April 2, 2014
cliftonlarsonallen.com
©2013 CliftonLarsonAllen LLP
©2013 CliftonLarsonAllen LLP
Shaping Tomorrow: A New
Blueprint for Senior Living
“We now stand on the threshold of a new age –
the age of revolution. In our minds we know that
the new age has already arrived: in our bellies
we’re not sure we like it. For we know it is going to
be an age of upheaval, of tumult, of fortunes made
and unmade at head snapping speed. For change
has changed. No longer is it additive. No longer
does it move in a straight line. In the 21st century
change is discontinuous, abrupt and seditious”
Gary Hamel 2000
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Many are just now discovering
that the earth is not flat
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A significant, expensive,
complex, and challenging
issue that begs for an
answer
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Senior Living organizations
tend not to die quickly they die slowly,
over time
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The signs are all here
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Sunday October 28, 2012
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. . . . to create the first national senior living solutions company. The
combined senior living communities with fully integrated and ancillary
services across the continuum of care. Following the merger, a Brookdale
community will be within 10 miles of 6.5 seniors 80 years or older
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The biggest challenge will come from
outside, not from within
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Or
Risk facing the trapdoor of irrelevance
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This is a time of abundant opportunity offering senior
living organizations the chance to flourish
• Initial set – circa 2007+/-
©2013 CliftonLarsonAllen LLP
Two sets of surveys
– Surveys conducted in the San Francisco Bay area, North Carolina,
Northwestern Pennsylvania and Maryland. Roughly 1,000 respondents
– Age 75 to 85 respondents = WWII Generation and Silent Generation
– Age 65 to 75 respondents = Silent Generation
• Second set – circa 2013+/– Surveys conducted in Massachusetts, California, Georgia and Tennessee.
Roughly 1,400 respondents
– Age 75 to 85 respondents = Silent Generation
– Age 65 to 75 = Baby Boom and Silent Generations
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2007 Surveys
Decision Factors Rated ‘Very Important’
On-Site Health Care
Unit Features
Cost
Location
Campus Amenities
Non Profit Status
Denomination
0%
20%
40%
Under 75
Over 75
60%
80%
100%
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2007 Surveys
Living Unit Features Rated ‘Very Important’
Cable TV
Washer/Dryer
Emergency Call
Internet Access
Balcony
Garage
Walk-in Closet
Storage
Full Size Kitchen
Pets
Whirlpool Tub
0%
20%
Under 75
40%
Over 75
60%
80%
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2007 Survey
Amenities Rated ‘Very Important’
Transportation
Open Areas/Paths
Library
Casual Dining
Exercise Center
Dining Choices
Take-Out Dining
Gardening
Convenience Store
Computer Center
Pool
0%
20%
40%
Under 75
60%
Over 75
80%
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2013 Surveys
Plans, Concern and Interest by Age
Inerest in moving to
senior living comm
Do you plan to move
Do you plan to remain in
your residence
Have you purchased
LTC Ins
How concerned about
future HC needs
0%
20%
40%
Under 75
Over 75
60%
80%
100%
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2013 Surveys
Importance of Structure, Services and Facilities
Not for Profit
Planned Social…
Access to health…
Housekeeping
Spiritual…
Swimming Pool
Fitness Center
Transportation
Multiple Dining…
Dining Plan
0%
20%
40%
Under 75
60%
Over 75
80%
100%
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The “Ideal Senior Living Community”
– Promotes wellness & healthy living through programming
and services
– Provides transportation services that appeal to all
residents – including those who still drive
– Provides access to current technology such as wireless
internet services – realizing technology continues to
evolve
– Allows residents to age-in-place
National sample of adult children of existing seniors housing (CCRC,
IL only, AL, Nursing) residents. Completed: Fall 2011
©2013 CliftonLarsonAllen LLP
Senior Living for the Next Generation
ASHA research
Older Boomers place greater importance on life
outside the walls. They desire:
– Walkability. Walking distance of shops, restaurants,
cultural venues
– Lifelong learning. Access to continuing education
– Meaning. Assistance getting connected to volunteer
opportunities
– Community. Assistance with finding ways to integrate
themselves with the surrounding town/neighborhood
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Senior Living for the Next Generation
ASHA research
Facing the Future . . .
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ü Accepting the Realities of Aging in Place
ü Renewing Our Focus on Person Centered Care
ü Developing New Models of Care
ü Opening Campuses to Greater Community
ü Using Technology to Support Aging in Place, Reduce Costs,
Improve Quality
ü Offering Expanded and Innovative Alzheimer’s and
Dementia Care
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Providers Are Facing The Future By…
• Consumers have strong preference to age at home over
institutional setting – nearly 90% prefer home
Aging in Place
Within
Seniors Housing
Key
Implications
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Aging in Place: Preference & Impact
Older Residents
Losing Appeal to Younger Prospects
Higher levels of Acuity
Sales & Marketing Must Change
Shorter Length of Stay
Smaller Addressable Market
Greater Pressure on Staff
Different Value Proposition
Note: “Aging in Place” refers to the desire of seniors to stay in a particular
residential setting as long as possible, even as health care needs increase.
