Collington-Strategic

Trends in Senior

Services

Presented by Steve Maag

Director of Residential Communities LeadingAge

State of Life Plan Communities and Other Service Providers Today

• Much stronger than a few years ago

• Far fewer distressed communities, very few bankruptcies anticipated

• 19 new Life Plan Communities in 2016-18, 30 anticipated in next five+ years

• HCBS is growing, AL especially memory care

What are the Four Major Trends Impacting Aging Services?

The changing consumer: Silent Generation to Baby Boomers

Health Care Reform changes how health services are delivered

Technology opens new ways to provide services

Workforce Challenges

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1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95

Popu

lati

on

Age

2010 US Population

Millennials Generation X Baby Boomers

Silent Generation

WWIIGeneration

Market Opportunity

4 Source: 2010 US Census Data

As of 2016, the oldest baby boomer is 70 years old

The Field Of Aging Services Is Evolving

Source: Adapted from previous Greystone and LarsonAllen LLP presentations

Spectrum of Services

Community Based

Services

Wellness Programs

Senior Membership

Geriatric Assessment

Case/Disease Management

Health & Wellness

Centers

Independent Living

Intentional Community

Personal Care Assistance

Assisted Living Telehealth

& Home Technologies

Day Care

Medical Social

Home Health

Skilled LTC

Respite Care

Palliative Care

Skilled Nursing Care

Hospice

Outpatient Therapies

Subacute Rehab

Diagnostic & Treatment

Center

Long Term Acute Hospitalization

Acute Hospitalization

Dementia Assisted

Living

Board & Care Intermediate Care

Want driven Need driven

Preventative Long-term care Hospital

Active adult communities Life Plan Communities/multi-level campus

Housing w/ Services

Shift from “Need” Driven to “Want” driven

NEED Historically, LTSS has been a NEED driven service. First nursing homes, then AL were primarily occupied by residents who NEED the service.

WANT IL retirement and “active senior living” have attempted to move into the WANT sector, with mixed results. The concept of WANT driven will become dominant even if there is a need because…

Consumers Will Drive Change

• Avg. age of entry is early 80’s, still mostly need driven

• WWII generation “Silents” • Demands will be much different, operational

involvement, choice, active lifestyle • No matter the setting, consumers will demand

more

WWII Generation

• Up to now customers have largely been the WWII generation

• Attitudes and preferences formed by two major events, the Great Depression and WWII

• They value security and stability • Goal is to have a career, provide a roof over their

families head and food on the table • Accepts the status quo, not very demanding

Next up: The Silent Generation

• Group that was born roughly between 1930 and 1946

• They came of age in time of huge opportunities and growth

• Major influences post WWII boom, TV, pop culture

Silent Generation

• Smaller in number 62 million WWII generation vs. 48 Silent's (about 78 million Boomers)

• Better educated, many more with college degrees • More affluent 20-30% more in the 60K+ income

range • They tend to stay married and more will seek

housing or services as couples

Understanding Boomers Expectations

• Expect variety of choices and to have a voice in all decisions

• First to live totally in the age of mass communication

• “Don’t Call Me Old”

Beatles

Moon Landing

Boomer Expectations

Customizable Living Areas

Spacious Rooms and

Storage

Variety of Amenities and

Programs

Dining Choices

Technology (Wifi)

Health Care (Dementia Care)

Stuff

Will Campus Based Providers and Life Plan Communities Survive?

YES IF they are

attractive to boomers

Lifestyle must be facilitated “experience economy”

Innovation and flexibility are key

Life Plan Communities

How Do Aging Service Providers Respond?

Tap into New Products and Services

OPPORTUNITIES FOR GROWTH

Opportunities

19

Traditional Bricks and Mortar • Expansions • New Community • Affiliations, Merger &

Acquisitions • Dispositions

Services • HCBS • PACE • Hospice • Other

Factors to be Analyzed

• The nature of your future customer will demand an updated and attractive physical plant

• They will also demand diversification and choices in services

• There will be a significant increase in the number of potential residents

• What will your community role be

What Are Your Options ? • Three approaches and they are not mutually

exclusive • First, is an honest look at your community/services

with a view to determine what you need to be competitive in the year 2025

• Second, consider a new opportunities, development or affiliation with existing providers

• Third, a look at whether and how you are positioned to provide services to “community” customers

Repositioning Your Community

• All the things we have been talking about • Is your building and physical amenities attractive to

the consumer? • Do your program and services meet what the

consumer is demanding? • Are your residents involved in the community, do

they feel like they have a say/input?

Why a New campus or Affiliation?

• Many organizations have growth as part of their strategic plan, population will grow, low utilization

• Market conditions vary for a full new campus, but this is a 5-7 year project so careful planning is a must, may not be feasible in some parts of the country

• Growth by affiliation is growing trend, finding campuses that are compatible and fit strategies

• Some affiliations of troubled campuses

Boomers Want To Stay In Their Homes

• 80+% want to stay in their own homes

• Senior housing market penetration rates 8-12%

• 90/90 rule • Large number of

potential customers in the future

• Is this you’re real competition?

