The senior living industry has adapted and evolved through the COVID-19 pandemic. In the latest NIC Leadership Huddle, titled “Trends That Will Shape Senior Living Post-Pandemic,” subject matter experts discussed how the pandemic has shaped the industry, and how some changes will likely remain. They explored trends to watch for, both short term and long term – and identified best practices to help operators and their capital providers stay ahead of the curve.
Co-host Maria Nadelstumph, senior vice president, Center of Excellence, Brandywine Living, outlined three areas for the discussion. These included healthcare, housing, and business. She pointed out that healthcare has grown as part of the senior living model, as operators have increased clinical capabilities, brought in onsite healthcare partners, and beefed-up infection control. On housing, she said, “We’re past the real estate. We’re talking more lifestyle.” Housing has also seen a growing use of technology, as well as changes in the use of space and the environment within a property.
On the business side, explained Nadelstumph, “Of course, it’s occupancy.” Trends in this category include the increased use of digital sales platforms and processes. Retaining and recruiting quality staff is another area where trends have shifted through the pandemic. The regulatory environment has also seen major shifts.
Nadelstumph’s co-host, Joe Kiernan, chief strategy officer and senior vice president of Network Development, Ocean Healthcare, posed the first topic for discussion with subject matter expert Fee Stubblefield, founder and chief executive officer, The Springs Living. Kiernan pointed out that seniors housing used to be about lifestyle, rather than healthcare, which had been considered the territory of skilled nursing and post-acute care providers prior to the pandemic. Now, things have changed. s He stated that, “Clearly, healthcare is a huge component of what we do for seniors housing. It has to be a component of it.” He then asked Stubblefield what changes had to be made through the pandemic, and which of those would remain, even post-pandemic.
Speaking of that traditional separation, Stubblefield said, “We’ve all been thrown in this together, because we’ve had to all be part of the solution.” He said environmental systems are here to stay. Clinical initiatives that were once considered experimental learning programs have now accelerated in Stubblefield’s organization. He mentioned telehealth and onsite clinical partnerships, as well as MA plans, I-SNPs (Institutional Special Needs Plans), C-SNPs (Chronic Condition Special Needs Plans), concierge healthcare partnerships, and other healthcare-related innovations. “It’s here to stay, there’s no doubt about it,” he said.
Nadelstumph described how some healthcare-related infrastructure and services had begun to move into senior living models prior to the pandemic. Operators had been keeping them in the background, to preserve the social and community aspects of their properties. Again, COVID-19 has changed operator models. “We have licensed nurses and clinical capabilities in our buildings, but we don’t want it to be in your face…putting in healthcare layers of support service, whether its telehealth, or onsite clinics, or physicians coming in-house, or therapy; whatever it might be; there’s a way to do both to make sure that it’s the right marriage.” She said operators must make sure their healthcare partners are fully aligned, to be a part of the team rather than transactional vendors.
Stubblefield agreed, but pointed out that operators have to align with the healthcare system as well. “As operators, we have to evolve and invest in the infrastructure because we’re going to have to improve the health outcomes for these residents. The delicate dance is that, while we have to become more integrated with the healthcare system, we don’t want to be the next nursing home.” He explained how assisted living, independent living, and memory care have evolved to meet customer demands, but that now, they must also prove how they are improving outcomes, both to their customers, and to the broader healthcare community. “And, do it in a way that the customer wants to be there,” he said.
“We’ve got to get better with data, with technology, invest more into infrastructure systems. I contend that has to connect with environmental information, not just personal health information…we have to do that not just for our residents but think about our staff. They have a healthcare need. They’re working one, two jobs at the entry level. How do they have time to get the healthcare access they need?” Stubblefield continued, “I think there are some opportunities for us not only to impact the healthcare system, the cost drivers, the quality for our residents, but also for our employees.”
Moving to the topic of housing, the panel first discussed the impact of COVID-19 on resident lifestyles, which were impacted by social isolation and safety protocols. Operators are looking at ways to reduce the social and community impacts of future pandemics. New technologies, such as air scrubbers and biological threat detection systems will likely become a part of new property design.
There was agreement that even while integrating new technologies and new health partnerships, the industry’s goal remains to offer the market a product that a new generation of elders will want to move into. Stubblefield pointed out the importance of attention from staff on a successful resident experience, and that staff are key to successful outcomes. Regarding property upgrades and new building construction, he said, “We’re really going to have to pay attention to the space for our employees and our staff, and create great environments to work in.” He said, “Our breakrooms are the size of a housekeeping closet, and there are these industrial looking lockers...our buildings are going to have to evolve to continue to attract talent that want to work there and create an environment that is supportive to them.”
Speaking further on the evolving housing model, Stubblefield asked, “What do we really do here? Do we rent apartments? No. We provide support. That’s really the need that we have to focus our new communities on.” After a discussion on the challenges around recruiting and retaining staff, Stubblefield said, “That’s our raw material; our labor. We’re not builders of buildings and communities, and real estate acquisition. We’re an HR company. We must become highly sophisticated in that.” He argued that the industry must improve in retaining staff, and that it will take help from regulatory partners, particularly around employment initiatives to solve the problem.
Moving into a discussion on the business aspects of the pandemic, Kiernan asked about the regulatory impact. Stubblefield compared the challenge of adhering to differing regulatory guidelines and interpretations, from one jurisdiction to another, to ‘herding cats.’ He said, “Really what it came down to…was how important communication was.” He said a key takeaway was that the industry would have to do more to partner and communicate with regulators and policy makers in the future.
“We’re going to have to make sure that we continue to tell our story very well, because it is a partnership.” Stubblefield said, concluding, “I think the inconsistency across the board for regulation was really, really challenging to manage. And we’re going to have to fix that now…we’re going to have to involve public-private partnerships.”