Living
- Kris Hansen, CEO, Western Home Communities
- Charles Turner, President of LifeWell Senior Living/PinPoint Senior Living
CDW: Please tell us a little about your community and your responsibilities.
CHRIS: I spent the last 18 years at larger senior living organizations —16 with Emeritus and two with Brookdale. Both were great experiences, but it’s fun to be building a company from the ground up. Vitality was founded last in January in partnership with West Partners, a private equity group that truly sees the value in investing in the right technology to support lifestyle. Together, we founded the company, with a spirit of empowering successful aging and revolutionizing the current state of the industry. Vitality currently has five development projects underway, and in the next five years expects to be developing and/or acquiring five to eight communities a year. As president and CEO, it’s my role to create and drive the team, vision and culture to achieve our growth targets.
KRIS: My job is to get the right leadership team in place to take care of our residents the best we can. Western Home Communities supports the full continuum. It’s a life plan retirement community and includes everything from in-home care through skilled nursing, and we partner on hospice as well as with a next-gen ACO. As much as we talk about senior living, the lines continue to get blurred, meaning we’re going to be doing a more on an intergenerational basis and with different care types. We’re already taking care of two-week-old preemies in the home, so even in our skilled nursing environment, we’ve got somebody in their 20s with a newborn whom we support.
CHARLES: Pinpoint Senior Living is the developer and owner of several senior living communities across southeast Texas and New Mexico, and LifeWell Senior Living is the operating company. We created LifeWell partially to enable and advance the leading innovation strategy for senior care communities. In order to be more competitive, I firmly believe that we as senior care providers have to know our residents better than the guys down the street. A significant technology investment is required to understand, measure and document how our residents are doing and how we are providing care, so we can share that with the medical world to show discharges are being well taken care of. We invest a lot on systems and processes that measure care outcomes.
CDW: What does the 21st century community mean to you? How do you think technology will play a role and most greatly impact the senior care space?
CHRIS: When someone moves from home to any supported living community, they’re giving something up. A home where they raised their family … space … some independence. A home is such a value basis for our society — it’s something that is very personal to you. In my view the 21st century community is putting control back into the hands of residents where they begin to see more opportunity gained than lost. It’s not about creating a home-like environment; it’s about creating an experiential environment, a destination. It‘s starting from a resident’s perspective and then creating the community around that perspective. Who really plays bingo at home? Not many people. Yet it’s a standard at most communities today because it’s easy. That is, it’s easier for us, not something truly experiential for our customers.
As we build Vitality, we believe there is an opportunity to expand the experience for residents, families and associates to stay more connected, and technology is a key part of that. The 21st century community is paperless, and it connects everyone, not just our residents. It connects our families and our associates to the community at large. It uses technology to engage residents — with virtual reality travel, for example. Tablets give our residents so much access, and so we now have classes on how to use your tablet as a way to be more engaged with life. Today our residents can stay much more connected with the outside world with a simple tool that costs under $200.
When you think about resident management and workflow, let’s get rid of paper there, too. Let’s use a device that most of our associates know how to use now, a smartphone or a tablet, and get all their information via that. Let’s transfer information to our healthcare providers electronically. How do we get real feedback and data from our residents and then create the lifestyle they want versus what we think they want or what works better for the operator? We’re also looking at developing communities in mixed-use locations where there’s access to retail and exposure to lifestyle opportunities that residents may not have access to if they stayed at home.
KRIS: The first thing that changes is the definition of community. From a senior living standpoint where we offer a full continuum, we are absolutely going to move away from just operating within our brick and mortar walls to engage with the greater community. We’re going to move beyond long-term, post-acute care. We’re pre-acute. This means thinking: How do we work with our partners again from the payer standpoint? How do we help with the continuum of care? How do we do outreach into patient residences and create the relationship and support stream to keep people in the least restrictive environment for as long as possible?
The other piece of the 21St century community is to have a lot more choice, convenience and access to amenities, whether via onsite clinics, telehealth visits, medically based wellness or wearable devices. How do we get the technology to support independent living, but also show that we’re gathering data to do predictive analytics so that we can be engaged prior to an episode? We’re giving interoperability a lot of lip service today, but we truly have to have a platform where the “health record” — not just a medical record — is shared across all different disciplines so we can really help that resident/patient/client.
Our focus has always been on taking action after the train wreck has happened or through end-of-life strategies. It’s creating a heck of a gap. How do we fill it? Not by replacing the human touch interaction, but by using technology to stretch the impact of that human interaction. We’ve got to get very intentional about innovation. Technology is 75% of it, but also innovation around different ways that we deliver services.
In 2011, we partnered with the University of Missouri at their “living lab” assisted living community, where they test technology applications — hydraulic tubes under a mattress or chair that measure heart rate, respiration and restlessness which, depending on acuity, indicate changes in health. HIPAA-compliant depth cameras that measure stride length so you can see if their center of gravity is changing or residents are sedentary. We were able to monitor some of our residents in a beta setting and then see if the algorithms indicated a pattern had changed for that individual, which would send a notification to our clinician. At the end of the experience, we were able to predict 10 days to two weeks in advance of major issues.
As we move to value-based or individual health management, you start thinking about quality of life as number one. Who wants to end up in an ER or the ICU if you don’t have to? One, it’s costly, and two, it’s the most dangerous place you can be unless you need to be there. So you can start to imagine the savings for the healthcare system that can happen if we can be pre-acute and catch warning signs before an acute event.