Supporting Emerging Models of Housing and Services

Innovations in service delivery

Small house models for all settings

Person-centered care models

Affiliations with Village programs

Continuing Care at Home

Affordable housing with services

Examples of Programs That Involve the Outside Community

• Dining, bringing the public on campus, Edenwald • Club, creating a program for non-residents based on

services/amenities you provide, Club Alexian • Fitness/Wellness, expanding to the community, Virginia

Mennonite • Educational Programming/Affiliations with colleges,

numerous • Full-time Physician employed by the Community with on-

site clinic/health services, Williamsburg Landing • Public storefront and Mosiac, La Posada

Health Care Reform for LTSS

• ACA helped trigger future changes

• Fee for service won’t survive

• Chronic conditions and dual eligible are high users of Medicare

Two Major Themes in Health Care Reform

• Reduced fee for service • Capitated payments

RISK and QUALITY based

payments

• Saves $$$ • Focus on preventative care

Population Health

Impact of Health Care Reform

Phase out fee-for-service

Providers Assess Risk

Experimentation

•Performance and risk-based payments

• Shift toward capitated payments

•How they perform •Know the costs

•ACOs •Bundled payments •Rehospitalization

penalties •Dual eligible

demonstration programs •Medicaid managed care

Comprehensive Care for Lower Extremity Joint Replacement

• New rule being implemented, 67 cities started in April • A mandated Bundled payment for hip/knee replacement,

largest cost in Medicare • Starting 1/1/17 hospitals will be “at risk” based on costs

and outcomes (quality) for those procedures • Post-acute participates, but not directly, hospital

controls, but patient has choice where to go • 3 day hospital stay waived IF SNF has an overall 3 star or

better 7 of last 12 months • Step towards 80% costs of Medicare in a capitated

payment system

Impact of Health Care Reform, cont.

Move to “population

health” -- managing the overall health

of older adults

aggressively

Recognition that those

with chronic conditions

use a tremendous amount of resources

Through preventive care

and management, incentives for

health care providers AND consumers will be developed

Many insurance

providers are incorporating incentives to

change behaviors

Health Management Initiatives

• Two examples of promoting wellness, Program to Reduce Avoidable Hospitalizations, Program to prevent Type II Diabetes

• Reduce hospitalizations in 250 SNFs, a targeting training and physician assessment program plus new equipment

• Results of pilot to use counselors to coach those at risk for Type II, lose weight and exercise, pilot saved $2,650 for Medicare a year

Role of Technology

Increasingly critical role with two impacts

Desire for older adults to

stay in their home

Health Care Reform

Technology and Senior Services

Tremendous increase in capabilities for remote monitoring: both behaviors and health

conditions which allow early intervention to mitigate costs and prevent hospitalizations

Some professional has to review the data, why not

your Life Plan Community?

Living at home can increase social

isolation/depression, technologies to intervene

and reduce the risk

Examples • “Honor”, “Carelink” Uber-like service that connects caregivers with elderly, hourly

basis, well vetted staff • “Scout”, $119 app tied to phone that monitors temp/blood pressure/heartbeat,

testing urinalysis • Apple/IBM, iPad for seniors in Japan, 4-5 million seniors by 2020 • “Chefs for Seniors”, buys groceries ($15 fee), cooks in the seniors home, $60-75 for

meals for a week • “HEAL”, Uber-like app that schedules in home physician visit, $99, in LA, next SF

and 15 other cities • “Never to Late”, multi-media system that will be looking to expanding to homes • “Vheda Health”, smart phone based system to monitor patients with chronic

conditions post-acute • “Respond Well” in-home PT, with preventative program (falls) and moving to post-

acute modules with live and programmed rehab programs • At home monitoring systems

Members Need to be More Data Driven

Interaction with acute care will be driven by data; the NFP sector is lagging in investing in technology

Document by diagnosis: cost, performance and quality, length of stay, re-hospitalization rates

Quality outcomes based on data you collect and analyze

Center for Aging Services Technology • Many resources/case studies • Tech selection tools • Workbook: strategic process • Role of tech in organization • How to further strategic goals • Tech selection/implementation • Tech infrastructure • Role of CIO

• A new resource for members to help them move forward as organizations

• Covers: Community Involvement and Engagement;

Philanthropy; Governance; Quality; Strategic

Partnerships; Strategic Planning; Workforce and

Leadership Development

• Series of questions with resources attached

Workforce

• Has emerged as the biggest challenge facing providers and will only get worse

• Need for workers by up to 250% by 2030’s • Issues include finding/retaining qualified front line and

professional staff • Members declining admissions because of lack of staff • Leadership development also an issue as senior managers

retire • No clear solutions, higher wages/benefits, more education,

career ladders, technology are all among areas being tested and explored

How do You Respond to These Five Questions?

• Have you developed a plan to position your campus, community or services to be attractive to a new consumer?

• Are you looking at ways to becomes a resource and service provider to older adults in your community, including using technology?

• Have you taken steps towards investment in systems and developing programs to assess your cost of care and quality outcomes?

• What is your role in post-acute care along side hospitals and health systems in your area?

• Have you developed a comprehensive approach to attracting and retaining qualified staff and developed an internal leadership development program

Questions/Discussion