Source: AARP, 2010; “Why Aging in Place Matters” by Point Forward
Solutions, 2012
Slide Courtesy of Point Forward
Solutions
©2013 CliftonLarsonAllen LLP
Developing new models of care.
Providers are starting to think outside of the ‘box’.
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Home Health
Assisted Living
& Nursing
Home
Social,
Educational
and Spiritual
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Access to a continuum
of services similar to
a retirement community.
Home Care or
Private Duty
CARE
MANAGEMENT
Hospice
Adult Day
Program
Technology
Home
Maintenance
Services
©2013 CliftonLarsonAllen LLP
Continuing Care at Home Models
• Retirement Home “without walls.”
• Life care plan where members prepay for guarantee of future services.
• An insurance hybrid.
• Entrance fee plus monthly fees.
• Package of long-term care services
provided at home and in retirement
home and LTCH.
• Focus on wellness and prevention.
• Care Coordinator assigned to each
Member.
• Admission only for independent
seniors not in need of services
(younger and healthier).
• Averaging 200-250 members.
• Sponsored by senior living facilities.
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• Based on Beacon Hill model which started in 2002,
now over 100 Villages with >120 in development.
• Largely volunteer organized and run – some are
sponsored by retirement living facilities and some
receive support from retirement communities.
• Membership Dues range from $100 - $1,200
annually.
• Mobilizes local resources to maintain independence
• Easy access to services for people aging at home.
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Map of Villages
Offers inter-generational
opportunities for neighbors to
support neighbors
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Uses time as currency
• Sponsored by Ralston Center,
a long-established, well-endowed
senior services organization in
Philadelphia, PA, who has affordable
housing and health/wellness
programming in a low-income
neighborhood.
• Developed in 2010 to serve the ‘gap group,’ or those with annual
incomes of $25,000 to $35,000 who are aging at home in two
target neighborhoods.
• Offers one-stop-access to any services a member may need.
• Sells home care, housekeeping, simple home maintenance,
transportation and errands at a reduced price.
• Membership is free - 3,000 members.
• Members receive a newsletter, invitations to social events, exercise
classes, etc.
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Free Membership
• A comprehensive, one-stop resource for information
and access to information, advice, care and services
for seniors.
• Owned by the owner of a non-medical home care
agency as a marketing tool. Offers one free care
management session at the center.
• Center includes central reception, with offices
located within for all types of senior services and
meeting spaces for large and small gatherings.
• Resource library, and opportunities for organizations
who don’t want an office to advertise.
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Senior ‘Shopping Center’
• Businesses can have office in building or advertise
through light boxes in the building—entitles
businesses to hold workshops and seminars that are
advertised to One Senior Place members.
• Having materials in the library $500/year— other
advertising options range from $750-1500.
• Office rent depends upon the size of the space.
• Offices included hospice, insurance broker, CCRC,
etc. One office is for senior living organizations with
brochures and light boxes.
• 43-44 businesses in the network so far.
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Senior ‘Shopping Center’
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Opening Campuses to Greater Community
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Outreach program of Alexian Village in Milwaukee, WI.
2,600 members have access to campus amenities.
Increased awareness of Alexian Village.
More than 50% of admissions come from members.
Increased vitality on campus (very little push back from
campus residents)
§ Focus group source for campus improvements and new
program development.
§ Offers platform for future development of home based
services.
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§
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§ Program Dusk to Dawn
Dementia
Program
§ Addresses typical
challenging behavior
of people suffering from
dementia
§ Sleeplessness
§Agitation
§Disorientation
§Sundowning
§ 7 am- 7 pm Program
§ 10 Recreational Therapist
for 40 Clients
§ Paid by Medicaid; Private
Pay - $215/night
ElderServe at Night
§ Typical Day Activities
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§ Dusk to Dawn Dementia
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• Built on the campus of CC Young Retirement
Community in Dallas, Texas.
• Goal to enhance the lives of campus residents and
the greater community.
• New construction funded by capital campaign.
• Includes fitness center, library, auditorium, class
rooms, bistro and chapel.
©2013 CliftonLarsonAllen LLP
• Large cook chill center attached to senior living
facility.
• Provides meals for community organizations.
• Develop a deliver and dine program for older adults
living at home in the community.
Using Technology
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Personal Emergency Response
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Medication Machines
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Smart Homes
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Independa – Stay Connected Through Your TV
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Memory Care
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Comments? Questions?
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Thank you!
Scott Townsley
Principal
[email protected]
610-805-6303
Sarah Lentz Spellman
Principal
[email protected]
609-760-2991
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