CHARLES: We fundamentally believe that the senior care world, especially assisted living and memory care, is going to become more and more a part of the post-acute care continuum in the healthcare space and that hospitals need to find reliable partners in order to ensure that their patients (i.e., our residents) are well taken care of.
We try to focus on a bit of a paradigm shift — you may be 85 years old and you may need significant assistance with your activities of daily living (ADLs), but what can we do in order to actually improve your quality of life? It starts with getting the fundamental tools standardized and operationalized, and then building in advanced analytics. The next phase is to create a holistic way to get smart with information to intervene in improving the quality of life. We’re starting to experiment with Big Data and some really high-level analytics, but right now, they’re pilot tests based on information we currently have. We’re probably a couple years out from really creating something that’s truly revolutionary.
However, some of the things that we’ve done are very simple but are starting to become foundational. For instance, we were the first assisted living and memory care communities in Texas to use RFID door locks. They’re the same kind of locks in new hotels. We use them from a resident safety standpoint. I now have an audit trail of who goes in and out of the room (both caregivers and residents), which helps me reduce abuse, neglect and theft. The RFID chip integrates with our fitness equipment. It’s designed specifically for seniors to be able to use on their own, which enables one staff person to work with multiple residents, who are then all encouraging each other. The chip tracks progress and will continue to up reps, encouraging strength improvement over time. It works in multiple dimensions of wellness, and seniors literally see themselves getting stronger every time. Those residents who stuck with the program have shown an overall increase in strength of 286%.
We want that same technology to integrate into our culinary program so we can then measure nutritional information. We also have some resident monitoring technology we love, and we’re looking at wearables. Integrate that with dispensing meds, which all then ties into electronic health records, and it has incredible Big Data potential with correlations we can find to our resident population that we did not even know existed.
CDW: What is the biggest barrier to technology success in the senior care industry?
CHRIS: Our industry is still somewhat in the technology dark ages. In my opinion, the first change is that companies really have to see technology as a worthwhile investment. Operators have to stop saying they embrace technology and then not fully commit to that pledge. It’s no longer optional. Can you imagine a Millennial who just spent the last four years in nursing school, completely online and automated, coming into one of our communities and having to fill out a paper assessment or medication administration record? They’re going to think it’s archaic. Residents want technology, associates will expect it, and our families will start to expect it as well.
Another problem I see is blind adoption or implementation of technology. You can’t just start putting technology in your communities without a strong strategic roadmap for your tech plans, including your company’s vision, tolerance and goals for technology infrastructure. Again, I feel many providers have not invested enough in the infrastructure and hence are playing catch-up. What are your priorities? What are your main pain points? Make sure you start with a tech plan that starts addressing those first and build from there.
Finally, you can’t make decisions on technology in an ivory tower. You’ve got to get to the ground level and really understand what your community teams, your residents and your families expect and need, and make sure you have the infrastructure to handle it. I’m fortunate in that we are primarily growing through development. So we are investing in an infrastructure upfront that is much more robust than we need for today, because I’m not thinking about today. If you just think short term with technology, you’ll always be playing catch-up. You have to have a long-term vision on what you need and how evolving technology can help your organization better meet the expectations of your customers.
KRIS: I think probably the biggest thing is how you truly measure return on investment. But the other part of that is return on effort. What’s the opportunity lost that you really don’t know? What’s the quality of life value? Regulatory reform continues to affect payments, and where we can start to deploy some of these technologies in a preventive way, we can keep the catastrophic events from happening.
One thing I’m working really hard on is an Innovator’s Alliance of communities and senior living service providers. It will be a group of like-minded, innovative organizations, geographically dispersed but aligned as a group to participate in concept and technology testing, working with universities and companies. How can we give them initial thoughts on the gaps we see, as well as feedback for refinement and evolution? Then, how do we find the right venture partners and distribution channels?
CHARLES: You read a lot in the press that senior housing is slow to adopt technology. I look at it a little differently. I don’t think we have a technology problem. When I worked in enterprise software and consulting, we always talked about any technology implementation requiring four things: people, processes, tools and outcome measurements. The implication is that we don’t have the right tools. I think there are a lot of technology tools out there. What we lack as an industry is identifying and training the right people, creating the right processes in change management, and then measurement. We have a bit of a cultural problem where we’re so focused on caring for people with the best intentions that we don’t necessarily focus on how we actually improve the quality of life — rather than just managing their current quality of life.
The other thing I get frustrated with from a technology standpoint is the great companies that have the underlying core technology to be incredibly innovative in this space, but don’t focus their attention the right way. They tend to look at solving problems from a non-senior care point of view. We make a recommendation about combining capabilities into one device, for example, but they don’t see that potential. They want to make a cool tablet or app for a senior.
This is always a common one — every vendor has a photo-sharing app where families can upload photos. It’s all well intentioned. But think about what you’re asking: families and seniors to look at a form factor they’ve never used before, family members to use a device or app that’s not part of their normal workflow, and an 85-year-old to learn something completely new. These technologies fail because you’re asking people to change their behavior, and that’s not what they want to do, no matter their age. That’s a bigger hurdle than asking a senior to do something in a situation where someone else is monitoring and managing their care. To me, it’s much more valuable when you can produce information that helps improve care.
We heard some fascinating insights from Chris Guay, Kris Hansen and Charles Turner about what’s ahead on the path to tomorrow’s senior care experience. Looking for the best place to start on your own senior care technology journey? Learn more about CDW Healthcare’s senior care technology solutions or start with our step-by-step eBook guide.